§ Order for Second Reading read.
§ 2.23 p.m.
§ Mr. Simon Mahon (Bootle)
I beg to move, That the Bill be now read a Second time.
I have been in this House for what could be considered a considerable period. Hoping to be a modestly good and assiduous Member and thinking that with my Celtic background I would have a little bit of Irish luck, I have pursued my weary way year after year into the Lobby and diligently signed my name hoping that I would come top of the form and would be able to introduce some tremendous measure that would find its way to the statute book.
In 20 years this is the first time that I have had modest good fortune. I know the position. I know that No. 14 in the Ballot is not the same as No. 1. I wondered what sort of Bill I would attempt to introduce into the Mother of Parliaments. There are many Bills suggested by Departments and there are others in an embryonic stage. I put forward this Bill for a particular reason. 1865 We are all aware of the tragedy of cancer not only in our midst but throughout the world.
I came to this House from an industrial background, from an area in which I had held most positions since I began working on the Liverpool dockside at the age of 14. I had become the managing director of my own firm. But there was one constant worry in my mind. I always recalled the people, particularly the boys, with whom I worked, often in dreadful conditions. Often these boys had the worst of all worlds. In some way I felt a bit more secure because I came from a good, modest, clean and comfortable home.
All of these points are relevant to the introduction of this Bill. In introducing it I speak as a layman who left school at the age of 14 and became a scaler boy on the Liverpool waterfront. I noticed in my passage through life that many of the boys with whom I worked contracted cancer and died earlier than might have been the case if they had been more fortunate in their worldly positions. Perhaps there is help somewhere else for people who have to suffer in this way.
I do not want to be too pessimistic about this subject because I have learned not to be pessimistic. The subject can be approached in an atmosphere of hope. An eminent American medical authority said recently that while cancer is fatal if untreated or if treated late, the fact is that early cancer is among the most curable of major causes of death. My authority for that is Dr. Clifton R. Read of the International Union against Cancer. situated in America. That statement gave me hope.
Having moved all the way through local government and seen miracles happen there, I thought I would introduce this modest Bill in an attempt to ensure that the things that happened in my youth happen less often in today's society. That is all it is—a small attempt by the hon. Member for Bootle to bring more knowledge, hope, faith and achievement not only into my own environment but into the national environment. I hope that we shall be able to add to international knowledge on this subject, which affects everyone at some time or another.
I hope that hon. Members will understand if I quote some statistics. In 1924 1866 my father had the privilege of coming to Whitehall—I recall this with some pride—to give evidence before an important body on the condition of boy labour in this country. At that time Parliament thought that they were being subjected to things to which young boys should not be subjected. Like myself, he knew about coal, oil, boilers, oil tanks and cofferdams, which were not beautiful places to be in, and rose boxes. The rose, box of a ship is the filthiest part but it has that beautiful name. I shall not go into the reasons for it, but it is called that for obvious reasons.
There were boys working in these conditions and there were other people who were working with slag wool and asbestos. They developed all kinds of conditions. I am quite sure that the hon. Member for Reading, South (Dr. Vaughan) would be able to analyse these conditions in great detail, because he is an eminent diagnostician. However, I shall keep to layman's language when talking about the things that cause the conditions that other men have to diagnose. It was insulation and asbestos that caused all these dreadful illnesses which my constituents have to suffer, and no doubt many others suffer from them in other parts of this industrial land.
People may say that this is old hat. I am assured by the best medical authority that this is not the case. It is possible that in modern industry there are more dangers than existed in old industry. That point has been made forcibly to me and I may mention an example later.
In my passage through public life I have discovered another inequality for working-class people. There are, of course, many. Is it not strange that the incidence of cancer among working-class people—a phrase that people do not want us to use any more—is far higher than it is among people who are better off, such as the middle class? Of course, I hope that that is always the case for the middle class, in all charity. However, it is obvious that a man in my situation, coming from the part of the land from which I come, can learn that this class distinction is relevant not only in financial, economic and social terms but even from the point of view of our personal health in the face of this disease.
1867 The example for which I was searching is to be found in the rubber industry, which is a modern industry using additives and is principally concerned, in this country, with the production of tyres. It has been established and proved positively that to work in this industry does not cause cancer of the lung but can cause cancer of the bladder. I am delighted to have the full agreement, I see, of that eminent diagnostician, the hon. Member for Reading, South. It bears out the point I am making. It applies not only to people of my generation but to people of future generations in the same way.
I do not want to use too many business names. However, may we be sure that great international organisations, not only in this country but abroad, such as the great international Dunlop Company, recognise this and make adequate compensation? Will they, with their great wealth, be able to inform workers in their factories that they are in danger of contracting cancer of the bladder? Will they be able to use a screening process which will be beneficial to the workers to whom they have a responsibility?
I want people in this country to realise that we are anxious about these things. We are not all medically knowledgeable. I certainly am not, and I am sure there are many poor innocent people who do not know much about this subject at all. However, we must keep insisting that cancer can be cured and that the pessimism that affected other times must be driven away somehow. I believe that the whole thing depends, firmly, on education and the earliest possible diagnosis.
All hon. Members have a great affection and esteem for one of the greatest physicians in the world. I have been a friend of the noble Lord, Lord Cohen of Birkenhead for many years. Whether this story is apocryphal or whether it is true in every syllable I do not know, but in Liverpool University the great Professor Cohen, as he was in those days, began every lecture of any importance with this statement to the assembled medical students and graduates: "There are three important things in medicine. The first is diagnosis, the second is diagnosis and the third is diagnosis."
1868 I believe that to be the case not only in medicine and cancer but in this country as a whole, economically and in every other way, where we have as yet been unable to diagnose our problems. Therefore, the diagnostic ability of people and the co-operation of people in the early diagnosis of cancer is essential.
Perhaps I may inject a note of hope. I have always been fortunate to have friends in the right places. As a layman I feel it essential to get expert knowledge to try to assimilate matters in any humble fashion possible. I have discussed this matter with an eminent cancer specialist. It was in Mr. Speaker's constituency—and I did not ask for his permission to go there. I went to this wonderful establishment and was given the information that in the Clatterbridge Hospital in the Wirral they have the highest cure rate for bladder cancer in the world. Is not that—were I not to say another word today—a wonderful thing to be able to say to people who think that every case of cancer is hopeless? That hospital has the highest cure rate for bladder cancer in the world. I asked how I could translate that fact as a politician. They told me that there has to be something to take the place of fear. The only thing that we can put in place of fear is hope. That hope has to be based upon achievements and on the knowledge of the people who work so hard.
It may be said to me today, "You are in the wrong Department." The Minister present is from the Department of Education and Science. I could have said with complete arrogance or lack of humility, "Where are the other two Departments? Where is the Minister from the Department of Employment and where is the Minister from the Department of Health and Social Security?" I do not know whether this fits in appropriately with my hon. Friend the Minister's true position.
Education in cancer has to start wherever cancer is found. If a little schoolboy does not start smoking until he is eight, he has to be told when he is eight, not when he is 16, that he will not be able to play in the football team or to run as fast as other boys. Education must start in childhood and continue in adolescence. The development of knowledge should occur naturally in industry, 1869 schools and universities according to the need for that knowledge, right through to maturity. I am sure the experts will be with me on that. When people reach maturity they tend to feel that the worst struggle of life is over, but they are the dangerous years.
We all remember what it was like to be 10 years of age. I can remember what it was like to be 21, but when I became 40, the age of 60 seemed a long time ahead, an eternity, but to me the years have gone by on velvet feet and I did not hear them going. I was hushed by the years as they elapsed and went my own way. In talking to the young, we must remember that they are young and do the best we can.
Every year, 32,000 people in the United Kingdom die from lung cancer—one every 16 minutes. Those are not my figures, but they are the most up-to-date figures that can be obtained. Here a note of sadness comes into my mind. I have always asked myself why my constituents have so much trouble. Why do they always get everything—bad housing, plus had health, plus bad environment, plus cancer. That is what I refer to as the plus factor. The theory that I have always held has been proved to be right. Which part of Great Britain has the highest incidence of cancer? Liverpool and Bootle. That is how I justify my Bill on behalf of my people. The plus factors include environment, atmosphere, diesel fumes and smoking. I am told that one can smoke with a freer mind in New Zealand because the air there is so pure that the same risks are not incurred.
People tend to think that the situation is hopeless, but I will inject a note of hope by saying that there has been an improvement over the years. When I first came into active public life in Bootle after the war, one responsibility which I was given was for housing. An eminent public health doctor sent for me and asked whether I had any idea of the dimensions of the assignment that I had been given. I said "I know it is fairly bad". He said "Do you know that you have the highest maternal mortality rate in the United Kingdom, the highest child mortality rate in the United Kingdom and the highest incidence of tuberculosis in the United Kingdom?"
1870 That was immediately after the war. Hitler had done a vicious bombing job and had taken thousands of houses from us. We thought that the town would have to be written off. But by diligent work by all concerned, within a few short years those terrible statistics were reduced below national average. People had thought that their position was hopeless, but by hard work, devoted care and application by all concerned, those dreadful figures were reduced. If the same endeavour can be put into attacking cancer, people will have less reason to be pessimistic. We are just beginning to see the light, and if we follow this road great results may be achieved in a shorter time than we imagine.
Young people should be given information on how to protect themselves. When I went to work I did not know how to protect myself—and I was not unintelligent. After leaving a good grammar school I went down to the docks because I had no choice. I had no idea how to protect myself. But for the grace of God I should have had cancer, as did some of my comrades. People should be told how to protect themselves. If we do not tell them, who will'? Is it not fair for me to ask Parliament for protection for young people in industry and elsewhere? Is it not fair for me to ask local education authories to assist? They are responsible for the teaching of many other subjects. Why should they not he responsible for teaching children how to look after themselves? I hope that the Bill will get its just deserts, because it is a good Bill.
The Bill requires local authorities to provide information. Until recently a local authority was a health authority. I hope that I shall not be accused of leaving out health authorities. There has been a separation of the two, but that separation occurred with the reorganisation of local government and does not occur in my mind. I hope that the term "local authority" will not be taken to mean just a local education authority. It means every kind of local authority, including regional hospital boards and others. The Bill would be a nonsense if it were read in any other way.
I shall probably be told I should not interfere with the curricula of schools and that it is a mistake to force certain things to be done. What are we to do? I am 1871 not talking about people who live in Richmond or in Dorset or in Kent but of people who live in my constituency. There are people there who have never known the privacy of their own bedroom. Is that not a significant factor when everybody says that hygiene is important? Specialists tell me that hygiene is all-important and is becoming more and more so every day in the fight against cancer. There are people in my constituency who have never seen an inside toilet. In the 20 years I have been in the House, no Government have ever succeded in solving the housing crisis. I have always been disappointed on that score. The results can be seen in our streets.
If children and particularly young adolescent girls do not have the privacy which we all take for granted, how much harder is the situation that faces them. Perhaps, additionally, the girl concerned may have no parents, or indifferent parents, or may be a vicitim of a marriage which has broken up, and she is left on her own. Who is to tell her these important things, if Parliament is not to tell her through the medium of this Bill? Who is to tell her if teachers, nurses and doctors are not to do so?
Housing and hygiene are all part of the fight against cancer. My constituents are not getting a fair break—and they have never had a fair break. It is my duty as their Member of Parliament to say these things, even though it may bore the House. My constituents need more protection, and they need it from Parliament. That is the reason behind the Bill.
I shall no doubt be told that these matters cannot be included in curricula. However, most schools today have liberal studies, and I shall prove a little later that my proposals are being followed in other parts of the world. We are prepared to teach children of eight the exact situation of the equator, but we are not prepared to teach them about the equation between good health and bad. I do not want to be told about curricula because I have been the chairman of an education committee. I know that children could be taught about hygiene and the standards necessary to avoid cancer.
There is something more I should say. I wondered whether I should say this to 1872 the House, and I have decided to say it. The House will know of the stand I have taken on certain subjects in this House over the years. I have never liked the permissive society. I am a little sorry for the young today. I am certainly not envious of them. I believe that we have burdened modern youth with the permissive society. Who will tell the youth of this country that gross promiscuity brings cancer in its train—not in middle age or in old age but in youth'? Who will tell them of that tragedy? If we do not say these things in the Mother of Parliaments, where can they be said? I have heard these things said only in the colleges and medical schools.
When legislation has been enacted which has resulted in the permissive society those responsible have not told people of the dangers of the permissive society. The danger to which I have drawn attention is one of them. I believe that young women need to be protected by a Bill such as that which is now before the House. If they carry on in ignorance they will find themselves in an unfortunate state in a very short period of time. That needed to he said and I have now said it.
§ Mr. Bryan Davies (Enfield, North)
I have listened carefully to my hon. Friend's argument, much of which is valid, in seeking to tackle the question of education about cancer and the ways in which one should seek to prevent the disease. Certainly the Bill concentrates on the question of education and information rather than on the question of fear about the disease. Does my hon. Friend agree that if we emphasise the horror, rather than intelligent constructive ways in which young people can protect themselves, we shall not achieve our aims as successfully as we might otherwise do?
§ Mr. Mahon
As a reasonable man of course I underwrite my hon. Friend's intervention. Certainly I expressed hope at the outset of my speech, and I said that I was not pessimistic. I said that in place of fear we must put hope, knowledge and achievement. The more information and education we can give the various age groups, particularly the young, the better it will be for everybody.
I shall come shortly to the provisions of the Bill and explain them in more 1873 detail. It is not hard to explain these things to people. I have had information from all over the world which suggests that although we may think the mountain is very high and that we are only at the foothills, we are well advanced at present towards a solution.
I referred to the curriculum in the schools. It has been said that this subject could not be included in the school curriculum. However. I recently received an article from a lady doctor in Finland which reads:Schools offer an ideal climate for the growth of a sensible and unemotional acceptance of cancer as a part of life. They give us the chance to eliminate old inherited prejudices and replace them with honest, matter of fact types of information about the various kinds of cancer and the successful treatment of important types of the disease.She also mentions biology, chemistry, the environment, and hygiene, and health classes as being the natural places for the dissemination of this knowledge.
Referring to the Schedule, I was asked to provide information which would enable people to hope. I can provide that information. Paragraph 1 refers to the extent to which the various types of cancer are curable, especially if detected in the early stages. Reference is also made to the importance of early diagnosis and treatment. I am sure that hon. Members will support me in my plea concerning that matter.
I shall now give figures which will help all those who are interested in the problem. I refer to the extent to which the various types of cancer, to which the Schedule refers, are curable, especially if detected in the early stages. In one eminent hospital 25 years ago two cases of cancer of the tongue suitable for treatment with radium needles were diagnosed each week. In the same hospital they now only unhappily, discover six such cases each year.
I now refer to the existing treatment, the possible development of treatment and the improvement of the treatment of breast cancer. Mine is a layman's approach. However, I have consulted knowledgeable people, who have informed me that at the age of 30 ladies should take advantage of the screening available to them. The years in a woman's life between 40 and 50 are vital. Family history, and size of family must also be 1874 taken into account. People who are in the high risk groups should seek medical opinion.
If we try to build a house, school or hospital the question of cost must be considered. However, wars cost much money, lives, pain and wounds, and I make no apology for quoting these figures. The cost of screening women in hospitals is modest—between £5 and £6. However, total screening costs thousands of pounds per person. Even in those conditions, at a cost of perhaps £2,000 per person, the cancer pick-up rate for persons with no symptoms is 0.15 per cent. That is a costly exercise.
When women co-operate with the medical profession, the cure rate for breast cancer improves tremendously. There are many methods of examination. I have a note which tells me to try to avoid the use of long words. However, self-examination should be taught. We are arguing about the method by which it should be taught.
It is sometimes necessary for examinations to be carried out by doctors. However I am informed that, in this natural difficulty, women are more helpful to other women. Qualified nurses are successful when examining other women. That fact should be known. Many women are modest and fearful. Trained, diligent, devoted and knowledgeable women should be employed by local authorities to do this work, which would encourage women to seek examination. If a woman aged 30 to 50, who is modest, as most of them are, knew that she could be examined by another woman, she would be less fearful. However, if further advice were needed, that would have to come from the appropriate higher medical level. I am told that there is a very high "pick-up' rate by the nurses who do this valuable work.
I have done my best to present a Bill on this difficult subject. So difficult is the subject that at one time I thought that people were kidding me when they told me about the dangers of aerosols in ladies' hairdressing establishments. I believe that the particles emanating from an aerosol can be cancer-forming. Aerosols are used throughout the land in massive numbers. One eminent medical authority told me that they were a menace.
1875 We are not doing sufficient to educate people about the dangers of smoking. I regard the notice on cigarette packets as hideous. The warning that cigarettes may kill may be justified, but is that all we can do to warn people of the dangers of smoking?
Could not the Government find time for my Bill? Who will stand in the way of the Bill? It is better than most Bills. I hope that no one will block it. It is a good Bill. My constituents and other people throughout the land will ask questions if it is blocked, because it is such a deserving Bill.
The Bill was not in existence until a few days ago. Considerable thought has been devoted to it. I am grateful for the considerable help of those in the House who help Members such as myself who have little legal knowledge. I am grateful to those hon. Members who have helped me and to my sponsors on both sides. I am grateful to all the doctors who patiently advised me. I hope that I have conveyed to the House at least some of the facts which it would wish to hear about.
In a recent article Dr. E. C. Easson, of Glasgow—he is a doctor of medicine and a Fellow of the Royal College of Physicians—wrote:With present-day therapeutic measures many cancers are entirely curable. When we cure these cancers we know why we cure them.That is tremendous.When we fail we know why we failed. The greatest single source of failure today is the patient who gives his cancer time to go beyond the measurable possibilities of cure. This is the problem, this is the tragedy we seek to control.
§ 3.9 p.m.
§ Mr. Bryan Davies (Enfield, North)
It gives me considerable pleasure to be called so early in the debate and to have an opportunity of welcoming this Bill. I am not one of its sponsors, although I would gladly have added my name to the Bill had the opportunity airsen. My attitude to the subject has been substantially confirmed by the able way in which my hon. Friend the Member for Bootle (Mr. Mahon) introduced the main provisions of the Bill. I hope also that I may be somewhat luckier than he in not having to wait 20 years before I draw 1876 a sufficiently high place in the Ballot to introduce a modest measure of my own, and I hope that such a measure will be as worthy of the attention of the House as I consider this Bill to be.
I imagine that one of the major objections which may be put forward to this excellent Bill is that here again is the Mother of Parliaments recommending legislation which it requires other authorities to implement; and that at a time when we are all conscious of local authorities creaking and groaning under the weighty burdens that we have placed upon them, and cognisant of our failure to offer them sufficient resources with which to meet those obligations, it might be thought that this Bill runs into son-le difficulties in yet again suggesting that local authorities should bear an additional burden.
I do not take that view. I sometimes think that local authorities inflict upon themselves burdens which are less meritorious. Many local authorities have certainly been prone in recent years to expend a substantial amount of money on rather grandiose civic centres and offices which I do not think have always been totally justified. Perhaps I may enter a caveat. I was privileged in the past week to participate in a ceremony in which the civic centre in my constituency of Enfield was opened by Her Majesty the Queen Mother, and I am not in any way suggesting that money expended on that civic centre is not completely justified. Indeed, I would emphasise that the development of those offices is in the area of an authority which has been operating for more than a decade under the reform of the London Government Act.
My criticism is more substantially reserved for those local authorities which have barely seen the light of day in terms of their new roles before there has been substantial expenditure of public money on what may not necessarily be regarded as the most beneficial resource uses on behalf of their communities. However, I do not place the obligations represented by this Bill, should it successfully negotiate the parliamentary obstacles, in the category of an unwelcome burden.
One is conscious that in recent years many pieces of legislation connected with health have greatly extended the obligations on local authorities. One thinks 1877 particularly of the example of the Chronic Sick and Disabled Persons Act. I do not think anybody in any local authority would wish that obligation to be removed or even reduced. What we are witnessing is a substantial transference of crucial areas of health care to the local communities. This philosophy of health in the local community is absolutely right. We should attempt to solve the problems of those who are suffering illness by as far as possible locating their support and help in the local community itself.
One thinks, for example, of the mental health provisions by which greater encouragement is given to the treatment of mentally-ill people at home with sufficient back-up resources from the local authority to ensure that people are nursed back to health so far as possible within the framework of their own community rather than being isolated in hospitals with special facilities.
Moreover, the advantages of this to local authorities are not to be underestimated. In many respects this represents the local authorities as having a human face. Whatever the strident cries for a reduction in the increase in rate expenditure and demands upon the rates, one always recognises that the community is eager to provide appropriate social service support for those in most need in the community, and I do not think that these resources are begrudged by anyone.
One should recognise that there are certain ways in which one can increase the participation of people serving in local authorities, so increasing the motivation towards public service, and it is my view that the increase in the obligation on local authorities in respect of health provisions makes the role of the councillor more satisfying and helps to recruit people to carry out that honourable service.
The Bill represents a small but significant step in the development of our thinking about medicine in our community. For a long time in our history, all our resources with regard to medical provision were concerned with the curative aspects of health. One calls to mind the eighteenth century emphasis on such matters and some of the more horrendous Hogarthian prints. One must recognise that the cure, if not more painful than the disease, looks to have been more horrendous. The movement from there was to- 1878 wards the area of the great public health reforms of the nineteenth century. Then it was recognised that the cure of the diseased patient provided no answer to the outbreaks of epidemics and that the community had to have a wider responsibility not of providing a cure but of preventing outbreaks of such epidemics.
The cholera epidemic of 1847, which led to the Public Health Act, was a clear example of the community realising that without the development of suitable sanitation, without the guarantee of clean water for our developing industrial cities, the curative response to the incidence of health could provide no solution.
We are now moving to a situation in which we are developing extremely high standards of public health. Through the National Health Service we have greatly increased the degree of sophistication in our treatment of patients. This is particularly so on the curative side, and the Bill emphasis what I consider to be highly desirable, namely, the need to develop the preventive aspects of medicine. It is cheaper to prevent the development of illness than to cure it, and for individuals it is better that they should never have the disease than that they should be cured after having contracted it.
It is the case in the development of our modern medical history that the fastest spreading diseases in advanced societies are those which people can be taught to avoid. The Bill emphasises the educational aspects of health in our society, and it is therefore appropriate that the Under-Secretary of State for Education and Science is present to reply to the debate.
The incidence of disease in a modern society can substantially be reduced by an increase in our educative facilities to spread an awareness of the dangers of certain practices leading to the development of cancer. This disease has had considerable publicity in recent years, certainly to that point where it is recognised that certain social habits are crucially related to it—particularly the habit of smoking. It is estimated that almost all human activities have within them the capacity to increase the possibility of cancer, and some activities like sun-bathing, smoking and making love, are regarded as more likely to increase that incidence than 1879 are other activities. These would seem to be the activities which people regard as particularly pleasurable.
I am not here to produce a Benthamite version of the felicific calculus or to produce a prohibited list of such pleasures. But if, to take the obvious extreme case of smoking, there is a problem in the development of educational techniques to overcome the natural tendency to indulge in smoking, this should be remedied. The relationship between lung cancer and smoking is well established and is supported not just by the advice of the medical profession but in the action it has taken in recent years, for example, by GPs being prepared to practise what they preached. Substantial numbers of them reduced their consumption of tobacco, and the result is that while lung cancer is increasing in our society generally there has been a significant drop in the incidence of the disease among doctors.
The problem of emphasising the dangers of smoking is not that the devil has the best tunes but that he has the biggest orchestras at his command to play them. This is why, in educational institutions, it is essential to concentrate our resources in combating the powerful influences in society which are working in the opposite direction.
The pressures in society are clearly enormous and should be reduced. We should particularly look again at the question of advertisements for cigarettes and tobacco. It is not that we want to deny pleasure to people who are already, unhappily, hooked on that habit. We are seeking to reduce the numbers of people who take up smoking, risking injury to their health. That is why the Bill is important in emphasising the educational institutions aspect. That is why we should look particularly closely at the increasing number of advertisements that are found at sporting occasions and events. In a modest way I participate in sport, in the parliamentary soccer team. The team has not been offered sponsorship by a tobacco firm and I doubt whether, after my speech today, it is likely to get one. However, it is important to distinguish the sharp correlation which exists between what I believe to be distinct opposites and which is highlighted by the presence of substantial 1880 cigarette advertisements at sporting events.
Restrictions on TV advertisements have been circumvented by the judicious placing of hoardings at sporting fixtures. This happens even on the glorious occasion of the Cup Final, and at motor racing, although one cannot distinguish the driver or tell one "mobile Hoover" from another, one can see the name of the advertiser.
In our educational institutions we should emphasise the development of powerful countermanding techniques against the pressures of the outside world. The Bill shows how local authorities can play a significant role. The outside visitor to a school is more readily accepted by the pupils than are their familiar teachers. This prestige can help to bring home the message. Doctors still enjoy considerable influence with the young.
Health is our most precious asset, and we must protect it. This does not mean interfering with the school curriculum. Physical education should be abolished in schools and replaced with health education, since it is meaningless without a full education as to the advantages of health. The Bill offers great opportunities for the extension of information to prevent the dreadful scourge of cancer. It is a step along the road to preventive rather than curative medicine and as such should be applauded.
§ 3.27 p.m.
§ Mr. Anthony Fell (Yarmouth)
I want to speak briefly about the Bill introduced by the hon. Member for Bootle (Mr. Mahon). I was about to call him "my hon. Friend" and that would not be so far from the truth. I agree with the hon. Member for Enfield, North (Mr. Davies). I cannot believe, I will not believe, that the Under-Secretary of State, an old friend of mine, will oppose a Bill which seeks to establish a method which will enable us to find out more about cancer and to notify it more quickly. The six hon. Members present assume that he will oppose the Bill but I do not believe that a Member of this great Socialist Government which is bringing so much pleasure and greatness to the British people will speak against this humble Bill.
§ Mr. Bryan Davies
Perhaps if the hon. Gentleman resumed his seat, he would 1881 find out what response the Minister intended to make.
§ Mr. Fell
With respect, I was not rude enough at any stage to interrupt the hon. Gentleman, although it would not have been the most difficult thing that I have ever done in the House.
I do not credit the story that is going around today that this little Bill, which will help to find out where cancer is arising, will become the subject of dispute when we decide whether we should help its passage through the House. It is not possible to believe that. The only reason for my contributing to the debate is my great feeling for the hon. Member for Bootle. I find it impossible to believe that such a distinguished and important Socialist from the North-West, a representative of this great Government of the Socialist Party, will be denied the right to introduce a Bill which will do some good in alleviating the suffering of the people of our nation.
§ 3.32 p.m.
§ Dr. Gerard Vaughan (Reading, South)
After that passionate and forceful support from the hon. Member for Yarmouth (Mr. Fell) I shall bring matters to a slightly more subdued and medical view. I cannot believe that anyone who was present a short time ago could not have been moved by the sincerity and compassion with which the hon. Member for Bootle (Mr. Mahon) presented his case. I thought that he put it forward with a sincerity which all of us would want to support. I and my hon. Friends congratulate him and the other sponsors of the Bill.
The hon. Gentleman said modestly that he considered it a modest Bill. I believe that it could be a valuable Bill medically. We need a much wider appreciation of the risks of cancer within the community. We cannot achieve that by adopting only one line of approach. We need to adopt many different approaches. That is why I agree that we need a multitude of information channels. The Bill would provide fresh and valuable channels.
Understandably, cancer is something which we all regard as happening to the other person but never us. That is our attitude, until it is too late. We then wake up to the realisation that we are 1882 as fallible and as humanly vulnerable as our neighbours.
It is important that people should understand the risks. The hon. Gentleman took a wider view than I propose to take and he quite rightly spoke of commercial hazards which are not understood by many people. Very often young people work in industrial processes and they have no idea of the risks that they are running either immediately or in later life.
I agree with the hon. Gentleman that, quite apart from the importance of recognising cancer before it is too late for treatment—and this is very much in the medical tradition of the great Osler to comfort always—there is the need to recognise cancer at an early enough stage so that major anxieties and disfiguring or disabling surgery do not have to take place.
The hon. Gentleman referred to breast cancer and I shall return to two different kinds of cancer, both of which affect women. They both illustrate the possible value of the Bill. A greater awareness amongst women of the risks of breast cancer and cancer of the uterus would undoubtedly save a great many lives. My colleagues in this branch of medicine tell me that one in 17—in some surveys it is one in 16—of all women is likely to develop breast cancer in her life. A short while ago I was looking at the gallery. Statistically one woman of all the women listening to this debate is likely to develop breast cancer later in life.
Each year, about 10,000 women die from this complaint. It is the greatest single killer of middle-aged women that we face today. While the death rate for women generally is falling, the death rate for cancer of the breast has remained alarmingly the same; if anything, it has gone up slightly.
§ Dr. Vaughan
As so often, my hon. Friend the Member for Yarmouth is slightly ahead of us. The importance of the Bill and of the awareness it urges is that nine out of 10 cases, or 90 per cent., of cancers of the breast can be detected by the women themselves if they know the risks and what they should be looking for. There are a number of 1883 books on the subject which are not well known. They are expensive and difficult to get hold of, but they tell women simple ways of examining themselves. Every woman should know of the existence of these books and should have access to them.
We have already heard a little about the costs of medical screening, which is a far more elaborate process. It is expensive, but even so the benefit that we have had in recent years from screening has been increased. A falling rate, for example, of cancer of the cervix and the uterus, is probably directly due to the medical screening services, which are now better than ever.
For example, BUPA's medical centre—which provides only one form of medical screening—is providing in the private sector a form of regular screening. It is perhaps ironic, when we were discussing what, in the view of many, are the disadvantages of the private medical service this week, that this service is providing a pioneering activity in an area which needs more national attention. The centre has screened about 13,000 women. Of every 1,000 women screened it has picked out 7.5 cases of breast cancer and 3.2 cases of cancer of the cervix. It does this at a cost which is by no means prohibitive.
In these two significant areas where preventive medicine and greater understanding can actually save lives we have a situation in which 90 per cent. of women could detect breast cancer before it was too late if only they knew what to look for. The hon. Member for Bootle mentioned the age of 30. My advice is that every woman over the age of 20 should examine her breasts once a month. It is a very simple thing to do. In that way she is likely to detect the earliest stages of this illness. Nationally, we should provide full medical screening for every woman over the age of 50.
I have spent some time talking about those two medical aspects because from the medical point of view they seem so significant. A number of books have been produced by the BMA. One of them is about what to look for in cases of cancer. The Royal Marsden Hospital has produced a very good pamphlet on cancer of the breast.
I revert to the purpose of the Bill. There is one area about which I am 1884 slightly unsure. In the list of places where the local authorities should be required to provide educational facilities, schools are mentioned as being very important. I wonder whether we want to bring more of this kind of topic into our schools. I suggest to the hon. Member for Enfield, North (Mr. Davies) that children are not likely to be very concerned about an illness which is, as they see it, far into later life. Some anxious children might be made more anxious and others might be confused or simply regard it as irrelevant. While I welcome other suggestions for increasing educational facilities, I would put a big question mark beside the teaching of cancer risks within the classroom.
§ Mr. Bryan Davies
Does the hon. Gentleman agree that it would be possible to get over successfully to schoolchildren the relationship between poor physical performance and the consumption of cigarettes? That would be emphasising not the dangerous aspects of the disease but, rather, sporting performance in relation to smoking.
§ Dr. Vaughan
Perhaps the one exception I would make is the risk to health caused by smoking, which I do not think can be taught to people too early in their lives. I know that the Minister wishes to make some remarks, so I shall conclude by congratulating the hon. Member for Bootle on his Bill. I welcome what he had to say. I wish the Bill great success. I hope that it will appear on the statute book in the near future.
§ 3.41 p.m.
§ The Under-Secretary of State for Education and Science (Mr. Ernest Armstrong)
I congratulate my hon. Friend the Member for Bootle (Mr. Mahon) on raising this important subject and taking advantage of his good fortune, after so many years in the House, to present this Bill. His speech, to which I listened most carefully, was a typically moving speech, concerned with the well-being of his fellow citizens and particularly with his constituents who, like mine, have more than their fair share of the incidence of this disease.
I thank the hon. Member for Reading, South (Dr. Vaughan) for speaking with such brevity and allowing me to say a few words. The hon. Member touched on the difficulty I am in, despite the 1885 passionate outburst of the hon. Member for Yarmouth (Mr. Fell), in dealing with this Bill. I would not disagree with very much that has been said by anyone. We have had some good speeches which have shown care and compassion and have revealed the House at its best.
I remind my hon. Friend, however, that this is a Bill to require local authorities to provide information in educational institutions under their control. It is not about the dangers of cancer. It does not deal with ways of bringing home to people the 'need for them to be examined for example. This is why—because the Bill seeks to place this requirement on local authorities—I am at the Dispatch Box rather than a Minister from the Department of Health and Social Security. I assure the House that I have naturally discussed the Bill with my colleagues at that Department and have received considerable help from them.
The Bill embodies a naturally laudable wish which is shared by the Government and all hon. Members. It may have been in my hon. Friend's mind that attempting an educational programme specifically intended for young people is one way of being sure of conveying the requisite message. It is well nigh impossible to attempt this with the adult population. There is an obvious drawback to which the hon. Member for Reading, South drew our attention in placing to much emphasis in the education of young children on the dangers of the disease, which, fortunately, is essentially one that strikes at the young only relatively rarely. My hon. Friend has had a lifetime's experience in the education service in local government and will no doubt have anticipated some of my remarks.
The obvious point that occurs to me is that in directing local authorities to ensure that information about cancer is made available in schools and colleges, the Bill is proposing something which, as he has admitted, is completely incompatible with principles underlying the way in which education is organised in this country.
§ Mr. Armstrong
It is not nonsense. It is a fact. This is a criticism which transcends in scale of importance any question 1886 of merit or otherwise of the proposals themselves. I cannot emphasise that last point too strongly.
This system of decentralised control, of local authority autonomy, has its critics but it is one that is ideally suited to this country. In practice the responsibility is one which is almost invariably devolved to head teachers and to teaching staffs. That is why I have reservations about and, indeed, objections to the Bill.
However, I want to be positive in what I have to say because I was very moved by my hon. Friend's intentions and by the speech that he made.
The Government believe that information about cancer should feature in health education programmes. I think that the House has done rather less than justice—not purposely, because my hon. Friend had to move the Second Reading of his Bill in less time than he would have wished—to what is being done in the country about this matter. I want to outline some of the things which are being done—and which are being done in a more effective way than would be the case if we were to implement the provisions of the Bill.
We are concerned not only to keep the problem in the proper perspective but also to see that our inevitably limited resources are deployed in the most effective way possible. In our view, the greatest emphasis in cancer education is best laid on aspects of primary prevention—by advising on improved personal hygiene, on the dangers of smoking and on the need to observe specified precautions in certain industrial processes. My hon. Friend mentioned all these features. We also consider that cancer education ought to be pursued not in isolation but as an element—an important element—in a wider and co-ordinated approach to health education.
Here, perhaps, it would be appropriate for me to say something about the work of the Health Education Council, which is specifically mentioned in the Bill and which was formed as a result of the Cohen Committee Report in 1968. The council was set up some seven years ago as a national body responsible for the promotion of health education in England, Wales and Northern Ireland. Not only does this council advise Government Departments on health education matters but it also provides advice and assistance 1887 to the National Health Service, to local authorities, to voluntary organisations and to other bodies concerned with health education.
This assistance can take a number of forms, but featuring prominently in its work are the making of financial grants, the training of health educators through courses, seminars and conferences, and the provision of health education leaflets and posters. I am sure that those of us who have been in any kind of educational institution have seen the various leaflets and posters.
The council also carries out its own national health campaigns. This involves the achievement of publicity in the Press, on television and on radio and through its posters and leaflets. It has built up a wide range of health education expertise and material and it regularly circularises area health authorities and others about the availability of this and other facilities. It has also undertaken or sponsored a varied programme of research and, in the Government's view, it can be fairly claimed that during its relatively short span of life the council has established itself as a focal point for everyone involved in the planning and development of health education on a rational or scientific basis. The hon. Member for Reading, South said that certain sectors of the population would not be covered if educational institutions were compelled by local authorities to take this action. I put it to him that the work that is already being done is all-embracing.
The Health Education Council is doing a tremendous job. One of the council's main priorities in recent years has been the anti-smoking campaign which hon. Members will recognise as a preventive area of the first importance to lung cancer. In the campaign, the public are also being informed about the risks of contracting chronic bronchitis and heart disease and of injury to an unborn child where women smoke during pregnancy.
The council is also arranging with the British Cancer Council a series of joint study days in different parts of the country and, during these, the discussions will cover not only the promotion of cancer education in general terms but the particular needs and views of the region in which they are held.
§ Mr. Mahon
I have acknowledged that it would be necessary to consult the Health Education Council with a view to co-ordinating the publication of information if the Bill became law. I have not ignored the great work that has been done by the Health Education Council. I have not always been pleased with all that it has done in recent years, but most of it has been commendable.
§ Mr. Armstrong
I acknowledge what my hon. Friend says. I am not blaming my hon. Friend, who has his job to do in moving the Second Reading of the Bill. Through lack of time we perhaps have not recognised the tremendous amount of information that is being made available. I want it to be made available, but I do not think that the provisions of the Bill would improve communications in the way my hon. Friend suggests.
The first of the study days to which I have referred will take place in Nottingham on Monday next. A wide variety of professions interested in health matters have been invited, including teachers and other involved in education. There will be seven more such meetings in other parts of the country this year.
I have spoken about how the council has established a network of links with area health authorities, local authorities and others. It is important for hon. Members to bear in mind that that has been achieved entirely on a voluntary basis. I know that the council would not consider it helpful for such contacts to be made mandatory through legislation or regulation. Indeed, it would rightly feel that such a step would have a damaging effect on its relations with other bodies.
I want now to bring the attention of the House back to the subject of education in schools and colleges—which is what the Bill is about—and in particular to the health education programmes that are to be found in them. Many schools and colleges now provide health education programmes for their pupils and students in a variety of ways. I want to emphasise the phrase "in a variety of way", for the institutions that present the subject under that label in their time-tables are probably only a small minority. In most instances it is presented through 1889 other subjects or groups of subjects. There are sound reasons for this.
The aims of such education are to get young people to understand and to accept their personal responsibility for their health, to know when and how to call for advice or help, and to form attitudes which will help them to resist the many pressures which society or circumstances may exert upon them to live unhealthily. What is especially important is not that a particular body of information should have been put across to young people but that they should absorb and accept the implications for behaviour that go with this information.
Many teachers recognise that the young are particularly susceptible to suggestions that they are being "got at". Therefore, their aims in giving health education are more likely to be achieved where both information and its implications develop naturally out of other areas of work. There are, however, a number of difficulties which schools and colleges face in attempting such work. It is a relatively new area of education for them, although one which is developing rapidly.
§ Mr. Fell
The House realises that the Minister is trying to do his best, but he is a Minister on the educational side of things. Will he tell the House why there is no Minister from the Department of Health and Social Security present on the Government Front Bench when we are dealing with a Bill which is of deep concern in the health of the nation?
§ Mr. Armstrong
It is typical of the hon. Gentleman. The Bill is aimed at requiringlocal authorities to provide information in educational institutions under their control relating to the dangers of cancer and the need for early screening".I would also remind the hon. Gentleman that the title of the Bill is the Cancer Screening (Education) Bill.
§ Mr. Armstrong
We also deal with these matters in schools, colleges and institutions. What is important is not that a particular body of information should be put across to young people but that they should absorb and accept the implications in terms of behaviour and act on that information.
There are a number of difficulties which face the medical staff in educational institutions. Co-ordination of programmes—which are usually, of necessity, presented in an oblique or diffuse way—presents particular difficulties. An encouraging development in recent years has been the development in many local education authorities of comprehensive programmes of work in which health education plays an important or key rôle. Such courses appear under a multiplicity of different labels. In my visits to schools I have come across a number of courses—for example, "Education for Living", "Education for Parenthood" and "Education in Personal Relations", to name but a few.
§ Mr. Fell
The Minister is trying very hard, and I admire him for the way in which he is trying to build up from his humble situation. But this matter affects the nation and its health. What he is burbling about comes from an extraordinary brief which he has had from his boys at the Ministry. He should be able to give the House something better than this.
§ Mr. Armstrong
The hon. Gentleman says that I am trying very hard. That is what they kept saying in the educational institutions which I attended, "He must try harder". I am glad that I am carrying out the injunctions of my teachers.
I was saying, when I was interrupted, that some authorities are also providing or arranging in-service training courses for their teachers in this area of work. A number of voluntary organisations are able to offer them invaluable help. It is encouraging to note that both the Schools Council and the Health Education Council have curriculum development programmes in health education in progress at present.
I mentioned earlier the autonomy which authorities and teachers possess over the management of their schools and their 1891 curricula. It is they who decide what is to be taught and how it is to be taught. I suspect that the House would be very suspicious if the Government were to attempt to lay down that central Government had the right to say what should be taught and how it should be taught. However, it is clear that authorities and teachers generally consider that health education should be presented, not in isolated or fragmented themes, but as a coordinated broad programme, and that emphasis is placed on helping young people to understand how to keep healthy. This includes providing information and discussing attitudes and behaviour—
§ It being Four o'clock, the debate stood adjourned.
§ Debate to be resumed upon Friday next.