§ 12.26 a.m.
§ Mr. Bob Cryer (Keighley)
I am grateful for the opportunity to raise a question that is shattering the nation—that of baby food. The subject was raised with me by a group of young mothers who have organised themselves to provide playgroup facilities and to take up the cudgels for young housewives in a village in my constituency.
It is a creditable reflection on our democratic institutions that grassroots concern can be expressed, albeit on what appears to be a comparatively minor matter, in Parliament. It will be to the enormous credit of the Government if they take notice of this concern. Credit is due entirely to the Denholme Toddlers' 578 Club, therefore, for drawing my attention to the matter.
The anomalous position is set out with clarity in the Department of Health and Social Security circular HSC (15) 17, sent out last April. It says:This circular advises Area Health Authorities to continue the practice at clinics where it has existed before 1st April whereby, as a convenience to mothers, some proprietary foods and other goods are sold at certain local maternity and child health clinics. Regulations entitled 'Sale of Goods at Maternity and Child Health Clinics (Designation and Charging Regulations, 1974', specify the goods concerned, the basis on which charges are to be made and the basis for exemption from charges.It gives a brief history of the practice:Since 1948, with the approval of this Department … some local health authorities (and other local authorities with delegated health powers) have made arrangements for goods such as proprietary brands of milk for babies, nutrients, infants' foods, vitamin supplements, milk drink beverages, toothbrushes and other items mainly for young children, to be sold on maternity and child health clinic premises, as a convenience to parents and at prices lower than retail. The items have been sold at cost price plus a handling expenses charge with exemptions from charges made in a few areas, usually for proprietary brands of milk for babies, for families considered to be in financial need.It goes on:While the sale of goods for mothers and young children at clinics is not an essential part of the health services, it is a convenience to the mothers.The last sentence on the first page reads:Goods should not be sold at clinics where sales were not previously made nor should new kinds of goods be sold at any clinic.It is the last sentence which is the cause of concern.
In 1973 the West Riding Area Health Authority, in my view wrongly, decided not to sell proprietary brands of baby food such as Cow and Gate milk, Trufood, Ostermilk, optrose, and orange juice, and to provide instead only National Dried Milk. In Bradford County Borough area, however, the dual system continued, with both National Dried Milk and proprietary foods provided.
I understand that National Dried Milk is as nutritious as the proprietary brands and is a good deal cheaper, but some others prefer proprietary brands for reasons I shall explain later and which are not altogether creditable to the baby food industry.
579 On local government reorganisation the existing system was retained, although the organisation of the health authorities was reshaped in line with local government. This emphasises very strongly the duality of the system so that within one area health authority one clinic provides both types of food and one does not. However, in the old Bradford County Borough area, clinics provide proprietary foods. Since all the area covered is now part of the Bradford Metropolitan District Council, people rightly feel that unification should take place. One can well imagine the feeling that it is a bureaucratic anomaly that in one village proprietary foods should not be provided while a short distance of perhaps three or four miles away proprietary foods are provided, albeit within the area of the same authority.
One of the members of the Denholme Toddlers' Club has written to me as follows:The argument of the Committee of the Toddlers' Club and of the mothers in the area is that there should be a uniformity of distribution of goods and services throughout an area. The proprietary brands of Welfare Foods are much cheaper when bought at the clinic and mothers in this area, in particular, are handicapped by the shortage of retail outlets and transport costs from having a choice as to where they can buy these and similar goods and consequently often have to pay a high price.I think that it is worth noting that the pricing of proprietary foods in clinics is not entirely subject to market forces, being governed by regulations which I mentioned earlier when I quoted from the circular. Hence clinics' prices may well be below shop prices.
I emphasise the difficulties for those young women with children in Denholme in relation to the lack of provision of proprietary foods. A young mother, with perhaps one, two or three small children, will have to walk up a hill to the clinic situated at the top of the village, which can be wearing for a mother with small children. If her children are on a proprietary brand of baby food she will often be reluctant to change to National Dried Milk. She cannot obtain the proprietary brand at the local co-operative supermarket, where she might well do her shopping—since it is the largest shop in the village—because a few years ago the local co-operative sold off the chemist's 580 side of the business to another party, with a restrictive covenant that the co-operative would not sell baby foods. Consequently the mother has yet a further trail to another shop.
Denholme is an isolated village in my constituency. If the shop is shut it means an expensive trip to either Bradford or Keighley. It might be argued that the selling of proprietary foods by a local clinic could adversely affect the commercial position of a local shop selling these foods. If discretion were given to the local authority in these matters, representations could be made to the local authority where it seems unlikely that such representations would be made to a centralised body such as the Department. That is why we have local government—so that some degree of concession can be made to take into account special circumstances.
The Minister will recognise that if he were to allow the sale of proprietary foods at clinics at the discretion of the area health authority it would be much appreciated in Denholme because of the circumstances that I have outlined. Otherwise the restriction seems noticeably unnecessary and bureaucratic. A recent answer to a parliamentary Question gives me some hope that a recommendation will follow and will allow some discretion, and I hope that the Minister will confirm these thoughts tonight.
Genuine choice, however, works both ways. Many young mothers going to clinics need proprietary foods because that is what they are feeding their children on, and this is so because, I believe they are never given a genuine choice in maternity hospitals. National Dried Milk is never offered to them. Some paediatricians say that National Dried Milk is not good enough and recommend some form of brand food, yet at the same time these paediatricians would no doubt claim that mothers can have National Dried Milk if they request it. This means, in practice, that mothers or mothers-to-be in a most vulnerable situation, and going through one of the most traumatic situations that they will face in their lives, are expected to ignore doctors' advice and insist on obtaining National Dried Milk. One understands and appreciates that in such a situation most young mothers would accept the 581 doctors' advice and would not dream of requesting National Dried Milk.
Worse still, evidence has been presented to me that less than three years ago—and I have heard nothing to suggest that this practice has changed—representatives from baby food firms actually visited maternity wards handing out free samples to mothers round the wards. In one case brought to my attention, Golden Oster-milk was handed out together with announcement cards in a gift pack to each mother so that she could announce proudly the arrival of her baby at the commercial expense of the firm providing the cards in order to gain commercial advantage from them, which seems to me to be the most unscrupulous commercial exploitation.
In a letter dated 28th April 1972, the chief nursing officer of the Central Middlesex Group Hospital Management Committee wrote:The gift packs, samples and parcels are distributed by area representatives, and this is a practice which is common in maternity units up and down the country.If this practice still exists, it is a scandal. Young mothers are being deliberately exploited in order that their babies may be "hooked" on commercial baby foods, always to the exclusion of the much, much cheaper and many would claim—including the Department of Health and Social Security—equally nutritious National Dried Milk.
A health visitor wrote at the time:I am very worried about recent trends concerning mothers who have recently had confinements at Central Middlesex. On leaving the hospital they are presented with a free packet of Golden Ostermilk which mothers then feel is the recommended milk for the baby. They are not informed of the cheaper brands of dried milk.It must be accepted that in some instances where a mother is told or informed or has it implied to her by a hospital that a brand of milk is suitable or better for her baby, she will take a good deal of persuading when she goes to a clinic that the very much cheaper National Dried Milk is just as good. Moreover, there may be some sort of social cachet in obtaining a more expensive milk, although she may not be in an easy position to afford it, on the basis—and I accept that this is a genuine aspiration of most mothers—that nothing but the best is good enough for her child, although the best 582 might well be National Dried Milk and be much cheaper.
I should like an assurance from the Minister that he will look into this nefarious practice in National Health Service hospitals and issue regulations preventing this sort of unscrupulous commercial exploitation of mothers, and ensure a genuine choice of brands and a genuine choice of National Dried Milk. I suggest to him that nothing less than regulations will do. We are dealing not with local authorities, who follow circulars although they do not have legal effect, but with commercial interests which can be shaped and controlled in the interests of the community only by being regulated.
I should like to be assured that a choice of proprietary brands will be available at clinics for mothers whose children are already taking a particular brand. This could lay the basis possibly for an eventual phasing out of branded foods in hospitals and so the range of foods in clinics would become redundant. Until that day there should be genuine choice in the hospitals between branded foods and National Dried Milk and there should be a choice at the clinics.
§ 12.41 a.m.
§ The Under-Secretary of State for-Health and Social Security (Mr. Alec Jones)
My hon. Friend the Member for Keighley (Mr. Cryer) is right to draw attention to the problems of mothers and children in the villages in his constituency.
I can understand that mothers attending the Denholme and Queensbury maternity and child health clinics feel that they are less fortunate, to put it mildly, than those attending other clinics in the area of the Bradford Area Health Authority because they cannot buy proprietary brands of baby food at the clinic. The main function of child health clinics is to provide advice to mothers on caring for their young children and surveillance of the health and development of their children. We have good reason to be proud of this service. Over the years clinics have developed and also provide vitamin supplements and National Dried Milk for mothers and young children as part of the Welfare Food Service.
The sale of proprietary goods such as baby milk foods is also undertaken in some clinics. I think I should make clear the distinction between proprietary brands 583 of dried milk for babies and National Dried Milk, which is supplied as a part of the Welfare Food Service. National Dried Milk is available free of charge at clinics and other welfare food distribution centres for children under school age in families who are receiving supplementary benefits, family income supplement, or are in special need because of low income and also, regardless of income, for all but the first two children under school age in families with three or more children under school age. For children who are not entitled to free supplies of National Dried Milk, mothers may buy it at clinics at a lower price than that of the equivalent proprietary baby milk foods.
Before April 1974 local health authority clinics in addition to services for the health and welfare of mothers and babies, could sell many proprietary goods. But it was not mandatory upon them to do so and, as a result, practice varied between areas and possibly between clinics in the same area. Of nearly 200 local health authorities, about 160 made some sort of sales at clinics. Practice in the nature of sales varied from clinic to clinic. At some clinics, the sales were just cups of tea for mothers attending child health clinic sessions and classes; at others sales ranged from baby milk foods and nutrients to food drinks, Marmite, vitamin supplements, medicated and other shampoos toothbrushes, toothpaste and booklets—almost like a village shop. Thus, the pattern varied widely and it was not the case that proprietary foods were sold in all clinics.
Before April 1974 the child health services at clinics were a responsibility of the local health authority. As part of the reorganisation of the National Health Service, under the National Health Service Reorganisation Act 1973, these responsibilities were transferred to area health authorities, and it was essential to the Government to give guidance to the authorities on the future of the arrangements for sales in a national unified service.
There were three possible lines of action. We could have extended these sales to all authorities, thus giving the 584 activity a new status as almost a part of the National Health Service. We could have abolished them altogether as inessential—a service which was making an undue call on staff time at the very time when we were all conscious of the strains on the resources of the National Health Service. Between those two extreme courses lay a third possibility. It was this third course which we decided upon as what we then considered to be a reasonable compromise. It was that sales might continue at those clinics at which they were made before reorganisation and cover the same kinds of goods. This was the basis of the circular to which my hon. Friend referred.
The merit of this decision was that no additional staff were needed, the same arrangements continued and individual mothers who were used to buying certain baby foods at their clinic could continue doing so. They were not inconvenienced by an ending of sales because of the reorganisation of the National Health Service.
I recognise that this decision has caused the anomalies to which my hon. Friend has drawn attention. Because of boundary changes, some clinics in an area health authority make sales whilst others do not. This is what has happened in the Bradford area, as my hon. Friend has described in some detail.
An extension of these sales to all clinics would indeed have taken up staff time, both in the sale of these products and in the ordering and stocking of the items, and in the administration involved. It was feared that this might have reduced the staff time available for the main clinic activities in caring for the health of young children. These sales could also have been regarded as unwelcome to certain retail pharmacists, as they are sometimes regarded as unfair competition.
However, one of the points which causes me some concern is that if we took any action which might injure or threaten the viability of certain chemists and as a consequence of that action those chemists' shops closed down, we should have taken an action which was not in the best interests of the communities. I suspect that this might be particularly so in certain rural areas, though I certainly 585 do not have the experience to describe my hon. Friend's area in this respect.
Another reason why we were reluctant to introduce a national compulsory scheme for sales of proprietary goods was that the item most often sold by local health authorities was proprietary baby milk food. As I have mentioned, the Government already provide at clinics National Dried Milk. I wish that we could get over the message that National Dried Milk is a baby milk powder which is equal in nutritional value to the proprietary brands and is sold at 20p for a 20 oz. pack. I hope that even from this late debate some of this will go out to those mothers who are under some pressure—
§ Mr. Cryer
May I ask my hon. Friend to send the message out to the maternity hospitals, in the way I suggested?
§ Mr. Jones
I shall come to that point.
I appreciate that, although the composition of National Dried Milk is almost identical to that of proprietary brands, a doctor may sometimes advise a mother to use a proprietary brand for her baby either when she is in the maternity hospital or when she is home. This does, of course, mean that, if her local clinic is not one of those which have continued the sale of proprietary brands, she will have to buy it when she does her ordinary shopping, either at a chemist or a shop.
If not direct evidence given by my hon. Friend, certainly the charges made by him—I am not challenging his good faith in the matter—of undue pressure being exerted on mothers are matters which I shall take up as soon as I get to the Department in the morning. If my hon. Friend has any specific information on this matter I should be delighted to receive it. Like him, I believe that at times like this mothers ought not to be subjected to any sort of pressure in deciding what sort of baby foods they should provide for their children.
I should like to take this opportunity of doing almost a commercial plug for the Department and I am sure that my hon. Friend will forgive that. We are at risk of forgetting the provision which 586 nature has made for a mother to breast feed her child. The report published last year under the title "Present Day Practice in Infant Feeding" was the report of a working party of the Panel on Child Nutrition of the Committee on Medical Aspects of Food Policy. It recommended an increase in breast feeding. I suppose that no one could regard this as a "commercial". The working party was convinced that a child's satisfactory growth and development is more certain when an infant is fed an adequate amount of breast milk, and it recommended all mothers to be encouraged to breast feed their babies for at least a fortnight and preferably for the first four to six months.
The Department will be drawing the attention of the health authorities to its recommendation and doing all that is possible to make it known among doctors, midwives, health visitors and other staff of the health service who are in touch with expectant mothers and their young children. The Department also plans publicity aimed at the parents.
I have taken note of everything my hon. Friend said. Certainly, I believe that the reply which he received from my right hon. Friend the Minister of State indicates that we have an understanding of the position of the mothers in an isolated rural area whose local clinic does not sell proprietory baby foods. My hon. Friend indicated apparent pressure that is being made by baby food representatives and the use of sample gift packs. This came as complete news to me since they do not seem to be that generous in my part of the world. I have never heard mothers in Rhondda complain on this score, so perhaps they have been forgotten in this respect.
It is important, however, that we should ensure that this sort of pressure, if it exists, should be removed and that mothers should have a genuine choice. If my hon. Friend has any specific information in addition to what he said tonight I shall be pleased to receive it.
My right hon. Friend the Minister of State told my hon. Friend the Member for Keighley yesterday that I, as Under-Secretary in the Department, would be sympathetically re-examining this whole 587 issue. I will take on board my hon. Friend's suggestion that we might consider giving discretionary powers to the area health authorities. I can assure him that the expression "re-examining the whole issue" means that I will make a genuine re-examination of the decision we made and the advice we issued in the 588 light of everything he said this evening. As soon as I come to any conclusion on this matter I will certainly communicate to my hon. Friend.
§ Question put and agreed to.
§ Adjourned accordingly at seven minutes to One o'clock.