Commons Sitting of 20 April 1978

Preamble
The House met at half-past Two o'clock
PRAYERS
[Mr. SPEAKER the Chair]
ORAL ANSWERS TO QUESTIONS
  AGRICULTURE, FISHERIES AND FOOD

    Blue Whiting
    Mr. Brothertonasked the Minister of Agriculture, Fisheries and Food what discussions he has had with representatives of the fishing industry about fishing for blue whiting.
    The Minister of State, Ministry of Agriculture, Fisheries and Food (Mr. E. S. Bishop): My officials keep in close touch with the industry about the exploitation of the blue whiting fishery.
    Mr. Brotherton: Is the Minister aware of the great contribution that blue whiting could make to the British fishing industry both industrially and for human consumption? Is he aware that other EEC countries assist their fishing industries in research into the use and catching of blue whiting? Is he aware that just 20 hours-worth of British Steel money would be of inestimable value to the British fishing industry?
    Mr. Russell Kerr: Why blue whiting?
    Mr. Bishop: I largely agree with the hon. Member for Louth (Mr. Brotherton). Blue whiting is a species of major importance and one which, in the years ahead, could help to offset the reduction in the United Kingdom of other species that are in shorter supply. On operating aid for blue whiting fishing, no convincing case for direct aid has been made at present but the Ministry and the Government have, in various ways, given significant aid. We have given about £1·4 million in the last four years and there will be a further input in the 1978 season.
    Mr. Watt: Blue whiting may have a role in the future, but will the Minister turn his attention in the present to the immediate problem of mesh net sizes being used by the French, Belgian and Danish fishermen—
    Mr. Speaker: That is another question completely. We must have fair play.
    Mr. Watt: All right, Mr. Speaker, may 1 put another question? What is the Minister doing about mesh net sizes—
    Mr. Speaker: Order. We are dealing with blue whiting.
    Mr. Bishop: I thought that the hon. Member might have referred to the fact that we are undertaking very significant work in research into blue whiting, and the filleting and processing problems in the Torry research station at Aberdeen. On his particular question, I remind him that this is a matter which the Minister and many others are pursuing earnestly in the common fisheries policy review that is now taking place.

    Monetary Compensatory Amounts
    Mr. Hendersonasked the Minister of Agriculture, Fisheries and Food what progress has been made in agreeing a new system for calculating monetary compensatory amounts.
    The Minister of Agriculture, Fisheries and Food (Mr. John Silkin): The Commission has not submitted formal proposals to change the market rate used for the calculation of monetary compensatory amounts following its report on the European unit of account. It has promised to make proposals for changes in the calculation of the MCAs of some individual products, including pigmeat, in time for decisions to be reached in the context of the prices package.
    Mr. Henderson: Is the Minister aware that my farming constituents, particularly those involved in pig production, view this matter with exasperation and bewilderment? Is he further aware that there is unfair competition from the Danes and others who are heavily subsidised through the system? Will he be more forthcoming and give a forecast of when he believes this matter will be resolved?
    Mr. Silkin: Not only the hon. Gentleman's constituents but many people throughout the United Kingdom feel this

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    way. As the hon. Member knows, we have been pressing for a proper and reasonable recalculation of the pigmeat and other MCAs which distort competition so much. What makes a slight difference now is that the Commission has promised to put proposals on the table for the first time. Also, we are not alone any more; the French and Italians are with us on this. If I am to make a forecast, I have no doubt that there will be some change—I hope a beneficial one—in the prices package.
    Mr. Corbett: Will my right hon. Friend make clear in Brussels that while these proposals are dribbling around large sections of our meat processing industry are being severely mauled by heavily subsidised imports from countries such as Denmark? Will he make clear that unless there is speedy action to alter this iniquitous system, Britain will reserve the right to take its own national action?
    Mr. Silkin: My hon. Friend has put his finger on an important point. It is not so much the question of a green pound change, for example, which affects processors, because all that does for them is to put up the price of the raw material. They need a recalculation, and I agree that it is vital that we have one.
    Mr. Jasper More: Irrespective of any proposals put forward by the Commission, has the right hon. Gentleman worked out how these monetary compensatory amounts should be recalculated, and will he make a statement to the House on what he thinks should be done?
    Mr. Silkin: I have on many occasions, and rather boringly, described the pig as a walking cereal, because that is what it is from the point of view of production. I have many times said to the House and, more specifically, to the Council, that in the calculation of MCAs pigs should be regarded in the same way as poultry, namely, as a walking cereal. This has been the French view recently and they have been making it strongly. On the other hand, I must wait to see the Commission's proposals, because if the Commissioner carries out what he has said he will do, there will be a basis for some alleviation.
    Mr. Watkinson: Does my right hon. Friend accept that the MCAs are tied to
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    the calculation of the unit of account itself, and will he tell us what prospects there are of untying the unit of account from the snake and bringing it in line with the basket? Is that a possibility?
    Mr. Silkin: The trouble with a Question Time of this sort is that the technical language gets a little difficult for outside people to understand, but there is great merit in what my hon. Friend said. Put another way, if the common price level in the Community were tied to the three weakest currencies, it would have the majority of population and majority of area within its scope. At present, it is tied to the strongest currency and to the smallest area in the Community.
    Mr. Peyton: Will the right hon. Gentleman remind the Leader of the House that the Scrutiny Committee picked out this difficult and important subject for debate as long ago as November? Time has passed. Will he press the Leader of the House, whose interest in these matters is not as great as it might be, for an early debate on a matter which is doing very great damage to our livestock industry?
    Mr. Silkin: I have known my right hon. Friend for many years and I have always assumed, perhaps incorrectly, that he had a greater affection for debates in the Chamber than for debates upstairs. That has semed to be his philosophical view. Therefore, I think that he has taken this matter very much into account, but I shall draw it to his attention, as the right hon. Gentleman has raised the point again.

    Food and Drugs Acts
    Mr. Giles Shawasked the Minister of Agriculture, Fisheries and Food what progress has been made with his Department's review of the Food and Drugs Acts; and when a consultative document will be published.
    The Parliamentary Secretary to the Ministry of Agriculture, Fisheries and Food (Mr. Gavin Strang): The Government's review of the Food and Drugs Acts is making steady progress. It is hoped to publish the consultative document at about the end of the year.
    Mr. Shaw: I thank the Minister for that reply. Will he give an assurance that in view of its vital importance to the food industry he consulted the Food and Drinks

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    Industries' Council and the other appropriate bodies at each stage during the review of this legislation?
    Mr. Strang: Yes.

    Council of Ministers
    Mr. Dykesasked the Minister of Agriculture, Fisheries and Food when he next expects to have an official meeting with his counterparts in the other EEC member States.
    Mr. Gwilym Robertsasked the Minister of Agriculture, Fisheries and Food if he plans to meet the EEC Commissioner for Agriculture.
    Mr. John Silkin: I shall attend a meeting of the Council of Agriculture Ministers next week and I expect that Commissioner Gundelach will also be present.
    Mr. Dykes: I thank the right hon. Gentleman for his reply. Can he make any comment on the Commission's latest sheepmeat proposals, with particular reference to New Zealand?
    Mr. Silkin: I do not think that the sheepmeat question will be coming up during the discussion of the prices package. I do not think that it possibly can. Therefore, there will be plenty of time to consider it before the proposals are discussed by the Council.
    On a number of occasions, I have made the three points that are essential and that must govern our attitude to regulations, or lack of them. First, there must be a fair deal for the consumer—there must not be excessive price rises. Secondly, there must be a fair deal for the producer. Thirdly, there must be a total safeguard for New Zealand.
    Mr. Roberts: Will my right hon. Friend make clear to the Commissioner that the Government expect not only a modification of, but fundamental changes in, the common agricultural policy and that they will not rest until they achieve these changes?
    Mr. Silkin: I had a feeling that we were already starting those changes and that, to some extent, the atmosphere was beginning to change inside the Commission and the Council chamber, to the extent that they were moving much more towards the position that we have advocated many times in the House. How-
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    ever, I agree that the process is only at the beginning and that it has a long way to go.
    Mr. Raphael Tuck: When my right hon. Friend meets his counterparts, will he draw their attention to the fact that the Australian Prime Minister, who was originally a supporter of the EEC, has now called it a narrow, self-interested trading group, seeking to make the rest of the world dance to its tune, and has pointed out that Australian exports of food to the EEC in the last four years have declined by 80 per cent.? Does my right hon. Friend not think that something should be done for Australia, which, like New Zealand, fought for us in two world wars?
    Mr. Silkin: I have never had the slightest doubt that there is as much of an obligation to Australia as to any other of our Commonwealth countries and, because of that, it has always seemed to me that we must consider carefully the Australian complaint that at the time of our entry to the EEC they were told that this would merely mean that they would have to diversify their market, that perhaps that might not be a bad thing and that it would be easy, though they would no longer have the United Kingdom market that they had once had. In fact, their exports went down from 46 per cent. to 6 per cent.
    The trouble is that, having sought out other markets, the Australians have found EEC exports there, accompanied by restitutions on a basis that, in the old days, we might have called dumping.
    Mr. Powell: When the Minister next meets his counterparts to coninue discussion of a common fisheries policy, will he bear in mind the importance of this House having the opportunity to know and, if necessary, to debate in advance the many detailed proposals that are being put into a package on the common fisheries policy, which does not consist exclusively of the question of fishing limits?
    Mr. Silkin: There is a great deal in what the right hon. Gentleman said. As one approaches this problem, one sees how important the details are and how near they come to questions of principle. I shall certainly consider what the right hon. Gentleman said.
    Mrs. Winifred Ewing: Will the Minister give the House an assurance that at the forthcoming meeting he will hold firmly to his stand on the 50-mile limit? What success, if any, does he forecast will be achieved at the meeting?
    Mr. Silkin: I doubt that at this meeting there will be anything more than a series of bilateral discussions, as there were at the last Fisheries Council. I do not think that there has yet been a sufficient meeting of minds to enable one to define a common fisheries policy—at least on the basis that we would like. However, being by nature optimistic, of course I believe that we shall succeed.

    "Food From Our Own Resources"
    Mr. Michael Lathamasked the Minister of Agriculture, Fisheries and Food whether he will make a statement on his review of the White Paper "Food from Our Own Resources".
    Mr. Strang: The review of the White Paper is both wide-ranging and thorough, and the industry has not yet supplied us with all the relevant evidence. We hope the review will be completed by the early summer, and are giving consideration to the form in which its conclusions should be made public.
    Mr. Latham: As previous forecasts and targets by the Government have turned out to be farcically over-optimistic, why should farmers have any confidence in this latest exercise?
    Mr. Strang: The best answer to that is probably to be found in the Budget. We must bear in mind that we have recently had the best farmers' Budget since the war. My right hon. Friend's breakthrough on tax averaging has received an unqualified welcome from the farming unions.
    Mr. Hardy: Will my hon. Friend confirm that the variations of agricultural production in recent years have been more reflective of variations in weather than anything else? Does he expect the Conservative Party to promise farmers good weather at the next General Election?
    Mr. Strang: Everyone knows that the main reason for production levels being well below what we believed the industry could achieve was the adverse weather in 1975 and, especially, the exceptional
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    drought of 1976. I agree that it is not possible to lay down specific production targets for individual years, and the White Paper did not do this.
    Mr. Nicholas Winterton: If the Under-Secretary of State and the Government are to honour their objectives in "Food from Our Own Resources", does he agree that his right hon. Friend will have to declare to his colleagues and counterparts in the Council of Agricultural Ministers in Europe that there is a desperate crisis in the pig industry, and that unless there is a recalculation of the MCAs immediately irreparable damage will be done to the industry, which will be damaging to the housewife and consumer in the United Kingdom?
    Mr. Strang: The hon. Gentleman must realise by now that my right hon. Friend is fully seized of the serious situation in the pig industry. He has been repeatedly raising the issue in the Community and modifications have been achieved in recent months in the calculation of the MCAs. The present position is still totally unsatisfactory, and that is why my right hon. Friend emphasised again, earlier this afternoon, that having persuaded the Commission to bring forward proposals we are determined to ensure that these are agreed as part of the prices package.
    Mr. Geraint Howells: Does the hon. Gentleman agree that if we are to increase production from the land of Britain, especially from the hill and marginal lands, we shall have to spend more money on research? Is he aware that we are spending less money on research on agriculture than on any other industry in Britain? Has he any plans to give more financial aid to the research stations?
    Mr. Strang: I cannot accept that we are spending less money on research in agriculture than on research in any other industry. However, I agree with the hon. Gentleman that agricultural research and development is enormously important. As the nature of our agriculture industry is one of relatively small units, responsibility for carrying out research lies, to a large extent, with the Government and Government establishments.
    Mr. Madden: Does my hon. Friend agree that two objectives of the White Paper were maximising consumer choice and employment? Therefore, will he do

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    everything that he can to assist today's talks to ensure that work-sharing within the breadmaking industry is undertaken, thereby safeguarding several thousand redundancies that otherwise will take place at Spillers French?
    Mr. Strang: My hon. Friend refers to important negotiations that are taking place in relation to Spillers and he will be aware that the Government have expressed support for a reduction in the working week for bakers in these circumstances.
    Mr. Peyton: In redrafting this interesting document, will the hon. Gentleman recall that the major gap in "Food from Our Own Resources" was any reference to how the objectives would be achieved? This time it is incumbent upon the Government to fill that gap.
    Mr. Strang: Surely the way to achieve the objective of increasing agricultural production in the United Kingdom is to provide the right framework of confidence for producers to expand and increase production. Even the right hon. Gentleman might be prepared to acknowledge that the statement last week by my right hon. Friend the Chancellor of the Exchequer represents a tremendous advance in this area. It represents an important breakthrough in tax averaging, but in addition there is the increase in the buildings allowance and important additional roll-over provisions on capital gains tax.
    Mr. Peyton: I should hate to be unfair. If the hon. Gentleman does not realise this, I should like to say that we salute the rather fragmentary death-bed repentance on the part of the Chancellor of the Exchequer.
    Mr. Strang: That grudging comment is a reflection on the stance of Her Majesty's Opposition. It contrasts sharply with the official statements that have been issued by the farming unions.

    Potato Marketing
    Sir David Rentonasked the Minister of Agriculture, Fisheries and Food what arrangements have been made for the marketing of potatoes grown during the coming season.
    Mr. Bishop: The Government are discussing with the interests concerned the
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    best approach to marketing and support arrangements for the 1978 potato crop, and in particular are considering the new stabilisation and insurance system which the producers' organisations have suggested. In view of the uncertainties about the timing and content of an EEC regime for potatoes and the future of our import ban on main crop potatoes, my right hon. Friend does not expect to be able to announce a decision until the summer.
    Sir D. Renton: Is the Minister aware that this is a most unsatisfactory situation? Is he further aware that it costs farmers nearly £600 an acre to produce a good crop of potatoes, and that uncertainty about whether they will be able to sell them, and at what price, may have a serious effect upon our home crop? Will he use all his persuasion to try to get the matter clarified and resolved before the summer, whenever he thinks the summer may be?
    Mr. Bishop: I agree that the position is unsatisfactory. We are well aware of the situation. I have been made aware of it not least by the farmers in my constituency who are in touch with me. We recognise the real problems that they face. The right hon. and learned Gentleman will know that the Potato Marketing Board has already given some guidance to the industry on the 1978 crop, especially on the target acreage, to avoid a surplus. There is no doubt that Her Majesty's Government have pressed the Commission as hard as possible to try to achieve a resolution of the matter. The right hon. and learned Gentleman will appreciate that although we want early answers to the questions that we are facing, we want to get the right answers. That is important if producers are to have confidence to produce and, at the same time, consumers are to have reasonable prices.
    Mr. John Ellis: Does my right hon. Friend remember the correspondence that I had with him recently on the problem of farmers pulling up potatoes that were not moved sufficiently fast and were found to be rotting in the bags? Will he explain to the House that that is the responsibility of the Potato Marketing Board? Has he drawn its attention to the problem, so that next year we shall not have any complaints from farmers such as those that I received?
    Mr. Bishop: We are sensitive to the problem that my hon. Friend mentioned. That is why we are sensitive about the need to keep in perspective the uptake of the Potato Marketing Board.
    Mr. Mills: Does the Minister realise that this Question is linked with the previous Question about "Food from Our Own Resources"? Why is that? It is because of the uncertainty that arises from the Government in not telling British agriculture what they really want. What do they want in food production? What do they want in marketing? The Government must stop this uncertainty and bring forward proposals.
    Mr. Bishop: If the hon. Gentleman is fair, he will accept that the uncertainty is due entirely to the fact that the transitional stages in the EEC have not yet been resolved. We have been pressing hard for the resolution of these problems for the very reasons that he stated. We have said that the guarantee for the 1977 crop will be honoured. Guidelines have been laid down by the Potato Marketing Board. We are doing our best with the Community to resolve the situation as speedily as we can.
    Mrs. Dunwoody: Will my right hon. Friend try to make it clear to Opposition Members that we have no choice and that the ambivalent attitude of the Commission towards the Potato Marketing Board is evidence that it does not want the Board to be reorganised in an orderly fashion? Will he also tell Opposition Members that it is putting a punitive tax on early potatoes from our traditional suppliers to make it impossible for the housewives to buy them at reasonable prices?
    Mr. Bishop: My hon. Friend has certainly stated a few true factors in relation to this matter. I think that both she and the House will realise that the import ban that we have imposed on main crop potatoes is still in force and that the matter is still being looked at by the Commission and the European Court. Until that matter is resolved, we cannot say with certainty what the future will be.
    Mr. Jopling: As the farmers who grow potatoes are emerging from a season in which their total returns have been more than 10 per cent. lower than the guaranteed price for the previous year, and
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    as there is no price guarantee for the year to come and no firm idea of what the state of the market base will be, what does the right hon. Gentleman think will be the effect on lower plantings this year and the possibility of much higher prices for potatoes later in the year? Will he understand that the Opposition feel that the Government should have shown much more vigour in avoiding this very difficult situation?
    Mr. Bishop: There is no lack of vigour on the part of the Government in pressing this matter. The reason for the uncertainty is entirely in the hands of the Community. With our present support arrangements, we have to balance the needs of the Market with the interests of the producers. We want to make sure that the producer gets a fair return, or he will not produce, and, if the price is too high, the consumer will not buy. Those two matters must be kept in focus. However, it is a matter for the Community, not for us.

    Animals (Exports)
    Mr. Ron Thomasasked the Minister of Agriculture, Fisheries and Food if he will make a statement on the report of the official working group on the export of live animals for food.
    Mr. Ronald Atkinsasked the Minister of Agriculture, Fisheries and Food if he will make a statement on the report of the official working group on the export of live food animals.
    Mr. Strang: My right hon. Friend the Minister expects to make a statement in the House in due course, when all those with an interest in this subject have had the opportunity to study the report and to form their views.
    Mr. Thomas: Is my hon. Friend aware that this report clearly puts far too much emphasis on the profitability of the trade and not enough on the welfare of animals? Does he agree that the major conclusion—that the majority of animals are not subject to stress or left for long periods without food and water—shows an indefensible level of complacency?
    Mr. Strang: My hon. Friend has made some points which we shall have to take into account. But I think that he will

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    recognise that the Government are considering this report and will not reach any conclusions until they have had the views of interested parties, including hon. Members.
    Mr. Atkins: Does my hon. Friend agree that if a tiny fraction of the compassion shown by all EEC Governments to farmers were to be given to farm animals being exported in this cruel way this trade would not exist? Does he also agree that more and more people in this country are demanding the ending of this trade, including workers who will lose jobs in abattoirs and in food processing, which is work which should be in this country, not abroad?
    Mr. Strang: I have to acknowledge that some progress has been made in the Community generally on animal welfare. But I accept that, as my hon. Friend said, there is great concern in this country on this question. That is why my right hon. Friend called for this review and why we are giving careful consideration to all the points made, including those made by my hon. Friend.
    Mr. Burden: Am I right in saying that the members who comprise this committe are all employed in the Ministry of Agriculture, Fisheries and Food? Would it not have given much greater confidence to the vast number of people outside and across the Floor of the House who consider this a very grave matter if some outside people had been included? Will the Minister give an undertaking that this matter will be debated in the near future and that he will be prepared to tell the House about the proposals for the transport of animals in Europe after August?
    Mr. Strang: I cannot accept the hon. Gentleman's observations. It was not so long since we had the O'Brien Committee, which was an outside committee along the lines indicated by the hon. Gentleman. This was a review carried out by Ministry civil servants who took into account all the evidence which was submitted to them. That report has now been published. I think that hon. Members will welcome that as a good example of open government. Ministers are not committed to the conclusions in that report, but they will reach their decisions as a result of the report and the comments which they receive on it.

    Glasshouse Growers (Fuel Costs)
    Mr. Newensasked the Minister of Agriculture, Fisheries and Food if he will make a statement on progress made towards the equalisation of the costs of fuel used by glasshouse growers in the United Kingdom and other countries in the EEC.
    Mr. Strang: The cost of oil to British growers does not differ greatly from the cost of that used in other EEC countries, although Dutch growers still derive some benefit from their onshore resources of natural gas. The Dutch Government are already engaged on a programme of equalisation of gas and oil prices and full equalisation should be achieved in just under a year's time.
    Mr. Newens: Does my hon. Friend agree that the Dutch producers have enjoyed, are enjoying and will continue to enjoy, unless something is done about it, lower prices for their fuel than British producers will have to put up with for the oil equivalent? In these circumstances, is it not high time that some unilateral action was taken to end this unfair competition and to give our efficient producers the opportunity of being able to sell their products on a level with the Dutch?
    Mr. Strang: No one has been a more persistent campaigner in this area than my hon. Friend. It is a reflection of his efforts and those of the British Government that we have achieved a situation where the Commission has communicated with the Dutch Government and that they have embarked on this equalisation programme. By 1st April next year they will have equalised their gas and oil prices, which is what my hon. Friend is seeking.
    Mr. Costain: How can the Minister make such a statement? Is he aware that the NFU has produced evidence that gas in Holland costs 9·2p per therm and that gas in the United Kingdom costs 17·7p per therm? Even related to oil prices, there is a big difference. Will he take a personal interest, get the facts clearly in mind, and do something about it?
    Mr. Strang: We are taking a very great interest in this matter. We have achieved a policy of equalisation of gas

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    and oil prices. Hon. Members must accept that gas is much cheaper in Holland, because it is an onshore source. Notwithstanding that, the price has been increased to bring it into line with that of oil.

    Departmental Staff
    Mr. Freudasked the Minister of Agriculture, Fisheries and Food what was the total number of staff employed in his Department at the latest available date.
    Mr. John Silkin: 14,799 on 1st March 1978, but some 660 were transferred to the Welsh Office on 1st April.
    Mr. Freud: Is the Minister aware that, in view of the latest Common Market regulations, farmers now have to keep log books for all journeys within even 25 miles of their farms? As farmers in my constituency do not have the kind of staff whom the Minister employs, will he use his best endeavours to ensure that the time of farmers is spent more constructively and profitably than keeping black books about short journeys from field to field?
    Mr. Silkin: There are quite a number of directives and regulations that would interest me and that I ought to keep an eye on, but that might not leave me much time to do anything else. It was recently pointed out to me that, whereas the Ten Commandments occupied under 200 words and the Declaration of Independence under 500 words, the Common Market directive on duck eggs occupied 120,000 words.
    Mr. Radice: On the subject of jobs, will my right hon. Friend see what further steps he can take to save jobs in the baking industry following the Spillers dispute?
    Mr. Silkin: My hon. Friend the Parliamentary Secretary touched on this point. It is a matter in which there is great concern, in particular in my hon. Friend's constituency, where there is a grave danger of loss of work. As a result, I have made contact with the employers, who are meeting the Bakers' Union today, and asked for their assurance that they are prepared to agree to a five-day working week. I have that assurance. That at least will be a start. Other prospects may open up. Certainly both my
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    right hon. Friend the Secretary of State for Employment and I will do everything that we can.
    Mr. Shepherd: Will the Minister let the House know what his views are on the suggestion for ADAS that it might broaden the sphere of its operation to include marketing functions? Will this not lead to an increase in civil servants and duplication of service and be yet a further burden on the taxpayer?
    Mr. Silkin: There are a number of matters on the role of ADAS that still need to be clarified and a number of suggestions of which the hon. Gentleman may be aware. I say two things about ADAS. First, every farmer I meet tells me how worthwhile the organisation is. Secondly, every farmer I meet bitterly regrets my Conservative predecessor's cutting of the organisation.

    Grain Imports
    Mr. Litterickasked the Minister of Agriculture, Fisheries and Food what tonnage of grain has been imported into the United Kingdom from EEC countries during the last 12 months; and what would have been the saving to the United Kingdom balance of payments had this grain been imported from other sources, free of EEC levies.
    Mr. Bishop: Total United Kingdom imports of cereals originating in the member countries of the EEC for the 12 months ending February 1978 amounted to 2·8 million tonnes. As there is no single world price for any cereal, and because prices differ according to quality and variety, it is impossible reliably to estimate the balance of payments saving which would have ensued had alternative supplies to this grain been imported, free of EEC levies, from third countries.
    Mr. Litterick: Does the Minister agree that that answer is singularly unsatisfactory, as it does not tell us the truth about these imports? According to other information that I have received, the cost, in terms of EEC levies, of the current importation of unmilled cereals from the EEC by compulsion is about £195 million a year. Those grains are coming in at prices to the British taxpayer and British consumer which are double the average of the available unmilled cereal prices in the rest of the world.
    Mr. Bishop: The reply may be unsatisfactory on the basis of my hon. Friend's Question—I think that it would be helpful if we could assess what the differences are—but he should appreciate that variable levies are designed to protect our producers within the Community and to provide some form of stability and confidence. We had these objectives before. I make two points about our policy. We are seeking to obtain reasonable prices within the Community, and therefore lower prices. We also want to help liberalisation of trade with third countries.
    Mr. Farr: Does the Minister regard the markedly increased import of sugar from EEC countries in the last year as desirable? Will he assure the House that the output of home beet growers will be preserved, and also the special position, in this country, of Commonwealth producers?
    Mr. Bishop: The hon. Gentleman has misread the Question, which refers to grain. However, if it is helpful to him I shall write to him on the question that he wishes to ask.
    Mr. Jay: As the EEC Commission's own agricultural board shows that these import levies on wheat, maize and barley are all running at about 100 per cent., is it not obvious that this must be adding to the cost of food in this country?
    Mr. Bishop: I draw my right hon. Friend's attention to the reply that I have given, which is that one has to protect our own producers. At the same time, the two points that I have already made will, if we can make progress on them, make a substantial contribution to saving and to liberalisation, which is another factor.
    Mr. Jopling: As the Minister of State has told us that we imported 2·8 million tonnes in the past year, would it not give a fairer and complete picture if he were to refer also to the exports of grain from this country? Am I not right in thinking that we exported almost 1 million tonnes in the first three months of this year alone?
    Mr. Bishop: These are factors which have to be taken into account, but the main Question was about the cost of grain coming into the country through the levy system.

    Pigmeat (Monetary Compensatory Amounts)
    Mr. Boscawenasked the Minister of Agriculture, Fisheries and Food what is the current state of negotiations with regard to the recalculation of pig-meat monetary compensatory amounts.
    Mr. Ridleyasked the Minister of Agriculture, Fisheries and Food what progress he has made in persuading the Council of Ministers to agree to changes in the manner in which pigmeat monetary compensatory amounts are calculated.
    Mr. John Silkin: The Commission has promised to make proposals for revising the calculation of pigmeat MCAs in time for them to be considered in the context of the price package.
    Mr. Boscawen: Does the Secretary of State agree that we have been hearing for three years the same tune, that the MCAs are to be recalculated? Now that we are seeing the £ sterling plummeting again, does it not underline the wisdom of the Opposition's case for revaluing the green pound as being the only way, in the long term, that we shall save the pig industry?
    Mr. Silkin: It has absolutely nothing to do with the green pound as it is at the moment. Had there been, as the Tory Party suggested, a simultaneous devaluation of the green pound in pig-meat and in cereals the result would have been disastrous. The real question is that of recalculating the MCAs. I suggest that the hon. Gentleman should be very careful about the Opposition's views on the green pound. Parity—which the Conservative Party is talking about—over the next two or three years means an increase of 6p to 6½p in the pound in the shopping basket.
    Mr. Ridley: Does the right hon. Gentleman realise that the subsidy on Danish bacon sides imported into this country has increased from £192 per tonne, just after the 5 per cent. devaluation of the green pound, to £280 now? Is this classical piece of unfair competition the result of the Government's agricultural policy or its economic policy?
    Mr. Silkin: It is the result of the need for a recalculation of the MCAs.

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    Perhaps the hon. Gentleman did not listen. If one had adopted the Opposition's view at that time the cereal price would also have increased.
    Mr. John Ellis: Will my right hon. Friend cease using the Dispatch Box to try to educate Opposition Members? Will he now conduct a seminar for them, so that they can get it clear in their minds that it is a question not just of the green pound but of the monetary compensatory amounts? Will he conduct the long educative meetings elsewhere than in the Chamber, so that we can have more sensible questions asked?
    Mr. Peyton: At the next meeting of the Council, will the right hon. Gentleman combine with the French and Italian Ministers to bring pressure upon the coalition of the German and Danish Ministers in this matter? For far too long reasonable arguments have been stalled.
    Mr. Silkin: But progress has been made, because the Commission, in answer to us—it is true that the French and Italians are now backing us on this, which I welcome—has promised to bring forward its proposals. I share with the right hon. Gentleman the view that it is time that this matter was brought to a conclusion.

    TUC
    Mr. Gouldasked the Prime Minister when he next intends to meet the TUC.
    The Prime Minister (Mr. James Callaghan): I met representatives of the TUC on 28th February. Further meetings will be arranged as necessary.
    Mr. Gould: Will my right hon. Friend point out to the TUC that the one good feature of the secret Conservative report on confrontation with the unions is that it apparently gives the short shrift that it deserves to the belief of the Leader of the Opposition that a referendum would be a useful weapon in the Tory armoury? Is it not disturbing that the Conservative Party is apparently thinking in terms of confrontation when our own experience over the past four years shows that co-operation with the unions is not only possible but is very beneficial to the whole country?
    The Prime Minister: Unless and until the Opposition decide to publish this document, I have no particular knowledge of it. However, if it is true that it is pointing in the opposite direction, namely, that there should be no confrontation, it is high time that the Conservative Party revised its whole approach to trade unions. The great misfortune of British politics is that the Conservative Party seems to have come to the conclusion that it cannot beat the trade unions, but its distaste for them is such that it cannot co-operate with them, either.
    Mr. David Steel: Is the Prime Minister aware that some of us are dismayed by the reception given yesterday to Mr. Weighell and Mr. Jackson at the Scottish Trades Union conference? Will he make it clear in future meetings with the TUC that the Government are determined to stick to a fourth phase of pay policy, preferably by agreement with the trade unions?
    The Prime Minister: I am not yet in a position to discuss what happens when the present phase of pay policy is over. I note that Mr. Weighell and Mr. Jackson are in the public sector. In this sector the Government have a special responsibility and must take a view about pay. The comments that have been made—by Mr. Basnett, for example—emanate mostly from trade union leaders in the public sector. We should discuss these matters with them, but it would be wrong at this stage to do anything except to try to win through on the current pay round. Then we should be able, as we are now increasingly able, to present the trade union movement with the statement that inflation is going down, and will stay well in single figures, and that much will depend upon our being able to maintain it in single figures during 1979.
    Mr. Terry Walker: When he next meets the TUC will my right hon. Friend discuss the implications of his "Buy British" speech at Huddersfield, with special regard to the news that British Airways wish to buy foreign aircraft? Will he make sure that the TUC and trade unionists are reassured by the fact that the Government will be influencing British Airways over this matter?
    The Prime Minister: In reply to the general point, I, with my colleagues, have been giving a good deal of attention to

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    the subject of "buying British". Although I am strongly in favour of that concept I must emphasise that the British goods must be in the shops and elsewhere if they are to be bought. Therefore, perhaps we should start with the relationship between suppliers and those who sell the goods. I hope to have more to say about that matter later.
    As for British Airways, there is a great conflict of interest, which is probably threefold. I do not propose to be rushed into a statement, but the whole matter will be considered carefully and our conclusions laid before Parliament.
    Mr. Hannam: When the Prime Minister meets the TUC, will he discuss the increasing shortage of young people coming forward for training in engineering skills? The Budget has done nothing to provide incentives for young people or anybody else to take up skilled training? Is this not related to our low level of productivity? When will he do something about the situation?
    The Prime Minister: I am surprised to hear the hon. Gentleman make that comment, because I understood that the Engineering Training Board was carrying out a very good job and maintaining the level of training and engineering during this recession at a higher level than had been maintained earlier. However, I shall bring the hon. Gentleman's remarks to the notice of my right hon. Friend the Secretary of State for Employment and I shall examine the matter further.
    Mr. Robinsonasked the Prime Minister when he next plans to meet the TUC.
    The Prime Minister: I refer my hon. Friend to the reply which I have just given to my hon. Friend the Member for Southampton, Test (Mr. Gould).
    Mr. Robinson: When my right hon. Friend next meets the TUC will he further remind it of the firm and courageous support given by the Government to British Leyland, which makes such an important contribution to the nation's economy, balance of payments and employment? Will he contrast the Government's attitude with the irresponsible and hypocritical equivocation of the Opposition who, despite their weasel words of support,
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    voted against the provision of finance on a sufficient scale as to ensure the success of this vital national asset?
    The Prime Minister: I welcomed my hon. Friend's informed speech on this subject when we debated the order relating to British Leyland. It was in marked contrast to some of the other speeches that we have heard.
    It is the case that the Opposition seem to be a little uncertain whether to support British Leyland. Indeed, at one stage they were not even certain whether they intended to vote against the order. However, I hope that they will clear up the uncertainty of their attitude towards this great firm and the industry that depends on it.
    Mr. Michael Marshall: Did the Prime Minister have an opportunity to read the full report in The Times about the relationship between the TUC and the major parties? If he did, did he take in the remark from a senior Whitehall source, contained at the end of that report, that the TUC could probably count on a better relationship with Tory Ministers, since Labour Ministers treated it with contempt?
    The Prime Minister: I saw that remark as reported. I thought that if that was typical of former civil servants' opinions, on which they advised the previous Administration, it was a jolly good job that those civil servants had now retired.
    Mr. William Hamilton: Will my right hon. Friend discuss with the relevant union leaders in the National Health Service the consequences of the speech made by the right hon. Member for Leeds, North-East (Sir K. Joseph), who suggested the establishment of two Health Services, one private and one public—the public one dealing with all the less glamorous facilities, such as geriatric and mental health, and the other, presumably, with rich women wanting abortions?
    The Prime Minister: I would consider discussing this matter with the TUC, but I have no doubt, without discussing it with its members, what their views would be, namely, that there should be one Health Service in this country and that good health is not something that should be denied to anybody because of poverty.
    Mrs. Thatcher: Does the Prime Minister agree that although he is discussing problems of pay, the real problem in this country is low output, and that one of the limiting factors in the way of increasing output is likely to be an insufficiency of skilled labour? One of the reasons for that is that the differentials are not sufficient to give proper rewards for skill and extra responsibility? Will he discuss the matter with the TUC and tell the House what are his proposals to restore those differentials and give the TUC the freedom to negotiate to see that differentials are restored?
    The Prime Minister: I agree with some part of the right hon. Lady's comments, although instead of saying that the problem is due to low output, I would say that it is more due to low productivity and that we need a higher level of productivity if we are to have a high wage economy.
    The shortage of skilled labour has been discussed with NEDO on a number of occasions at National Economic Development Council meetings, and will continue to be discussed. The subject is under review by employers and trade unions, and I shall bring to their notice the right hon. Lady's observations.
    Mrs. Thatcher: The Prime Minister is ducking the main question. He will not get sufficient people training for extra skills until the differentials are restored. Is he aware that skillcentres have vacancies for those who wish to take up engineering skills—vacancies that are not being filled by our workers are going instead to foreigners? [HON. MEMBERS: "Oh."] Does he agree that until he restores differentials, the retraining programme will not be taken up by the unemployed for whom those places are meant?
    The Prime Minister: I do not think that I would object to skillcentre vacancies that are otherwise not required going to foreigners, and I hope that the right hon. Lady would not do so. All our past experience shows that those trained in British factories who then return to their own countries tend to order from British firms and increase our future exports. On the subject of differentials, the right hon. Lady shows her incomplete understanding of the way in which bargaining systems
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    work. It is not for me to restore differentials; that is a matter for negotiation between trade unions and employers.

    PRIME MINISTER (ENGAGEMENTS)
    Mr. Greville Jannerasked the Prime Minister whether he will list his official engagements for 20th April.
    The Prime Minister: This morning I presided at a meeting of the Cabinet. In addition to my duties in this House, I shall he holding further meetings with ministerial colleagues and others.
    Mr. Janner: Will my right hon. Friend be speaking to President Carter today to congratulate him on his highly imaginative energy conservation programme? In view of the limited nature of our own North Sea treasures, is it not time that we had a similar programme here?
    The Prime Minister: I shall not be speaking to President Carter today, but I am sure that he would not mind my telling the House that I spoke to him on this matter on Monday last. We had a very interesting conversation. I repeated the view that I have expressed to him privately—I know that he will not mind my saying it publicly—that I believe that the passage of the energy Bill by Congress would do more to strengthen the dollar, in the short term, than would any other single action by the United States. I hope that Congress will pass that Bill, if it is not improper for me to say so. I believe that it would strengthen world confidence and world output.
    As for our own policy, I believe that the domestic insulation and industrial insulation conservation measures announced by my right hon. Friend the Chancellor of the Exchequer will be a great help, together with the other measures announced in the White Paper on North Sea oil.
    Mr. Churchill: The Prime Minister will be aware that since 1st April 1975 the pay of the Armed Forces has now fallen more than 30 per cent. behind average industrial earnings.
    Mr. Ashton: Because they have such a lousy shop steward.
    Mr. Churchill: Does he agree that it would be wholly wrong for members of

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    the Armed Forces to be penalised over the next 12 months merely because they had been badly treated over the past 24 months? Will he now confirm that he realises that if he were to give a pay increase of less than 30 per cent. he would be perpetuating an already grave injustice?
    The Prime Minister: I note the hon. Member's views. I hope to make a statement on this subject next week. All these matters will be taken into account before then.
    Mr. John Garrett: Will my right hon. Friend contact President Carter today to verify newspaper reports that the American Administration are rather concerned about the growth of racialism in this country, prompted by the leading figure on the Opposition Benches, because he believes that this detracts from the moral superiority of the West?
    The Prime Minister: I discuss matters of substance, not the Opposition, with the President of the United States.
    Mr. Gwynfor Evans: Has the Prime Minister had time today to reflect upon the major change to the Wales Bill that was made last night by the House, with the unexpected help of the Conservatives? Is the Prime Minister aware that this change, according to "Erskine May", means that if the Bill becomes an Act it will become operative immediately without a referendum? What proposals has he to make in view of this situation?
    The Prime Minister: I thought that this was very interesting. I went into it with some care and I believe that the hon. Member's interpretation is right. What the Conservative Party—which is opposed to devolution—has voted for is that the Bill should come into force immediately that Royal Assent is given without a referendum being held. The Opposition then have the infernal impudence to suggest that the Bill is a shambles. I agree. They made it a shambles.

PARLIAMENTARY PAPERS
Mr. Pymasked the Lord President of the Council if he will make a statement about the supply of parliamentary papers?
The Lord President of the Council and Leader of the House of Commons (Mr. Michael Foot): As I told the House on 13th April, the Advisory, Conciliation and Arbitration Service took the initiative with the management of Her Majesty's Stationery Office and the National Graphical Association nationally regarding the industrial unrest at the St. Stephen's Parliamentary Press. I am now pleased to be able to inform the House that this initiative has led to a resumption of normal working being accepted by the chapel concerned.
Obviously, the issues which led to the industrial unrest have yet to be resolved. But I understand that conciliation by ACAS on these issues will begin tomorrow. Whilst I am confident that the ACAS conciliation will be pursued as quickly as possible, the timing cannot be predicted in advance of tomorrow's meeting.
Her Majesty's Stationery Office is making every effort to ensure that normal service to the House will resume at the earliest opportunity.
Mr. Pym: Will the Lord President accept that the whole House is extremely grateful that the supply of parliamentary papers has begun again today? He knows the extreme inconvenience and the numerous problems that arise when supplies are interrupted.
We are also glad to know that the underlying problems behind this dispute are to be further investigated. Is the Lord President aware that, naturally, we hope that the processes of conciliation will lead to a permanent solution to this problem? At the end of that process will he make a further statement to the House?
Mr. Foot: I thank the right hon. Member for his forbearance in this matter. I say to him and to the House that I fully understand the impatience and the concern about this matter. I know that the House is anxious that there should be a settlement to this dispute and that there should be a longer and better understanding.
Two investigations are being undertaken by ACAS. One deals with the immediate matter to which I have already referred. The other is a longer-term investigation. Both are proceeding speedily, I hope. I shall certainly report to the House as I can.
Mr. Fitt: In view of the announcement that was made yesterday by the Prime Minister about the increase in the number of Northern Ireland seats—
Mr. Speaker: Order. I think that the hon. Member thinks that we are on business questions. We have not reached business questions yet.
Mr. Dykes: As a result of those discussions with ACAS, can the Leader of the House confirm that the chapel appreciates that the printing of House of Commons papers is not a conventional printing operation? Without wishing to sound constitutionally presumptuous, I must say that there is a special need for continuing the printing of parliamentary papers. Does the chapel now accept that extra argument for Parliament's own papers?
Mr. Foot: All of us have always stressed that aspect. I have done so in all the statements that I have made from the Dispach Box.
Mr. Fitt: In view of the important announcement made yesterday, will the Leader of the House make all relevant papers available to the House, particularly those that relate to the 1920 debates on the creation of the Northern Ireland State?
Does he remember that in his evidence to your conference, Mr. Speaker, he was not able to say why 12 seats were given to Northern Ireland in the 1920 settlement. Would he arrange—
Mr. Speaker: Order. I am not sure whether the hon. Member is going to relate his question to the current dispute. If not, he will probably catch my eye later.
Mr. Fitt: In view of the importance of this subject, will the Leader of the House make available to the House all the relevant papers and arrange for a major debate on this most important issue, which affects the whole constitutional position of the United Kingdom?
Mr. Foot: I fully understand my hon. Friend's concern about this matter. But I think that he is raising a question about other forms of parliamentary papers—papers that might be governed by different rules. I shall look at all the questions in all their relevance.

BUSINESS OF THE HOUSE
Mrs. Thatcher: May I ask the Leader of the House to state the business for next week?
The Lord President of the Council and Leader of the House of Commons (Mr. Michael Foot): The business for next week will be as follows:
MONDAY 24TH APRIL—Second Reading of the Nuclear Safeguards and Electricity (Finance) Bill.
TUESDAY 25TH APRIL—Completion of the Committee stage of the Wales Bill.
WEDNESDAY 26TH APRIL—Remaining stages of the Inner Urban Areas Bill and of the Home Purchase Assistance and Housing Corporation Guarantee Bill.
THURSDAY 27TH APRIL—Second Reading of the Finance Bill.
Remaining stages of the Trustee Savings Banks Bill.
Consideration of any Lords Amendments to the Shipbuilding (Redundancy Payments) Bill which may be received.
FRIDAY 28TH APRIL—Private Members' Bills.
After which the House will adjourn until Tuesday 2nd May.
Mrs. Thatcher: The Government have made no provision yet for a debate on Rhodesia. Can the Leader of the House give a firm undertaking that there will be a debate on Rhodesia before the Whitsun Recess? Secondly, when may we expect a statement on forces' pay?
Mr. Foot: As the Prime Minister said a few minutes ago, he expects to be able to make a statement on forces' pay next week. In reply to the right hon. Lady's first question, I hope that next week in my Business Statement I shall be able to make a reference to a debate on Rhodesia.
Several Hon. Members rose—
Mr. Speaker: I have a long list of hon. Members who hope to catch my eye in the debate on the National Health Service. It will help if we can get on to that debate soon.
Mr. John Mendelson: In view of the announcement about the production of

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the neutron bomb by the Government of the Republic of France, and since the Prime Minister has recently taken part in an important discussion with the President of the United States on this subject, would it not be right to arrange for a debate in the House without delay? The Prime Minister and the Foreign Secretary could both take part in that debate, as was the case in days gone by. We could then be given some indication of where the Government stand on this matter, without letting the subject go cold by leaving it to a debate on the Adjournment months after the event.
Mr. Foot: I understand the importance of this subject. My hon. Friend should take note of the statement which I understand has been made by the Minister of Defence in France which casts some doubts upon the reports that have been published. I shall certainly look at what my hon. Friend says, but I cannot promise a debate in the immediate future.
Mr. Adley: Is the Leader of the House aware that the purchase by British Airways of new aircraft will involve a political decision by the Government? Does he realise that many people have strong views and are concerned about the propaganda campaign that British Airways is conducting and about which British Aerospace seems to have been strangely silent? Since this is a political matter, may we have a debate about it in the House at the earliest opportunity?
Mr. Foot: I must assure the hon. Gentleman that the earliest opportunity will not be next week.
Miss Richardson: Will my right hon. Friend try to find time, next week if possible, for a debate on Press freedom, in view of the restrictions on Press freedom in connection with the case of Colonel Johnstone, otherwise known as Colonel B?
Mr. Foot: I cannot promise any debate on that subject in the near future.
Mr. D. E. Thomas: When does the Leader of the House hope to arrange for a debate on the report of the Pearson Commission on civil liability and compensation for personal injury, which is a matter of grave concern to us in Gwynedd in view of the plight of the slate workers and the negative recommendation
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of the Royal Commission in that respect?
Mr. Foot: I understand the concern expressed by the hon. Gentleman and by many other hon. Members about this matter, but I cannot promise an early debate on it. Very wide questions arise from the report and we must examine them carefully. The House will wish to contribute to those discussions.
Mr. Christopher Price: Will my right hon. Friend say when we are to get a White Paper on official secrets and a debate on the subject in view of the crisis that has emerged between the Government and the NUJ over the Colonel Johnstone affair?
Mr. Foot: I cannot give my hon. Friend a promise about the date of the White Paper. I am not sure that the two matters he refers to could be dealt with together. Of course, Questions can be put down in the House on these matters, but I do not think that we should necessarily say that the two subjects should be discussed together.
Mr. Marten: Since the direct elections Bill was guillotined in this House, and since the other place has made almost indecent haste with it, may we have an assurance that its remaining stages will not take place until the question of the salaries of the Assembly Members has been settled? Is the right hon. Gentleman aware that there is a lot of opposition in this House to the excessive sums that have been mentioned?
Mr. Foot: I am sure that the hon. Gentleman does not expect me of all people to follow him in criticism of the other place, particularly when it is suggested that it might be acting with indecent haste, which I would not have thought was necessarily the case. The Government have given their view on that matter in debates in this House, and although there was a timetable motion, there was considerable debate on the subject. We shall have to see the state of the Bill when it leaves the other place.
Mr. Kilroy-Silk: Is my right hon. Friend aware that there is great disappointment in the country at the Government's failure to implement their manifesto commitment to legislate on official secrets and a freedom of information Bill?

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Will he give an assurance that the Government will legislate in this Session and that we shall not have a continuation of cases of the sort that have surrounded the publication of Colonel Johnstone's name?
Mr. Foot: I can give no promise that we could legislate in this Session. The House has had indications that we do not believe that it would be possible to legislate in this Session in such a far-reaching matter. I have said—and I believe my right hon. Friend the Home Secretary has indicated this to the House—that there will be a White Paper and that it will be debated. We shall have to see then how we should proceed. I am not saying that there is not considerable interest in the subject in many quarters, but I suggest that what I have proposed is the best way to proceed now.
Mr. Maurice Macmillan: If the Leader of the House is considering having a debate as suggested by the hon. Member for Penistone (Mr. Mendelson), will he consider linking it with the debate on Rhodesia to make it a two-day debate on defence and foreign affairs, which would include Southern Africa, in view of the close links between the defence of Europe and the situation in Southern Africa?
Mr. Foot: I am not sure that it would be best for the House to amalgamate those two subjects. Last week hon. Members from many quarters were understandably asking for a special debate on Rhodesia. I said that I would take account of their requests. That I am doing. I have told the House that next week I might be able to indicate when the debate might take place, but a wider debate is a different question.
Mr. Ted Fletcher: Is my right hon Friend in a position to report to the House on the prospects of getting time to go through the remaining stages of the Employment Protection Bill?
Mr. Foot: I am in no position to make a fresh statement on that subject. There are still some days left for Private Members' time, and we must see how we proceed further in that direction. I fully understand my lion. Friend's concern to proceed with his Bill, but there are opportunities left according to the normal rules of the House.
Mr. Stokes: When will the right hon. Gentleman bring forward the Bill on Members' pensions? When will he make an announcement about Members' salaries?
Mr. Foot: Members' salaries is a matter which will come up later in the year. I think the date is some time in June when, under the 12-months rule, a fresh decision by the House on the subject would be required.
I fully accept, as I have said before, the desire that exists in all parts of the House that we should deal with parliamentary pensions. I have given a firm undertaking that we shall act on the subject in this Session. This is a complicated matter, but it can be brought forward, and when the House sees some of the complications that we have to deal with, it will understand the delay. The Government, however, are certainly eager and determined that we should deal with the matter in this Session.
Mr. Abse: Has further consideration been given to the allocation of time for the Windscale debate? Does my right hon. Friend appreciate that there will be an enormous sense of frustration if, in spite of the last debate that took place, it was believed outside the House that the subject would be debated for a mere one and a half hours?
Mr. Foot: What is believed outside the House on the matter depends on what is said inside the House about it by some hon. Members. I believe that all hon. Members who have followed what we have done should be able to tell the country that we have sought to give Parliament a full opportunity of discussing this matter. I have also said that I agree that when we come to the fresh debate we have to consider carefully how we go about it, but I shall take into account my hon. Friend's representations. In the meantime. I hope that he will tell the country that the Government made a special arrangement whereby the House was able to give its view on the matter.
Mr. Burden: Will the Leader of the House draw to the attention of his Ministers the growing tendency for statements to be made outside this House on matters that are of grave concern to it, statements that are made by way of leaks to newspapers and other means, a procedure

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that denies hon. Members the opportunity of questioning Ministers in the House on matters that often cause concern and involve considerable expense?
Mr. Foot: I do not know whether the hon. Member has a particular point of criticism in mind. If he has, I shall look into it. We seek to make arrangements whereby statements are made to the House as frequently as possible, but we have to bear in mind, in considering the interests of the Opposition and hon. Members generally, that if a lot of time is taken up with statements in the House, that leaves less time for debate.
Mr. Flannery: Does my right hon. Friend agree that the tactics of the Conservative Party in blocking our attempts to set right the Employment Protection Act are strangely at variance with its passion for law and order, and that they are bound to produce more Grunwicks throughout the country which will produce the sort of disorder the Conservatives say they do not like? Will he therefore seriously consider changing his answer to my hon. Friend the Member for Darlington (Mr. Fletcher) and say that the Government will be taking over that Bill so that it can be whipped, so that we may set this Act right? In that way the people who support George Ward—in other words, the entire Tory Party—will not be able to do such things as produce scenes of the sort that we have seen in the streets.
Mr. Foot: I do not propose to alter the reply that I gave a few minutes ago. I certainly agree that both the Bill introduced by my right hon. Friend the Member for Darlington (Mr. Fletcher) and the Bill introduced by my hon. Friend the Member for Bethnal Green and Bow (Mr. Mikardo) are extremely important Bills, which are greatly needed in the interests of industrial peace and conciliation in this country. I fully accept all that. I think that we should see a little further how we can proceed with them.
Mr. Michael Latham: Regarding Wednesday's business on the Home Purchase Assistance and Housing Corporation Guarantee Bill, could the Minister for Housing and Construction take the opportunity then to make a statement to the House on the working of the Government-
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imposed mortgage cut-backs, because all the signs are that this is causing grave difficulties for building societies and grave hardship for prospective house purchasers?
Mr. Foot: I shall see that what the hon. Gentleman says is passed on to my right hon. Friend, and no doubt he will judge the matter.
Mr. Raphael Tuck: Would my right hon. Friend be kind enough to ensure that the date and duration of every parliamentary recess is given to the House at the earliest possible moment, because if it is to be delayed until the last moment, many people, particularly those with children, will be inconvenienced, because either they have to make arrangements which are nullified later when the date is given or they wait until it is too late to make any arrangements at all?
Mr. Foot: I fully accept what my hon. Friend says. I am sure that he will have noted that last summer we succeeded in carrying out what we had sought to achieve—that is, the House rising for the Summer Recess at a time which was convenient for Members. I assure my hon. Friend that I take this into account. However, if we settled in advance, and everyone knew in advance, on exactly which date at every recess Parliament was to be adjourned, perhaps we might not be able to proceed with some of the necessary business in the meantime.
Mr. Nicholas Winterton: Will the Lord President arrange for his right hon. Friend the Secretary of State for Education and Science to make a statement to the House on her powers and functions under the Education Act 1976, in that her irresponsible interference in the reorganisation plans for Cheshire has meant that inadequate suitable secondary school places exist within the areas of Congleton and Macclesfield? Does not the right hon. Gentleman think that parents and pupils should know to which school pupils are to be allocated and which schools pupils will be attending in September?
Mr. Foot: I repudiate every criticism of my right hon. Friend that the hon. Gentleman makes. A great temptation to have a debate on the matter would be that I am sure that if there were a debate,

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she would knock him all round the ring. But I am not quite sure whether that field day should be staged in the House of Commons or somewhere else.
Mr. Heffer: In view of the sympathetic response that my right hon. Friend gave to a question from myself and my hon. Friend the Member for Liverpool, Garston (Mr. Loyden) last week, calling for a debate in the House about the problems of unemployment in the North-West, with particular reference to Merseyside, can he indicate when such a debate will take place, particularly in view of the fact that the workers on Merseyside are now reacting most strongly to the closures and we can expect action on their part? It is absolutely essential that we have an early debate.
Mr. Foot: As I said to my hon. Friend last week, I fully understand the pressure of demand from Merseyside for a debate on unemployment. There are other areas in the country which are also very severely affected, and they also would naturally press for a debate. There are arrangements whereby there can be debates upstairs in Committees on individual areas. But I am not saying that that would be fully satisfactory for dealing with the situation, so I would be happy to have discussions with my hon. Friends from some of the areas affected, particularly the regions especially affected, to see how best we should approach such a debate in the House when the time is available.
Mr. Durant: Will the Lord President arrange as soon as possible a debate on the future of the water industry, bearing in mind that it is some time since the White Paper was produced, that we have subsequently had the Select Committee report on the British Waterways Board and that there is widespread uncertainty about the future of this industry?
Mr. Foot: I do not know about "widespread uncertainty". We shall have to await, I am sure, the comments of the Department on the Select Committee's report. But until then I do not have any suggestion for an earlier debate, although I shall look at what the hon. Gentleman has proposed.
Mr. Loyden: Will my right hon. Friend consider very seriously the point made by my hon. Friend the Member
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for Liverpool, Walton (Mr. Heffer)? I agree with my right hon. Friend that the question is not one only of Merseyside but of, in fact, the regions of the whole of the United Kingdom—probably, in particular, the English regions. Does not my right hon. Friend think that now is the time to make some assessment of regional policy and that, indeed, the best way of doing this would be to have a debate on the Floor of the House on regional policy, industry and employment?
Mr. Foot: I think that that is a real possibility. It may be that that approach is the best one. That is why I was suggesting that I might have some conversations with my hon. Friends, and with other hon. Members who wish to put any case to me about it, as to how we might approach the matter. However, I am sure that my hon. Friend appreciates that what would be difficult, if we have a special debate about one area, is that there are other areas to be considered as well. My hon. Friend has put the matter in a different framework, and I am certainly prepared to look at it along those lines.
Mr. Hastings: Did not the Foreign Secretary lay stress in his statement this week on the heavy responsibility which this House bears for the outcome in Rhodesia? Is this not added reason why there should be an early debate? Indeed, would not our principal allies expect, by this time, that we in this House should be given the opportunity to give our views, particularly in the light of what the Foreign Secretary said to the House after his recent visit to Africa?
Mr. Foot: I think that my right hon. Friend the Foreign Secretary indicated at the time that he was perfectly ready to have a debate in the House. What I indicated to the House a few minutes ago, in response to the representations that were made to me by the right hon. Lady the Leader of the Opposition and others last week, is that we have considered it, and I hope that next week we shall be able to indicate to the House the day when that debate will take place.
Several Hon. Members rose—
Mr. Speaker: If they will be brief, I shall call the four hon. Members who have risen.
Mr. Ron Thomas: If it is not possible to have a debate on Press freedom, could the House at least have a statement on what to all intents and purposes looks like interference by the Attorney-General in the democratic proceedings of the National Union of Journalists annual conference in regard to the activities of Colonel B, who the whole world knows is Colonel Johnstone?
Mr. Foot: I would not accept my hon. Friend's description of what has occurred. In view of the legal position, I doubt very much whether a debate in the House is the best way in which to proceed. I have no doubt that some of my hon. Friend's who wish to make representations will make their representations to the Government on this matter.
Mr. Edward Lyons: Following the savage and contemptuous disregard of the Government's regional policy by Thorn Consumer Electronics Limited in deciding to close the huge Bradford factory and concentrate in the South-East, and the announcement that the Minister of State, Department of Industry, is to take the chair at a meeting of both staff and the board next Tuesday, will the Lord President arrange for the Minister of State to make a statement to the House on the decisions reached at that meeting and the Government's proposals for changing the mind of Thorn Consumer Electronics?
Mr. Foot: I shall certainly convey what my hon. and learned Friend has said on this important matter to my right hon. Friend the Secretary of State for Industry. I cannot promise a statement immediately next week, but I shall certainly consult him on the question that my hon. and learned Friend has raised.
Mr. Fitt: Being in order, I hope, Mr. Speaker, or, as some of my hon. Friends have already concluded, having a second bite at the cherry, may I ask the Leader of the House whether, in view of the fact that the present Government are the first United Kingdom Government who
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have considered granting extra seats to Northern Ireland, and in view of the very important constitutional position which then arises, he would give an indication that before such decisions are taken there will be a White Paper and a major political debate in the House?
Mr. Foot: I think that what we have to do is to proceed on the basis that the Prime Minister stated yesterday. I cannot promise that there will be a debate on a White Paper in that sense. I think that the Prime Minister indicated the way in which we should proceed.
As regards the documents to which my hon. Friend refers, he and I have had some discussion about those documents ranging over many years. I am perfectly happy to see whether all those documents are in the Library and whether there are omissions from them, and we can have a consultative investigation of that matter.
Mr. Rooker: When can the House expect to debate the report of the Royal Commission on standards of conduct in public life, published two years ago, the contents of which carried out part of a Labour Party manifesto commitment, along with the reform of the Official Secrets Act, to make the processes of government more open?
Mr. Foot: I cannot promise an early debate on it, but I have no doubt that some matters that are associated with it will be discussed when the White Paper on the Official Secrets Act is published.

BUSINESS OF THE HOUSE
  BILL PRESENTED
    COMMUNITY SERVICE BY OFFENDERS (SCOTLAND)
    Mr. Secretary Millan, supported by the Lord Advocate, Mr. Harry Ewing, Mr. Frank McElhone and Mr. Robert Sheldon presented a Bill to make provision as respects the performance of unpaid work by persons convicted in Scotland; and for connected purposes; And the same was read the First time; and ordered to be read a Second time tomorrow and to be printed [Bill 108].

STATUTORY INSTRUMENTS, &c.
Mr. Speaker: By leave of the House, I shall put together the Questions on the three motions relating to Statutory Instruments.
Ordered,
That the Agricultural Holdings Act 1948 (Variation of Fourth Schedule) Order 1978 be referred to a Standing Committee on Statutory Instruments, &c.
That the Agricultural Holdings (Scotland) Act 1949 (Variation of First Schedule) Order 1978 be referred to a Standing Committee on Statutory Instruments, &c.
That the Firearms (Variation of Fees) Order 1978 (S.I., 1978, No. 267) be referred to a Standing Committee on Statutory Instruments, &c.—[Air. Foot.]

ORDERS OF THE DAY

  SUPPLY
  13TH ALLOTTED DAY—considered
  Motion made, and Question proposed, That this House do now adjourn.—[Mrs. Ann Taylor.]

  NATIONAL HEALTH SERVICE
  Mr. Speaker: Before I call the right hon. Member for Wanstead and Woodford (Mr. Jenkin), I remind the House that I have an impossibly long list of right hon. and hon. Members who hope to catch my eye in this debate. I shall be able to call more than otherwise would be the case if there are brief speeches, but it is up to the House.
  4.0 p.m.
  Mr. Patrick Jenkin: This is the first full day that we shall have had on the National Health Service for some time. The Conservatives have but two objectives. The first is to convince the Secretary of State that the NHS is facing very serious problems indeed, that the widespread anxieties which we read about in the Press every day are real and are not imagined, that morale in the Service is at a very low ebb and that none of this is helped when he and other Ministers go around the country trying to give the impression that all is well. Our other purpose is to spell out our view of what needs to be done about it all.
  The Secretary of State for Social Services (Mr. David Ennals): Good.
  Mr. Jenkin: The Secretary of State says "good". I have had a slightly curious letter from him in the last day or two under the heading
  "Six straight questions on the NHS"
  in which he says
  "This debate initiated by the Opposition gives the Conservative Party an opportunity to set out its policies on the NHS"
  I do not know what the right hon. Gentleman thought we were going to do, but he will find that by the time I sit down I shall have answered his six questions. Perhaps I may invite the right hon. Gentleman, in those circumstances, not

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  to put those questions all over again, in order to give more hon. Members on both sides of the House a chance to make their speeches.
  I should like to start with a text taken from the Daily Mirror—which is not a paper which on the whole is inclined to support the Conservative Party On 13th March, under the heading "The Sick Service", it stated:
  "There's only one word for the National Health Service today. Sick".
  When one bears in mind that 1978 is the thirtieth anniversary of the NHS—I understand that the right hon. Gentleman is proposing a little celebration later in the year—this is a verdict which can give no one any pleasure at all. The Daily Mirror puts its view with a characteristic pungency. The right hon. Gentleman will know that the same verdict is echoed up and down the country.
  I do not intend to weary the House with a large number of quotations, which I could. From Cornwall to Cumbria the message is the same—sagging morale, lengthening waiting lists and falling standards, all exacerbated by industrial disruption, by anger over pay anomalies, by staff shortages in some areas, by building work years late, by forced closures and so on.
  Waiting lists are often taken as an indicator of NHS progress. In 1974 there were fewer people waiting for inpatient treatment than in 1970. Since 1974 the number has risen dramatically and has been hovering around 600,000 over the last two years. That is a good deal higher than for a very long time past. More serious, the Secretary of State has had to disclose that nearly 40,000 of these cases are urgent, of which nearly two-thirds have to wait over a month. I find it very difficult to disagree with the view of Dr. James Cameron, the chairman of the British Medical Association Council, who said:
  "The sum total of human misery represented by these record figures for waiting lists over the past year is a scandal without parallel in any technically developed country."
  But the best that the Secretary of State can say about it is that the number of urgent cases is falling. Yet even there he cannot resist the temptation to try to fudge the issue. This was clearly brought out in a recent leading article in the
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  Health and Social Service Journal on 10th February which stated:
  "While it would be harsh to describe Ennals as a man not given to honesty, there is certainly a case to be made against him in the selective use of figures when he claimed the number of urgent cases awaiting treatment had fallen. For what he failed to mention was that there was a rise in the percentage of urgent cases waiting for more than one month."
  It is this kind of attempt to put a favourable gloss on what everybody recognises is a serious situation that so exasperates people.
  Or take the growth of industrial disruption. This is another cause for serious concern and is evidence of a malaise in the Service. We have had the telephonists pulling out the plugs and censoring doctors' calls. We have had the guerrilla walk-outs at Westminster Hospital, which brought all admissions to a halt, and which the Daily Mirror described as
  "the unacceptable face of trade unionism … on parade".
  We have had the operating theatres at Dulwich closed because professional staff with clinical responsibility for patients found themselves quite unable to maintain discipline among ancillary staff. Again, I could cite examples from all over the country, but I shall spare the House the burden of listening.
  Mr. Lewis Carter-Jones: Why?
  Mr. Jenkin: Because many hon. Members want to speak.
  Mr. Carter-Jones: Tell us.
  Mr. Jenkin: I have brought a file, but I shall not weary the House with the details. Of course, the great majority of staff in the hospitals work cheerfully, conscientiously and without interruption. They give devoted care to the patients in their charge. I would not wish it to be thought otherwise. However, there can be no hon. Member who does not recognise that this rash of disputes has become too numerous and too disruptive to ignore and that it is evidence of a deeper malaise.
  Mr. Carter-Jones: Name them.
  Mr. Jenkin: I can, but I have already quoted some examples. Perhaps I can leave it there. My hon. Friends may wish to give other examples.

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  But of all the reasons that are given the most frequent and most insistent is the shortage of money. We had that from the BMA, the TUC, the National Association of Health Authorities—in the letter from Mr. Bettinson, the chairman—and many others. I should like to look at the question of money.
  I put down a recent parliamentary Question to the Secretary of State which showed that betweeen 1948 and 1976 spending on the NHS increased in real terms, at constant prices, by nearly 130 per cent. According to my mathematics, that is an average annual growth of almost exactly 3 per cent. a year. That was a pretty steady increase with only minor fluctuations. By and large, during those years the NHS broadly kept pace with the demand.
  But the latest public expenditure White Paper—Cmnd. 7049—shows a very marked slowing down of spending. From 1972–73 to 1976–77 the annual average growth was not 3 per cent. but 2·1 per cent. Perhaps more serious, the forecast for spending from 1976–77 to 1981–82 shows an average annual growth of 1·6 per cent. These figures relate to the situation prior to the Budget increase of £50 million in the current year 1978–79. If one adds that in, the figure of 1·6 per cent. rises marginally to 1·8 per cent.
  What we have faced in recent years is a growth at about two-thirds of the rate in the first two decades of the NHS. Over the next four years the NHS is facing a growth in expenditure at about half the rate of the first two decades. That is for total spending—capital and revenue.
  Mr. Carter-Jones: Are we now hearing from the right hon. Gentleman that he intends to increase that spending substantially? When will that take place?
  Mr. Jenkin: If the hon. Gentleman will have patience and wait, I shall, of course, deal with that. But I hope that there will not be too many interruptions because many hon. Members want to speak.
  Mr. Jack Ashley: We are all very interested in these proposals. I know that, in challenging the Secretary of State, the right hon. Gentleman is prepared to give exact details of how much public expenditure
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  he is prepared to propose in this debate. It is exact details that we should like from him.
  Mr. Jenkin: That was actually one of the Secretary of State's questions—but never mind, I think that the hon. Gentleman will get his answer.
  I was going on to say that capital spending has been cut in absolute terms to two-thirds the level of three or four years ago. That is the level at which it will run over the next four years. That is the harsh reality, yet, as we all know, the demands on the Service are constantly increasing, for all sorts of reasons—the increasing age of the population, new medical technologies and new drugs—and the results of this equation are becoming apparent all over the country.
  But, again, the difficulty is that on this subject the Secretary of State speaks with two voices. He wisely confessed to the British Medical Association—he will know that I wrote an entire article around this text:
  "Resources do not meet all needs and I shall not stop saying so."
  That is absolutely right, and we applaud his saying it. That poses the eternal dilemma of infinite demand and finite resources. But what are we to make of the Secretary of State's statements elsewhere? In "The Way Forward", he included this remarkable sentence:
  "the money available will be enough in principle to meet increased demand arising from demographic change".
  What does "in principle" mean? The right hon. Gentleman has never answered that question. How does one meet expenditure "in principle" unless the money is there in practice? That is one of the oddest statements ever made.
  I therefore find it surprising that, in his letter to the BMA referring to the document "The Way Forward", the right hon. Gentleman said:
  "'The Way Forward' was brutally frank in recognising the difficulties and problems".
  I see nothing "brutally frank" in trying to fudge the issue and saying that there is enough money "in principle" to meet the demands on the Service.
  It did not stop there. The right hon. Gentleman has gone on pretending. I quote now from the most recent official

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  document, the planning guidelines published on 20th March:
  "It has been argued that, unless a greater increase is achieved in the total resources available for health and personal social Services, the strategy underlying the priority guidance contained in previous documents is untenable. The Secretary of State does not accept this … he is satisfied that the broad strategy, as promulgated, is the right one and capable of achievement nationally."
  If the right hon. Gentleman believes that, he is just about alone. It has not been accepted by the great majority of those with whom he has to deal. Of course he has been trying to get more—we all Know that—
  Mr. Ennals: I have succeeded.
  Mr. Jenkin: How much he has succeeded we shall perhaps see.
  The Health and Social Service Journal said:
  "It is an open secret that David Ennals fought long and hard in Cabinet to get a substantial increase for the NHS and it is understood that the DHSS was hoping for about three times the amount which it eventually got. But the opposition, one presumes from Treasury mandarins, was formidable and obviously successful."
  I have been Chief Secretary to the Treasury. I know what is involved in facing spending Ministers who are asking for more money. I know that the Treasury carefully studies what those Ministers say when they speak to the public outside. Of course, if the right hon. Gentleman has been trying to pretend to everybody that he has enough money, why should the Chief Secretary or anyone else provide him with large sums more?
  Therefore, instead of the £200 million or £150 million for which the right hon. Gentleman was hoping, he got £50 million Thus, the Chancellor announced last week these ludicrous priorities—free milk for all children whether they need it or not, subsidised meals for all children whether they need it or not—
  Mr. Ennals: Hear, hear.
  Mr. Jenkin: The right hon. Gentleman says, "Hear, hear", but this is while the NHS, which is facing acute problems of which we are all aware, has to live on a rate of increase of spending over the next four years which is about half the rate
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  with which it has been blessed over the first decades of its existence.
  The Secretary of State has tried to specify in detail exactly what the £50 million is to be spent on—commissioning completed hospitals, £8 million; capital cost to help waiting lists, £2 million; new equipment and urgent maintenance, £8 million to £9 million; more staff and urgent maintenance for mental and geriatric hospitals, £14 million. I would seriously ask, does it make sense to try to spell out in this detailed way exactly how every pound shall be spent?
  Mrs. Gwyneth Dunwoody: Yes.
  Mr. Jenkin: The hon. Lady says "Yes," but can one honestly say that those in the DHSS at the Elephant and Castle know exactly the priority needs of each health district all over the country? How can they know?
  Is it not one of the chief causes of the malaise in the NHS that the gentlemen in Whitehall think they know best how to meet the needs of local communities? The right hon. Gentleman says that there will be 9,000 more jobs. How can he know that? Is this not just another part of the pattern of make-believe, with more of an eye on votes than on patient care?
  Mr. Ennals: Does the right hon. Gentleman really think that I and my colleagues in the Department do not have the closest links with the health authorities and know what their priorities are? We have worked out their priorities with them on their own strategic plans. Of course we know where the urgent needs are and, therefore, of course we can say how that money will be spent. I think that the country respects us more if we come clean about how we will spend the the money. People do not want to think that it simply goes into a pool. They want to know how it will be spent, and I think that they will thank us for it.
  Mr. Jenkin: This may be one of the differences between us—a difference, I think, of degree rather than of kind. I just do not believe that the central bureaucracy can know as well as local people what are their immediate priorities. I very much doubt the wisdom of this kind of earmarking.
  The Health Service is facing great difficulties, and it does no service to the

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  nurses, doctors and other professional people who are struggling to make it work to go on pretending that all is well, that things are better than ever, and so on.
  I shall now spell out what I believe should be done. I have no hesitation in saying that the first requirement is realism. We must be absolutely realistic and face the facts, acknowledge the deficiencies and recognise the limitations. I would say to some Labour Members below the Gangway that realism means that, before more money can be spent, more money must be earned. The state of the NHS today is a reflection of the poor performance of our economy over many years.
  My hon. Friends and I have visited health services in other countries, where we often found higher standards, shorter waiting lists—in some cases none at all—and better hospitals. The reason is that they are spending more because they have more successful economies. The quality of United Kingdom medicine still stands as one of the centres of excellence of the world. It is as high as anywhere in the world. But it will not survive if this nation cannot generate the resources to nurture and sustain it.
  Improving the performance of the economy has therefore to be a top priority. On that there is no difference between the two sides. Therefore, I am not standing here to argue for a massive new injection of funds at this stage. That would be quite unrealistic. If I am the first Opposition spokesman on health to say just that, let history record it. I do argue that we can make better use of the money we have, and I shall go into detail on that in a moment.
  I group my remarks on the NHS itself under five main heads: first, our commitment to a National Health Service and a proper partnership with the private sector; second, the funding of the NHS; third, the structure and management of the Service; fourth, financial discipline and incentives; fifth, the people who work in the Service and on whom all depends.
  I would therefore state clearly in the House, as I have frequently said outside, that the Conservative Party unequivocally supports the concept of a National Health Service—national in the sense that it is substantially funded by the Exchequer
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  and with no one denied access to care because he cannot afford it; national also—here I answer one of the right hon. Gentleman's questions—in the sense that standards of health care should not vary widely across the country but should be brought progressively to a national standard. But it must be a process of levelling up and not of levelling down. The Secretary of State has occasionally cast doubt on our commitment to the NHS, and I hope that he will now stop.
  There are two other principles. First, we must seek to foster in each individual citizen a proper sense of responsibility and awareness of his own and his family's health needs. Education, and especially education in preventive health care, is essential, but I draw a clear distinction between education in the sense of imparting information and instruction in the sense of preaching. I think that the Secretary of State will recognise that some of his pronouncements, particularly those on smoking, have been profoundly irritating to many people and may well have been counter-productive. He certainly got a very bad Press.
  I believe that giving health information is the role of the general practitioner, the health visitor and the community physician. That is vital. It is also needed in the schools.
  The second principle is that we must build a proper partnership with the independent sector. My party firmly opposes the system of medical apartheid embodied in the foolish Health Services Act 1976. We are committed to reversing it. We believe that the Health Service can ill afford to lose the money coming in from pay beds. It was £26 million last year, and it will be more as the charges rise.
  We believe too—and Nye Bevan himself realised this—that there is positive merit in keeping the best consultants in the National Health Service hospitals. We shall therefore see that pay beds are provided where there is a demand for them and that the pay bed revenue accrues to the hospital where it is earned.
  We see no reason for quantitative controls on the private sector. They seem to us incompatible with a free society, and they are there solely because the pay beds have been hounded out of the National Health Service hospitals.
  Mr. E. Fernyhough: When the right hon. Gentleman's party may get the chance—I do not believe that it will ever happen—will he assure me that those consultants who take in private patients will also be responsible for the hospital debt that many of the private patients leave behind?
  Mr. Jenkin: I recognise there is a problem. It is a minor problem, but I note the right hon. Gentleman's suggestion.
  I come to my second point, which is the funding of the Health Service. I have already said that I do not think that a new injection of funds in the short term is possible, but we see no reason for holding down prescription charges when the National Health Service needs every penny it can get. They should keep pace with rising costs. Especially in the context of the Secretary of State's newly-launched attack on drug costs to the Health Service as a whole, it would be reasonable that prescription costs should rise—with all the usual exemptions, of course.
  As for other changes in the basis of funding the Service, we shall wait to see the report of the Royal Commission. It would be very unwise for any party to commit itself in advance either way. We shall also wait for the report to see what the Royal Commission has to say about switching more of the cost to specific health insurance contributions. This is clearly within its remit, and it would be very unwise for a party to commit itself to anything in that line in advance.
  Thirdly, I turn to the structure and management of the Service. Ministers have themselves testified to the positive side of the 1974 reforms. Four Labour Secretaries of State subscribed to a document which said that it was
  "now possible to look at priorities more comprehensively and to plan the allocation of resources more effectively both at local and national levels."
  I think that that is right.
  But no one can deny, and I do not deny, that reorganisation has not fulfilled the hopes of its progenitors. My right hon. Friend the Member for Leeds, North-East (Sir K. Joseph) said last Saturday that the NHS reorganisation had been
  "in part patchy, in part awful, in part not bad and in part curable".
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  It has proved over-bureaucratic, but reorganisation is not responsible for much of the bureaucracy. [HON. MEMBERS: "Oh."] Let us look at this example. I have here a DHSS circular of December 1977, HN(77)190, which tells health authorities how to cook turkeys. There must be some limit to the bumf that comes out from the right hon. Gentleman's Department.
  Mr. William Hamilton: The right hon. Gentleman's Government told us how to clean our teeth.
  Mr. Jenkin: Let me return seriously to the structure of the Service. We do not want to see another major "big bang" upheaval. The watchword must be evolution, not revolution. The National Health Service needs, as my hon. Friend the Member for Reading, South (Dr. Vaughan) has said on a number of occasions, a period of intensive care if it is to come through the present crisis. How would we deal with it?
  First, we do not want a uniform, dull mediocrity. No one pattern can possibly be right in all circumstances across the country. Secondly—this is absolutely crucial and ties in with what I said a short time ago about the £50 million—we must aim to make the Service as local as we can. It is wrong to talk of the National Health Service as if it were a vast, great, integrated machine, controlled and manipulated by the Secretary of State sitting at a great console like a power station console. It does not work like that. It involves an enormous bureaucratic tail if one tries to work it like that.
  The National Health Service is a large number of local services delivering health care locally to local communities. Therefore, the primary control should be by local people. Probably, but not universally, the district is the right level at which to focus authority.
  The mistake in 1974 was to separate out management, through the district management team, at the district level from direction or control by the area health authority at area level. I believe that the right answer is that the lay element in management should be at the district level, with the DMT answerable directly to a district health authority, with local lay representation at that level.

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  The result of this would be that over much of the country an area tier would be seen to be superfluous. It should be merged into the districts, which would become the primary authorities. It is at the district level that the buck should stop. There never has been any reason why decisions should go chuntering up the tiers of management. That was never the intention.
  Mr. Doug Hoyle: The right hon. Gentleman's Government introduced the change.
  Mr. Jenkin: I recognise that that is what has happened, but it was never the intention. When I come to funding I shall explain how one can make sure that it cannot happen.
  The Department's role must be to lay down overall policy and establish broad priorities. That is the proper role for the Secretary of State. It will be his duty to allocate the cash to the various authorities, to lay down minimum standards, which I believe is enormously important, and to establish a proper inspectorate to maintain those standards.
  Between the Department and the districts I would retain a regional tier, but essentially as a co-ordinating and planning tier, with most of its members drawn from the districts which it would administer. It would in no way be concerned with day-to-day management. It would be a strategic tier.
  We would reinforce the structure with a more effective financial discipline. The instruments are to hand. We now have working across most of the Health Service an effective system of cash limits. This gives us the chance to introduce effective management incentives to cut out waste, to cut out extravagance, and to make the buck stop where it should, with the people who actually have to take the decisions.
  Mr. Ashley rose—
  Mr. Jenkin: I must get on.
  Incentive budgeting should allow for a good deal more flexibility. As one chairman put it to me, one should give each authority its crock of gold, as it were, capital as well as revenue, subject to a regional plan and to ministerial priorities, and then leave it to that district to get
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  on with it. If one does that, there is no reason to have the nonsense of what one regional chairman called "the colour television sets in March syndrome", the last-minute scramble to spend money right at the end of the year. This is still going on. My hon. Friend the Member for Ealing, Acton (Sir G. Young) drew my attention to what an Ealing alderman, Alderman Tomlinson, a member of the North West Thames Health Authority, said the other day. He said that the regional health authority was £5 million underspent for the current financial year. That was last year. He added that the authority
  "will have to work quickly to reduce the surplus, because only £3·46 millions of it can be carried forward into the financial year. … One also wonders whether the money is going to be spent wisely, since they only have a couple of months in which to dispose of it."
  This practice still goes on, because there is only a 1 per cent. allowance for spillover.
  Mr. Ennals rose—
  Mr. Jenkin: I will gladly give way but the right hon. Gentleman is to speak immediately after me and I am anxious to finish my speech.
  With the cash limit system there is no need to have any limit on carry forward. When we had the old system of Treasury control of expenditure, when I was at the Treasury, perhaps this rule was necessary, but I do not believe that it is necessary now. It is widely accepted within the Health Service that it is wasteful. I visited a hospital the other day where every secretary in the hospital had been furnished with a new electric typewriter because it was the only way the authority could spend the money before the end of the year. That is crazy financing. No business allows itself to be run in that way.
  Mr. Ennals: Would the right hon. Gentleman agree that during his time at the Treasury there was no carry-over period at all and therefore there was a mad rush? The 1 per cent. carry-over that has been agreed has changed the basis of the financing of authorities.
  Mr. Jenkin: So have many other things been changed. When the Conservatives were in power we were still working on the basis of Supplementary Estimates.

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  The cash limit system, with its built-in rate of inflation, creates—I am glad to see the Under-Secretary nodding his recognition of this—a new opportunity to give authorities flexibility in managing their money efficiently. Why should not an authority decide to save a bit out of revenue for a couple of years and then spend the money on something which it badly needs? Why should it have to squander money in the last few weeks of the financial year?
  Mr. Ashley rose—
  Mr. Jenkin: I have given way a number of times.
  I turn finally to the people on whom the Service depends. It is on the professions that the main burden and the main responsibilities must lie. They are entitled to the resources necessary to do the job. They are entitled to the respect and willing support of those who work with them. They are entitled to the level of pay commensurate with their responsibilities and comparable with other professions. Above all, they are entitled to the unqualified backing of politicians who administer the legislation under which they work.
  In recent years doctors, nurses and administrators have had none of these things in proper measure. Pay has fallen badly behind. I hope that the Secretary of State can give us some news about that today. The Prime Minister has had the report of the Review Body for two weeks now. The profession is waiting anxiously to know how the Government will deal with it.
  Although pay is important, I believe that clinical authority is even more important. Nothing has done more to undermine confidence in the National Health Service than the repeated attempts of groups of unqualified people to usurp the function of doctors and nurses. I believe that Jennifer Burke, the courageous theatre sister at Dulwich, deserves the praise and thanks of all right-minded people for the stand she took in defence of discipline. As The Times said on Tuesday of last week,
  "hospitals cannot be run safely and efficiently unless clear-cut responsibility in clinical matters lies with those who are qualified to take clinical decisions."
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  We look to the Secretary of State today to give unqualified and unequivocal support for that proposition. The unions, of course, have an important role to play. My right hon. and hon. Friends and I are meeting union leaders at several levels within the Health Service so that we can better understand their problems. One important role must now be to go to the limits to see that patients never suffer as a result of industrial action.
  We do not intend to divide the House today on this motion. The main thrust of National Health Service policy ought not to be a matter of party dispute. What we look for is some recognition by the Secretary of State that the state of the National Health Service today is a good deal more serious than he has so far allowed. Whether or not he acknowledges it today, I suspect that by the end of the debate the House will have left him in no doubt of it.
  4.35 p.m.
  The Secretary of State for Social Services (Mr. David Ennals): I very much welcome this debate, which is an opportunity the House does not have often enough to consider the state of the National Health Service, its problems and its achievements. It gives us the chance to look at the way forward, especially in the thirtieth anniversary year of the National Health Service.
  Most of all, I welcome the debate because it has given to the Opposition the opportunity to spell out their alternative policies. This is why I sent my letter with its six questions to the right hon. Member for Wanstead and Woodford (Mr. Jenkin), to enable the right hon. Member to explain to the country what would be the nature of the Health Service if the Leader of the Opposition were, by some misadventure, to become Prime Minister.
  This issue is of no slight interest because, however much people may be concerned about the problems of the National Health Service, there is no service in this country which is more respected. There is no service—it has been established by a Labour Government—which has rendered a greater service to the quality of life of our people than the National Health Service. I believe that the people want to see it as a National Health Service and basically as a service which is free at the point of delivery. There is no doubt that people

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  will be interested to know what changes the right hon. Member would make.
  I gave the right hon. Member plenty of notice of my questions. He has given me some answers. Let us look at what he has said on financing. He has said that there is no case for holding down prescription and other charges. We know that prescription charges will go up under a Tory Government. I asked him a supplementary question on that point because I wanted to know by how much these charges would go up. At least we know that prescription charges will go up.
  I also asked the right hon. Gentleman whether there would be charges for seeing the family doctor. He said "We shall leave that to the Royal Commission. It has not made up its mind." He did not say that the Royal Commission was talking about this subject, although we know that it is. The right hon. Gentleman did not deny the suggestion in my question.
  My next question was whether the Tories would introduce "hotel charges" for hospital patients. Again I asked him by how much. Again he said that we would have to wait for the report of the Royal Commission. The right hon. Gentleman did not deny that that was one of the proposals studied by the Opposition. I also asked the right hon. Gentleman what he thought of the reorganisation of the National Health Service. I put it in this way. I asked:
  "Is it now the official Conservative view that the reorganisation of the NHS imposed on the Service by the right hon. Member for Leeds, North-East was a costly mistake?"
  The right hon. Member for Wanstead and Woodford did not actually say that it was a costly mistake but went on to say that he believed, in effect, that it was a costly mistake. He said that there was one tier too many. He said that the Service was excessively bureaucratic—as if somehow or other the Tories did not have total responsibility for the establishment of this system.
  The right hon. Member and his hon. Friends can trip around the country saying that they have decided to abolish an area tier and will have members at district level. They have reached conclusions on that. What happens when I ask whether patients will pay when they are ill or whether patients will pay to see their general practitioner or will have to pay to go into hospital? The right hon.
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  Member has said that we must wait for the report of the Royal Commission. What sort of an answer is that? Why cannot he be honest with the country? Is it that he wants a little more time? If so, let him get up and say so. I would have thought that this was the occasion to come clean with the House and the country. Since the Tories have not been prepared to deny these suggestions, we must assume that it is their intention to make these charges.
  Mr. Patrick Jenkin: The right hon. Gentleman is making bricks without straw. I meant exactly what I said. These are matters which are being looked at by the Royal Commission. I think that it would be unwise for any political party to commit itself firmly either way on this issue until we have the benefit of the Royal Commission's advice.
  Mr. Ennals: I am glad that the right hon. Gentleman said that. In terms of structure, or whether there should be an area tier, or a district tier, or a regional tier, he felt it possible to come forward with his views and spell them out in articles, going round the country and creating uncertainty among those who work in the area tiers. He is perfectly satisfied to do that. But on the matter of deep principle—whether the people who are sick should have to pay at the moment when they are sick rather than pay for the services from taxation—he hides behind the Royal Commission. There is no honesty in his answer.
  On what is perhaps the most fundamental question of all I asked him:
  "Is it Conservative policy to reorganise the National Health Service into a two-tier service, one for the elderly, the chronic sick and those on modest incomes financed from taxation, and a private acute sector financed from tax deduct-able insurance premiums?"
  To that question, which is fundamental, he gave no answer at all. Yet the right hon. Member for Leeds, North-East (Sir K. Joseph) certainly hinted at that policy over the weekend—his speech could have meant nothing else.
  The right hon. Member for Wanstead and Woodford himself said in March, speaking in York:
  "I believe we should seek ways of transferring more of the cost of the health service from taxes to insurance. This could be achieved by extending the existing health contribution, or by offering a choice (as in

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  Australia) of insuring with the State or insuring with the private sector."
  What on earth does that mean? The idea seems to be to cut income tax—we know that that is the objective of the Conservative Party—but to raise national insurance. The only gainers from that would be the rich, because national insurance contributions are paid on earnings only up to a certain level.
  There is a whole series of questions for the Opposition. I shall not go into all of them but I shall mention only two or three. Will the Conservatives allow the better off to opt out of paying for the NHS altogether? That is what the right hon. Gentleman's proposal amounts to, with its option to insure privately instead. Will there be two services, one for the rich and one for the poor? Will there be different premiums to pay for these different standards of service? Will parents have to pay extra premiums for their children? I shall not go further, but certainly these are questions which the electorate would expect to be brought before the House and answered.
  I shall give way to the right hon. Gentleman now if he wants to deny that this is the purpose of the Opposition when it comes to presenting their plans for the NHS. I know where the answer lies. From this debate, in this thirtieth anniversary year, when the deep principles of the NHS that we hold will be shared by the public, we shall see what alternatives would be before the public if the Leader of the Opposition were ever to become Prime Minister. We are quite clear.
  Mr. Patrick Jenkin: The right hon. Gentleman, when he wrote to me about these thirtieth anniversary celebrations—I hope that I am not disclosing anything that I should not—said that he saw no reason why they should be on any party basis at all. I replied in similar vein. Is he now saying that he will use the occasion to attack the Opposition for what he imagines may be their plans?
  Mr. Ennals: I shall treat this very coolly. One of those parts of the right hon. Gentleman's speech that I welcomed was his conversion to the NHS—a conversion and commitment. I welcome it. I hope that it will be possible for us, during this time of anniversary celebrations, to stand together on certain
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  common platforms about the future of the NHS. But I am certainly not going to pledge myself that, during a whole year, I shall not seek to press relentlessly upon the right hon. Gentleman and the Leader of the Opposition to say where they stand on the future structure of the NHS.
  Our position is clear. We believe in a National Health Service financed out of general taxation. That is the right and fair thing to do. Of course there are limits to the amount of money that can be made available and limits to what we can do within any given budget. We should all like more money for the NHS But there is only so much that the taxpayer is prepared to afford.
  I was interested to hear the right hon. Gentleman say that he would not use this occasion as an opportunity for demanding additional expenditure. Perhaps he would like to have done so, but his right hon. and hon. Friends—particularly those who have been demanding cut-backs in public expenditure—would hardly allow a sort of errant boy to stand up and make demands which would put him absolutely out of turn. No doubt he hopes for promotion—or perhaps he just hopes to stay in his present job. When the right hon. Member for Leeds, North-East made his speech over the weekend, some people in the NHS thought that his spectre was returning, that perhaps he was taking over responsibility for speaking for the Opposition on the NHS.
  Mr. Ashley: My right hon. Friend the Secretary of State is making a very good speech, with which I wholly agree. If I am fortunate in catching your eye, Mr. Deputy Speaker, I shall nevertheless be criticising the Government and asking for more expenditure. But my right hon. Friend should sit down now and allow the right hon. Member for Wanstead and Woodford (Mr. Jenkin) to spell out exactly how much the Opposition would give to public expenditure for the NHS if they took office. That figure has not been forthcoming. Why does not my right hon. Friend listen to the figure put forward for increased expenditure on the NHS by the right hon. Gentleman?
  Mr. Ennals: I do not sit down because I suspect that, if I were to do so, there would be a blank silence from the right hon. Member which would be readily

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  filled by some of my right hon. and hon. Friends waiting to get into the debate.
  Of course we have only so much money available. But, even so, the Government have consistently, year by year, increased the total resources available to the NHS. In spite of economic difficulties and restraints on public expenditure, we have given priority to the NHS because we recognise its vital role in the lives of ordinary people.
  Since we took office in 1974, the proportion of our gross national product that is spent on the NHS has risen from the 1973 figure of 4·7 per cent. to 5·8 per cent. in 1976. Certainly that is not enough, with all the needs, to solve all the problems. I have made that clear on many occasions. We are under heavy pressure on many fronts, and I was interested in and agreed with the point made by the right hon. Gentleman which was generally in line with a statement made two or three weeks ago by the right hon. Member for Down, South (Mr. Powell), as a former Minister of Health. The right hon. Member for Down, South said:
  "The National Health Service is not about to break down. Of course it is not; to suggest that it is is a lot of nonsense. Such a statement is nonsensical, It is no nearer breaking down now than in 1958, and also no further away.
  The life of the Service is a continuing confrontation between finite resources and infinite demand."
  I have never denied the pressures on the NHS. I live with the NHS. I travel the country, and I know what people feel and the difficulties they face. I will touch on a few. We have a legacy of neglect in the Cinderella services for the mentally ill and the handicapped and the care of the elderly. Before I came back to this House in 1974, I spent years visiting precisely those hospitals and seeing the problems we have to face now. We have still an unfair allocation of funds across the country, which we are steadily putting right, thereby remedying an injustice which has been done over the years to such regions as the North, the North-West and Trent, which have been denied funds to which they were entitled.
  We have a growing number of elderly people making bigger and bigger demands on the Service. I am not saying that this is a tragedy. Indeed, it is a tribute to the
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  National Health Service that people are living so long, but they make demands on the Service.
  We have made rapid advances in medical techniques. We have new and expensive equipment and treatments which had not been thought of a few years ago. We have long waiting lists for treatment, but these are often for treatment that was not available a few years ago.
  New hospitals have been coming on stream, replacing older outdated facilities, with all the problems of closures, changes of use, loss of familiar local hospitals and so on.
  The right hon. Gentleman accused me of being less than frank in "The Way Forward." Of course, he is very selective. But I direct his attention to paragraph 3.3 on page 18, where I said:
  "In some districts, long sought improvements will be further delayed. Some hospitals will have to continue to manage with facilities which are outdated or inadequate. The expectations both of the professions and of users will not be fully satisfied. In other places where services are not under the same pressure, the provision of new facilities which are expensive will have to be postponed. This is the price which has to be paid if progress is to be made in those parts of the service which have been given priority for development."
  Could any Secretary of State be more frank than that in indicating the problems that the National Health Service has to face, and pointing out that, in the context of scarce resources, we have to use courage and show some leadership? Even when resources are tight, we must get our priorities right, and shift resources into those geographical areas which have been neglected, and into those parts of the Service which have been neglected. That means determining priorities, and that is the Secretary of State's task.
  Mr. Cranley Onslow: Can we have the Secretary of State's assurance that, before he ends the speech, he will touch on the very important point which many people feel to be one of the problems of the National Health Service—that a growing minority of employees in the National Health Service is more interested in rights than in duties?
  Mr. Ennals: That is a very serious accusation. I shall be coming soon to industrial relations, but I shall not wait

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  five minutes before dealing with that intervention.
  Mr. Hoyle: Will my right hon. Friend say something about another part of the Service that is under severe pressure—the accident and emergency services? I am completely alarmed when I see a letter from the district administrator in Burnley which talks about closing down the Burnley accident and emergency service if more staff cannot be obtained. It also speaks of having talks with Blackburn, which is also under severe pressure. This sort of difficulty is not confined just to my area but is to be found countrywide. There is a need for more money. If the threatened closure were to take place, there would be a great outcry from my constituents. I hope that my right hon. Friend will say something about that aspect of the service.
  Mr. Ennals: I shall not make any immediate comment on the accident and emergency service in Burnley, otherwise I shall have to deal with other similar situations. But the importance of the additional £50 million in the Budget package is clear, and it will help several different parts of the Service. I shall not spell out, as I have done previously, the different ways in which help is being given. Having given way a good deal, I feel that I should now be permitted to get on with my speech in my own way.
  The right hon. Gentleman mentioned administration costs. He referred to the increase in the administrative staff employed by the National Health Service since 1974. He has done this on many occasions. All over the country he has been talking about a swollen bureaucracy, the increasing number of staff, and so on. It is true that there has been an increase from 82,700 administrative and clerical staff in 1974 to 98,500 in 1976, the last year for which we have reliable figures, but that was the direct result of the Conservative Party's reorganisation.
  Mr. Patrick Jenkin: According to the Ninth Report of the Public Accounts Committee, in the seven years before the reorganisation of the NHS, the number of staff employed by former hospital authorities in England and Wales increased by 40 per cent. from 39,296 to 54,974. I am not quite sure what con-
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  clusion the right hon. Gentleman is drawing.
  Mr. Ennals: What I conclude is that, quite apart from the figures I gave, which showed the increase as a result of reorganisation, the right hon. Gentleman's Government, when in power, were unable to deal with the situation.
  I share the right hon. Gentleman's desire to cut unnecessary administrative costs, but much of the present criticism, as he well knows, is ill-informed and unfounded. Many administrative and clerical staff, such as ward clerks and medical record officers, make a direct contribution to services to patients, and, by relieving them of clerical duties, enable doctors and nurses to spend more time on patient care. Nevertheless, I felt that the administration of the Service ought to be slimmed. Therefore I did something about it.
  After discussion with the chairmen of regional health authorities, a standstill on management costs was introduced in 1976. As a second step, and with the agreement of regional health authority chairmen, all regions were required to reduce their management costs to a common proportion of their revenue allocations—5½ per cent.—by 1980. Overall, this will result in a reduction of about 5 per cent. in real terms in the level of management costs at 31st March 1976 and will free about £11 million a year to be spent on services more directly of benefit to patients. That figure of 5 per cent. is not bad by any standards for a national or local organisation.
  Most regions have already achieved their 1980 objective. The number of managerial posts has already been reduced by over 2,000 since 1976. I was very glad that the right hon. Gentleman intervened with his figures, which showed that when his party was in power it not only imposed a structure which virtually forced additional administration but was unable to restrain it.
  I say with some pride that we have been able to make this reduction as well as achieving a major saving on non-staff costs. If, as I expect, the present trend continues, in the current financial year some £10 million will be available to be spent on services to patients which, without our initiative, would have been spent on management.

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  I want no lecturing from the right hon. Gentleman on the administration of the National Health Service, after the mess that he and his party made of it when they were in power. I hear too much of people who get cheap applause by pointing fingers at the administrators. We have some very fine administrators in the National Health Service. There are not only men of long years of experience. There are also young men who have been trained in the Service and are doing a fine job. It is not they who should be the target of attack. We should attack the system itself.
  The right hon. Gentleman referred to industrial relations. Of course there are industrial problems in the National Health Service. There have been more industrial problems since the reorganisation of the NHS than there were before. One reason was the extent to which NHS pay had fallen behind that in the private sector at the time when we took office. A second reason has been the management structure for the NHS which we inherited, under which it is by no means always clear where management responsibility lies. This is one of the questions that the Royal Commission on the NHS is examining.
  Until we took office, industrial relations in the NHS had been sadly neglected. It was my predecessor who asked Lord McCarthy to study the working of the Whitley machinery at the national level. Since we received his report, intensive training courses for industrial relations specialists have been mounted under the auspices of the National Training Council. I am doing all I can to develop the personnel function as a specialist service in the NHS.
  I am as anxious as anyone in this House to find ways of avoiding local industrial action which disrupts services to patients and causes irritation to the public and to those who work in the Service. Our Health Service is too precious to be marred by irresponsible industrial action.
  I have already held a meeting which brought together leaders of the doctors and the NHS trade unions representing the largest groups of staff to discuss these questions. What was remarkable was that, as far as I am aware, a meeting of this kind had never been held before. I have also discussed this matter with
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  representatives of the Royal College of Nurses and the Royal College of Midwives. I shall be meeting again to discuss the possibility of agreeing a code of practice to define the parameters of industrial action in the NHS.
  We must improve the local disputes procedures. The NHS is not a factory but a service for patients. Everything must be done to ensure that the interests of patients come first. One must consider the fact that we have working in the National Health Service almost 1 million people of all sorts of skills, backgrounds and organisations. The amount of industrial upset in the NHS is minimal. However, every time something happens at local level it is big news. I am not surprised at that, but I think that Conservative Members should keep it in proportion and recognise that the vast majority of doctors, nurses, technicians, porters and ancillaries are dedicated to the cause of the NHS. If our system is not good enough to deal with industrial disputes, it is the system that we must get right.
  On the question of waiting lists, the last figure I have shows that in September 1977 there were 594,000 on the waiting lists as against the peak of 607,000 in December 1976. Of the total waiting last September, 40,000 cases were designated as urgent. There is a serious problem, but the fact that the figures have gone down since December is a matter for some satisfaction, even though the fact that they are as high as they are must cause us concern.
  This is not a new problem. There has been a waiting list figure of around 500,000 for most of the life of the NHS. Although it is sickeningly high, one should consider that if that figure is taken as a proportion of the total number of patients who are dealt with, it is considerably less than it was some years ago.
  The increase in waiting lists during the life of this Government was caused not by under-financing but by industrial action. The number of main operations performed in hospitals fell by 250,000 between 1974 and 1975. The main reason for this was the dispute with the junior doctors. The origin of that dispute can be traced to the previous Government's pay policy and their unwillingness to concede a new contract for junior doctors. The new contract negotiated by my predecessor paved the way for the

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  reduction in waiting lists which has since occurred.
  We have considerable ground to make up. Most urgent cases are nearly always admitted quickly. Thus the main problem is the time spent waiting for treatment of conditions which, although not life threatening, nevertheless involve pain, discomfort or incapacity which could and should be avoided. That is why I have told the health authorities that a proportion of the extra £41 million allocated to the Health Service in England this year should be spent in ways to help cut down the waiting list problem.
  On the question of priority for the Cinderella services, it is time for a complete rethink of our attitudes towards elderly people, the kind of help they need and the contribution that they can make to the rest of society. This is one of the biggest pressures on our health and personal social services. For this reason we are publishing a discussion document on the elderly in a few weeks' time with a view to stimulating public debate to help us with the preparation of the first ever White Paper on the elderly next year.
  Nor have we forgotten our commitment to the mentally ill and handicapped. For example, the last six or seven years have been years of action by society in tackling the problems of mental handicap.
  In 1969 there were 24,500 day places in adult training centres in England and Wales. Today there are 37,900 places, and we are well on the way to achieving the target set in the 1971 White Paper of 72,000 places by 1991. The number of children in mental handicap hospitals is now only 4,500—already below the White Paper target for 1991. No one can be complacent about the mentally sick and handicapped and the elderly. We must put more and more resources into the Cinderella services and do so with determination.
  Mr. Carter-Jones: I do not intend to be helpful to my right hon. Friend; I never am on these matters. However, nor do I wish to be helpful to the right hon. Member for Wanstead and Woodford (Mr. Jenkin). If there is a perinatal death rate in an area that is well above national average, we should not talk about not intervening and allowing local autonomy.
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  Surely we should do something when 4,000 babies die and 10,000 kids are born disabled. We cannot keep on saying that there should be local autonomy and allowing that to continue. Let us get our priorities right.
  Mr. Ennals: At this moment I am not going to make any new statement about the powers of local authorities. Nor will I go into the problems of establishing minimum standards which, I think, eventually will be a necessity. I recognise so clearly the problems that my hon. Friend has raised that in my statement on the allocation of £50 million I said that additional money would be devoted to capital projects in inner cities—on-the-spot accommodation for health visitors and special care units for new-born babies, and health education. All these things are designed to deal with the serious problem of perinatal mortality rates.
  Mr. Paul Hawkins: Although I agree with my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) that the Secretary of State cannot realise what is happening in every region, I know that he understands Norfolk's problems pretty well. Therefore, I want to ask him about the waiting lists and the serious extent of the lack of geriatric services in Norfolk. Will he tell us whether the amount we are to receive from the £50 million is £2,400,000 as stated recently in the Eastern Daily Press, or £1,700,000 as the Eastern Regional Health Authority told me the other day.
  Mr. Ennals: That second figure that the hon. Member gave was correct for the East Anglian Region. In the East Anglian Region Norfolk is an area of considerable deprivation, which has the largest growth rate. I am not saying that because I am a Member for a constituency in that area but because that is what the RAWP formula shows.
  In looking at the problems of the National Health Service we must get into proportion the major problems and the major achievements of the NHS. I want to touch on two aspects. We have increased the number of doctors, nurses and midwives in our hospitals. In the three years between 1973 and 1976 the number of doctors went up by more than

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  3,000 and the number of qualified nurses by 21,000.
  Our hospitals are treating more patients. During the same three years the numbers of in-patients and day patients rose to record levels. There are many achievements of which the country should be aware. The NHS is alive, active and battling with severe problems and coping.
  If the Conservatives should come to power the NHS, as we know it, might come to an end.
  Mrs. Lynda Chalker: Non-sense.
  Mr. Ennals: Unless the hon. Lady is denying what her right hon. Friend said about an insurance-based system, I am entitled to make my claim. The official spokesman on policy for the Conservatives, the right hon. Member for Leeds, North-East, said so as well, and if she is saying that that is a load of bunkum, I agree with her. Opposition spokesmen are going round the country making vague noises about further reorganising the structure of the NHS and the basis of its funding. This is disturbing for those who work in the Service and for patients.
  The right hon. Member for Leeds, North-East has great experience in these matters. He was responsible for the 1974 reorganisation, which his party recognises was a failure, and now he is bringing forward a new proposal. I suppose the Conservatives have seen the error of their ways and what they wish to destroy was something of their own creation. It is a callous case of infanticide. They brought the creature into the world and propose to kill it without even waiting for a trial.
  The Opposition have failed to give answers to four of my fundamental questions, and this will be noted. We shall ensure that it is noted. Some things are clear from what the right hon. Member for Wanstead and Woodford said. To put it at its lowest, the Conservative Party is considering major new charges in the Health Service, including charges for visiting one's GP and charges for being in hospital with, perhaps, other charges as well as increased prescription charges. They are preparing to cast aside the basis of the NHS which is a national service financed out of taxation.
  Mr. Patrick Jenkin: Absolute rubbish.
  Mr. Ennals: The Service at present is available to all on the basis of medical need.
  Mr. Patrick Jenkin: The right hon. Gentleman was kind enough about 20 minutes ago to welcome the commitment to the National Health Service that I gave on behalf of my party. He should tear up his peroration and say something sensible.
  Mr. Ennals: It is easy for the right hon. Gentleman to say in one sentence that he believes in the NHS and for him, his right hon. Friend the Member for Leeds, North-East and his other hon. Friends to spend the rest of their time putting forward proposals that would destroy the NHS and the basis on which it is constructed.
  If the right hon. Gentleman had been prepared to deny my allegations, the country would know where it stood. If the hon. Gentleman who is to wind up for the Opposition claims that what I am saying is a load of nonsense, he will have his chance to say exactly what the Conservative Party policy is. His right hon. Friend blatantly failed to do that.
  5.12 p.m.
  Mr. W. R. Rees-Davies: I thought that it was appropriate that the Secretary of State dropped his trendy peroration on the floor just before he finished. It was better that it rested there.
  The matters that I want to say a few brief words about arise from the fact that, strangely enough, one gets certain advantages when one becomes disabled. I derived certain advantages from the fact that I was knocked down on my way to the House when trying to attend for a three-line Whip. In the event, it would not have been very helpful to have reached the House, because we were soundly defeated on that occasion.
  Nevertheless, it is not until one is disabled that one sometimes sees the small ways in which disabled people can be helped. I pay tribute to the Minister with responsibility for the disabled who is dealing with the Access for the Disabled Week that is to be held in June. Schools and local authorities are participating, at the Government's instigation, to see what part they can play.

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  I was involved in a small film on this matter recently and I found myself in the middle of Margate in an area that had been specially designed for the disabled. There was an excellent ramp to help disabled people to get into the local authority buildings and it was a perfectly designed centre. The problem was that, in trying to get to the centre, I was bamboozled because there was no place where I could get on to the pavement in a wheelchair and, once on the pavement, when I tried to get down, I was left like a stranded whale in front of my constituents.
  A few changes to kerbstones, alterations to the entrances of hotels and boarding houses and a little more thought by those in charge of cinemas and places of entertainment would do a great deal to help access by disabled people. Pregnant women would also get on the bandwagon. There are many opportunities for improvements and much of the work can be done on an all-party basis.
  While I was in the Westminster Hospital, I saw the excellent work being done not only by the staff but by the volunteer helpers, some of whom turned out to be my friends. It is amazing how valuable their work is. They not only look after the books and sweets but help with the evening meals. They also provide a rather welcome change of face from the general staff, and it is entertaining to see them.
  I invite the Minister to make an appeal, through the hospitals and elsewhere, to encourage a considerable increase in this sort of voluntary help. It is in the best traditions of this country and could be very much improved. Many local authorities would find local people willing to help in that way.
  In addition, it is not the job, if it can be avoided, of trained nurses and sisters to serve meals in hospitals. This could be done by voluntary helpers and paid auxiliaries. In the Westminster Hospital we found at various times, particularly in February, that, through illness and other causes, there was an acute shortage of nursing staff. The more we can encourage the use of auxiliary staff, whether paid or voluntary, the better it will be.
  In East Kent and Thanet we have a grave problem with waiting lists. The
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  waiting time for ophthalmic treatment is more than 12 months and for orthopaedic work, including hip treatment and other expensive work, the delay is more than a year and, in some cases, two or three years. We badly need another operating theatre and additional services in the Royal Sea Bathing Hospital. We must try to encourage the recruitment of the necessary additional staff and find the money for that. The question is, where we save the money that is required.
  I take the point that my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph) may be partly responsible, with his colleagues and, indeed, all of us in the House, for not getting the structure right. We must now get it right and we must begin by ensuring that the NHS is more of a local service wherever possible. We must set up and encourage the expansion of the district health service and abolish the county services at an early date.
  The Kent County Health Authority is unnecessary. The region is necessary, but its task is communication and coordination. Let us keep the regions and districts and get rid of the county authorities. I am advised that this would save about £200 million.
  It is a great change that I am proposing. I believe that the administrative services are grossly overmanned, although many of the staff are competent and able. I am not criticising the quality of the staff. I am merely saying that there is too much duplication. For example, when we write a letter on an NHS matter it is necessary to send six copies. We write to the Minister and copies go to Sir John Donne, the Kent regional chairman, the Kent regional authority, the district, the specialist or doctor and the person who has raised the matter. It is an impossible situation. We must make big cuts in the whole area of administration.
  It seems that there is only one basically controversial difference between the two major parties. My right hon. and hon. Friends want to see the continuance and expansion of the private sector. We want to save money to spend on the public sector. That is our aim. If we can reduce dependence upon the NHS by payment and by setting up various different organisations, we shall be able to

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  do a great deal in that direction. I should like to see many public companies pay for the NHS by supporting a nursing home and their own staff. There should be encouragement wherever possible to increase the sum that has been obtained from patients overseas and to expand our service to make money in that sector, which could then be spent on the doctors, the services and all the other things that we need.
  There are many other matters that I could raise, but I end by saying that we should introduce financially careful local balance sheets in the local district councils and ensure thereby that we provide management incentive at that level and the best of value for money.
  I am indebted to you, Mr. Deputy Speaker, and to the House for having the opportunity of making this brief contribution. I hope that something will be done by the Secretary of State, especially as regards voluntary service.
  5.23 p.m.
  Mr. E. Fernyhough: I am sorry to see that the hon. and learned Member for Thanet, West (Mr. Rees-Davies) has a further disability. I am sure that we all wish him a speedy recovery from his latest handicap.
  Having been complimentary in that way, I must say that if Nye Bevan had heard the hon. and learned Gentleman's speech he would have been killed by it before his tragic death. I was in at the birth of the National Health Service. The Service was introduced by Nye Bevan to offer that in which I had been brought up to believe—namely, equality. It introduced equality in the one area in which there should never be any inequality. When it comes to health, the least of us is as important as the greatest of us. There should never be any question of inequality.
  I do not mind others buying larger houses, larger motor cars or having holidays abroad. I am not denying them those things. They can have all those things. But once we say that one man, one woman or one child has a right to jump the queue so as to receive medical treatment the more quickly—it might be that such a person is suffering from an identical illness or that the individual with the money is not suffering as much pain—we are departing from the morality
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  on which I was bred, born, reared and suckled.
  Over the many years that I have been in this place I have gone through some dreadful days and weeks. When some of my right hon. and hon. Friends in former Governments decided to stick an unnecessary needle into the Service, to impose some charge upon it, I felt that to be a personal attack. I felt that we were surrendering to the forces of greed. I have always felt deeply about these matters.
  We have always had a national health service. Such a service existed even before the present Health Service. After all, we have a national health service in the Army, Navy and Air Force. No one would ever pretend that any of our Service men—I would attack anyone who tried to say this—should not receive free of charge whatever they want in the way of medical, optical, surgical or dental treatment. None of us would ever think for a moment of questioning the right of every man in the Services to have such treatment. It would never he questioned that only the best is good enough. There would be no question of any inferior service. That is a wonderful principle and I want it extended universally to every man, woman and child so that there is never any question but that if a person needs treatment, he will get it immediately, even if he does not have any money.
  When the right hon. Member for Wan-stead and Woodford (Mr. Jenkin) said how he might be able to make more money available he talked about the provision of school milk for the children and said that we need not do that.. He spoke in the same way of school meals. How mean can we get? How low can we sink? These are the basic expressions of a civilised Christian society.
  Mr. Patrick Jenkin: It is a matter of priorities.
  Mr. Fernyhough: Of course it is, and we shall note the right hon. Gentleman's priorities within the next three weeks when, no doubt, he will be voting for further reductions in income tax. I can prove to him that repeatedly in my election addresses I have told the electorate that if it wants tax reductions, it should not vote for me. I cannot do what I want for Jarrow and its people on the basis of reduced taxation. I want a free Health

  715
  Service. I want it to be as efficient and as capable as possible. I want waiting lists reduced. I want everyone to have the speediest treatment possible. I am prepared to pay for that and I want everybody else to pay for that.
  It may be said that at my age that is a natural point of view. However, throughout my life I have been more afraid of being killed by cancer than by Communism. I have never lost any sleep as a result of worrying whether I might be killed by Communism, but I have had the occasional bad moment when the doctor has said to me "You are not up to the mark. You are smoking too much." When he has said that I have thought "It's the old cancer bug that is getting me". Some may say that in such circumstance it would be a self-inflicted wound and that I should not receive any treatment. All right, but I want those who need treatment for chest, heart or anything else to receive it.
  I am prepared to defend in my constituency whatever income tax measure may be necessary to give us the Service that Nye Bevan started to build. Whatever any Government in post-war years have done, no piece of social legislation is comparable with the National Health Service. I tell Opposition Members for their own benefit and advantage that, although there are many things that they may be willing to attack and to undermine, they will undermine their own standing with the ordinary people of this country if they tamper with and try to crucify the one thing of which the British people are most proud—their National Health Service.
  5.31 p.m.
  Mr. Geoffrey Johnson Smith: First, I should like to thank the Minister of State for so kindly, courteously and helpfully receiving a deputation which I led from East Grinstead concerning the lack of provision of geriatric services and the problems which face people in that area. I do not want to weary the House—I know that many hon. Members wish to speak—with a detailed exposition of the problems facing East Grinstead and which we explained to the Minister. East Grinstead is not the only area which suffers from a lack of proper care for the old, but it is a growing and serious problem.
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  I believe that it has something to do with administration. I think that East Grinstead—I promise not to be too local in what I say—suffers, as probably other areas do, not only from the top-heaviness of administration but from the multiplicity and confusion of it. East Grinstead is not the only place which is at the crossroads of different health authorities, but such a situation leads to great confusion in the minds of the elderly and those who have responsibility for administration.
  I welcome any steps which could lead to the simplification of the administration of the National Health Service. Reference has been made repeatedly to the fact that the Conservative Government had something to do with this problem. If it is as bad as it is supposed to have turned out to be, the responsibility is clear. We should do something about it. No doubt the Government are waiting, as is my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), for the Royal Commission to say something about administration. There is only one comment that I should like to make in passing. We should give some credit to the reorganisation which took place under my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph), because it brought together the three different parts of the Health Service under one roof. If that is the kindest thing to be said about it, it is worth it on those grounds.
  Another aspect arising out of the East Grinstead situation is financial. It is intolerable—more and more people throughout the country are beginning to realise this—that as the years go by we seem, at what I should call the point of consumer medicine—there are other aspects of medicine to which I shall turn later—to suffer from a lack of resources and a decline in standards.
  I respect what was said by the right hon. Member for Jarrow (Mr. Ferny-hough). He belongs to a generation which felt that this was the birth of a noble ideal. I share his idealism. What I have to say to him and to other Labour Members may make it appear that I have deserted the ideal—that I have come to preside over the obsequies of the death of the ideal. I know many people in the National Health Service who believe in that ideal

  717
  but who are equally committed to changing the structure of the NHS. They believe that unless we do change it, we shall see the complete destruction of that ideal.
  I do not want to bring my wife into this matter, but, if it is of any interest, she is a part-time doctor in the NHS. I understand the value of the work that she and her colleagues do. I give praise to all at every level in the National Health Service who practise a high standard of medicine in many quarters and give devoted and dedicated service which is second to none.
  Having said that, there is no reason why we should be complacent. I do not accuse anyone of complacency. I believe that Labour Members' political ideology runs away with them and blinds them to sad defects in the NHS.
  The quality of administration is bad, not because the people administering it are bad but because the administration is top heavy. There are too many administrators. We now have 100,000 more nurses than we had in 1965, but we have a shortage. That cannot be right. Too many are administrators.
  The ratio of doctors to administrators—I shall not weary the House with figures they are there for anyone to see—is appalling. It is deteriorating. The bureaucracy groans. It has something to do with the structure, not as my right hon. Friend the Member for Wanstead and Woodford pointed out, with the reorganisation of a few years ago.
  I should like to quote from a distinguished member of the medical profession whose comments I saw recently. He said:
  "The dangerous delays and utter frustration of such a system can perhaps be imagined, but not really appreciated by anyone who has not personally suffered it. And this top-heavy, overmanned administration has to cope with such vitally urgent problems as dissatisfied medical staff, militant trade unionists, insufficient funds, ageing facilities (70 per cent. of Britain's hospitals are pre-war and 50 per cent. of these are last century!) and a demanding public."
  That is the first point which arises out of what I see as a confusing situation in one tiny corner of Britain.
  I turn now to the financial aspects. It is an interesting fact that in 1978—many years after the end of the war and many years in which country after country
  718
  settled down to look at its social services—Britain is the only country in the Western world which has sought to finance its Health Service almost exclusively from taxation. That was part of the ideal to which the right hon. Member for Jarrow referred. Therefore, we can say, as has been said today, that at the point of delivery the Service is regarded as "free".
  I do not want to underestimate the contribution to the peace of mind of a patient, or any member of the public, that the knowledge that he does not have to pay can bring. It can bring a great deal of comfort, particularly to someone who suspects that he is about to enter into a catastrophic phase of his wellbeing which may result in long, protracted diagnostic procedures which could lead to a great deal of expense and some agony of mind. I recognise that that aspect of the NHS has removed much anxiety, but I should like to make some comments on it.
  I do not think that this free Health Service about which we talk should remove from the whole of our population—this has been the trend recently—the right for all, be they rich or of limited means, to pay through insurance—if they wish to make some sacrifice, as the majority of people with private insurance schemes do—for the provision of more comfort for themselves and the medical care of their choice. There is a difficult balance between equality and freedom of choice, and it is not resolved by slogans. I believe that there is room here for some freedom for both the medical profession and, indeed, the individual citizen. A society does no good to the noble ideal to which the right hon. Member for Jarrow referred if it denies that right to people. There is a balance here. I believe that it is unwise to weaken the will of the citizens to devote part of their resources to medical care. Unfortunately, that is what we are doing now.
  I said that no country had followed our example of setting up a basically "free" Health Service out of taxation. Perhaps that is because other countries suspect that no country in the world has been able or has the will to provide sufficient funds to ensure the maintenance of a comprehensive State medical service. But I can think of one such country—the Soviet Union.
  Mr. William Molloy: It does not.
  Mr. Johnson Smith: All right, it does not. I am told that it has a comprehensive State medical service. The Russians do not allow the private market to flourish in the drug industry on the pharmaceutical side or with regard to the individual patient. However, I suspect that no country is able to sustain a comprehensive State medical service.
  I believe that the countries to which I refer in the Western world are as caring as we are. They have an equally dedicated concept of the nobility of the medical profession and of the regard that we should have, as members of legislature, that people, regardless of their means, should have the very best possible medical care and attention that the nation can afford.
  I do not believe that we have any monopoly of moral care, yet it is interesting that so many of these countries spend more on health than we do. It used to be said that other countries spent more on health but that this did not necessarily indicate an increase in the quality of care. It was said that this was because it was more expensive in other countries and they were more commercially minded. That used to be argued about the United States. I doubt whether that argument can seriously be sustained now.
  If ours is the cheapest Health Service in the West, that perhaps has now less to do with our being more cost-effective than other countries and more to do with the fact that our standards are falling behind, our hospitals are more out of date, the staff are more badly paid and our waiting lists are too long. So it makes common sense and is furthering the ideal to which the right hon. Member for Jarrow referred to find supplementary methods of ensuring additional funds for the provision of health in this country.
  Mr. Molloy: Is the hon. Gentleman's philosophy that the only way in which ordinary people can obtain the finances for a Health Service is for the rich people to be ill? What happens then, as is happening now in Great Britain, is that many of those who have private medical treatment in our National Health Service hospitals cheat and do not pay.
  Mr. Johnson Smith: I do not want to get drawn into that sort of ridiculous statement.
  Mr. Molloy: Of course the hon. Gentleman does not.
  Mr. Johnson Smith: All I know is that with the phasing out of pay beds we are getting more and more polarisation of private and State medical care in this country, which is a reprehensible step, in my view.
  It is alleged now—we have to study this carefully—that other countries with less ambitious schemes than ours are beginning to produce better medical care. The Australians consider things carefully. They have a compulsory national insurance scheme, except that the very destitute are not expected to pay. They back their national insurance scheme by State subsidy as and where necessary.
  In France and in Canada, I understand, the public enjoy the status of private patients. That is a status that we regard as something to be enjoyed. It can give an independence of attitude to those concerned. In France a charge has to be paid by a patient on a visit to his doctor. For ordinary people no one would want a charge to be pitched so high that it becomes a deterrent, but it might well be argued that a nominal charge can help to prevent abuse.
  Mrs. Dunwoody: How much?
  Mr. Johnson Smith: I am not going into details. I am talking now about the ideal. It is not too difficult to devise a system in which there is a nominal charge, which helps to prevent abuse and encourages the private independence and individuality of the patient.
  I therefore welcome the fact that the Royal Commission is looking at all these problems. I think that it should. It would not be doing its job unless it did. This is—or I hope it will be—one of the best Royal Commissions that this country has appointed for many a long year. It is high time that we considered the problems which vex so many of us who want to see the opportunity for better medical care increased and improved.
  I do not believe that the areas that I have mentioned or those mentioned by my right hon. Friend strike fundamentally

  721
  at the basis of the National Health Service. I shall say why I think that is so. This is the problem that we have to face. We have moved away from a basically horse-and-buggy type of medicine in this country. The sort of medical care to which the Chancellor of the Exchequer referred involving kidney machines, the increased cost of modern diagnostic procedures, the capitalisation of medicine, the cost of expensive drug treatment and the transplants is that which people will increasingly demand. If it is assumed that the Health Service from taxation can meet people's needs in those areas as well as in the ordinary day-to-day areas, I believe that we shall see the death of a very noble ideal.
  5.46 p.m.
  Mr. Jack Ashley: It is always interesting to follow the hon. Member for East Grinstead (Mr. Johnson Smith) although he would not expect me to go along with many of his views. But those views were similar to those put forward by the Shadow Secretary of State. At least the hon. Member for East Grinstead was prepared to give way when he was interrupted. I am sorry that the Shadow Secretary of State cannot be present. He is very busy and I am not blaming him for that, but I was disturbed that he could not give way to interruptions from Labour Members. I am always willing to give way and I would hope that other Members are always willing to do so. My hon. Friend the Member for Ealing, North (Mr. Molloy) and I were very concerned that the right hon. Gentleman was not prepared to give way on a basic issue, which was that if we are to listen to Conservatives putting forward their views about the National Health Service they should spell out exactly how they are prepared to pay for the improvements that they propose. We welcome their suggestions. We are always glad to hear of improvements. But they must spell it out.
  We do not mind having a debate, but we object when Conservative Members put forward a policy and say "We are not prepared to give way to challenges" when asked to say exactly how much they are prepared to pay and what kind of a Health Service they are prepared to pay for.
  I am glad to see that the Minister of State is present. The last debate that
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  we had about the National Health Service concerned kidney machines and on that occasion no one was present from the Department of Health and Social Security on the Government Front Bench for part of the debate. I think that that was absolutely disgraceful. I hope that never again shall we have a debate on any aspect of the National Health Service during which Back Benchers are treated with contempt by the Department of Health and Social Security.
  I listened to the hon. and learned Member for Thanet, West (Mr. Rees-Davies) with great interest and great sympathy. It is very rare that I listen to him with sympathy because on every issue we are diametrically opposed, whether it is the law or whether it concerns the Home Secretary, the Prime Minister or whatever. However, I share his views that we should all try to pull together on the question of disablement. There is one point on which I would disagree with him. He said that there are advantages to being disabled. That is nonsense. There are no advantages to being disabled. They are all minuses. One loses in every way, whether one is blind, deaf, dumb or paralysed. Whatever disablement one might have, one has a profound handicap. There are no advantages. I therefore disagree with the hon. and learned Gentleman, even though I appreciate the spirit which motivated his remark.
  When we speak of the National Health Service and the way with which it deals with disabled people we are often far too preoccupied with physically disabled people. I have been guilty of precisely that error. We neglect the problems of mentally ill people and mentally handicapped people; such people live in the shadows of the National Health Service and the nation at large. I wish to beg forgiveness for my sins of omission, because I am as guilty as anyone of failing to appreciate the appalling problems of these people. I pay tribute to the Secretary of State, who has a fine personal record of working for MIND, and to his compassionate concern for mentally ill people and mentally handicapped people.
  I also wish to pay tribute to my hon. Friend the Member for Basildon (Mr. Moonman), who has been assiduous in fighting a lone battle in this House for these people. I know that he has been

  723
  supported by some hon. Members, but he has fought practically by himself for the mentally ill and mentally disabled. The message I wish to convey to my hon. Friend publicly is that the very small band that supports him will be enlarged. That group now has interested many Members who are at last becoming aware of the fantastic problems of the mentally ill and mentally disabled.
  It is true that the physically disabled have a degree of public sympathy and it is equally true that the mentally ill and mentally disabled have suffered a large degree of public indifference, or indeed derision. It is time that we ended that situation, but in order to end it we do not want only fine words from the Department. We have had some fine words and some action, but we want now to see a radical transformation in the place of the mentally ill and mentally handicapped in our society. We want to see the Department using its powers in this context and we want that to be backed by the full and enthusiastic efforts of the Treasury. Furthermore, we want the warm and wholehearted co-operation of the local authorities.
  I do not presume for a moment that we shall achieve that situation overnight, but the extent of the problem appals me when I examine it. Let me tell the House that one in eight women and one in 12 men will receive in-patient treatment for mental illness. I am appalled, especially when one recognises that that is additional to the 5 million men and women who annually seek tranquilisers or other drugs from their general practitioners. I understand that the Secretary of State has said that each year about 600,000 people receive specialist psychiatric help.
  I have examined the evidence given to the Royal Commission by MIND. It is a marvellous organisation and its work moves me deeply. To my astonishment the share for the mental health services out of the total capital and revenue programme for the National Health Service and the social services has dropped from 8·2 per cent. in 1970–71 to a figure of 7·8 in 1975. What moron is responsible for cutting expenditure when the problem is so large? Is it a Minister? Is it something that has been done by default? Is it a statistician who has gone out of
  724
  his mind or is it just a matter that has slipped through because some of us have been preoccupied with physically disabled people? I hope that the Minister will say whether this under-financing is something we are prepared to tolerate in health problems or whether there is to be a radical, instant and immediate reappraisal.
  I believe that a time in which 65 per cent. of our psychiatric hospitals were built before 1891 and in which 40 per cent. of all psychiatric hospitals are over 100 years old is not the right time to slash expenditure. We must bear in mind the fact that the most recent costings in respect of hospitals reveal gross discrepancies in expenditure between acute hospitals and psychiatric hospitals.
  The amount of expenditure on food, laundry, lighting and heat and on medical and nursing care is worse for the mentally ill and mentally disabled people. What a scandalous situation that shows. If one has a son or daughter who is mentally disabled, does one expect that son or daughter to be treated with derision and to be given less food, fewer clothes, less light because of being mentally disabled? That is a scandalous and outrageous situation. It is the Government's responsibility that they have allowed that kind of situation to happen.
  I have been campaigning for a long time for various groups of disabled people, but are these groups of mentally disabled people to be cast aside, especially after the so-called exposures of the Dick Crossman era? How long is it since Dick Crossman's exposé of this scandal? What has the House of Commons been doing since? I do not profess to know the answer, but I hope that when an answer is given to this debate, good reasons will be given to the House for allowing this situation to develop. A great number of words have been used when dealing with this subject. The question now is what sort of action we shall see from the Government.
  The Department has suggested that we should examine ways in which the Department can assume a more strategic role in ensuring that the policies for the care and treatment of the mentally ill are implemented at area level. It is always a problem. How can the Government, with the best will in the world, compel area regional or local authorities to do

  725
  what is necessary? I do not pretend to know, but I have one proposal to put to the Minister. I suggest that the Government should earmark funds categorically and say to the local authorities "Do not fiddle about. Do not start building bypasses with this money. Allocate it as a specific grant for mentally ill and disabled people". We have been pressing for a very long time for specific grants for physically disabled people. The time has now come when we have to insist that local, regional and area authorities are instructed on what should be done.
  I appreciate that joint funding has made a major contribution towards solving this problem. I want to congratulate my right hon. Friend the Secretary of State for Social Services and his colleagues on initiating joint funding and on pressing as strongly as they can on that score. But this commitment to earmarking funds by local authorities is of crucial importance and I hope that pressure will be brought to bear by the Government on local authorities.
  I have a good deal to say but I shall trim my remarks because I know that many other hon. Members wish to take part in the debate. I wish to say a few words not only about the mentally ill but about the mentally handicapped. I know that many hon. Members will have read a book entitled "Children Living in Long-stay Hospitals", by Maureen Oswin. It is a very moving book, indeed, and it makes one wonder how well we do our job in this House and how effective the Government are in dealing with these problems.
  Some of the facts outlined in this book are as follows: mentally handicapped children and adults are in an appalling situation. They are pushed away in hospitals when they should not be in hospitals. About 5,000 children under the age of 16 are in these hospitals. The hospitals are incapable of offering them substitutes for the parental or foster care which we should be providing for them. The numbers have fallen as a direct result of the fine efforts of the Department of Health but we are still in a serious situation.
  The problem can be resolved only if we get these children out of the hospitals into residential care where they can be given education and treatment within a
  726
  developing pattern of community based services.
  The Spastics Society is financing this wonderful study by Maureen Oswin. There can be no more articulate spokesman for the society than James Loring. Many hon. Members will have read his letter in The Times a few days ago. He said that we should ask the Government to make a mandatory provision for each local authority to provide that each mentally handicapped child within the normal range of provision should be able to live with his own family as soon as possible. He also said that by January 1982, at the latest, the local authority programme of alternative care should be completed. He said that no child should then be living in a hospital for the mentally handicapped, that children's wards would be closed and no child would be admitted to such hospitals.
  I find that James Loring is being too tolerant about this problem although I am prepared to be as tolerant as he if the Government are prepared to go along with his line.
  In order that hon. Members may understand the issues behind that letter, I shall give one quotation from Maureen Oswin's book. It comes from the cover of the book. If any hon. Member can listen to this without being appalled at the problem, very well. But it is something that should be pinned up in every hon. Member's room. It states:
  "A group of Committee members was visiting the mental handicap hospital. In the spastics' ward, six-year-old Shirley played with her tears, whirling her fingers disconsolately around in them as they puddled on the bare table in front of her. Her action epitomised a bleak existence. One of the visitors said 'These children are cabbages' and the others agreed with him, but perhaps it had not occurred to them to look at Shirley and consider that cabbages don't cry."
  The theme of any discussion about the mentally ill or mentally handicapped should be that "cabbages do not cry." Far too many of these children and adults are written off as cabbages. We are far too easily deterred by the parrot cry that they do not really understand, that they are cabbages and beyond human reason. This is a rubbish which we should never accept.
  I pay tribute to my hon. Friends who have been campaigning for the mentally ill and the mentally handicapped. Let me

  727
  assure the Government that, much as we appreciate what is being done for them, unless a radical reappraisal takes place, unless radical action is taken and more money is provided, the Government are due for a very rough ride indeed.
  6.5 p.m.
  Mr. David Crouch: If the mentally ill and the mentally handicapped now have a new champion in the hon. Member for Stoke-on-Trent, South (Mr. Ashley) they are in some small measure fortunate. I know that that is using the word "fortunate" in an exaggerated way and in a way in which the hon. Member would not wish it to be used, but there can be no greater champion of their distress and problems than he. We are grateful to him for the approach that he has adopted during his years in the House to those who are disabled. We admire enormously his courage in overcoming his own problem and facing the most difficult audience in the world, in this House. We admire him for fighting for what he believes in for so many people who are disabled. Now the mentally handicapped and mentally ill are to have his help, and they deserve our help also.
  I was glad to see my hon. and learned Friend the Member for Thanet, West (Mr. Rees-Davies) in the Chamber. We saw that he had to struggle in here today. He has never been afraid to fight his disabilities. He might have been dismembered again but he has never been "disvoiced". He spoke only briefly, but we enjoyed what he had to say, because he had something to contribute from an inside knowledge of the working of the Health Service.
  I have to declare two interests. I am a non-executive director of a pharmaceutical company. I am also involved in another organisation, which employs 74,000 people and which has an annual income of £352 million. I should have been there today attending a board meeting, but I chose to put the House of Commons first.
  That organisation, for which I have some responsibility, does not make a profit. It is the South East Thames Regional Hospital Authority. I give more time each month to that authority than I do to the other interest that I declared this afternoon. I was appointed to that
  728
  authority by the patronage of a friend—my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph). I was kept on by the friendship, patronage—call it what one will—of the right hon. Member for Blackburn (Mrs. Castle) and the present Secretary of State.
  I regard it as an honour to do a small service in the Health Service. I am very proud if it. It is a fearsome responsibility. It is a responsibility which every hon. Member points to every time we consider the Health Service at Question Time or in debate. That £352 million for which I am in a small way statutorily responsible is a fearsome and worrying responsibility. In the South East Thames Region we have been short of cash for many years, but in the last two years the situation has become much worse. We have been subject to criticism in the House from colleagues, particularly those from my own county of Kent, for the failure of the region to be more generous towards Kent.
  This year in the South East Thames Region, income will rise by only 0·3 per cent. We need between 1 per cent. and 1·5 per cent. to remain as we are. These figures include compensation for inflation, and I have deducted that. The Region, income will rise by only 0·3 per South East Thames Region covers a quarter of London and two counties—Kent and East Sussex. The population of Kent and East Sussex is rising, and the population of London is declining. We have been charged by the Secretary of State with the responsibility of redistributing funds accordingly.
  Kent has asked for another £22 million, and we have just allocated it £3·3 million. The process of equalisation will have to continue for a number of years and Kent will need about another £40 million in the next 10 years. Where is the money to come from? It will not come from the Secretary of State or, as I believe, from his successor on the Conservative Front Bench.
  Health is suffering because our economy is sick. In the same way, education is suffering. Teachers cannot get jobs, and teacher training colleges are being closed down. That is the sort of thing that is happening in the social services in the brave new world that we say we live in. Our social provision in Britain is being curtailed. Where is the money to come from in my South East Thames Region?

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  It is to come from London. London is thought to be too well provided for. Many hon. Members will dispute that—[HON. MEMBERS: "Hear, hear."]—and rightly so. Yet there is a case for maintaining the degree of excellence of our capital city in medicine if for no other reason than that it is here and in our other great cities that we have established a worldwide reputation in medicine and health care.
  Our great teaching hospitals have to be sustained. I am thinking of Guys, St. Thomas's, over the river, and King's College Hospital. We have a statutory responsibility to maintain the medical universities, and so it is right that a cry should go up from inner London, notwithstanding the population decline, or that it might get provision beyond that of other areas, bearing in mind that in London and the other big metropolitan areas there reside the great teaching hospitals of which we are so proud.

  We are having to tell London that we have been over-generous in the past and that now it must take a cut. That is the economic truth. We must say that there are areas where the people are less well provided for and that there is nothing we can do about it—London will have to like it or lump it.
  The Minister of State, Department of Health and Social Security (Mr. Roland Moyle): I do not seek to deny the general thesis that the hon. Gentleman is advocating, but it is the Government's firm intention that nothing will be done to reduce the teaching hospitals' output of doctors for the future. We must maintain that.
  Mr. Crouch: I accept that from the Minister of State. He is quite right to have made that proper correction of the emphasis that I am giving. I am not seeking to over-emphasise the problem. I hear the cry from London Members representing those areas that are concerned about the cuts, just as the Minister of State hears it.
  The result of these cuts will be a reduction in services to the sick, not in the production of graduates from the teaching hospitals. But wards will be closed and the number of beds will be reduced. That is what it is like these days in the Health Service.
  730
  I do not want to dwell just on the problems of my region and I shall therefore stop being parochial. The many troubles in the health business today are nation-wide. I could so easily make a call this evening for more money for Kent, particularly for my constituents, and I should no doubt be thanked for that. That would not help to solve the national problem, however.
  In the present crisis it has become fashionable to turn on the Health Service and say that it is failing the nation. I do not join in that chorus. Perhaps I should be more radical, or perhaps more reactionary. Perhaps we should be considering a change in our delivery of health care and the prevention of sickness. There is no doubt that we need more money, but the Government cannot afford it. They are broke and in the hands of the receiver. Perhaps we should be looking for additional ways of attracting money into the Health Service. I would favour such an examination, because we must explore all avenues.
  I believe in the principle of more self-reliance as an addition to the State provision, but I do not want another major upheaval in the Health Service. I was glad to hear my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) say that this afternoon. Such an upheaval could be catastrophic at this stage. The ice is pretty thin and we must move with care and responsibility in any changes. We must also, however, have courage, because something must be done to enable health provision to match the demands of the people.
  What are those demands? As our standard of living has increased in recent years, so has our demand for social provision. Better incomes lead to demands for better schools, more universities, and so on. Similarly, there has been an increase in demand for more and better health services. I agree that the health provision stock that was inherited 30 years ago was not up to date, but we have not done enough in those 30 years to replace it.
  Another question arises whether we are using our resources wisely, economically, and scientifically. I say that we are not. We are tending to use the hospitals, particularly the out-patient departments, too much. Perhaps once again in the history of health care in this country there is

  731
  happening what happened in the latter part of the last century, when there was too much referral from the GPs to the hospitals and consultants. In many cases a second opinion could be gained from another GP working in the practice, in the health centre or in the group practice. Dr. Finlay could ask Dr. Cameron for his opinion, perhaps, rather than refer the patient to the hospital where health provision is much more expensive, and where the queues can form.
  I agree with the Secretary of State, who said recently that we should encourage people to consult their local pharmacist in the case of minor ailments. That is a practice which the medical profession has always encouraged, up to a point. The history of the health profession is that the pharmacists were assisted by the medical profession from hospitals such as Barts and the Royal Free—I am going back 100 years. Pharmacists have always been ready to accept this responsibility and we could rely on them to advise a medical consultation if that seemed necessary. There is nothing wrong in that. If everyone went to hospital or to the doctor for every trivial disorder, the Health Service would be overwhelmed.
  Consideration of the way in which we use our resources—not just money—would not be complete without a reflection on the nature and the definition of ill health itself. If that were narrowed down, the provision of medical care could be allocated more scientifically as I have suggested. The problem today is that in the NHS we are concerned primarily with ill health, while the problem of social medicine is insufficiently regarded.
  If we were more concerned to keep people healthy and in a position to ensure that the body could perform its functions we should be going a long way to redefining what is meant by ill health. We should also be doing something that is fundamental to the Health Service—moving the centre of gravity and allocating to the GP a much bigger responsibility in health care. We should be reducing at a stroke the demand on the more expensive health services of the hospital and the consultant. We should be putting the GP into a closer relationship with his patient.
  That would entail a greater responsibility from the GP and a better understanding
  732
  and trust from the patient. Such a move could gather momentum and cause the development in our society of a greater awareness of the advantages of preventing ill health and avoiding disability. Such a reallocation of resources, quite distinct from shifting money from one area to another, might do more to revive the NHS than anything else.
  This week's edition of the British Medical Journal contains some very interesting thoughts on this problem. It points out that even in the United States, where expenditure on health care is half as much again as it is in Britain, they are facing a medical care crisis. There is now a considerable public subsidy of the national health bill in the United States through Medicare and Medicaid and through generous tax exemptions, with the result that there is little restraint on the use of the most expensive health services. There is no incentive to doctors or hospitals to cut costs, which has produced a multiplication of expensive and under-utilised specialised facilities and services.
  The British Medical Journal says that the problem in the United States is
  "how to improve medical care without at the same time giving the health-care providers an open cheque on public funds."
  That is not bad, coming from the British Medical Journal. But is goes on further to say:
  "The medical profession"—
  in Britain—
  "has a special responsibility for helping to find a solution for this problem. … The price of professional freedom is clinical self-restraint."
  I close on this thought. I believe in the NHS and I want it to succeed. I want to do nothing that would weaken or reduce the service that it provides for everyone. I am immensely impressed by what I have seen of the delivery of service on the shop floor, as it were, where health care is delivered to the patient. I am immensely impressed by the GP in the health centres and by the approach to their work of everyone in the hospitals—ambulance men, ancillary workers, radiographers, and so on. When I say that they are dedicated, I mean it. But we should not trade on their dedication to their profession. It is remarkable how good their morale is, often in very difficult, frustrating and depressing conditions.

  733
  We need new hospitals with wards of six beds and not 32. This week I was in Liverpool, at the great new Royal Liverpool Hospital. I was immensely impressed by this hospital of 850 beds. It is a magnificent complex. It is a credit to those who have put their abilities into its design and construction—albeit that as a member of the Public Accounts Committee I was looking into its excessive cost. But that is over and done with. The fact is that that hospital is designed to meet conditions today, and the biggest ward that we saw had six beds in it. I thought that it was a well designed hospital, and I wish it well.
  As I say, we need more of these hospitals, and hospitals with plenty of modern bathrooms and lavatories, because those are extremely important to patients' morale. We need hospitals with efficient central heating, and, where possible, air conditioning. But we shall not get them by shooting now at the NHS or at the administrators. Costs get out of hand, in Liverpool as anywhere else, when administration and costs management are not good, and one needs an element of extremely able administrators and controllers to ensure that one works within one's budget.
  We are, of course, entitled to take a pot-shot at the Secretary of State and the Minister of State from time to time. However, as has been said already, we in Britain must recognise that we have got ourselves into a mess economically, and we are paying some price for it. That is the Government's fault. We have to accept certain restraints on Government expenditure, even in essential areas, but there are limits. We must not neglect the sick and the disabled. We must cut the waiting lists and remove the agony from so many people's lives.
  It is the duty of the Government to produce the service and make it work. They should remember that it is the patient that matters. The problem is not so much what to do with the NHS, the RHAs, the AHAs and the DMTs; the problem is the health of the community that the NHS seeks to serve. I believe that the time has come to send for the doctor.
  Mr. Moyle: The hon. Gentleman said that there was a very modest growth rate of ⅓ per cent. for the South East Thames Regional Health Authority. He
  734
  might like to know that it has been slightly increased, and is now ¾ per cent.
  6.26 p.m.
  Mr. David Penhaligon: One advantage of being a Liberal Member is that one lands up being the party's spokesman on several subjects—in my case, about four. Therefore, one finds oneself attending rather a lot of debates on subjects that have no connection whatsoever. I have got to know the hon. Members who deal with health, the hon. Members who deal with energy, the hon. Members who deal with employment, and the hon. Members who deal with transport. Therefore, I am able to reflect more, perhaps, than some hon. Members on who won the debate between the Government and the Opposition on a particular day. Today, there is no doubt that the Government won, and quite handsomely. They also won on not a very good record. However, they won the argument overwhelmingly.
  One of the aspects that has been discussed in various ways today is just what we in Britain should do about private medicine. I believe that both sides of the House, from their various points of view, are exaggerating either the dangers or the advantages that might be created by it. For example, even if there were no control of it whatsoever, I do not believe that private medicine would ever make a really significant contribution to health care in Britain. I cannot imagine a private hospital in my part of the country—it is the same in other areas—seriously dealing with the problems of geriatrics. That is what really costs money—when someone is in hospital for three, four, six or nine months with some sort of ailment. I cannot see any real contribution ever being made to solving that problem of geriatrics.
  The hon. Member for Stoke-on-Trent, South (Mr. Ashley) mentioned mental health. I have never heard of private treatment for mental health. That is yet another example of something that costs an enormous sum of money.
  I believe that the Conservative Opposition are fooling themselves if they believe that an extension of a separate private system—which I would not discourage—will solve the problem.
  Mr. Michael Morris: The hon. Gentleman said that

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  he has never heard of private provision for mental health. I should like to invite him to my constituency, which has one of the very best hospitals, St. Andrew's Hospital. It is one of the largest in the country, and it is totally provided for out of private funds.
  Mr. Penhaligon: I am delighted to hear of it. I do not know what percentage of the total number of people in mental hospitals is provided for under that system, but certainly I am encouraged to know that that exists, and I may well accept the hon. Member's invitation, although I am not quite sure how far his constituency is from London. I suspect that the percentage is very small indeed.
  I can illustrate one problem that exists in the constituencies of all hon. Members. At Christmas and, perhaps, at other times of the year, we all make our visits to various old folks' homes. One of the standard pieces of conversation goes as follows: "Mr. Penhaligon, I have been to see the doctor. Mr. Penhaligon, the man says that I should have a new plastic hip. Mr. Penhaligon, can you get it done for me?" If we are honest, most of us know that the answer, most of the time, is "No." What real contribution will private medicine make to the solution of that problem?
  One-third of our pensioners—this is art absolute scandal—are on supplementary benefit. We all know that probably another third are not more than a little better off than those at the supplementary benefit level. Just what contribution will private medicine make to people who are 70 years of age and have this sort of difficulty?
  Mrs. Dunwoody: Has not the hon. Gentleman taken on board one simple fact? Insurance schemes that support private medicine always specifically exclude from the sort of medicine that they get from the National Health Service anyone old, chronically sick or really in need.
  Mr. Penhaligon: I would not argue with that.
  Mr. Michael Morris: It is not true.
  Mr. Penhaligon: The schemes that I have been offered certainly exclude those categories.
  736
  It is obvious that the Conservatives are considering imposing a charge to visit one's local GP.
  Dr. Gerard Vaughan: Absolute rubbish.
  Mr. Penhaligon: The Minister challenged the Opposition about eight times in his speech and no one denied that they were considering it. It is obvious that it is being considered. The rhetoric is that we must charge a fee which prevents abuse but does not discourage use. There is no such fee, and this House is fooling itself if it believes that there is.
  There are many people in my constituency, some of whom I have known for many years, who are no doubt a pain in the neck to doctors with their frequent visits, but if they had to pay a small fee each time, they would still go. There are others whom I try to persuade to go to the doctor. I do not know what is wrong with them, but they do not look very well to me, as an ordinary individual. They will not go. They say, "I do not want to bother him." No fee can manage those two objectives.
  Hon. Members may laugh, but if they have not met people with similar views they are not talking to those whom they represent.
  There has also been discussion of pay beds. I voted against the Health Services Act to phase out pay beds because I thought that the whole issue should have been given to the Royal Commission. No doubt I shall be corrected if I am wrong—
  Mr. Timothy Raison: You will be.
  Mr. Penhaligon:—but I believe that the Government have closed hardly any pay beds which were actually used. In those parts of the country that I have studied, those which have been closed were not used, anyway. To pretend that to reverse that legislation will bring a great inflow of cash to the NHS is just not true, and it is not fair of the Opposition to pretend that it is.
  If we held a referendum on what public expenditure should be increased, the NHS would win overwhelmingly. It is the one subject on which no one says that we should spend less.
  Mr. A. J. Beith: I am not sure that no one says it.
  Mr. Penhaligon: Even the Opposition say that they would not spend less. The right hon. Member for Wanstead and Woodford (Mr. Jenkin) said that of course they would not spend more. In effect he congratulated the Secretary of State—rare for an Opposition spokesman—on having got the spending just right. There is only one answer, and that is to spend more on the NHS. There are 600,000 people on waiting lists-1 per cent. of the population. We are kidding ourselves if we think that we can make those lists disappear totally, but 600,000 is too many.
  I was disappointed that the Secretary of State did not mention some of the current disputes in the NHS. We need an explanation of the dispute involving the pharmacists and chemists, who have asked to go to arbitration. After reading their submissions, I find their request reasonable. I should like to know why the Government have rejected it.
  I was amazed that nothing was said about dentists. Some hon. Members might think this funny, but a few weeks ago a lady on supplementary benefit who was talking to me in my surgery in a mumbling way reached into her pocket for a handkerchief and at the same time pulled out her dentures. She said "I have been trying for a month to get these repaired and have not been able to do so." Being on supplementary benefit, she could find no one in my constituency to repair her dentures. Dentists say that they lose money on that sort of work and they will not do it. That is an appalling scandal. I managed to ring a dentist whom I know who eventually did that job for my constituent. This dispute is severe in some areas, and the Government should have said something about it.
  How valid is the dentists' complaint that, for some basic forms of treatment, like the removal of a tooth, they have received increases of as little as 3 per cent. or 4 per cent. over the last three years? Can the Minister tell us what increases they have had for one or two common forms of treatment? They might have a good case, but I am amazed that the matter was not mentioned by the Secretary of State.
  Everyone has asked everyone else to condemn industrial action. No one has
  738
  failed to condemn it. I believe that industrial action in the NHS will get steadily worse over the next decade. The tragedy is that in about 1973, because of the niggardly attitude towards nurses' pay, large sectors of the NHS became unionised overnight. The militancy bred then and the success that it brought has caused a fundamental change of mind among those in the National Health Service. They now know that if they want to make a point they have to cause trouble.
  During my first 12 months as an MP, the junior doctors went through the same process. They knew that if they were militant, people would take notice. We must find a better solution to these problems. But even if we do, I suspect that this sort of industrial action in our hospitals will rise steadily. It is part of the disease of modern Western society, and that is that.
  Mr. Molloy: Does the hon. Gentleman believe that we should spend more money on the NHS to meet the threats which we both recognise, or that we should make more cuts in income tax?
  Mr. Penhaligon: I believe that we should impose a payroll tax, which could largely achieve both objects at the same time.
  The Under-Secretary will not be terribly surprised if I turn now to some of the problems that I know so well in my county of Cornwall. I do not know how many times I have brought them up, but here we go again.
  Cornwall has a winter population of 400,000 and, I am told, 3½ million visitors a year. If each of them stays a week, as I understand is the average, that is equivalent, in terms of Cornwall occupation weeks, to an extra population of 70,000. Obviously, if someone has an accident, a heart attack, or some other disaster on holiday—it is amazing how a change of environment on holiday can lead to sudden health problems—he should have treatment, and the only hospitals in which he can have treatment are those in Cornwall.
  That is accepted, but it has long been a matter for anguish in my county that we do not get any allocation of funds to deal with that. For at least the fourth time I ask the Government to instigate a major inquiry into that allegation. It

  739
  is not unique to Cornwall—it relates to other areas which have substantial numbers of visitors—so the inquiry should be broadly based.
  Many people in my area would be greatly relieved to know that an investigation was to take place—preferably, it should not take long—and that this problem would be recognised and evaluated for what it is, or for what it is not. The facts should be examined. We should first have the facts, as opposed to the rumours, which is all that we can deal with now.
  The other matter that is relevant to Cornwall—but Cornwall is not unique in this respect—is that of equal health care throughout the United Kingdom. Some time ago I asked, by way of a parliamentary Question, how much money was spent on nurses per 1,000 population in my county and in the rest of England. I was told that for Cornwall the figure is £18,200 and for the rest of England it is £24,100. That is a massive difference. Whether it is greater in my county than anywhere else in the country, I do not know. I shall ask a further Question to obtain the figures for elsewhere.
  When will the great day arrive when we receive equal treatment, at the present rate of equalising expenditure throughout the country? According to those figures, another 33 per cent. should be spent on nurses in Cornwall merely to bring us up to the average for the United Kingdom, but those of us who have done a little mathematics know that if we bring Cornwall up it will push the average up, so that we shall still be behind. We shall need more than an additional one-third in Cornwall to bring every area to the same sort of level. That is the trouble with averages.
  I do not know how the Conservative Party will ever deal with this problem in Cornwall, the North of England, or wherever it exists—
  Mr. Hoyle: The North-West.
  Mr. Penhaligon:—if, at the same time, it says that it will not increase expenditure on the Health Service.
  I think that the right hon. Member for Wanstead and Woodford said that we must bring standards up to a common
  740
  level, not bring some down. That will make a lovely quotation. But it is a nonsense. It does not square the circle. It is time the Conservative Party clearly recognised that.
  The simple fact is that once again the people who are paying most for our failure to run our economy sensibly are a disadvantaged section of our community. The Health Service deals with one of those sections of the disadvantaged who vary at different times. One goes into ill health and comes out again. I had pneumonia last year. I suppose that for a period I was disadvantaged.
  It is a direct penalty that the unemployed, the disabled and, in this case, the sick are being asked to pay. There is nothing more important in this country than to get our basic economy running in a reasonable manner. That is why I totally defend what my party has done in the past 12 months, because I believe that we are nearer to that basic object than we were. I am not saying that we have got the economy right, by any means, but progress has been made. Until we get the economy right, solving this deep and fundamental problem is a pipe dream.
  With any improvement in the economy, and even within the present economy, there is a good and substantial argument for spending any extra money that we can find on the National Health Service, even to the extent of money that was put in the Budget to be spent on education. I honestly believe that the arguments are far more pressing within the Health Service than within education.
  My son, who is 5 years old, lives in the village in which I have lived for many years, in my constituency. He attends a primary school that is 139 years old—a very old primary school, indeed. But I tell the people who live in my village that, given the choice of doing something about my local hospital or building a new primary school in Chacewater—and making such decisions is what politics is all about—I would spend it on doing something about our local hospital. In reality, that is what this debate is all about.
  6.44 p.m.
  Mr. Lewis Carter-Jones: In this country 4,000 babies die unnecessarily every year and 10,000 are born with a handicap that they should not have.

  741
  I have no doubt that the Hansard reporters have written this down time and time again, but I must say to my hon. Friend the Under-Secretary of State for Health and Social Security, who is on the Front Bench, "This is a matter you can do something about." I am not asking for anything substantial. I am merely saying "If you use the best medical practice known, we could, without a great deal of additional cost, save ourselves substantial sums of money."
  I want to talk about two items in the National Health Service—prevention and rehabilitation—which have been neglected. From time to time hon. Members on both sides of the House have raised the matter with my right hon. Friend the Secretary of State. The latest statistic I have, which is the only additional one I shall give, is one which means that of 3,363 children born in Wolverhampton in 1976, 50 died unnecessarily and 125 were born with handicaps which could have been prevented.
  The "in" term in government these days is "self-financing productivity deals". I tell my hon. Friend, "If you go for good perinatal care, it will finance itself and you will make money on it." I hope that my hon. Friend will not think that I want no money. I want a lot more money, but I am telling him one way in which he can save substantial sums.
  The right hon. Member for Wanstead and Woodford (Mr. Jenkin), who opened the debate, said that he wanted local autonomy. I think that we all want it, but I shall not go along with him if one area has a perinatal death rate of 19·6 and a good area has a rate of less than 14. We are presiding over death and disability unless we tackle that matter.
  The rules of the House prevented me from bringing into the Chamber the documents that I wanted to bring. I wanted a portmanteau to bring in all the documents produced by my hon. Friend's Department since 1945 on the prevention of perinatal death and disability. They all say the same thing. No matter which report is produced, no matter how thick it is, it will contain a summary. In all those reports the last two pages summarising their findings say the same thing, that too many babies die and too many children are born with a disability which is preventable.
  742
  I do not think that one should merely issue paper. There comes a time when one must act, because one has clearly identified that in certain areas death and disability are being caused by lack of interest and lack of activity by the area health authority.
  If anyone wants me to give a figure for prevention, I shall. I think that £10 million would buy it. What is £10 million? It is peanuts in terms of what we are spending.
  How do I arrive at my figure of 4,000 children dying unnecessarily and 10,000 being handicapped unnecessarily? It is simple. It is done by comparing the perinatal mortality rate of Sweden with ours. One ends up with 4,000 deaths and 10,000 disabilities every year. I say in a non-partisan way that those of us on both sides of the House who go to surgeries know precisely what is involved.
  The loving, caring mother will say "I will look after this baby." She does so. She lavishes love upon the child. But we all know that 20 years later that same woman will be sitting in one of our surgeries, having worn herself out caring for that child, with not much longer to live, asking who will sustain the child. She will want to know what happens when she has gone. Such problems must rest with this House.
  The Secretary of State would be upset if I did not attack him. If he uses the appropriate muscle he can make sure that such problems are solved. He has one disadvantage. The Treasury has not yet seen sense. Yesterday I saw a film, in which I participated, called "Priority of Priorities". It was given that title, not because of anything that we did but because in 1966 the French Treasury asked itself "How do we save money? How do we prevent disaster and suffering?" It decided to go for good perinatal care. As a result, much suffering and hardship have been avoided. Incredibly, substantial sums of money have been saved. The best is often the enemy of the good.
  The second area in which I should like my hon. Friend to spend some money concerns rehabilitation. We in this House hide behind paper excuses. They are no substitute for action. We have had no end of reports, from the Court Report down, on perinatal care. The same thing is true of rehabilitation. I believe that as

  743
  parliamentarians we hide behind these reports. We are cowards. When a report tells us what we ought to do, we should do it and not beat about the bush. Court has told us what to do with children. Tunbridge and Mair have told us exactly what we should do for the disabled who need rehabilitating. What have we done? We have buried these reports. They are gathering dust on the shelves.
  There is a method of rehabilitating all kinds of people. In industry people survive medically, following accidents, to be tucked away and forgotten. That is immoral. As a result of motor accidents people are paralysed but, because we have the medical knowledge, they survive tucked away for 30 or more years. Why cannot they come back into our society? Nothing new is required: simply the will to implement what is known.
  We have heard people talk about the elderly and the fact that a growing proportion of people are living until the ages of 70, 80, or 90. There is absolutely no reason why we cannot rehabilitate the elderly. It has been done in such places as Ladywell. I have seen it done for the severely handicapped by people such as Dr. Philip Nichols of Oxford, and across the water by people such as Geoffrey Spencer. This has involved the most severely handicapped people. Let us get our values right. We should spend more. We could spend it more effectively if we supported perinatal care and good rehabilitation.
  6.54 p.m.
  Mr. John Stanley: It is a pleasure to follow the hon. Member for Eccles (Mr. Carter-Jones). whose speech I am sure was appreciated on all sides of the House. I wish to address my remarks to the problem of the distribution of resources, a topic touched on by other hon. Members. I make no apologies for dealing with this subject. It is a fitting reflection on the parlous state of the National Health Service in the county of Kent that two of my hon. Friends representing parts of the county have taken part in the debate so far. I hope that that remark in no way prejudices the prospects of my hon. Friend the Member for Folkestone and Hythe (Mr. Costain), who is also in his place.
  744
  The Secretary of State referred to the Government's policy of continuing the process of producing a greater measure of equality of treatment between the various geographical parts of the country. I fully endorse that. There is a fundamental point involved here and, while I believe the right hon. Gentleman accepts it, we have yet to see action taken in my constituency. The disparities between regions are, to some extent, severe but they are at least equalled, if not exceeded, by the disparities within the regions. As my hon. Friend the Member for Canterbury (Mr. Crouch) has said, we have the most serious problem in the South-East Thames Region affecting the county of Kent.
  There is a marked contrast between a falling population in London and a dramatically expanding population in the Home Counties on the periphery of London. I realise that London Members feel that this is no reason for there to be any reduction in the standard of service in London. Over the county of Kent we are caught in a serious "nutcracker" situation involving a rapidly rising population and resources which in no way match that increase. Over the county as a whole we are £27 million below our RAWP target and we have almost 20,000 people on our waiting lists.
  I see that, of the 90 area health authorities, there are only two others with a greater number on the waiting lists. One is Birmingham and the other is Lancashire. In Kent we have a poor ratio of beds to population. To lend perspective to my point about contrasts within regions, I would point out that the ratio of beds to population in Kent is lower than the average for the whole of the North-West Region, the Mersey Region, the Northern Region and the Yorkshire Region. That must be taken into account in deciding on the distribution of resources.
  I realise that this may smack of special pleading but I believe that we in Mid-Kent are in a special position. Within the county we have a critical position developing in the Maidstone health district. In that area there is an exploding population as a result of its designation as an area for growth within the South-East strategic plan. In a parliamentary answer yesterday the Secretary of State

  745
  gave me the figures for population growth in the Maidstone Health District. In 1971 it was 175,000 and in 1976, 189,000. The forecast for 1981 is 196,000 and for 1986, 208,000. We are facing a population explosion involving 33,000 people within a 15-year period. When we set that against the fact that the Maidstone Health District is further behind its RAWP target than any other district in the county, we can see the size of the problem.
  I can bring home the reality of the kind of pressure being created in this part of Kent by referring to some of the letters I have received from those working in the NHS in my constituency. We have often heard it said that, although there is a very serious increase in the length of time it takes to get treatment if one is not an emergency case, those who need treatment on emergency grounds can get it very quickly indeed. But I do not believe that even that is now necessarily the case in our area. A doctor wrote to me a week ago about a cancer patient. He said,
  "One of my patients (man aged 35) had to wait from 11th January to 27th January to be admitted for treatment of this disease despite being on the most urgent waiting list".
  As we know, with that disease, literally days can matter.
  The situation is also affecting the children. Another doctor wrote to me concerning a child needing a hernia operation. He said,
  "A typical child (aged 4) on my list has a right inguinal hernia, which is a large one. He is still waiting for operation, having been referred on 29th January 1976."
  That is a four-year-old baby.
  I have another letter from a doctor referring to orthopaedic treatment. He said,
  "This girl aged 15 suffers her knee locking, and then falls in the street without warning. I have just referred her. She will be seen in 15–28 weeks, and have an operation in 4 years from then unless she is categorised as urgent when the operation will be 3 months. Thus, she has a minimum delay of 6½ months."
  Again, as other hon. Members have said, the elderly are also affected acutely by the pressure of the waiting lists. I refer to the case of a husband and wife. She is waiting for a hip operation, and another doctor has written to me as follows:
  "She has now been waiting one year and the Surgeon can give no idea how much longer
  746
  she will have to wait—possibly another two years.
  Her husband is also on a surgical waiting list to have his prostate removed, and it is likely he, too, will have to wait two years, during which time he will probably develop acute retention, and require urgent hospital admission.
  Both are retired, and I just wonder whether either of them will live long enough to have their operations."
  So it is evident that, in this area of designated and rapidly expanding population, we are facing acute pressures on our health services. I accept fully what the right hon. Gentleman said—that there is no need for alarmist talk about the NHS breaking down; but I believe that at particular points of pressure we have nearly got to that situation. I must remind the right hon. Gentleman of the pressures that those in the NHS, particularly those meeting the patients most regularly and closely, come under as a result of the enormous strain of trying to cope with a growing population with such demands on limited sources—pressure from relatives, pressure from patients in particular.
  I refer to what another doctor said to me about the sort of pressure that he comes under from his patients and the relatives in these conditions of such enormous strain on our resources in the Maidstone health district. He said:
  "I have had distressed patients, distressed relatives telephoning me and abusing me about the situation and the shortages.

  "Not only are the patients suffering stoically, their relatives are distressed and my workload is increased some two or three times above that which is necessary, due to my having to constantly badger the hospitals on my patients' behalf."

  I offer three proposals to the right hon. Gentleman in this situation. First, will he do all he can to examine the way in which he is constructing his formula for the allocation of funds as between the regions, and in particular ensure that the highest possible priority is given to the population factor in determining how such funds should be allocated between regions?
  Secondly, will the right hon. Gentleman ensure that clear instructions are given to the regional health authorities themselves that, when they in turn make their allocations to the areas, they give the highest priority to the population factor? It seems to me to be fundamnetal

  747
  that, when trying to establish a fair distribution, the basic number of patients must be the first and foremost criterion to follow in establishing how money can be distributed fairly.
  Thirdly, will the right hon. Gentleman ensure—this is not a criticism of him, because the situation has gone on for many years under successive Governments—that there is far better co-ordination between his Department and the Department of the Environment when major planning applications are under consideration? I shall illustrate this point, because it applies everywhere in the country and many other hon. Members will have found themselves in this position.
  In the last few months, the Secretary of State for the Environment has made a decision to release another large area of land in my constituency on which 1,000 houses will be built. At the public inquiry, a large number of representations was made against the development on ground of the inadequacy of the existing hospital facilities. The inspector, Mr. Adshead, in his report to the Department of the Environment—and I assume that he was simply following existing policy in that Department—in commenting on the argument that the development should not go ahead because of inadequate hospital facilities said:
  "Any difficulties caused by deficiencies in the medical or other similar services … appear to me to be a matter for the appropriate authorities and should not be regarded as a reason for not allocating any more land for housing."
  If we are talking about overall planning, it is absurd that we do not build into our planning and planning judgments the key question of the provision of hospital and health facilities for the people for whom the houses are proposed. It is fundamental that the Department of Health and Social Security should get into the planning process.
  In the application I am referring to—at Leybourne—the Ministry of Agriculture gave evidence against the development but the Department of Health and Social Security, no doubt following existing practice—gave none. It is very important that the DHSS should express a view, which may be in conflict with the Department of the Environment in
  748
  some of these cases. It is entirely valid that if the DHSS feels that the existing provision of hospital facilities is not sufficient to support a development, that is a major argument why the development should not take place.
  I fully appreciate the pressures on the Secretary of State, that he has to work within his existing resources, and that it is not likely that they can be increased. But I urge on him that he should look very closely at the distribution of existing resources so that in the areas with acute population growth the allocation of health resources reflects the need to provide for that increasing population.
  7.8 p.m.
  Mr. Eric Moorman: I begin by referring to the problem faced by the Opposition in this debate, as we have heard it outlined already and as we shall probably hear it repeated later this evening. It stems from what is perhaps a paradox which is reflected in many of their policies. On the one hand, they chastise the Government for not doing enough in the social services and, on the other hand, they wish to see cuts in public expenditure. I make this point at once because later I wish to be somewhat more critical of the Government's decision-making in the NHS than of the Opposition as reflected in the speech by the right hon. Member for Wanstead and Woodford (Mr. Jenkin).
  It seems to me that if the Opposition were rather more wily than appears to the case and, further, if they were genuine in their belief that there is need for improvement in the health services, there is no reason why they should not beat us in telling the nation that they want more spent on the NHS and not less.
  We were not bored with listening to one Kent Conservative Member after another, but we were surprised that so many Members from Kent wished to speak and were successful in catching your eye, Mr. Deputy Speaker. We listened with interest to the statements that were made by them. No doubt if my colleagues from Essex had wished to deal specifically with the problems of our county, we should all have been able to give some tragic examples showing that there is a need not for contraction but for expansion of the Service.

  749
  The problem for the Opposition, as I see it, is to decide, when planning their alternative financial structure for this county, how to come to terms with the fact that there is such a widespread demand for a greater and improved National Health Service. If they are talking about the way in which the money is spent and decision-making in the NHS, that is another question.
  I listened very carefully to what was said by Conservative Members—no doubt we shall hear others as well—and to the points made by the representative of the Liberal Party. There was emphasis on the need for a greater degree of improved services to people, and on the need to shorten the hospital queues—in other words, to give people more rather than less. I doubt whether the Opposition will be able to square the circle, but they will establish credibility with this nation only if they can show that in arguing for an improved Service it means, inevitably, a greater degree of public expenditure. But that is their problem, and I leave it with them.
  Mr. Geoffrey Johnson Smith: I am sure that the hon. Gentleman would acquit me of any charge of demanding more money from the taxpayer, but does he not agree that we must look very carefully at additional or supplemental methods of health financing of the sort used in other countries? Our present structure actually suppresses the demand for health services. That is the awful consequence.
  Mr. Moonman: It might well be that the very action of looking for alternative measures of supporting the Health Service in the way that the hon. Gentleman suggests would have the effect of depressing the existing National Health Service. The point has been made by a number of hon. Members—including the representative of the Liberal Party—that many of the people in the greatest need of health services are not people who would be able to afford the fees of the private companies associated with health care.
  I am sorry that my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) is not here. He said some kind things about the work of the all-party parliamentary mental health committee, and myself. I am sure that the members of the committee welcome the interest
  750
  in this matter which he expressed in the debate. We know that he is a great champion of the needs of the handicapped.
  I turn now to the way in which the Government are handling the administration of the National Health Service. I was surprised not to hear anything from the Secretary of State about the report, published only a week or two ago, of the Parliamentary Commissioner, which indicated that the Department of Health and Social Security had more complaints against it than any other Government Department. This is probably only the tip of the iceberg, but it reflects the deep concern that is felt about the way in which decisions are made by those administering the Health Service.
  Mr. Ennals: What the ombudsman said was that my Department, which covers both health and social security, had the largest number of complaints. But it must be remembered that in terms of social security we are supplying benefits to about 18 million people at any given time. That is quite apart from the very large number of people who are dependent on the Health Service. In view of these very wide responsibilities, touching so many members of the population, it would be extraordinary if the Department did not have the largest number of complaints. In fact, the complaints are from only a minute proportion of the people who receive the services.
  Mr. Moorman: I agree that the size of the Department and the widespread nature of its services may be factors to be taken into account; nevertheless, the complaints should be a genuine matter of concern.
  I monitor the work of the Department of Health and Social Security, and the comments that I make are offered in a spirit of the greatest support and admiration for my right hon. Friend. We have worked very closely together in mental health matters. But, in all innocence, I ask my right hon. Friend: who is running the National Health Service? On a number of occasions recently I have been told by Ministers from the Department of Health and Society Security, in regard to the different issues that I have raised with them, that when it comes to the crunch I cannot count on their support

  751
  and that these matters must be resolved by the regional health authority.
  I shall give two examples, both of which have aroused considerable public and parliamentary concern. The first relates to Friern Hospital in North London. Information came to the parliamentary mental health committee which suggested that conditions in that hospital for the mentally sick left much to be desired. There were allegations of the rough handling of patients and the forcible confinement of voluntary patients. The matter was investigated and a report was produced. Despite what I believe to be considerable public interest in this type of report, it was not published.
  There was a leak in a national newspaper, but that is by the way. As members of the all-party committee, we were not able to receive a copy of the report. The committee, of which I am chairman, expressed concern about this secret report. Some of us went to the hospital and talked to the people concerned. We felt that the report ought to be published.
  When I raised the matter with my right hon. Friend the Secretary of State—I am sure that he will confirm this—we had a very helpful discussion. He did all that he could, but he had to end by saying that it was up to me to persuade the chairman of the regional health authority to publish the document, that this would be the only way. I think that is a fair reflection of what was said.
  I do not believe that a senior Minister should have to leave to the discretion of a regional health authority the decision whether a critical report is published. I could have understood it if it had been an in-house report or an internal management document. Had that been the case, I would not have challenged it. Obviously, there must be a degree of operational work which must remain within the confines and the concern of the people who are implementing the Service. But there was considerable public interest in the matter to which I have referred, and the fact that it leaked into the national Press gave another dimension to our concern.
  This is not a matter of the day-to-day running of the Health Service; it is a matter of public policy. Regional health authorities usually consist of the same self-perpetuating oligarchies as were on
  752
  the old hospital boards, on which Labour representation is very low, and consumer representation is often nil. This gave us little confidence in their willingness to reveal the weaknesses in the services which are theoretically under their control. The Secretary of State should have power to step in and take the necessary action to allay public suspicion about cover-ups and whitewashing. This should not need spelling out, least of all to a Labour Government pledged to reduce secrecy in official matters.
  Mr. Patrick Jenkin: Did the hon. Gentleman take note—as I did, with great interest—of what was almost an aside in the Secretary of State's speech, when he said that he thought that he would have to establish certain minimum standards and have some kind of inspectorate? Does the hon. Gentleman support that view? It seems to me that that would be a most important and valuable development in achieving exactly the objective which he is seeking.
  Mr. Moonman: I take the right hon. Gentleman's point entirely. I believe that on both sides of the House we accept the importance of the National Health Service. I do not think that at this late stage anyone needs to justify its importance. Let us take that as read. What we are trying to do at this stage is to go into rather more detail than is possible on other occasions—certainly it is not possible at Question Time—and to look at some of the fundamental questions that concern us. My concern is with the decision-making aspects within the NHS.
  Mr. Ennals: I am grateful to my hon. Friend for giving way. If he raises detailed points, he must expect that I shall want to respond to them. He referred to a report on Friern Hospital—a report that was produced by a regional team. It was not a report for which I had any responsibility. I did not say—in what my hon. Friend rightly described as a helpful interview—that I would wish to see that report published. I told my hon. Friend that I thought that it was an irresponsible and tendentious report, which gave no evidence of any of the allegations contained within it, and that it would serve no purpose, in the interests of Friern Hospital or those concerned about psychiatric hospitals generally, that an appalling report such as this should

  753
  be given credence by the Secretary of State's asking that it should be published. I put it on record that my interpretation of the conversation is quite different from that of my hon. Friend.
  Mr. Moonman: I am glad that the Secretary of State has intervened. He is quite wrong and has misunderstood what I said. Hansard will show what I said, when it is published. I did not say that he felt the report should be published. I made no comment about that. I said that it was a helpful interview and that the Secretary of State said that I had to convince the regional health authority chairman. I said very little about the contents of that meeting, because I regard much of what took place as confidential. I repeat that what we were told was that if we could convince the regional health authority chairman that the report should be published, that was fine. He certainly condemned the way in which some of the items were discussed in the report.
  I had no intention of detailing this problem; I wanted to raise it as one of the problems of decision-making. If the Secretary of State is now saying that this is a tendentious report, it reflects on the manner of inquiries and the conduct of a regional health authority. Therefore, he will not be too surprised if some of us feel that we have too many levels of organisation. It would be appropriate if the Secretary of State could give Back Benchers some encouragement occasionally on how we weighed some changes in the organisational structure. It is not without faults. At some point a review must be made—I am not in favour of another major reorganisation—but one of the problems of the Friern Hospital case was that the regional health authority was in some degree in conflict with the area health authority. We all know where that put the hospital.
  The second example is that of the Royal Liverpool Teaching Hospital. The hon. Member for Canterbury (Mr. Crouch) said that the Public Accounts Committee had been there again this week and that he was impressed with the hospital and its concept. But, of course, we have a report on this hospital. The PAC last year expressed concern about the fact that the costings of the hospital had escalated. At the end of the day it was costing five times the original estimate. That original estimate was just about
  754
  enough to bring the fire precautions, apparently overlooked in the original design, up to current standards.
  Following the all-too-brief debate on this subject and some 60 other matters on which the PAC reported, I argued that the Department of Health was not tackling its management responsibilities adequately. The Minister of State wrote me a rather critical letter. I hope that we do not have a further disagreement about this. He took me to task for having said that the Department of Health had awarded a new contract to Bovis Limited, whereas in fact
  "the Mersey Regional Health Authority awarded the contract (with our full approval) and the Department is neither named in it nor legally a party to it."
  The Minister went on to say:
  "To be fair I should add that, as far as the Liverpool Teaching Hospital was concerned, the distinction between the Department's role and the Health Authority's role was less clear cut before 1974 than it is now."
  What I find alarming is that the Minister considers that the more clear cut distinction that now exists is an improvement. Surely the Department of Health has learned something from its mistakes over Liverpool, for example that the placing of responsibility for major teaching hospital projects on the shoulders of inexperienced boards of governors is obviously dangerous. While it is true that the new regional health authorities have specialist advisory staffs, they cannot build up the managerial experience in hospital building that the DHSS could. This is simply because each region is apparently not involved in a sufficient number of projects to enable it to build up such experience. Yet it is the regions that will design hospital projects, place the contracts, and supervise the building.
  My examination of this type of decision-making in the Health Service throws up many problems. Perhaps the Government are unable to tackle them in the way that some of us would like. It shows which problems relate to matters that should be decided centrally and which should be delegated. It is a continuing complaint of the nationalised industries, which I do not always accept, that the Government are always intervening in their day-to-day running. In the Health Service matters that are delegated should be kept under central control. But the point has been reached at which morale inside the

  755
  Health Service is so low amongst the medical staff, management and auxiliaries that the Service is failing to achieve its fundamental purpose—the care of the sick.
  It is not enough simply to pay lip service to Aneurin Bevan's memory, and pass the buck. Nye's dream was a great one, but if the National Health Service must not rest on its laurels, reality will become even more nightmarish for those caught up in its toils. The attempt to cure its maladies by reorganisation has made matters worse, involving everyone in a bureaucratic tangle because there is no longer any clear chain of responsibility.
  I suspect—it may only be a suspicion—that many of the individual problems, complaints and concerns that have been expressed on both sides of the House as reflections of constituents' complaints, are not necessarily due to the amount of specific budget allocations. They are caused by the way in which the Service is interpreted and the way in which advice is given at area and regional levels. They are caused by the way in which correspondence is handled and the way in which people fail to get a decision quickly enough.
  Of course everyone will argue for more money. I am talking about making money work—through good management and organisation. In this area, industrial relations also play a part. Looking at the National Health Service as a management entity, knowing the problems that lie ahead, one sees that the chances of industrial relations being anything like reasonable over the next five or six years are illusory. The management structure of the NHS simply will not be able to cope with some of the acute problems. It has not been able to deal with them in the past year, and God knows it will not be able to deal with them over the next few years.
  I believe that people working in the system find that they have to go through two tiers in order to get a decision. One consultant told me that this meant that it now took two years to get a piece of vital equipment instead of two or three months. Medical staff have found themselves involved in industrial relations negotiations with non-medical staff. Not only is this not their job, and not only has the time spent in such negotiating
  756
  been lost from doctoring; medical staff are not particularly well qualified for it, and some of the resultant clashes have led to industrial action in which the only losers were the patients. That is what matters. I believe that management failure in the National Health Service leads to failure in relation to patients. We have to devise a formula and a system, and I think that this is an area that must be given serious consideration.
  We need to consider seriously how far the moneys that have recently been allocated and distributed will go, and to what extent certain sectors of the country can be given greater support. I am bound to say that I would be more impressed if we could have, after the money, a reassurance from the Secretary of State that he was instituting a critical analysis of the way in which moneys were to be used and, more important, that he would be satisfied that the money would not be lost in terms of adding additional support for the autocratic structures that we have created in the National Health Service.
  Mr. Ennals: When I announced the ways in which the £50 million extra was to be spent I made perfectly clear not only how it would be spent but that I would ask for reports from the authorities by the end of June about the way in which it had been spent, so that I could report back again. I made it clear that I would monitor this expenditure. My hon. Friend may not have been in the House at the time, but he should not make these allegations against me without having made inquiries in advance.
  Mr. Moonman: My right hon. Friend must not be so hostile. I am not making allegations against him. We are all entitled to make much stronger points than have been made so far in this generally low-key debate. However, if my right hon. Friend wanted to put that important statement on the record, I appreciate that and I am glad that he did. By the same token he must realise that we must also monitor and assess his actions—his ability to deliver. This is not something between the parties. This is something that every Member wants.
  NHS money must be used in an effective way. This will be difficult to monitor in fact, and we shall be subjected to pressure from constituents. Having said that

  757
  he will monitor this, the Secretary of State should give some time and thought to the way in which the Service is run within the structures.
  If the Secretary of State thinks that monitoring means, in such a critical service, that he will continue to instruct hon. Members to refer key decisions to the regional boards, he will find growing criticism from this House; sadly, it means no more than passing the buck from one level of authority, and that surely is not worthy of a Secretary of State's responsibility for the NHS.
  Several hon. Members rose—
  Mr. Deputy Speaker (Sir Myer Galpern): Order. Assuming that the winding-up speeches will begin at 9 o'clock we have one and a half hours left in which to try to accommodate the 16 hon. Members who are still anxious to take part in the debate. My appeal to the House is for some effort at brevity, so that we may do the best we can for those who have been sitting patiently throughout the whole debate.
  7.30 p.m.
  Mr. Neil Macfarlane: I shall do my best to follow your instructions, Mr. Deputy Speaker. It is always a pleasure to follow the hon. Member for Basildon (Mr. Moonman) and I echo all he said in the latter part of his speech. It would be interesting to a number of my hon. Friends to be present at the next meeting between the hon. Member and the Secretary of State, because I should like to hear the rest of their argument being developed.
  I shall ignore the generalities that I wanted to make about the National Health Service and confine myself to a number of constituency points that highlight much of what has already been said by hon. Members on both sides of the House. I wish to draw the attention of the Minister to two or three important matters affecting the London Borough of Sutton, which is part of Surrey and part of the Merton, Wandsworth and Sutton area health authority.
  First, however, at the risk of striking a note of discord with my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), I must say that the reorganisation of hospitals and the NHS in the early 1970s needs drastic reconsideration. My constituents would
  758
  need a lot of convincing that the reorganisation had benefited them.
  The creation of the St. Helier super district general hospital in my constituency has created a number of difficulties in an area of London where there are many elderly people. The hospital is located on the edge of the borough boundary and access is not easy. The problem has become more acute because this hospital, having developed as a centre of excellence in a variety of ways, has tended to denude of funds the old community hospitals elsewhere in the constituency.
  In the past four years, junior medical staff with, not unnaturally, an eye to their future, have looked at this type of large unit as an ideal means of furthering their training. The diagnosis equipment is sophisticated and of the latest design and the facilities are good, ranging from coronary care through physio-care and the entire medical care range. It is all at this big district general hospital. The same applies to the nursing staff who need to get training in this type of large unit. Technicians, radiographers and physiotherapists are in the same category. They all tend to gravitate to this type of hospital centre and the effect on the hospitals further down the line does not need development by me.
  Following the creation of this large St. Helier Hospital, which has 547 beds, only five of which are private—there used to be 14 private beds—it is still touch and go whether it is able to meet its commitments to the community. There is enormous pressure on a worthy staff, not only medical, but nursing and administrative and the most worrying aspect was summed up recently in a newspaper report in the Sutton and Cheam Herald under the headline
  "Beds crisis—plea for help."
  The story said:
  "Local hospital officials have made an urgent plea to the Area Health Authority to ease what is now becoming a 'crisis' pressure on bed space at St. Helier Hospital.
  The plea comes after five years of gradual increase in the number of patients without an increase in the number of beds.
  Instead, the number of beds has been dwindling because of alteration work and staff shortages.
  Mr. Richard Springall, secretary of the 547 bed hospital, said 'Last week for half a day we had a crisis situation of having no beds

  759
  available for any male patient who might have had to be admitted as an emergency.
  'What we want are more beds. We have a 30-bed ward which is closed awaiting upgrading—we need it now.'."
  The article goes on in the same vein, but in deference to other hon. Members who are waiting to speak, I shall not quote more of it.
  Sutton is an outer London area where there is an ageing population. There is no let-up even in the summer and I fear that some patients may be discharged prematurely—not so as to endanger life, but they will lose a comfortable post-medical recuperation period. This early discharge creates other pressures on locai GPs, home helps and visiting nurses.
  On this question of the ageing population, the Government must begin planning now. I was encouraged to hear the Secretary of State refer to the plan that I understand is to come out later this year dealing with the problems of geriatric and psychiatric cases. The problems within the next decade in the cities will be massive. These twin problems will cause a great deal of difficulty and extending resources will create all sorts of problems whatever party is in power.
  If hon. Members doubt what I say, I suggest that they spend a day or two in the next recess, as I did, a summer or so ago, with the local meals-on-wheels service. I was horrified with what I found when I was delivering meals in an area in my constituency. I had no idea of the number of potential elderly geriatric cases living alone and dependent upon the service. A detailed assessment of this problem is essential.

  I turn to the Royal Marsden Hospital which, as I said in a debate earlier this year, is the leading cancer hospital and cancer research unit in the United Kingdom. I understand that on a recent visit the Secretary of State was as impressed as my wife and I have been on our visits there in the past three years.
  The reputation of the hospital is of the highest order, but, as the Minister knows, there is a question mark over its future role within the framework of our health organisation. At present, it is funded directly by the Department of Health and the research institute is financed by the Medical Research Council and the Can-
  760
  cer Research Campaign but, because of its specialised work, I make the plea for this hospital to be permitted to stay out of the local health service structure. I do not criticise the area health authority. Its resources are good. It is stretched, but it is doing what it can. However, the Royal Marsden is unique and it must be permitted to stay, in effect, as its own health authority. I hope that the Minister can say something about that because I understand that the five-year exemption expires in the spring of 1979 and the many people who work in this hospital and the community itself would like to be given some idea in the Minister's speech of future proposals.
  A look at the other hospitals in my constituency reflects the problem faced by all hon. Members. At the Sutton General Hospital there is, in community terms, a most difficult situation. I believe that it would be far better deployed as the district general hospital. Its location is better than the St. Helier Hospital in every way, but while it has 200 or so beds and handles a range of general medical care—ear, nose and throat, a children's ward, general surgery, a geriatric ward and a psychiatric ward—it has had to close its casualty ward within the last 18 months. This happened at a time when a GLC overspill estate was developed just 500 yards away, bringing with it 3,000 or 4,000 people into the area. Recently we had the absurdity of an elderly patient at the hospital falling and breaking a limb and having to be taken to the St. Helier Hospital live miles away. It is a great pity and quite absurd that this has to happen.
  Alas, the Sutton General has no pathology lab so everything has to be referred to the St. Helier Hospital and this results in delays and time being wasted. I suggest that the Minister should find time to visit the hospital because I and many people in the area would welcome a visit.
  Sutton General, with the wide range of services to which I have referred, has to wait very much as a back-up hospital upon the St. Helier Hospital and this creates a classic example of the shortage of resources to which my right hon. Friend the Member for Wanstead and Woodford referred earlier. The Secretary of State is not in the Chamber at the moment, but I hope that other Ministers

  761
  will pass on the invitation to visit the hospital.
  Before I conclude, I ask the Minister of State what he intends to do to help area health authorities overcome the expenses that they incurred during the national firemen's strike. I can do no more than read a letter that I received two or three days ago from the chairman of the Sutton and West Merton Community Health Council. It sums up the problem. The letter states:
  "members were informed that the potential cost to the Merton, Sutton & Wandsworth Area Health Authority … of payments to staff who undertook additional night duty to act as fire patrols during the national firemen's strike was approximately £16,500, and grave concern was expressed that this sum had to be financed from the National Health Service resources and from the area's budget."
  In the fullness of time I shall send copies of that correspondence to the Secretary of State. It highlights further potential deprivations to patients and a substantial burden on our already hard-pressed National Health Service resources. What can the Minister do to help in that respect?
  Generally speaking, we in Sutton are well served by the full range of dedicated workers in all aspects of hospital life. However, the morale of staff is low everywhere. The reputation of the Department is not high. The hon. Gentleman should not dismiss the concern that I and others express. I urge him to fulfil his thrice cancelled visit to the St. Helier Hospital. If he undertakes it, he will be able to assess for himself the many problems that are facing a large unit in outer London.
  If the Secretary of State fails to recognise the problems of low pay, a standstill in some hospitals of gradings and the shortage of staff—the charge of complacency has been levelled against him on previous occasions and I think it is an accurate one—he may well, alas, have the dubious distinction of being the Secretary of State who, unhappily, presided over the disintegration and collapse of the Health Service. I hope that that does not happen.
  7.43 p.m.
  Mr. William Molloy: It is fair to say that those of us who have a deep interest in the National Health Service would not mind if we had a debate of this nature for an entire week.
  762
  However, we are now reaching a position of selecting what to leave out of our speeches, which is most distressing.
  There were a number of matters that I wanted to raise in the debate—for example, the family practitioner service, health centres, equipment in the NHS, hospital services, dental services, the various forms of health council administration manpower resources, the supply and manufacture of pharmaceuticals and the role of the representative staff organisations. Those are only a few of the matters on which I wished to speak.
  I am apprehensive whether those facets of the NHS will be improved, because in the current situation they do not bring any happiness either in their administration or in the contribution that they are making to the Service. It is even more agonising that no blame can be attached to any one of them. Therefore, it has to be faced that Parliament has a responsibility. I have to acknowledge that we are spending, despite what some Members have said to the contrary, more money on the Service than ever before. It has to be acknowledged that the health and personal services of Great Britain are costing us £7,000 million a year. That means that merely paying out more money does not guarantee that we shall get a better Service.
  We all know that there are many people in our constituencies who are proud of the Service when they need it and when it serves them well. They are proud of it and, quite rightly, they reveal a Dr. Jekyll attitude. However, when they face the bill they display a Mr. Hyde attitude. Some of the speeches from the Opposition Benches seem to reveal a Mr. Hyde attitude Mark I and a Mr. Hyde attitude Mark II.
  I have a constituency matter that I wish to draw to the attention of my hon. Friend the Minister of State. He is aware that it is my judgment and the judgment of many who have been involved in the issue that the building of Ealing Hospital is one of the most fantastic disgraces in the history of the Service. That is not a nice thing for any Member of Parliament to have to say about the private enterprise contractor, the trade unions and everybody involved in the building of the hospital, work which started about eight and a half years ago. It was scheduled to be finished in

  763
  four years and with a bit of luck it might be opened this year.
  That is serious enough. My hon. Friend knows full well that I have narrowly missed having an Adjournment debate on the matter. At the time that I tried to raise it a piece of prices and consumer legislation was passing through the House. As hon. Members on both sides of the Chamber will understand, I lost an Adjournment debate. However, to the credit of my hon. Friend, I must add that he allowed me to set out in a somewhat lengthy letter what I would have said in the Adjournment debate He is aware of the situation. I hope that he will undertake an examination.
  I press the matter because of a disgraceful handout by the publicity men of the regional health authority in announcing some form of opening for the hospital. It is said quite blandly that it has taken twice as long as was expected and that it will probably cost millions more than was estimated but that it is nobody's fault. It is said that it is not the fault of the contractor as events have taken place beyond his control. If it is not the responsibility of the regional health authority, if it is not the responsibility of the contractor and if it is not the fault of the local people, what has happened?
  I urge my hon. Friend to take on board an examination of the incredible story of Ealing Hospital. I accept that nothing can be done to shorten the incredible time that has been taken to build the hospital. I raise the matter on the Floor of the House in the sincere hope that something will be learnt from a full-scale examination and inquiry into the hospital so that nothing of the sort will happen again. The Service has probably lost millions of pounds that it need not have lost.
  It is time, too, that we acknowledged that there is the possibility of grave industrial unrest in the Service at all levels. There have been extremely good industrial relations in all parts of the Service. That is because organisations such as the Confederation of Health Service Employees spend as much time advocating improvements for the Service and the patients who need it as they do for their own members' remuneration and other aspects of their employment. The Whitley system has served the Service
  764
  well, thanks to the unions and the employers.
  There have been difficult and dangerous moments, especially when the cuts started to take effect. There could have been not so much a wages explosion within the Service as a Service explosion, with no one wanting to go on any more. It is to the credit of my right hon. Friend the Secretary of State, who laboured so hard and diligently, that he was able to get many of those on the Whitley staff side to recognise his point of view and not to take some of the action that in many instances they would have been right to take. A great deal of credit is to be shared by the general secretaries of the unions and the ever-ready attitude of my right hon. Friend to meet them and hold discussions.
  I have an interest that I declare. From time to time I advise the Confederation of Health Service Employees. It is a trade union of the Health Service. As I have said, CoHSE—I think that that is a beautiful name—is campaigning for improvements in the Service on behalf of the general public and not for personal gain. It wishes to ensure that its members can work in a better service. It is pursuing that policy not so that its members may have a better time but to ensure that they make their contribution in a better and more efficient Service. Therefore, when it speaks, it speaks with the voice of knowledge and of experience.
  I hope that my right hon. Friend understands that much of what it is putting to him is not a wage or pension claim but a desire to work in a Service which gives a high standard of care to the people who have to take advantage of it—the patients.
  I should like to make one recommendation to my right hon. Friend—that he be prepared to read the evidence that CoHSE has given to the Royal Commission.
  Mr. Ennals: I have.
  Mr. Molloy: Then I hope to see it reflected in future legislation.
  There is one other matter which is vital to all London Members. The community health service in London is in grave difficulties for a number of reasons, but one in particular. Will my right hon. Friend look at the problems facing the

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  community health service, because they are not coterminous with the London boroughs? It would help if that could be done.
  The duties set out in the 1946 Act on the promotion of a comprehensive Health Service are as valid and objective today as they were then. I believe that the nurses, doctors, specialists, those who look after the mentally ill, the NHS trade unions and all the people of this country want it.
  Let us not be hypocritical about this matter. If, when we have a great debate about our National Health Service in the House of Commons, we say "It is a wonderful principle; we must improve it; but unfortunately, now and then, we must cut public expenditure", the sick and the maimed will not give us any thanks. We shall be looked upon as hypocrites if we say that. Therefore, I hope that there will be real unity in the House towards the uplifting and sustaining of this great institution—the National Health Service. Those who work in it and those who receive its benefits want it. I believe that the people of this country want it. I hope, therefore, that Parliament will respond.
  Several Hon. Members rose—
  Mr. Deputy Speaker: Order. I propose to remind each hon. Member, before he is called, of the desire and need for brevity. Mr. George Thompson.
  7.53 p.m.
  Mr. George Thompson: I shall do my best to heed your admonition, Mr. Deputy Speaker.
  I should like to record my personal commitment and that of the Scottish National Party to the National Health Service.
  The Secretary of State posed a question. I do not write shorthand, but I think that I got the gist of it. He asked: is there to be one service for the rich and another for the poor? The answer, in my opinion, clearly is that that is not the way forward at all. We must go forward with a Health Service which caters for the whole population and which is financed for the most part from taxation.
  I congratulate the Secretary of State on unmasking the Tory Party's intentions with regard to financing the Service by increasing charges and perhaps by charg-
  766
  ing for free services. We shall certainly await what the Tories have to tell us about that aspect after the Royal Commission has reported.
  I welcome the £50 million allocated to the NHS in the Budget. I assume that about £5 million of it will come to Scotland, and I welcome that. But I regret that the Government have not set up a special fund for using revenue from North Sea oil in ways which could be identified. I think that people would have reacted well to the imaginative use of a fund for doing things such as replacing the very old hospital buildings which are still with us. I should add that my area has been remarkably lucky in obtaining new hospitals, but that does not apply throughout Scotland.
  Will any of the extra 400 kidney machines which have been promised be coming to Scotland? There was a dispute some time ago whether there was a shortage of such machines in Scotland.
  I should now like to refer to geriatric services. I welcome the discussion document and the White Paper which is to come. The Minister did not tell us whether these documents would cover Scotland or whether his right hon. Friend would be instituting a special discussion document and White Paper for Scotland.
  One problem in my constituency is the relationship betwen old folks' homes which come under the social work departments of regional councils and geriatric units in hospitals which come under the health boards. It would seem reasonable to place both institutions together and let them share services, but there is difficulty in running them because people naturally like to have their own service to themselves.
  I should like to touch on immediate care schemes. Galloway has an excellent scheme in the West Galloway accident service. We are well aware of the number of road accidents in the area. After all, like the hon. Member for Truro (Mr. Penhaligon), I am aware of the influx of holidaymakers to my constituency in the summer and of the difficulties that we have on our particularly bad A75. Some constituents in the remoter parts of my constituency have raised with me from time to time the possibility of helicopter service. We are well aware of the num-areas as well as in the Islands. I think that matter should be looked into.

  767
  I should like to raise again the matter of detoxification centres for alcoholics. If more of these centres were set up, I am sure that we could cut the rate of alcoholism in Scotland, to the great benefit of the general population and to the reduction in the numbers of inhabitants of our prisons.
  A further point arises on rural areas. Will the Government bear in mind the effect of bus fare increases on the frequency of hospital visiting. It may not matter much for adults, although they are helped by hospital visits by relatives, but children seem to suffer.
  I should like to make two points on the Scotland Bill which is now making its way in a sensible manner through another place. I am glad that the Minister of State is present, because he will be as aware as I am of the difficulties that were occasioned in Scotland by reports in the Press about the implementation of the Briggs Report. It seems that Briggs attended carefully to the EEC implications of the rearrangement of the nursing professions but he could not have foreseen devolution. It does not seem to make sense to devolve with one hand and then to centralise with the other. What pressures are being exercised by EEC bodies on the organisation of the health care professions within the United Kingdom?
  I should like to see the Health Service's professional bodies in Scotland—the trade unions and so on—being actively and dynamically committed to devolution so that, when the time comes for the Scottish Assembly to take over the Health Service in Scotland, they will be committed to the concept of devolution and ready to take advantage of the new directions which will be possible under the new system.
  Finally, as we were reminded earlier today that this is the thirtieth anniversary of the Health Service, I wish it a happy birthday and many happy returns of this day.
  7.59 p.m.
  Mr. William Hamilton: The hon. Member for Galloway (Mr. Thompson) does not seem to understand the extent of devolution or of the provision for health in Scotland as it is. At the moment, Scotland has a completely distinct and separate Health Service administratively
  768
  and otherwise from the English Service. I remind the hon. Gentleman that Dunfermline has the only new mental hospital to be built in this century in the United Kingdom. We have nothing to apologise for about what has been done for the Health Service in Scotland.
  I stress a point made by the hon Member for Galloway on the emphasis that must be put on preventive medicine within the next 25 or 30 years. Through preventive medicine we can prevent a lot of people from going into hospitals. We need to save money rather than thinking about spending more money on new hospitals.
  The hon. Gentleman had a point when he referred to alcohol abuse and excessive cigarette smoking. Both involve considerable expense within the Health Service and could be avoided if there were more positive and aggressive action taken by the Health Education Council. I agree with the hon. Gentleman that alcohol abuse in Scotland is a cause of constant anxiety and increasing worry. It is three or four times as great in Scotland as in England proportionately to population.
  It is a startling fact that 3 per cent. of the young male adult population of Scotland is consuming 30 per cent. of all alcohol consumed in Scotland. The Scottish health education unit tries to combat this on a budget of £100,000 whilst the brewers are spending at least £50 million a year on advertising drink in a glamorous and romantic way, and most of their profits go into the coffers of the Tory Party. This is part of a problem that needs to be considered.
  Despite the enormous investment in the Health Service over the last 30 years and in the Welfare State, there are savage inequalities between regions and between social classes. Therefore, not only should we try to save resources by preventive medicine but we should consider carefully how those resources are allocated between one region and another and between one social class and another. I have no time to give the statistics, but this kind of question should be exercising every mind of those in the House who are concerned with the Health Service. Instead of that, Labour Members become frightened when they hear the Tories saying the kind of thing that I now quote from "The Right Approach". This was

  769
  the last version of the Tory Party policy statement:
  "We should encourage rather than deter private provision."
  That means quite simply that if we have enough wealth we can buy our way and receive superior health treatment compared with those who might need it more, the elderly, who have not the resources. The document continues:
  "It will be our aim to encourage this trend"—
  that is, towards private medical provision. The Conservative Party document goes on to spell it out by giving tax concessions to those who contract out of the public service and into the private sector. "The Right Approach" continues:
  "We see no reason for quantitative controls over the development of the private sector outside the NHS."
  Yet within the NHS there is said to be no case for holding down prescription and other charges. The message that that conveys is quite clear and unequivocal, that the Tory Party is committed to increasing prescription charges and every other charge in the National Health Service. Unless there is the rigmarole of a means test, the ordinary working people are bound to suffer.
  On 28th March there was a television programme on how the United States deals with these matters. That programme made me physically sick. It was obscene. It was the antithesis of the principles on which our Health Service is based. The proposition that I have quoted from "The Right Approach" were underlined by the expert on that matter, the head of the research department, the former Secretary of State for Social Services, the right hon. Member for Leeds, North-East (Sir K. Joseph). He spelt it out. He is a one-man Tory think-tank in these matters. It was not a spontaneous speech, but carefully prepared.
  The right hon. Member spelt out the policy in all its stark detail. He said that the Health Service should have a monopoly of care in all the specialties—in the areas of handicapped people, in geriatrics, in mental illness and in all such services. Those are not glamorous specialties. Very few specialists are normally attracted to those aspects of medical care. But all the rest would be in the private sector. That is a brutish division of the
  770
  sick based on wealth. That is the basic philosophical difference between the policies of the Conservative Party and the Labour Party.
  My hon. Friend the Member for Holborn and St. Pancras, North (Mrs. Jeger) has asked me to say a few words about the Elizabeth Garrett Anderson Hospital. My hon. Friend the Member for Ealing, North (Mr. Molloy) and I have been involved in this matter. We have visited the hospital. I understand that it will cost less to renovate existing buildings there than it would to put it in any other place. The EGA has always been one of the cheapest hospitals in London to have patients treated. The buildings have been examined by a well-known firm of consultants, Mott, Hay and Anderson of Croydon. It has assessed the situation and announced that it is soundly built and in relatively good condition—in much better condition than most of the buildings in the Whittington Hospital to which it is proposed to transfer the patients. To move it would therefore be expensive and unnecessary. The EGA would also lose its valuable identity.
  Insufficient has been said about the enormous dedication of the staff that we grossly exploit in this country in the Health Service. It would have lapsed long ago if the nurses and everybody up to the consultants had not given dedicated service without complaint.
  The closure of this hospital is opposed by all the trade unions concerned. It is opposed by all the staff and by thousands of petitioners. A petition has been signed by 50,000 people in favour of maintaining the hospital. They are mostly ordinary working people, who would suffer by the closure. There is enormous sentimentality attached to the hospital. Deliberately to destroy something in the National Health Service which is unique, infinitely precious and cheap to run would be a wanton act of ministerial and administrative vandalism. A decision is imminent. I hope that it will be the right one because if it is not, there will be repercussions in the House and, I fear, outside among the unions.
  This has been a good debate. I hope that I have not exceeded my time. I hope that I have spoken for not more than five minutes. However, if I have, I apologise.
  8.7 p.m.
  Mr. Tim Smith: Although I disagree with most of what the hon. Member for Fife, Central (Mr. Hamilton) has just said, I agree with him on one point and that is the importance of getting a fair allocation of resources between regions and, within regions, between areas and, within areas, between districts. I make no apologies for being parochial, but I hope from what I say to draw two general conclusions.
  I want to say a word or two about the financial provision for the health services in the central Nottinghamshire health district within which most of my constituency falls. The Minister of State, who, I am pleased to say, is present, visited the district last October. Therefore, he is well aware of the local problems that we face. The district is historically a deprived district because the hospital management committee was under-funded from the inception of the National Health Service in 1948.
  The amount that is spent per head is substantially below the national average and is even below that spent in the two neighbouring districts of South and North Nottingham. The geriatric services in the district are poor and, as in almost every other district in the United Kingdom, the percentage of old people is likely to increase rather than decrease. The psychiatric services are extremely limited and patients have to travel enormous distances to get to the Saxendale Hospital, which is near Radcliffe on Trent. The services for the mentally handicapped are also causing great anxiety. The situation at the main hospital for the mentally handicapped, which is the Balderton Hospital, is such that many parents of mentally handicapped children refuse to let their children go into the hospital when it is necessary.
  The waiting lists are exceptionally long for surgical facilities. The latest figures show that in September last year at Mansfield General Hospital there were 57 urgent cases on the list for more than one month and 430 non-urgent cases on the list for more than one year. The situation is similar for orthopaedic surgery where waiting lists are equally long.
  It was to overcome this historically inadequate funding in the Health Service, and in particular to eliminate the
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  regional variations, that the Resource Allocation Working Party was set up. The working party was concerned not just with the allocation between regions but also with the allocation within regions. In its report RAWP made this point emphatically when it said:
  "The criteria for establishing regional differentiation of need and the methods recommended for resolving the ensuing disparities would have no purpose unless applied to allocations below regional level. Indeed the only way in which our recommendations can have a real effect is to carry them through to the point where services are actually provided—the areas and districts."
  The situation in the Trent Region is that, since along with the North-West Region we are the most historically deprived, we have been allocated for 1978–79 the highest real percentage increase of 2·8 per cent., which means in cash terms £9·2 million.
  Mr. Moyle: The hon. Gentleman's figures are now out of date as a result of the Budget. The growth rate is 4 per cent.
  Mr. Smith: I am grateful to the Minister, because I was not aware of the way in which the £50 million had been allocated. I welcome that statement, and I hope that a proportion of the addition for the Trent Regional Authority will filter through to my district.
  The point is that the Nottinghamshire area is doing reasonably well within the region. Almost all the new money that is being devoted to the Nottinghamshire area inevitably has been attracted to the City of Nottingham itself to provide the revenue funding for the new teaching hospital. I fully understand that it is necessary and that capital naturally attracts revenue expenditure, but it leaves the central Nottinghamshire health district, which is some distance from Nottingham, in a position in which it is receiving only 1 per cent. increase for the next three years. This is not only below the regional average—which I am now told by the Minister is 4 per cent.—but it is also below the national average of 1·4 per cent.
  We have a situation in which a district which is already under-provided will now in real terms become worse off than it was before. This is precisely the opposite of what was intended and recommended by RAWP. Surely there must be a good

  773
  case—and I am sure that the Royal Commission will examine this suggestion—for the abolition either of the area level or of the district level. I am not an expert on the National Health Service but it appears to me that the region should have more control over the way the money comes into the district.
  I wish to conclude by quoting some words of the Secretary of State for Social Services in December 1976:
  "I am determined that the resources of this national service should be more fairly shared. Redistribution must be not only between regions but within regions, as some of the biggest inequalities are between rich and poor areas or districts."
  He went on to say that it would not be possible to implement the recommendations on the timescale that was recommended, but it appears that we shall be into the 1990s—or on the basis of the 4 per cent. it might be sooner, and I hope that that is the case—before this happens. It will certainly be spread over a long time span. In respect of the central Nottinghamshire health district, we now seem to be going backwards.
  8.15 p.m.
  Mr. Ian Wrigglesworth: So far the debate has concentrated largely on the resources in the Health Service and on their management. I am very much tempted to go down that road and to talk in general terms, but that will have to await another occasion.
  I wish to concentrate this evening on the predicament in the South Tees health district, which is the larger part of the area that I represent. Before I do so, I wish to mention the interest that I have in medical equipment and the fact that my wife works in the National Health Service.
  Complaints have been made over a considerable time about waiting lists and staff shortage in the South Tees area. They blew up recently in a dramatic way with the presentation of a petition by the nurses in February of this year. In that petition the nurses from the Middlesbrough General Hospital said that, as the situation at that hospital had reached a critical level, they felt that it was now necessary to bring the matter to our attention. Let me quote from the petition
  "To maintain any degree of nursing efficiency it is absolutely vital that the number of trained staff be increased. At present the
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  hospital employs 249 trained and untrained nurses to cover 449 beds, plus five theatres, a casualty department dealing with approximately 1,500 patients a week, an out-patients department and a number of regional and sub-regional specialities such as rheumatology, plastics, neurology and neurosurgery."
  A careful estimation made by the staff shows a shortfall in staff at the hospital of 150 people. That is a staggering state of affairs.
  I presented the petition to the Minister to draw his attention to it and to the chairman of the area health authority so that action could be taken. The response by the district management team was to produce a proposal aimed at closing 217 beds—not in the Middlesbrough General Hospital but in other hospitals in the area, so that staff could be moved to the Middlesbrough General Hospital. It was a case of robbing Peter to pay Paul. The exercise involved moving beds from one area to another, which achieved precisely nothing. Among the 217 beds allocated for closure at that stage were 93 children's beds.
  As a result of the representations made to the area health authority, action was suspended and the authority established a committee of inquiry to examine the situation, because it was so critical. I hope that the inquiry will report soon, but I am sure that it will call for more resources and emphasise better use of such resources in the area. I hope that the Government will back the recommendations of that body.
  I welcome the redistribution of resources to regions, such as the Northern Region. Of the £50 million in the Budget we are being allocated £2·7 million. Therefore, we shall be receiving some more, but not a great deal more, for the Cleveland area. I hope that we can have some more resources and concentrate the money we receive on the provision of more staff. But in my view we must also concentrate on the better use of the resources that we have in our hands and the increased resources that we shall be given.
  The worst area for waiting lists in Middlesbrough, in the South Tees district, is in the ear, nose and throat department, where almost 2,000 people are on the waiting lists for treatment. Sixty-two of those cases were classified as urgent the last time I tabled a Question on the matter. For one consultant

  775
  in the out-patient department in the ear, nose and throat specialty the waiting list is over three years. In respect of another two consultants the waiting list is over two years. Can one imagine anything more dispiriting than for a person to find that he has to wait over three years for an out-patient appointment?
  The community health council and others have made various suggestions on cutting back the tremendous waiting lists. The community health council in my area does a marvellous job and has advanced many constructive suggestions. It does not fail to be critical, but it is doing its job fully. The council put forward an eight-point plan, and I hope that the management and staff in the hospital, including the consultants, will co-operate in reducing these lists.
  Our comparison in respect of cases per bed and beds per 1,000 of population shows that we have more beds per 1,000 than in the rest of the Northern Region and in comparison with the national average. It also shows that we have fewer cases per bed than in the Northern Region, or compared with the national average. Clearly, there is a case for reallocation of resources and for increased productivity in the South Tees district and the area as a whole.
  We must use our resources more efficiently. One of the ways that we can do this is by reorganising the services in our area and making it a single-tier authority. I hope that the Minister will look at that. It is nonsense to have both a South Tees and a North Tees district management. Perhaps Hartlepool should be kept separate, but having two district management teams and two separate administrations for the area makes no sense at all.
  On Teesside, local government has spawned as a result of the local government reorganisation by the last Government. The same applies to the Health Service. If my right hon. Friend could move on this before the Royal Commission reports I am sure that there would be great relief and that more resources would be available for patient care in the district. That would be a great relief not only to the patients and the population but to the staff, who are complaining constantly that more and more money
  776
  is being spent on administration when it could be spent on patient care.
  Mr. Deputy Speaker: I remind the House of my appeal for brief speeches.
  8.21 p.m.
  Mr. Robert Boscawen: When one has to make a rushed speech at the end of a long debate, one is in danger of making an unbalanced speech. If I appear very critical of the National Health Service, it is because of that.
  But I endorse what hon. Members have said about the dedicated skill and attention to duty of thousands of individuals who are working for the National Health Service in all parts of the country. I pay tribute to them for their skill, service and duty to the sick. Many people who reach hospital receive treatment and service that are without equal.
  However, there is far too much wrong with the NHS for us to be asked to tolerate it and not to draw attention to it. The length of hospital waiting lists throughout the country in most of the specialties for non-acute cases—and regrettably even in some urgent cases—is a symptom of much that is wrong with the National Health Service.
  I have spent some time examining this problem. I understand what a complex and difficult one it is. I know that there is no single answer, and that money will not solve it just like that. Other hon. Members have made that point. Money is no guarantee that we shall have a Health Service with a high standard.
  Where must we start? We must start by looking at some of the things that the parties and the country must take the blame for. The Conservative Government misjudged the growth of bureaucracy that would result from reorganisation. The Conservatives tried to do what was necessary to bring the three pillars of the Health Service together. That had been needed since the beginning of the Service. It was the right thing to do. It was right to bring together the family doctor, hospital and local authority services. But that resulted in too much bureaucracy and over-management. We must try to put that right.
  The Government must also look at what they have done in the last two years. They caused considerable harm

  777
  to the Service by undermining the morale of doctors and nurses with their obsession with preventing doctors from using its facilities in their own time for come private practice. That dispute had consequences which bit deeply into the Service—consequences which continue and which will continue for some time. It would be wrong for the Government to continue their vendetta against the private sector of the National Health Service. I heard with alarm the comments of the right hon. Member for Blackburn (Mrs. Castle) on a television programme last night.
  The administrative mandarins of the Health Service have elevated their position and their own importance to an extent that has caused the treatment of patients in hospitals to suffer. Consultation with those in the front line of the hospital service has in too many cases appeared to be a farce. That must be put right.
  In certain places the trade unions have involved themselves too much in disputes over matters that are outside their province. Too often they have put their noses into decisions that should be left to the doctors and nurses. That must be put right.
  The public do not always help the Health Service. When people do not turn up to keep an appointment that has been made some time before, that can dislocate the hospital programme. That does not help the waiting list. Sometimes members of the public use unreasonable, selfish and bullying tactics to jump the queue. Many hon. Members will know of such instances from what their doctors and hospital administrators have told them. That must be put right.
  There has been too much of prejudice and politics within the Service within recent years. We should be better off if we got down to trying to make it work more smoothly and agreeably without trying to create a class battle between the various sides in the Health Service.
  The career structure for ancillary hospital workers is not good enough. They do not feel that they are part of the Service. They feel that they could be doing their job anywhere. That must be put right if they are to have more job satisfaction.
  778
  It is no good the Government's thinking that doctors are really satisfied with their pay structure or terms of contract. It is not nearly good enough when they see what some of their friends overseas are able to earn for less service and less skill in hospitals in other parts of the world. We must put that right if we are to maintain high standards of skill here.
  There is little doubt that this deplorable but complex problem of the waiting lists will not be cured overnight. It will have to be cured, because unless it is the people who are suffering much from being unable to obtain appointments with their consultants or treatment in hospital without having to wait for many months will lose confidence in the whole system. That would be a great tragedy to the system of health care in Britain.
  There are many things other than money that must be looked at in order to improve the NHS. I hope that each of us will see his own faults in this matter, not least the Secretary of State, who I hope will seek to put right some of the faults for which he is responsible.
  8.30 p.m.
  Mr. Bryan Davies: This debate has been about fundamental issues in the Health Service, including how much we are prepared to spend on it. We have had a series of speeches from Opposition Back Benchers who have followed the line established by the right hon. Member for Wanstead and Woodford (Mr. Jenkin) suggesting that the Conservative proposals would not affect the restoration of health to the NHS. The contrary is the case. Every time Opposition Back Benchers have advanced a case, it has been one of special pleading for extra expenditure in their areas, or seeking regional redistribution which could in no way be helped by an increase in the private sector.
  Where do the Conservatives think the private resources will go? The doctors will follow those resources and the resources will follow the wealth of the country. We shall be confronted with the historic picture that we know so well, in which the distribution of health resources reflects the distribution of wealth. The only thing that can change that will be consciously directed policies clearly defining areas of public expenditure.

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  My right hon, and hon. Friends should take careful note of the sort of attacks that the Conservatives launch upon the administration of the Health Service. The reorganisation of the Health Service through the misconceived 1973 reforms has created problems, but let us beware of the extent to which we sustain and support the attack upon the administration. I believe that behind such an attack is the Conservative defence of the existing interests in the Health Service, which oppose the kind of redirection of policies and priorities that we on the Labour Benches believe should be made.
  Complaints about the administration of the Health Service come predominantly from those interests in the medical profession which seek to resist the redirection of policy. Although excessive bureaucracy is wrong, we should not forget that a fundamental problem of democratic society is the relationship between the needs of society and the professional who satisfies them. We are beyond the stage at which we can pretend that determination of Health Service priorities is the preserve of the medical profession. This has created a problem in the organisation of the Service that we have never succeeded in resolving satisfactorily. That problem requires sympathetic and imaginative administration, carried out by competent and well-rewarded administrators.
  The hon. Member for Reading, South (Dr. Vaughan) came to my constituency and commented on one of the hospitals there—St. Michael's, which is an old hospital housing geriatric patients. That hospital faces the most acute difficulties in securing adequate resources. The hon. Member rightly praised the staff there. The staff are appallingly underpaid, however. Nearly every complaint levelled at that hospital—there are many, and they are well-founded, and cause me the greatest concern—revolves around the fact that the hospital has a nursing establishment which cannot be filled because the nurses will not do the work at present rates of pay.
  The Opposition argue that their priorities are the firemen—when they are in dispute—the Armed Forces and the police, and that other items of public expenditure do not rate such a high priority. Given our public expenditure rec-
  780
  ord over the last couple of years, this is an issue that my right hon. and hon. Friends should handle with some care, but in those circumstances it ill behoves the Conservatives to attack the level of public expenditure in the Health Service.
  Bearing in mind the contraints of time, I make one final point. It is a point that reflects my own interest at present. I have the honour to be the parliamentary representative on the Medical Research Council. In that I succeed the hon. Member for Reading, South. There are very acute problems in medical research. When my hon. Friend the Minister of State winds up the debate, he ought to think very carefully about medical research. Ultimately, if we do not plan and allocate resources to this area in a very real sense, we shall not be able to provide the service that we need.
  My worry is that a great deal of our present medical research relates closely to the question of higher education resources and the position of universities. We all know that they will be under severe constraints in the early part of the 1980s. If there is a student increase in that area, the research function will come under pressure. I am worried about the fact that the present career pattern that the Medical Research Council offers to its staff is excessively limited. At one time the universities offered a position as a cushion for staff when their services were no longer needed for a particular research project. That safety net is no longer available.
  What is required is a major rethink about the strategy of the Council and a major consideration on the part of the Department as well of just how far we have got along the post-Rothschild consideration of research in relation to the Health Service. In my view, in this area it is still the case that many more questions are posed than there are answers. We cannot depend upon the strength of the Health Service for the future unless we look very critically at the question of medical research.
  8.36 p.m.
  Mr. Timothy Raison: This debate has largely hinged upon resources. I shall not try to elaborate on that matter, important though it is, except to say that one of the great problems of resources in medicine that we face—and I imagine

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  that in a sense this is what a number of my hon. Friends have been saying—is that, whereas there is an understandable inclination on the part of the Government to pour additional resources into the deprived areas—the inner cities, and so on—it is, nevertheless, a fact that in the areas of growing population in this country there are inevitably very great problems.
  The Minister of State knows a certain amount about the problems in my constituency of Aylesbury. We have exactly that problem. We have the new town of Milton Keynes in North Buckinghamshire, and we have Aylesbury, which is still growing pretty rapidly. Inescapably, we have a very difficult situation. Frankly, there is a sense of disbelief when Ministers claim that we are still raising standards overall in the Health Service when we see in our own hospitals the harsh necessity of cutting back on beds and, indeed, of scrapping hospitals.
  I do not blame the Government for being concerned about the inner cities and the older areas, but I hope that they will never forget that they have a basic duty to provide a sufficiency of beds for everyone and that a poor person, a mentally handicapped person, a disabled person or a person with any kind of sickness is just as much entitled to service if he lives in Buckinghamshire as he is if he lives in the North-East or some other area of that kind.
  Secondly, the Government must accept that under the present Administration morale in the Health Service has sunk to a level that has never previously existed. They cannot duck that. Under the present Secretary of State and under his disastrous predecessor we have had an appalling loss of morale. Of course, some of that is to do with factors beyond the Government's control. It is to do with the change in the economic situation which followed the oil crisis in 1973, so there would always have been problems.
  But the Government have unquestionably aggravated those problems. They have aggravated them by the war against pay beds. I declare an interest as a director of Private Patients Plan. The Government are doing the very damaging thing of creating two quite separate health services in this country. It is they who are creating separate health services as
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  a result of their policy, and that is damaging.
  The feeble line that the Government took over the early signs of industrial action in the hospitals about three years ago has led to a lot of trouble since then. I acknowledge that industrial relations in the hospital service are difficult and that there has been very little experience of dealing with industrial relations in the hospitals over preceding decades. In a sense, I think that the hospitals have been taken unawares by this new phenomenon and have not known how to respond. However, I believe that, because of their irresolution three years ago, the Government must accept some of the blame for what has been going on.
  I want to touch lastly on the difficult question of the administrative structure. The 1944 White Paper on the creation of a National Health Service said:
  "There is a certain danger in making personal health the subject of a national service at all. It is the danger of over-organisation, of letting a machine designed to ensure a better service itself stifle the chances of getting on."
  Although it went on nevertheless to advocate a national service, that warning has had echoes in succeeding years.
  The Royal Commission is looking at structure, and I hope that no one will form a final view. I hope, in particular, that my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), who opened this debate so ably, has not come to a final view.
  It is still an open question whether it is realistic to switch to a much more insurance-based Service. I should want to see that much more fully argued before we took a strong line. There is a place for insurance in the Service—I have an interest in it, as I said—but I am not yet persuaded that a basically insurance-based Service would be the right approach.
  I also think—I know that here I am in very much of a minority—that the right organisation is not a three-tier or even a two-tier system but a one-tier system. I should like to see the area retained and the region and the district in due course disappear. My fundamental reason is that at the end of the day—I know that it is a long way off—health and local government should merge. The only effective basis for that is the area-county basis or, in the case of metropolitan areas,

  783
  the metropolitan districts. I therefore hope that, in any kind of new reorganisation, we do not lose the area and thereby lose the chance of what I believe to be ultimately the right solution to this whole problem.
  In the interests of better administration and saving money, I suspect that we should abolish the community health councils, but I think that we should give them a little longer before taking such a drastic step.
  To cast a final bombshell, I think that there is a very good case for splitting up the DHSS once again. The business of running health and the local authority personal social services, on the one hand, and the enormous social security element in Government today, on the other, is too much. There are two Cabinet Ministers in the Department, but that is not the right way to tackle the problem. I seriously question whether this leviathan can do as good a job as two separate Departments.
  8.43 p.m.
  Dr. Edmund Marshall: I should like to concentrate attention on the critical situation building up in various parts of the country over the use by general practitioners of surgery facilities in health centres owned by area health authorities.
  The terms under which family practitioners work in these centres are now drawn up in a licensing agreement. A new model licensing agreement was set out by the Department of Health and Social Security in April last year in Circular HC(77)8 which stated that the terms available to doctors were
  "such terms as the Secretary of State sees fit."
  It is clear, however, from the evidence which has come to my attention that that is causing difficulties in various parts of the country.
  I hear from a doctor who is actually practising in a health centre at Oakley near Dunfermline that his running costs have gone up fourfold as the result of moving from his previous surgery. I have a letter from the secretary of the community health council in Wandsworth and East Merton saying that the Balham health centre, in the constituency of my non. Friend the Member for Tooting (Mr.
  784
  Cox), has five suites for doctors only two of which are currently in use.
  Similarly, I have seen reports in local newspapers of doctors refusing to go into brand new health centres that have been recently constructed at Bransholme in the constituency of my hon. Friend the Member for Kingston upon Hull, East (Mr. Prescott) and in the Bentley area of the Doncaster district in the constituency of my hon. Friend the Member for Don Valley (Mr. Kelley). The Doncaster Area Health Authority has asked that it should be able to provide additional financial inducements to attract doctors to new health centres. I am disappointed to learn that that request has been turned down by the Department.
  But the silliest situation I have ever come across in relation to health centres is in my constituency, where, on the Warwick Estate at Knottingley in the area of the Wakefield Area Health Authority, there is a health centre built more than 10 years ago containing four consulting suites for family doctors which have never been used for that purpose. The health centre stands in the middle of a large housing estate now accommodating more than 5,000 residents, who still have to travel to other ends of the town to attend doctors' surgeries.
  I have described the situation in detail before in the House, in an Adjournment debate on 24th November 1972. There has been no official progress towards resolving this major local problem since then, despite representations to successive Ministers in different Governments. The medical practices committee refuses to reclassify Knottingley as a designated area, so there cannot be made available an initial practice allowance as a financial inducement to bring doctors to set up a new practice in this health centre.
  The local people have signed a declaration—1,040 adults from homes with an additional 1,260 children—saying that if the new practice were established at the health centre they would in general wish to be included on the panel of patients there, so there is clearly an opportunity for a viable new practice.
  However, in the absence of a new practice allowance it is very difficult to start such a practice from scratch. Attempts are now being made to raise such an

  785
  initial practice allowance by private subscription from individuals, trade union branches and local firms, but it seems to me incongruous that we should have to appeal for private donations in this way to encourage the use within the National Health Service of public facilities which have been empty for over a decade.
  In this situation we need some remodelling of the legal framework within which general practitioners operate, making it possible either to set up machinery which directs doctors in some way or other to use facilities provided for them in this way or to allow area health authorities to employ doctors to carry out general practice from health centres in much the same way as junior hospital doctors are employed within hospitals.
  I appeal to my hon. Friend the Minister of State, who I realise knows this problem full well, to agree that such measures are necessary. I hope that he will be able to give an indication of how he proposes to tackle these difficulties in respect of health centres and my constituents at Knottingley in particular.
  8.48 p.m.
  Mr. Robin Hodgson: On 20th March, or perhaps in the ungodly hours of 21st March, we debated hospital services during the debate on the Consolidated Fund Bill, and I was lucky enough to catch the eye of the Chair. I wish now merely to make a few additional points.
  I am sorry that the Secretary of State is not here, because he is a proud product of the town of Walsall, which I have the honour to represent. He is also a proud product of Queen Mary's Grammar School, an ancient educational foundation which this Government are trying to destroy.
  It is worth considering the view of the stewardship of this citizen of Walsall as seen from the grass roots. I think that the general feeling at the grass roots in Walsall and other parts of the country is that the right hon. Gentleman in his stewardship is showing a reluctance to come to grips with the real issues involved. There is too much of a bland Press release here and a carefully posed photograph there, by which he endeavours to persuade people that all is well. In his speech, at least a third of which, and probably half, was devoted to knock-786
  about point-scoring concerning our policies rather than discussing his own, the right hon. Gentleman confirmed that impression.
  All is not well and those on the ground know that that is so. Ask anyone connected with the National Health Service and the story is very much the same—at best there is indifference and at worst open hostility to the present policies. Few Secretaries of State can have so universally offended opinion, medical and lay. If anyone doubts this, let him ask the nurses. The whole profession is in a state of flux awaiting the reaction of the Government to the Briggs Report. We have raised this matter at Business Question Time during the past six months, but it is obvious that we shall get no resolution of this problem in the current Session.
  Let people who have doubts about the state of the National Health Service ask the chemists. There are more chemists' shops closing than ever before, affecting the fabric of many of our towns, villages and high streets, thereby affecting the lives of many people who are unable to shop as they used to do. Ask the ancillary workers. We have already heard that industrial unrest is at record levels. Telephonists in the West Midlands are actually censoring telephone calls. They censored one of mine. I was speaking to someone in one of the Walsall hospitals when I was told that the call was not urgent and I was left with a buzzing telephone line.
  Let people concerned about the National Health Service ask the doctors who face an appalling situation, with lengthening waiting lists and a mismatching of resources which leaves completed hospitals unopened because of a lack of medical staff. Ask the consultants, who await the outcome of the negotiations on their present contract and who are faced with a Government who seem bent on taking away a most important personal freedom, the freedom to practise professional skills and the right to earn a living in the way they wish.
  Above all, let people ask the patients, the patients in my constituency who are waiting one year and five months for gall-bladder operations and three years and 10 months for hernia operations. Let them ask the pensioner in my constituency who, desirous of obtaining a

  787
  minor operation to cure a small foot deformity, has been offered a first consultation—not an operation—on 2nd September 1980.
  What do we see ahead? If we are to base our hopes on the contents of the Secretary of State's speech earlier today, we have only a gloomy picture. On Monday night, the "Tonight" television programme looked at the burgeoning private health sector, much of it taking badly needed revenue which could and should be brought into the National Health Service but which is lost because of the Government's petty vendetta against pay beds. What did the right hon. Member for Blackburn (Mrs. Castle) say in that programme? She was the right hon. Lady who introduced this policy. She did not say that her policies were faulty. Rather she said the system needed more rules and regulations and, no doubt, more administrators to enforce them.
  The idea, it seems, is to strangle the private sector with red tape, if at all possible, but it will not be strangled. It will, if necessary, go abroad and take with it facilities, doctors, nurses and, above all, money.
  Earlier the Secretary of State said that his programme was designed to even up regional differences. We have to applaud that and support it absolutely. But the right hon. Gentleman did not say how vast those differences are or how slowly they are being ironed out. In the Walsall Area Health Authority the difference between the RAWP allocation figure and the actual position is between £7 million and £8 million. Our annual increment at the moment is £85,000 per annum and at that rate it will take well over half a century before the difference is finally made up.
  What we need above all—and we support the Government on this absolutely—is a commitment to the National Health Service, but not a commitment to an unchanging Health Service in a changing world. What we need is a fresh approach. There must be a fresh approach towards revenue, which in turn means a fresh consideration of pay beds. We need to reconsider the possibility of encouraging the private sector rather than restricting it.
  There must be a fresh approach towards man power and woman power. That
  788
  means taking up some of the points made earlier by my hon. and learned Friend the Member for Thanet, West (Mr. Rees-Davies) about bringing in voluntary movements and getting them to play a fuller and more varied part in the running of hospitals. It means bringing in private sector firms to undertake catering, laundry and cleaning. In this way we make better use of our resources and free our skilled doctors and nurses to carry out the tasks for which they are properly trained. Above all, we need more real action and less public relations action. The Secretary of State has put a lot of effort into the latter and it is cynical that he should not be as assiduous in his practice of the former.
  8.55 p.m.
  Mr. Bruce Grocott: I can only assume that there has been an outbreak of masochism on the Opposition Front Bench in selecting this subject for debate today. The speeches that I have heard—and I have been here all the time—have boiled down to two basic points; either that the NHS needs more money or that the money that is in it needs to be more effectively spent.
  Considering that the Opposition are opposed to any more money being spent on the NHS, and that they were responsible for the structure of the Service which determines the way in which the money in it is spent, they should have had the sense to keep quiet about the whole subject. Nothing that I have heard from the Conservatives today has done anything to give anyone the conviction, in this any more than in any other subject, that they are capable of running the country.
  The speech of the right hon. Member for Wanstead and Woodford (Mr. Jenkin) was of a pretty low standard, even by comparison with the standard that one has come to expect from the Opposition Front Bench. In effect, he said that Tory Party Health Service policy would be determined by the Royal Commission. We all know that the Opposition's industrial relations policy is to be determined by referendum. Now their policy on the NHS is to be determined by the Royal Commission. We know that they have not got an economic policy. One wonders what is left for a Tory Government to do. There does not seem to me to be any kind of choice between a Conservative Government and a Labour Government.

  789
  I want to direct the attention of the House to two aspects of the administration of the NHS which deserve attention. One is the question of democracy in the Service. We all know that there is no proper democratic structure in it; that in the reorganisation the only sop to democracy was in the form of community health councils. Whatever one thinks of them, they are not accountable; they are not democratically elected. I know that many of them do their utmost to do a good job, but they need to be strenghened.
  At the very least, they should be strengthened by being given the right to have observers at meetings of family practitioner committees. It is idiotic that they have not got that right at the moment. As far as I know, my right hon. Friend does not intend to direct them, and it seems to me that in considering democracy in the NHS we are going through again the same old tired arguments that we used to have about democracy in local government and the openness of committees 10 or 15 years ago. Most of the arguments against such democracy and openness in local government have proved unfounded.
  Then there is the question of the relationship between doctor and patient. Democracy is about attitudes as much as about structures. Essentially, in the NHS the real relationship between the doctor and his patient is a paternal one; it is not one in which there is an attempt to discuss problems as near equals, as happens with most other professional groups. Professional groups other than the medical profession are prepared to discuss the problems of their profession with others outside them.
  In putting my other suggestion, I am referring to a crying need in the West Midlands, namely, that patients should be given details of the waiting lists of various consultants. It is ridiculous that the waiting times can vary dramatically between hospitals just 10 or 15 miles apart. It is clear that if patients were told by their general practitioner "You need surgery. If you go to hospital A, the waiting time for the consultant is so-and-so; if you go to another hospital further from your home, the waiting time for the consultant will be such-and-such," the waiting times would, to a large extent, equalise themselves. In effect, the patients, through
  790
  patient choice, would balance out the waiting times.
  The other aspect of the administration of the NHS—and it relates to matters outside it—is the question of private practice, about which both sides of the House are highly equivocal. For half the time the Tory Party says that private practice helps the NHS. The hon. Member for Walsall, North (Mr. Hodgson) at least had the honesty to say that as far as he could see, it did not help the NHS at all. He was the only Conservative Member who admitted it.
  We should be absolutely plain about private medicine in this country. I am rather pleased when Socialism and political self-interest coincide. I certainly think that they do on this issue. We should make it plain to the people that a private sector is not compatible with the concept of the National Health Service and that to have a private sector at all means that the resources are taken from the NHS. It means that, inevitably, we shall end up with the system under which the people who run this country, whether civil servants, leaders of industry, leading politicians or whatever, will find themselves being treated in one type of Health Service and the rest of the population in another.
  I very much welcome the attempt by the Leader of the Opposition, these days, to apply Christianity to modern British politics. I understand that she has been in the pulpit once or twice recently. I hope that she follows through the logic of her position, because she cannot stay in the Tory Party long if she continues to apply Christianity.
  On the issue of private medicine and treatment on the basis of cash, I know of no evidence whatsoever that when Jesus was faced with the 10 lepers, he asked which of them wanted to be treated privately, so that he could deal with them first. As far as I know, Jesus dealt with them on the basis of need. I wish the Tories would occasionally think through some of the conclusions to which their views bring them.
  We need to have a clear commitment to end private practice, for as long as it exists the NHS cannot develop as a truly national Service. I hope that this Labour Government—and certainly the next Labour Government after the

  791
  General Election—will be firmly committed to that objective.
  9.2 p.m.
  Mr. Tony Newton: I am grateful to my hon. Friend the Member for Reading, South (Dr. Vaughan) for allowing me a few moments in which to say a few sentences, as I have been here throughout the debate.
  I do not want to follow the hon. Member for Lichfield and Tamworth (Mr. Grocott), except that I think the unkindest thing I could say to him is that his speech had a lot in common with that of the Secretary of State. About 50 per cent. of each of those speeches consisted of the crudest type of party political points. I can only hope that they were not broadcast, because they would have confirmed in the mind of the British public that our party political system is quite incapable of discussing serious problems in a serious manner. Frankly, if I had to listen to too many speeches of that sort, I should also be put off the party political system.
  I found the Secretary of State's speech depressing for another reason. It seemed to me that he displayed a closed mind about any kind of fresh approach to our problems. I should be grateful if the Minister of State, when he replies, could tell us whether there is any real point in the Royal Commission on the National Health Service proceeding with its work, because the implication of what the Secretary of State said was that he has no intention whatever of considering any proposals about finance, and nothing very much about administration either. I fail to see any point in setting up a Royal Commission on that basis.
  Although we can see aspects of the Health Service where improvements could be made, I think that it is common ground on both sides of the House that more money is needed. But neither side feels able to offer an addition to public expenditure in this respect. Yet despite this, Labour Members—the speech of the hon. Member for Lichfield and Tamworth is an illustration of the point—appear to be totally unwilling to consider the very real question of priorities.
  The hon. Gentleman was among those who laughed and jeered when the question of school meal subsidies was raised. My children take sandwiches to school
  792
  because they prefer them. If they wanted to have school meals, I would immediately qualify for a subsidy which would be equivalent to a pre-tax pay increase of between £4 and £5 a week.
  Hon. Members may complain about their pay, but we are not yet among the group of people who cannot afford to feed their children. It is ridiculous that that sort of subsidy should be offered to people such as myself when, if my children fell down in their school playground and hurt themselves, the State could not offer them a decent accident and emergency service. I leave that thought with the Ministers.
  When I raised the subject of my constituency and the catastrophic difficulties over the Health Service a few weeks ago the Minister assured me that it was the Government's intention to redistribute resources towards Essex. He told me that the problem had been recognised. On the information that I have from the Essex Area Health Authority, which is calculated to have been £24 million underfunded in l976–77—£1 short in every £5—the redistribution within the North-East Thames Region is giving Essex only £250,000 a year of additional uncommitted revenue this year and for the next four years. This extra revenue will not be enough even to maintain standards of services already provided. One must also consider this against the background of the increasing population.
  The Minister said that it is his intention to redistribute resources towards Essex. I take it that that means he intends some improvement in the services provided for a rapidly expanding population. The area health authority does not believe that is happening. I do not believe it is happening, and neither do my constituents. I shall require a great deal more assurance from the Minister than I have had today that it will happen.
  Mr. Deputy Speaker (Mr. Bryant Godman Irvine): I offer the commendation of the Chair and the House to the last 11 speakers, none of whom has exceeded nine minutes.
  9.7 p.m.
  Dr. Gerard Vaughan: I should like to join in the congratulations, particularly to the brief and constructive comment of my hon. Friend the Member for Braintree (Mr. Newton).

  793
  I am sorry that at the end of this debate, which was positive and far-ranging, the hon. Member for Lichfield and Tam-worth (Mr. Grocott) should have spoken as he did. It was a pointless, irrelevant and rather nasty speech.
  As hon. Members know, I have spent the greater part of my working life, other than in Parliament, working within the health field. In all sincerity, I must say that never has the National Health Service been more in need of a genuine, quiet and honest look at what is happening. I am appalled at the way in which standards have fallen recently. There cannot be any argument about that. Nowadays it is commonplace to have minor misunderstandings, accidents and areas of communication that a few years ago would have led to a serious internal inquiry being considered as so ordinary that they are just part of the daily wear and tear of the Service. It is common to have rudeness to patients and frustration caused to them of a kind that was never seen some years ago.
  That is why I was so sad when I listened to the Secretary of State. I remind him that it is not his National Health Service. Neither is it the Government's or the Labour Party's. It is our National Health Service, and it is part of our national heritage. We all have a vested and real interest in seeing that we have an effectively functioning, high-standard NHS. That is why my party wholeheartedly and unequivocally supports the concept of a National Health Service with immediately available high standard health care for all who need it.
  I was sad to hear the Secretary of State make such an extraordinary defensive, truculent and strident speech. Out of it came his total unawareness of what is going on and how morale has fallen within the Service. He said that he lived with the Service and knew what people felt. The hon. Member for Truro (Mr. Penhaligon) said that this was a debate about reality, but that part of the debate was not about reality.
  The Secretary of State seems to have no understanding of how morale has gone to pieces. Of course, there are places where a great deal of devoted work of a very high standard is going on. The Secretary of State says that he knows what people feel, but so do I. With the
  794
  help and support of my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), I have been to hundreds of meetings in the last year or so, right across the country. I defy any hon. Member to name any part of the country that I have not been in or near in the last year or 18 months.
  During that period, time and again people have come to me saying how awful conditions are. Some Socialist administrators said that they would never vote Conservative because they do not agree with other aspects of our policies, but they wanted us to know how wide a gap there is between the administration and the patient, how awful it is to work in the Service and how much they were looking to the Opposition to make constructive suggestions about what should be done.
  At another meeting a surgeon told a roomful of young consultants that he had worked all his life to get where he was and, now that he was there, he did not think that it was worth it. I recently asked another surgeon why he was looking so fed up and he said that he no longer enjoyed working within the National Health Service.
  One nurse in a roomful of nurses said that she was no longer so proud, when asked what she did, to reply that she was a nurse. [HON. MEMBERS: "Nonsense."] Hon. Members may claim that it is nonsense, but this is what is being said.
  I wonder where the Secretary of State gets his information. Who talks to him? When he goes to hospitals, do they show him the new things because they want to please him, the bad things because they want extra money, or do they show him the great multitude of small things that are going wrong? I do not believe that they do.
  Has the Secretary of State failed to grasp what is going on, or is it that he does not like to admit it to us? Does he ignore the opinion of the Royal College of Nursing, and Miss Hall, who is a most careful person in choosing words, who said on 4th March that staffing levels of qualified nurses had fallen so drastically in the last two years that looking after patients has become impossible? Does the right hon. Gentleman ignore her warning that the health services are close to breaking point? Does he ignore the

  795
  nurses from King's College Hospital, who said:
  "It is time Social Services Secretary David Ennals woke up to the fact that the National Health Service is breaking down"?
  Nurses in the Guy's group wrote to Sister Burke recently to congratulate her and tell her how comforting they found it that someone was speaking out about the steady deterioration that they saw going on in the Service. These are cries from people working in the field.
  A nurse from Bristol wrote—these are sad words:
  "It used to be a matter of pride to work in an operating theatre. But now, due to the invasion of the militant … porters, that has been shattered. God only knows what people awaiting operations feel."
  One of my colleagues was recently taken ill in France and went into a French hospital. She had thought that the London teaching hospital where she works had high standards, and she was proud of it. When she returned to this country, she told me that she was shattered to discover what a difference there was between her own hospital and the working conditions there and those in a modern French hospital.
  If the Secretary of State is not hearing these things, we shall tell him. We shall gladly pass them on to him. It is important that he should know the reality of what is happening. He clearly does not know at present. If he did know, he would not have made the sort of speech that he delivered this afternoon.
  There are a whole series of scandals, one of them being the tragedy of the waiting lists to which the right hon. Gentleman referred. I regard waiting lists as rather like taking a person's temperature. That operation does not tell us what is wrong but it tells us that something is wrong. The total figures that the right hon. Gentleman quoted are not the really serious ones, although they are tragic in themselves. Many factors decide whether we shall have this number of thousands or that number of thousands. Many people decide not to join the waiting lists, as they do not think it is worth while. The really serious figures apply to the waiting lists for urgent cases. The Secretary of State took the extraordinary step, in my view, of blaming junior hospital doctors.
  796
  The numbers on the urgent waiting lists have increased, as he knows. We must all have been moved by the examples that my hon. Friend the Member for Ton-bridge and Mailing (Mr. Stanley) recited. My hon. Friend the Member for Maidstone (Mr. Wells), who cannot be present, has told me that he is extremely anxious about waiting lists in his constituency. It is the length of the urgent waiting lists that has doubled. The right hon. Gentleman does not do himself any good or improve his credibility when he appears on television, as he did in January, and says that he does not believe that patients have to wait as long as five months or six months for urgent investigation. He said in January that if there were any such instances, he would like to know about them. That is incomprehensible to those who are working in the NHS.
  There are many urgent cases that have to wait over a month. Between 60 per cent. and 70 per cent. of urgent cases in some parts of the country have to wait over a month. Many of them have to wait five months and six months. Some of them are likely to die as a result of that wait. The right hon. Gentleman knows that. In fairness to him, I must say that since January he has admitted that such waits do happen.
  We now have the longest waiting lists of any country in Western Europe. The only country with comparable waiting lists is Sweden. What does Sweden have? Sweden has what we are being moved to, namely, an almost complete State service. That is one of the factors that causes Sweden to have such long waiting lists.
  Mr. Martin Flannery: You do not wait, you pay.
  Dr. Vaughan: What do the figures tell us? For example, Bolton—
  Mr. Flannery: To think that the hon. Gentleman is a doctor.
  Dr. Vaughan: That is why I care so much about these matters.
  Mr. Flannery: The hon. Gentleman should be ashamed of himself.
  Dr. Vaughan: The Bolton waiting lists have increased enormously. I do not know whether the Secretary of State knows that. The number of urgent cases

  797
  awaiting attention has increased enormously.
  Mr. Flannery: They would wait longer if the Tories were in power.
  Dr. Vaughan: The present situation is a tragedy for those living in the Bolton area.
  I have before me a letter referring to the beds that have been closed down in the Bath area. It refers to the waiting period in Switzerland for hip operations, which is between six and eight weeks. In the United Kingdom it is a matter of months or years.
  Mr. Flannery: What is the cost of such operations in Switzerland?
  Dr. Vaughan: In the Bath area the situation will become worse. Some of the beds available for that sort of operation are no longer available. We have details from throughout the country.
  Another scandal is that of unopened units. What are the effects of opening some of the units at long last? It seems that there will not be enough money to maintain them properly once they are open. Where they are opened they will operate at the expense of closing many smaller units, which have advantages in terms of contact, communication and local community interest.
  My hon. Friend the Member for Hampstead (Mr. Finsberg) is deeply worried about the problems of the Elizabeth Garrett Anderson Hospital. He would have spoken here today, were it not for the fact that he is out of the country.
  I turn now to a very serious matter—industrial unrest. Last week the Secretary of State was ungracious enough to say—I think that he should apologise for and withdraw his remark—that I, on 13th March, had referred to widespread industrial action within the National Health Service and that such exaggeration was trouble-making. That was a disgraceful remark to make, because there is widespread industrial action within the NHS.
  Mr. William Hamilton: There is not.
  Dr. Vaughan: Of course there is. We know about Dulwich, Westminster, Southampton, Charing Cross and Liverpool, because they are publicised. But does the Secretary of State know about all those which do not hit the headlines?
  798
  In practically every hospital to which I go—there are some exceptions—I am told about threats of intimidation and restrictions on services if certain procedures are not carried out in the way that some members of the ancillary staff, particularly the porters, think is necessary.
  I have here a letter from the Royal Northern Hospital. I wonder whether the Secretary of State knows about that. In this letter he says—
  Mr. Flannery: Who says?
  Dr. Vaughan:—that there is widespread blockage to their work.
  "We have had numerous meetings at all levels".
  The thing which upsets him, the writer of the letter—
  Mr. Hamilton: Who said that?
  Dr. Vaughan: I will give it to the Secretary of State—
  "is the apparent total lack of concern of the Area Health Authority."
  That is the point that I wish to make.
  In my area only last week I was inquiring about a report that wards had been left without any staff at all in the Borough Court Hospital. I discovered, to my amazement, that there was longstanding and major industrial unrest going on in that hospital. The porters and the ancillary staff have now stopped all admissions, including emergency admissions, of mentally sub-normal and mentally handicapped patients. At one point they closed the day unit, so those patients had no help whatsoever. Does the Secretary of State know about that hospital?
  Mr. Hamilton: Can the hon. Gentleman substantiate that?
  Dr. Vaughan: Of course I can.
  Mr. Hamilton: The hon. Gentleman had better do so.
  Dr. Vaughan: I have done. There is a campaign of industrial blockage.
  Mr. Flannery: At which hospital?
  Dr. Vaughan: The Borough Court Hospital, Henley. All admissions have been stopped. I have a letter here. I shall not go into further details, but I shall be glad to give them to the Secretary of State.

  799
  We have letters of all kinds complaining on this front. There is a letter from a former radiographer at King's College. She says:
  "I had one difficulty or another with the porters every week. When they refused to work, I was quietly sent 'on holiday'.
  I regret I was unable to cope with the unreasoning power of the porters' union and finally quit the NHS to come to Australia where hospital work is untarnished by unionism.
  I took the easy way out. I am happy to hear that at least one senior nursing sister"—
  she was writing to Sister Burke—
  "has got the guts to stand firm."
  I was glad today to hear from the Secretary of State that he has taken up our suggestion, which is only common sense. He has had a letter from me on this matter. He does not seem to know that. Perhaps his Department did not tell him that either. I do not know. In his discussion with the BMA and the TUC he is trying to produce a code of practice. The interesting thing about this is that locally, in different parts of the country different people are endeavouring to do exactly that.
  Mr. Ennals: Will the hon. Gentleman give way?
  Dr. Vaughan: I shall not give way for the moment. The Minister of State wants to have a full speech.
  I tell the Secretary of State that when local groups feel that they are so frustrated that they have to take action, they usually do so because there is a lack of leadership from the top. It would not be necessary for local groups to do this if the Secretary of State were giving the guidance and firm handling called for by so much of the NHS.
  There is the scandal of the unemployed nurses. Who but the present Government could achieve a situation in which units are closed through a shortage of nurses and yet there are nurses unemployed because there are not jobs to take them? We are disappointed—we shall give our support if the Government can find the time—that the Briggs Report has not been produced in this Session.
  There is the scandal of the specialised services. We have heard a good deal recently about the kidney services. One of the things that the Secretary of State has told us is that he will do this great
  800
  thing—I welcome it—of increasing the number of kidney facilities. But he has not told us that we are bottom of the league in Europe for renal provision. Even Italy, with all its problems, provides services for twice as many patients as we do.
  I have the figures for all the major countries in Western Europe. In Italy they treat 7,000 patients. We treat 3,078 patients. In Italy they treat 93 per cent. of the kidney patients who come before them. In this country we treat 42 per cent. This is a serious situation caused by a Government who claim to be caring for this type of patient. There is no reason to believe that the incidence of kidney disease is any different in this country from what it is in Italy, France and Germany, the figures for which countries I have in front of me.
  There is the scandal of the dentists—the scandal of the centres of excellence to which my hon. Friend the Member for Canterbury (Mr. Crouch) referred. There is the scandal of the pay beds, which we were assured were needed for NHS patients but which are lying empty. There is the scandal of the committees which clog and frustrate the whole service.
  My right hon. Friend outlined to the House the steps that we would want to see taken. This is important. We divide those steps clearly into two stages. We think that there is an immediate, urgent and desperate need for something to be done. Afterwards, we see as a second stage perhaps the examination of more general changes in funding, and matters of that sort. We envisage in the first and immediate stage a package of needs. We think that the Service should be made local, so that there is somebody local to take decisions, who can give answers and be responsible for what is happening.
  We think that the Service should be made simpler. In most places that would mean doing away with the area health authority and turning the region into what it was intended to be—a co-ordinating body rather than an administering body. We think that it should be properly costed, which is not the case today. We think that there should be proper incentives, which would make economies and fresh ideas worth while. The voluntary services have been neglected and abused,

  801
  and should be developed and encouraged. The private sector should be allowed to rise to whatever level it likes. Every penny that is spent in the private sector releases money in the National Health Service.
  We near the end of the debate. It was very clear why we called for this debate and why the Government did not. The Secretary of State for Social Services was foolish enough to say that he was showing courage and leadership. I have news for him, because what most people say is that he is not showing leadership. I ask him to exercise his mind on this matter. It appears to us that he is surrounded by far too many Press officials. He thinks that paper is a substitute for action. I once called him the Nero of the National Health Service, but the difference between the right hon. Gentleman and Nero is that at least Nero knew that Rome was burning, whereas our present Secretary of State for Social Services has no idea at all what is happening in the Service that is under his care.
  9.31 p.m.
  The Minister of State, Department of Health and Social Security (Mr. Roland Moyle): I am grateful for the courtesy which the hon. Member for Reading, South (Dr. Vaughan) exercised in allowing me to speak for a full half hour. We have had an interesting debate, and a large number of points have to be answered as a result of the short speeches which the Chair urged upon the House—a request which has been so well followed by hon. Members.
  I only wish that the hon. Gentleman had taken the opportunity to make a constructive contribution to the debate. I thought that it was a disappointing concluding speech by the Opposition spokesman. The Conservative Party at least pretends to be one of the major national parties and to make a contribution to national policy. However, what we heard from the hon. Gentleman was nothing more than a long jeremiad based on anecdotal evidence. Everybody knows that one can construct any case one likes on the basis of such evidence.
  There are 1 million employees in the National Health Service, and the hon. Gentleman in seeking to build up his case must have quoted at least 13 malcontents from different parts of the
  802
  country. I repeat that it was a disappointing contribution to what has been—for all the inconsistencies of the right hon. Member for Wanstead and Woodford (Mr. Jenkin)—a debate about national policies and principles, however inadequately they might sometimes have been developed.
  Let me turn to the points raised by the hon. Member for Reading, South and seek to test their accuracy. Miss Hall is a very sensible person. The Royal College of Nurses has a warm and strong interest in the National Health Service and the hon. Gentleman must have misquoted Miss Hall, or quoted her words out of context, because the fact is that nurse staffing standards in the Health Service are going up. Between 1974 and 1976 the number of fully trained nurses in the Health Service increased by 21,000. I believe that the number has subsequently increased by a further 10,000 since then, and there is no correspondence between what the hon. Gentleman said and the actual situation. I do not believe that Miss Hall would make a misinformation of that sort.
  The hon. Gentleman then mentioned the nurses at King's College Hospital. The fact is that at King's there has been a considerable development of advanced medicine over the past years. Nurses have been drawn into highly intensive care nursing and have been under some strain. The nurses have made it clear that they have been under strain, and the area health authority has given authority to recruit an extra 50 nurses to ease that strain.
  We then come to the question of renal care. I agree that the provision of kidney machines in this country is not as substantial as we should like it to be, but in the Budget we have provided money for an extra 400 machines up and down the country.
  What the hon. Gentleman did not do—and what he should have done if he intended to give a full rounded picture—was lo say that in this country we have a proud record indeed of kidney transplants. In that regard we are ahead of most other countries in Europe, and if my right hon. Friend's publicity campaign succeeds for the donation of more kidneys, we shall consolidate and improve on that situation.

  803
  The hon. Gentleman went on to talk about industrial relations in the NHS. The way in which he spoke on that subject was revealing. Given that there are 1 million people employed in the NHS, it is not surprising that from time to time there are some industrial disputes. What is important is that there are so few disputes in relation to the numbers employed and most of them are unofficial. A high percentage of them involve personality clashes.
  I was disappointed that the right hon. Member for Wanstead and Woodford, who was reinforced by the hon. Member for Reading, South, commented in detail on the Dulwich dispute. That was essentially and importantly a personality clash. The less that is said about it at this level the more likely is conciliation.
  Mr. Moonman: Apart from the politics in the last speech, which I agree was regrettable, does my hon. Friend recognise that there are fundamental industrial relations problems? This means that management and administration must be alert to having a good consultation system, because it could become a serious issue in the next few years.
  Mr. Moyle: This is a serious issue now. My hon. Friend the Member for Waltham Forest (Mr. Deakins) has been supervising the implementation of the McCarthy Report, for which we were responsible, with a view to improving consultation in the National Health Service. We were left with an organisation which was bereft of adequate machinery for consultation.
  The whole tenor of the speech by the hon. Member for Reading, South on industrial relations and of other Opposition speeches involved the question of conflict. The Conservative Party has had a secret commission to investigate industrial relations. Not only are the conclusions reached interesting but another interesting point is that the Conservatives thought that such an investigation was necessary. The basis of the report was "Can we beat the unions if it comes to a clash?" The Conservatives came to the conclusion that they could not beat the unions and therefore they are to try to work with them. The basis of the hon. Member's contribution to the debate was not to consider how we
  804
  can come round a table and sort out the problems as sensible and reasonable people with different interests. The burden of his speech was that industrial relations in the Health Service were in conflict. That is the trouble with the Opposition. It is a matter that they should consider.
  Many points have been made and I shall try to answer them as best I can in the time that is available. The hon. and learned Member for Thanet, West (Mr. Rees-Davies) paid a warm tribute to my hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) for the work that he has done. The hon. and learned Member is not here. We can understand that, because he is in considerable discomfort. The hon. and learned Member drew attention to the importance of access to buildings for disabled people. There is now a requirement that access to public buildings for disabled people should be built in when the buildings are constructed. We are conscious of the access problems involved in private buildings and the barriers that are put in the way of disabled people.
  With that in mind, my hon. Friend the Minister who is responsible for the disabled established the Silver Jubilee committee last summer to improve access for disabled people. He set the committee the task of making the public in general, and those who manage public and social service buildings, more aware of access difficulties and the ways in which these can be minimised.
  My hon. Friend the Member for Lichfield and Tamworth (Mr. Grocott) was unfairly attacked. He made some good points about democracy in the Health Service. One of the things that we have done since we came to power in 1974 is to ensure that locally elected councillors can become members of area and regional health authorities. In that way we have done our best to import an element of local democracy into the administration of the Health Service. It is too early to say whether it has been completely effective, but there was a general desire for more democracy.
  Those representatives are elected by the people, and we have given them the chance to join in on the administration of the Health Service. My hon. Friend felt that community health councils

  805
  should have observers on family practitioner committees. More than 40 family practitioner committees now allow observers from the councils into their proceedings.
  There is one speech that I can dismiss fairly easily. It is that by the hon. Member for Walsall, North (Mr. Hodgson). It was a grotesque travesty of the Health Service and was designed only to stir up as much trouble as possible in his part of it. His speech does not require much of a comment or answer.
  My hon. Friend the Member for Goole (Dr. Marshall) raised the problem of health centres. He suggested that their legal framework should be recast. We are examining that. We are anxious to provide the best possible terms to encourage general practitioners to move into health centres. But I warn my hon. Friend that there are many other problems which arise in large part from the independent contractor status of GPs, and these need to be solved if the health centres are to be properly used. For example, the centres take a long time to plan, build and bring into commission. During this time, groups of GPs who originally committed themselves to moving into health centres often change their composition. Some of them change their minds. Sometimes there are personality clashes. Sometimes some of the partners die. All these problems, in addition to the purely legal ones, have to be surmounted.
  My hon. Friend asked about the centre at Knottingley in his constituency. Given the long history of difficulties there has been in that area I shall look personally into the matter to see what can be done to assist his constituents in getting a proper service going in that part of the world.
  The hon. Member for Aylesbury (Mr. Raison) raised a number of interesting points. He spoke of scrapping hospitals in his area, but we are to open a new community hospital in Milton Keynes this year. I shall be visiting Milton Keynes among other places next week in order to see the situation there.
  The hon. Gentleman made a sweeping criticism of the existing Health Service organisation. But I should remind him that not only did he vote for the new organisation, but he was actually a member of the Government which recommended it to the country—
  Mr. Raison: No.
  Mr. Moyle: The hon. Gentleman was an Under-Secretary.
  Mr. Raison: I was not a member of that Government when the Health Service reorganisation was brought in.
  Mr. Moyle: That is a feeble excuse. [HON. MEMBERS: "Withdraw."] I said that the hon. Member was a member of the Government which introduced the Health Service reorganisation, and he was. After the Health Service reorganisation went through, he joined that Government so he could not have found much that was objectionable in the reorganised Service. There have been more blinding lights on the Opposition Benches than Paul ever saw on the road to Tarsus on this question of the reorganisation of the Health Service—[Interruption.] The right hon. Member for Leeds, North-East (Sir K. Joseph)—
  Mr. Speaker: Order. I think that the Minister has upset hon. Members with his theological reference.
  Mr. Moyle: I knew you would appreciate it, Mr. Speaker.
  Mr. Speaker: I would have appreciated "Damascus" even more.
  Mr. Moyle: The reason why I am making this point is that I think that the right hon. Member for Leeds, North-East has a very bad Press. Anyone would think that he was a single-handed party on his own, but the fact is that he was just one member of a Government that included the right hon. Member for Wanstead and Woodford. He cannot get out of it on any ground on which the hon. Member for Aylesbury got out of it. The right hon. Member voted for every hook, line and sinker, dot and comma of the reorganisation—[An HON. MEMBER: "Get on."] I am getting on. I am pointing out the inconsistencies in the right hon. Member's position. He voted for all of it. He recommended to the House, along with his colleagues, that the reorganisation should take place and he was supported by his hon. Friend the Member for Reading, South. These points are worth bearing in mind. It was a concerted Government exercise. It was not something that the right hon. Member for Leeds, North-East thought up by himself.
  Mr. Patrick Jenkin: Perhaps the Minister of State will say whether he agrees with four of his right hon. Friends—the right hon. Members for Blackburn (Mrs. Castle) and for Kilmarnock (Mr. Ross), the Secretary of State for Wales and the Home Secretary, all of whom put their name to a document in which they said:
  "The reorganised NHS … provides an improved administrative framework within which it is now possible to look at priorities more comprehensively and to plan the allocation of resources more effectively both at local and at national levels."
  Does the Minister accept that?
  Mr. Moyle: Quite honestly, what we have done is to set up the Royal Commission. My right hon. Friends have set up the Royal Commission, which will look at all these problems with a view to solving them. That is the difference between our position and the right hon. Gentleman's position.
  The hon. Member for Truro (Mr. Penhaligon) raised a very important point in regard to the influx of tourists into his constituency in the summer. He raised this point in the debate on the Consolidated Fund Bill. I think that it is most important that as a Government we know the impact of movements of short-term populations into and out of various areas, in the interests of proper health planning. I shall certainly examine the situation in Truro to see what is the impact of this as an example that we can take for the rest of the country and for country-wide planning, and I shall ascertain what comes out of that to see what can be done and what is necessary to assist places such as Truro up and down the country. I hope that the hon. Member will be pleased about that.
  Incidentally, it is worth making the point that on the question of funding the NHS, as far as I can see, Opposition Members are out on their own. All other parties that have made a contribution to the debate—the SNP, the Liberal Party and, of course, my right hon. and hon. Friends—are totally opposed to the concept of funding the NHS that has been put forward in the debate.
  Mr. Geoffrey Johnson Smith: Will the Minister give way?
  Mr. Moyle: I have only a very limited amount of time in which to reply to the
  808
  debate. I shall be talking about the hon. Gentleman's speech if I have time before 10 o'clock.
  My hon. Friend the Member for Fife, Central (Mr. Hamilton) raised a couple of interesting points with regard to alcohol abuse in Scotland. He talked about the £50 million advertising budget of the drink industry. Of course, we are entering into discussions with the brewers and with the wine and spirit trades with a view to agreeing a code of practice on the advertising of drinks. They are co-operating with us to ensure that there is no undue association between glamour occupations and situations and drink, and no encouragement to young people to develop the habit of heavy drinking.
  My hon. Friend also raised the question of the Elizabeth Garrett Anderson Hospital, as did one or two other hon. Members. We have always been determined that the service for women should be maintained in the concept of an Elizabeth Garrett Anderson, whether or not it is in its existing buildings. The Camden and Islington Area Health Authority examined the question of the facility being placed at the Whittington Hospital, but was not happy with that proposal. The AHA is now discussing the matter with the regional health authority, which has accepted the AHA's report, and my right hon. Friend will await whatever the regional health authority has to say.
  The hon. Member for Galloway (Mr. Thompson) raised a number of interesting points. He emphasised that the NHS should be for the whole population and financed by taxation. He asked whether kidney machines will go to Scotland. An increased proportion of resources will go to Scotland for increased numbers of kidney machines. He asked whether Scotland would have its own White Paper on policies for the elderly. The Scottish Office is not planning such a White Paper, but no doubt it will keep in close touch with our debate with a view to developing its policies.
  The hon. Gentleman mentioned the Briggs Report. I regret as much as other hon. Members that we could not legislate on it this Session, but I am determined to do my best to get the reorganised nursing profession set up with its framework of legislation in the next Session. We are working hard on that.

  809
  The hon. Member for Galloway also mentioned derogation under Briggs. Few nurses in Scotland or England would welcome differences in professional training between the two countries being increased in a way which would limit free movement for purposes of employment. The united nursing profession will make its maximum contribution to the free movement of nurses. There will be a Scottish national board to look after particularly Scottish problems.
  My hon. Friend the Member for Basildon (Mr. Moonman) mentioned the Friern Hospital. My right hon. Friend and he are now crystal clear about their varying standpoints. He also raised with me the question of the Royal Liverpool Teaching Hospital and the structure of the NHS management as an example. It is not possible for my right hon. Friend, even with the brilliant assistance of my hon. Friend the Member for Waltham Forest and myself, to run the entire NHS from the Elephant and Castle. It is the concept of the Health Service that we delegate functions to area and regional health authorities, who look after the NHS in their areas and know the details of local problems much better than we possibly could.
  Dr. Vaughan: That is news.
  Mr. Moyle: This is the way we run the NHS. I am sorry that the hon. Gentleman was not aware of that before.
  My hon. Friend chose as an example of a breakdown the Royal Liverpool Teaching Hospital. It was a poor example. Most of its problems arose under the old board of governors. The contract between the Merseyside Regional Health Authority and the new contractors re-established the position in Liverpool and allowed us to make progress. For example, at one time we were afraid that the fire precautions would cost £11 million. The new fire precautions will cost much less than that—probably not more than £5 million. If my hon. Friend wants the exact figure, I can get it for him. So that was not a particularly good example.
  My hon. Friend the Member for Ealing, North (Mr. Molloy) was anxious to ensure that never again did the sort of trouble suffered at Ealing Hospital arise in any part of the NHS. The hospital was handed over on 19th April. I am informed by the regional health authority
  810
  that it expects no difficulties in bringing the hospital into commission. But money has been held back for liquidated and ascertained damages because the revised date of completion was to be November 1976 and that date was not met.
  At the same time the consulting architect will be holding the most thorough inquiry into the contract and all these matters and will be reporting to us before we make final payment of the sum of money for the Ealing District General Hospital.
  The hon. Member for Sutton and Cheam (Mr. Macfarlane) raised the question of the postgraduate hospitals. At least, he raised the question of the Royal Marsden Hospital, but I do not think that I can reply without dealing broadly with the whole matter of the postgraduate teaching hospitals. We are considering the future of those hospitals as a group, and we shall issue a discussion paper in the late spring or early summer for consideration by them and the National Health Service. What we do in the future will depend on the result of that debate.
  Mr. Macfarlane: When the hon. Gentleman says "late spring or early summer" presumably he means "in the next few weeks".
  Mr. Moyle: I do indeed. Preparations are reasonably well advanced for the publication of a paper.
  Mr. Carter-Jones: What about maternity?
  Mr. Moyle: One of the most thoughtful speeches made from the Opposition Benches was that of the hon. Member for East Grinstead (Mr. Johnson Smith). He had obviously thought out his position very clearly. It was interesting that he said that he did not think that any country could maintain a comprehensive national health service which was free at the point of user.
  Mr. Johnson Smith: Financed out of taxation.
  Mr. Moyle: Broadly speaking, that means free at the point of user. That is how we on the Government Benches look at these terms. It was very interesting, because it seems to me that the same health cost must be met whether it is met through private or public means.

  811
  The only implication of the hon. Gentleman's remark must be that we could afford what he would regard as a health service only if private services were used. It therefore means either that standards of service to substantial numbers of people will be reduced or some people will be excluded from the Health Service altogether. That is the logical conclusion. The hon. Gentleman is nodding his head.
  My hon. Friend the Member for Ealing, North put it in his irrepressible way by saying that the Opposition were thinking of running a health service on the basis that if a service was provided for the rich the poor would somehow be taken care of. That is not true.
  In spite of the denial about charges—now the hon. Member for Reading, South is shaking his head—the hon. Member for East Grinstead was joined even by the hon. Member for Canterbury (Mr. Crouch) in talking about supplementing public funds for the National Health Service. He was also joined by his right hon. Friend the Member for Wanstead and Woodford, who has been arguing for it. Indeed, the first four Conservative speakers all urged that public funding of the National Health Service should be supplemented by a substantial raising of funds by private charges in the Service.
  To Labour Members that can only mean that one develops two health services. Our limited experience of pay beds in the National Health Service was that they were used for queue-jumping, that people bought a higher place in the queue because they could pay for it.
  If that principle is extended by the Opposition to cover more facets of the National Health Service, we shall have a two-tier National Health Service which will cease to be a National Health Service. For Conservative Members to say that they believe in a National Health Service when they support such measures and to say that the Health Service should be confined to geriatrics, the mentally ill, the mentally handicapped and the less glamorous specialities of that sort, is merely playing with words.
  Mr. Johnson Smith rose—
  Mr. Moyle: I shall not give way, as I am nearly at the end of my speech.
  812

  The hon. Gentleman agreed with my comment on his speech.
  Mr. Johnson Smith: I was shaking my head. I did not agree with what the hon. Gentleman said.
  Dr. Vaughan: Nor did I.
  Mr. Moyle: In that case, there is a substantial division of opinion between the hon. Gentlemen and their right hon. Friend the Member for Leeds, North-East, who was urging that the Health Service be divided into two, that people pay privately for substantial parts of the acute medicine section, and that the rest of the Health Service be devoted to a second-rate workhouse-type service for the future. That is the obvious development of the lines along which Conservative Members are determined to proceed.
  It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.

  NATIONAL HEALTH SERVICE

    BUSINESS OF THE HOUSE
    Ordered,
    That the Medical Bill [Lords] may be proceeded with at this day's sitting, though opposed, until any hour.—[Mr. Harper.]

  DIRECTOR OF PUBLIC PROSECUTIONS (PRESS COMMUNICATION)
  10.0 p.m.
  Mr. J. W. Rooker: On a point of order, Mr. Speaker. I apologise for interrupting the business of the House to seek your guidance and ruling. It is within the knowledge of hon. Members that during the course of this evening the Director of Public Prosecutions sent a memorandum to the editors of the national Press in Fleet Street consisting of two sentences. I wish to point out that this memorandum flies in the face of all that we thought this House stood for, in the sense that we thought that our proceedings could be reported factually, accurately and without prejudice to the public by the media.
  The memorandum from the Director of Public Prosecutions reads as follows:
  "The legality of revealing the identity of Colonel 'B' a witness in the prosecution of Aubrey, Berry and Campbell is the subject matter of pending proceedings for contempt

  813
  of court before the Divisional Court of the High Court of Justice. It is not accepted despite the naming of the colonel on the Floor of the House of Commons that the publication of his name would not be a contempt of court, even if it was part of a report of proceedings in the House."
  It is extremely important that this matter is settled speedily, that is, this evening, simply because if it is allowed to pass until tomorrow there will have been a fait accompli and the House and the public will have had taken away from them a right which they thought they already had.
  This is really a simple matter. I have deliberately refrained from commenting on the detail of our proceedings earlier today because that is not in issue. The issue is a straightforward one, and you, Mr. Speaker, are the only person who can protect our rights and the rights of the public outside, in that the proceedings of this House are not the property of a civil servant, the Director of Public Prosecutions; they are the property of our constituents, the electorate. I ask you, if it is possible—and I have no doubt that you may have given some consideration to the matter during the evening—to rule on this important matter so that the public, hon. Members and the Press may know where they stand.
  Mr. Graham Page: Further to that point of order, Mr. Speaker. If the Director of Public Prosecutions had issued a notice saying that, because a certain name had been stated in the House, it did not necessarily mean that it would not be contempt of court to state it elsewhere, quite apart from fair reporting of our proceedings in this House, that would be obvious. But I think that what the Director of Public Prosecutions has said—and I have the report of it in my hand—is that even though it be fair reporting of our proceedings in the House, to repeat that name outside may be contempt of court. That seems to be contempt of Parliament—to give that direction to newspapers which are absolutely entitled and absolutely privileged to report cur proceedings in this House.
  What the House will want to know, since the Director of Public Prosecutions comes directly under the Law Officers, is whether he has received any instructions from the Law Officers to make this statement. It is of vital importance to the newspapers. No doubt they have their
  814
  presses already set up fairly to report what was said in the House. If they are to be told now, at this late stage, that this will be contempt of court and possibly contempt of the House, I hope that you will be able to correct the position at once.
  Mr. Doug Hoyle: Further to that point of order, Mr. Speaker. There is an anomaly here in that, as I understand it, this matter has already been reported on radio. Why should the Press be deprived of the same facilities as are now open to radio? Surely this raises an important issue which must be decided right away, particularly since it is giving an advantage to one part of the media as against another.
  Mr. Max Madden: Further to that point of order, Mr. Speaker. I further understand that these matters have been conveyed by television this evening, but I should also like to know whether the Official Report is concerned in a way by the steps which the Director of Public Prosecutions seems to be taking.
  This afternoon, as you will know, several of my hon. Friends referred to this matter, and presumably at that time they were in order. I refer you to page 77 of the 18th edition of "Erskine May", which says:
  "the publication, whether by order of the House or not, of a fair and accurate account of a debate in either House of Parliament is protected by the same principle as that which protects fair reports of proceedings in courts of justice, namely, that the advantage to the public outweighs any disadvantage to individuals unless malice is proved."
  I would have thought that, if the action of the Director of Public Prosecutions is upheld, it will be a substantial attack upon the freedom of the Press to report the proceedings of this House which has always been thought to have existed in the past.
  I think that it is most urgent, in view of the new arrangements that we have for the broadcasting of the proceedings of the House, that you rule and make clear that there have been no changes to the proceedings and the protection which we thought to exist, and that, indeed, we should have the right to ask under what instructions the Director of Public Prosecutions has taken this step in regard to issuing his advice to the editors of the national Press.
  Mr. Peter Rees: Further to that point of order, Mr. Speaker. As my right hon. Friend the Member for Crosby (Mr. Page) pointed out, the statement of the Director of Public Prosecutions is susceptible of two constructions. One of these is, of course, a trite proposition of law—that if the identity of Colonel "B" has been reported outside this House, and independent of the proceedings of this House, that may well be a contempt of court. As to that, I do not propose to address you.
  But if, on the other hand, the Director of Public Prosecutions is saying that the proper reporting of the proceedings of this House may in itself constitute a contempt of court, I would respectfully remind you, Sir, although I have no doubt the learned Clerks, if it were necessary to do so, have done so, of the case of Stockdale v Hansard in the last century.
  As I understood the position, the point had been determined once and for all and the reports of proceedings in this House were absolutely privileged in all circumstances whatever. if that is the proper construction to be put on the Director of Public Prosecution's statement, I respectfully suggest that it may be very important, first, to summon him to this House to ask him to explain his proposition, and it may even be necessary to find out whether he was making that case on his own authority or on the authority and advice of the Attorney-General.
  There are matters of grave constitutional importance. I had hoped that they had been determined once and for all in the last century, but I have no doubt that you will be able to give authoritative guidance, and in so doing you will perhaps be able to take the case of Stockdale v. Hansard a little further than we had appreciated that it had gone already.
  Mr. Speaker: I have listened with anxious concern to the right hon. and hon. Members who have raised this important question with me.
  May I say first of all to the hon. Member for Sowerby (Mr. Madden) that of course our Official Report is not concerned at all. We publish a verbatim report of our proceedings, and this is the High Court of Parliament.
  816
  Secondly, I also heard the report on the 9 o'clock news tonight when I was away from the Chair. It is not for me, not for the Speaker of this House, to rule what is a contempt of court. That lies in other hands. It is for the legal authorities to decide what they consider to be a contempt of court. My task is to protect the privileges of this House, and I never rule on contempt, as a matter of fact—all that I do is to submit to the House, or to give an hon. Member the right to submit to the House, a motion that has precedence for the House itself to decide whether a matter is an issue of contempt.
  I do not know whether I am being asked whether there has been a contempt of this House. I have heard tonight the report of our proceedings, and our proceedings will be reported in Hansard tomorrow—I hope. I cannot, therefore, advise people outside the House how they are to deal with the Director of Public Prosecutions in a matter of this sort.
  Mr. Martin Flannery: Your guidance, Mr. Speaker, does not seek to indicate to the assembled Press in the Gallery whether they can go ahead—[Interruption.] Could we therefore have your guidance with more clarity on the question whether a contempt is being engaged in, because we are confused. We are being approached by the Press, and have been approached all evening, to give our opinions about what is happening. The guidance does not seem to be—I say this with the deepest respect—as clear as we would want it to be.
  Several hon. Members rose—
  Mr. Speaker: Before I hear any more hon. Members, let me make the position perfectly clear. The decision is not for me. It is for those who wish to publish. If they wish to publish, it is their decision. I protect the rights of this House. It is for them to decide whether they will be breaking the law. Undoubtedly, there is a difficult situation, but the House can stay here until 4 a.m. and I shall not rule on a decision which must be taken by the people concerned.
  Mr. Graham Page: May I, then, Mr. Speaker, move that
  "the statement of the Director of Public Prosecutions is prima facie a contempt of this House, and should be referred to the Committee of Privileges."?
  Mr. Speaker: Following recent precedents, I never rule on privilege when the matter is raised. I always ask for time to consider it. The right hon. Member for Crosby (Mr. Page) will not expect me to go further than that tonight. I am quite prepared to rule on it tomorrow morning, when I shall have had time to consider it.
  Mr. Eddie Loyden: Further to the point of order, Mr. Speaker. I appreciate the point you have made and, indeed, accept the general argument, but would you not agree that the broadcasting of the House puts a different perspective entirely on the question? It means, in fact, that there is a differentiation between the House's attitude—or, indeed, the attitude of the DPP—towards the broadcasting of the House and the Press, the members of which are at this time inhibited from reporting what is generally public knowledge.
  Mr. Speaker: It only happens to be a matter of good fortune that it arose on business questions and not on Prime Minister's Questions; otherwise it would have been broadcast to the nation. But that is something for others to take into account, and not for me.
  Mr. Madden: I am most grateful for the advice that you have given to the House, Mr. Speaker, and for your statement that you will give a further ruling. But I should like to seek your further advice with regard to the repercussions on those who may tomorrow seek to republish matters which are reported in the Official Report. As you have rightly said, we must presume that the exchanges on business questions will be reported in the Official Report, and therefore I should like to know from you what protection we have, in publishing the Official Report, from any attempt by the Director of Public Prosecutions to proceed against the Official Report on ground of contempt.
  818
  I think that this is a matter of consequence and one which requires clear guidance from yourself as to what rights of protection those who re-publish matters which are published in the Official Report tomorrow can expect to have from this House.
  Mr. Speaker: Let me make it perfectly clear that the High Court of Parliament is sovereign, and we shall publish our proceedings verbatim.
  Mr. Rooker: I am grateful for the statement that you have made, Mr. Speaker. When considering the submission of the right hon. Member for Crosby (Mr. Page) will you accept that the real point at issue is not one of contempt of court? It is the fact that someone—in this case a civil servant—has interfered with the reporting of the proceedings of this House to the public outside. That is the crucial issue and we cannot let it pass without bringing this civil servant to book.
  Mr. William Molloy: When you consider this problem, Mr. Speaker, will you examine another important aspect? It would have been possible for the broadcasting authorities to broadcast extracts from our deliberations, as they do almost every evening. They have not yet started on one particular programme. There is now a possibility of a public servant setting himself tip as a censor of the BBC, ITN or anyone else if he feels that there might be something dangerous in broadcasting certain aspects of this evening's proceedings and as a result withholds them. That is bad enough, but it would also mean that the Director of Public Prosecutions would be automatically viewed by the media as a form of censor.
  Mr. Speaker: I am much obliged to all hon. Members. I shall take account of everything that has been said and give a considered ruling to the House tomorrow morning.

  MEDICAL BILL [Lords]
  As amended (in the Standing Committee), considered.
  MEDICAL BILL [Lords]
    New Clause No. 1

      REPLACEMENT OF PROVISIONS OF PART III OF MEDICAL ACT 1956
      '(1) Subject to the provisions of Part I of Schedule 5 to this Act, on the day appointed for the coming into operation of sections 22 to 28 below—

      (a) section 25 of the Medical Act 1956 (which provides for the temporary registration of medical practitioners), and the reference to that section in section 26 of that Act, shall cease to have effect: and

      (b) the register of temporarily registered medical practitioners shall be closed.

      (2) Subject to the provisions of Part II of Schedule 5 to this Act, on the day appointed for the coming into operation of sections 18 to 21 below, sections 18 to 24 and 26 of the Medical Act 1956 (which provide for the registration of Commonwealth and foreign practitioners) and the Medical Practitioners and Pharmacists Act 1947 (which, so far as still in force, makes similar provision) shall cease to have effect.
      (3) If the day mentioned in subsection (1) above is earlier than the day mentioned in subsection (2) above, the Medical Acts 1956 to 1969 and this Act shall have effect, during the period commencing with the first day and ending immediately before the second, subject to the provisions of Part III of Schedule 5 to this Act.'.—[Mr. Moyle.]
      Brought up, and read the First time.
      10.17 p.m.
      The Minister of State, Department of Health and Social Security (Mr. Roland Moyle): I beg to move, That the clause be read a Second time.
      Mr. Speaker: With this we may take Government Amendments Nos. 15, 17, 19, 49, 50, 21, 23, 24, 26, 29 to 41, and 43.
      Mr. Moyle: These are Government amendments designed to enable some of the new provisions relating to the registration of overseas qualified doctors to be brought in, particularly those relating to limited registration. The amendments mean that the provisions will not have to wait until the new General Medical Council is elected and the education committee is set up and functioning. That process might take two years. Therefore,
      820
      we want to allow limited registration to take effect almost immediately after the passage of the Bill. These amendments have been welcomed by the Overseas Doctors Association.
      Dr. Gerard Vaughan: We welcome the new clause, which implements the other changes that the Government introduced in Committee.
      This Bill arose from the recommendations of the Merrison Committee. It was universally accepted and agreed by the BMA, the GMC and the professions generally. We were presented with a Bill that had an almost suspicious amount of approval from everyone concerned, as well as a unanimous report from the Merrison Committee.
      On that basis we were happy to support the Bill and to agree that it should go straight into Standing Committee. For that reason we insisted that it should come back to the House tonight so that any hon. Members who were not on the Committee would have an opportunity to look at its main provisions.
      In one way it was a most unusual Bill. In another place first and then in Committee the substance of the Bill was transformed by a large number of new amendments. We are now seeing a Bill totally different in many respects from the original.
      However, we are pleased to give our support to the new clause which follows closely the recommendations of Lord Hunt in another place. I pay tribute to his work and initiative in having the various changes put in on the registration of overseas doctors and doctors generally. We welcome the new clause and support it.
      Question put and agreed to.
      Clause read a Second time, and added to the Bill.

    New Clause No. 3

      RETENTION FEES
      "There shall be no increase in the General Medical Council retention fees within two years following the passing of this Act "—[Mr. Beith.]
      Brought up, and read the First time.
      Mr. A. J. Beith: I beg to move, That the clause be read a Second time.
      We have heard from the two Front Benches the tone of sweet reasonableness, and it has prevailed because, if there is one thing that has virtually never been discussed from the start of the Bill's passage through the House, it is what it will cost and who will have to pay. These elementary questions should be dealt with tonight.
      We should not forget how much resentment was caused when retention fees were first introduced. The fees, by and large, pay for the expenses of the GMC. Many doctors took up practice thinking that there was a once-and-for-all payment to be made on registration. They were resentful when an annual retention fee was introduced. The Merrison Committee referred to that deep resentment. However, the fees have become accepted practice and we know that they will continue, but we do not know what will be the impact of the Bill and the additional work to be undertaken by the GMC.

      The Merrison Committee, on whose work the Bill is based, did not shirk the issue. It set out clearly that, in its view, quite a lot of expense would arise from these reforms. In paragraph 433 of its report, it says:
      "In any event there can be no doubt that the new functions which we recommend for the GMC would add considerably to the cost of its operation. A number of areas can be identified where there would be extra expense. First, fitness to practise proceedings have traditionally been an expensive part of the GMC's responsibilities and their cost would no doubt be substantially increased by our recommendation for a new role in relation to the sick doctor and for a unit to investigate complaints. Secondly, we have argued the need for a much wider scope in relation to the supervision of education."
      The Committee thought that this would be expensive and thirdly, it believed that the assessment of overseas doctors would be expensive. The Committee also thought that its recommendations that have led in the Bill to provisions for giving advice and guidance to doctors would give rise to expense. The report said that this
      "would put a further strain on the GMC's finances, and would hasten the increase of retention fees."
      The Committee argues strongly that it is worth doing and that better value for
      822
      money will result for doctors at the end of the day, though it is difficult to convince many doctors with this argument, because so many of the functions with which the GMC is concerned are designed for the protection of the public rather than the protection of the doctor.
      Much of what is in the Bill is designed to give the public the knowledge and satisfaction that the medical profession is well regulated from their point of view, so that the patient will know that he is well safeguarded. However, so much of what is in the Bill is bound to create further expense. If the GMC is enlarged substantially, as it can be under the Bill, there will be many more people trotting up and down the country to meetings and many more doctors' train fares and air fares to pay as they attend meetings. The additional branch councils must also necessarily give rise to expense. These are matters upon which all the parties, with the exception of the branch councils, are agreed. The need for the work has not been denied, but we must make clear what it will cost and who will have to pay for it.
      The Merrison Committee talked in terms of a possible partnership between doctors and the Government, with the Government chipping in a certain amount. So far the Government have held their reserve on this matter, because they see it as something to be discussed when the new GMC is set up. However, they have thrown out some interesting possibilities. In another place Lord Wells-Pestell said that the retention fees could be increased or the GMC could hold fund-raising activities. That conjures up delightful possibilities—"Come to the GMC's fund-raising bazaar". Doctors and their families will gather round running wheels of fortune in order to raise the day-to-day expenses of the GMC.
      I do not think that events will take that course. There is only one likely consequence and that is an increase in the retention fee. That will be resented by doctors, who are not convinced that the ability to set the payments against income tax makes it possible to ignore the cost altogether.
      We are drawing a blank cheque on the bank accounts of the doctors. We owe it to them to give them a clearer indication of what is involved, and to know ourselves before we give the Bill a Third

      823
      Reading. We should know what it will cost and the way in which the burden of the cost will fall. It is with that in mind that I bring this matter before the House.
      Dr. Vaughan: The hon. Member for Berwick-upon-Tweed (Mr. Beith) has raised an important point. There is no doubt that the costs of the new General Medical Council will be considerably higher than the present costs. There will be an argument whether the professions should pay the whole of the cost or whether the Government should pay part of it as the new General Medical Council will be carrying out various additional functions for the Government.
      That is a matter that the Merrison Committee considered. The Committee recommended that the new General Medical Council should be a totally independent body. However, can it be independent if the Government are paying part of its costs? I ask the Minister to tell us whether the Government have in mind to pay a proportion of the new costs. If so, what effect do they think that that will have on the independence of the new body?
      Mr. Moyle: The new clause, moved by the hon. Member for Berwick-upon-Tweed (Mr. Beith), would have the effect that the General Medical Council would be deprived of an increase in its income for two years to enable it to cope with rising costs. We hope that there will be no return to hyper-inflation, but there must be protection against all eventualities. It would be possible for the Council to meet rising costs only by increasing initial registration fees.
      I am sure that the hon. Gentleman does not wish the clause to have that effect. I understand that he is probing the Government as regards the future financing of the Council. He is doing so against the background of the original dispute which led to the setting up of the Morrison Committee and which was based on an increase in the retention fees.
      There will be an important distinction to be drawn between the General Medical Council as it is now and was when the dispute occurred and the Council in future under the Bill. The majority of the Council in future will be elected representatives of the profession. They will have the predominant voice, therefore, in
      824
      fixing the retention fee. That is a substantial change from the time of the dispute.
      Much of the work of the General Medical Council relates to the protection of the public, but by a paradox and interrelationship, what is done to protect the public leads to the protection of the profession. That process leads to public confidence in the profession and, in the end, protects it.
      I cannot give a precise indication to the House of the terms of the Council when it is formed under this measure. Clearly, it will have to make up its mind whether it wants to receive a financial contribution from the Government. It is only the new reconstituted Council that will be in a position to take that decision. It will have to take it against the background of the pertinent point made by the hon. Member for Reading, South (Dr. Vaughan)—namely, that if it receives some money from the Government it is conceivable that not the present Government, perhaps not even a Government in which the hon. Member for Reading, South is a member or a Government in which the hon. Member for Berwick-upon-Tweed serves, but some other Government in future might use that provision to reduce the independence of the profession.
      The profession will have to make up its mind about that. It will have to weigh inflation, the commitment that it wants to make to administration and the burdens of so doing against its desire for independence. All the other professions that I have been able to study have wanted to retain their independence and have not sought Government assistance.
      I hope that the House will join me in opposing the clause.
      10.30 p.m.
      Mr. David Crouch: I am glad to hear the Minister of State say that, because I cannot in any way support what was said by the hon. Member for Berwick-upon-Tweed (Mr. Beith).
      Mr. Beith: I did not say that. I said that the Merrison Committee said that.
      Mr. Crouch: I do not support what the Merrison Committee recommended.
      The General Medical Council is a very powerful body in our society. In Committee I said that it was one of the most

      825
      powerful statutory bodies of which we know. There is no such powerful body in the legal profession as exists in the medical profession. If the medical profession wants such a powerful body, it must pay for it. I should not accept so much as one penny or one farthing of that money going to support the medical profession in that sense. It must support itself if it wants this power.
      If it wants this power, it must have it 100 per cent. on its own. I should not support any contribution whatsoever from Parliament towards this body. I am not against it, but it must be paid for by the medical profession. It has this powerful body, and it must pay for it. No one else should be asked to make any contribution towards it. I feel extremely strongly about this matter.
      Dr. Alan Glyn: The point made by my hon. Friend the Member for Canterbury (Mr. Crouch) is that the General Medical Council wants to be independent. What worries me—the House should know about this facet—is how much it will cost. No one has calculated what fees will have to be levied for either initial registration or continuation. My recollection is that those who registered originally were given a once-and-for-all fee, but Parliament changed it.
      I am concerned about what the Minister said. Rightly, he said that some of the functions now being taken on are not entirely GMC matters, although they may be in the interests of patients. I do not know. I want to see an entirely independent GMC which is not in receipt of Government money. On the other hand, I have no idea to what extent the fees would have to be raised to achieve that object. There is no estimate in the Bill.
      Mr. Beith: It is nice to have generated some excitement over the Bill. I share with the hon. Member for Canterbury (Mr. Crouch) the belief that any professional self-regulating body which wants to retain its independence should look warily at the prospect of finance from the Government, but, as I pointed out, that was one of the possibilities canvassed by the Merrison Committee when it looked at ways of financing it.
      I think that the hon. Gentleman misleads the House slightly if he supposes that doctors from end to end of the
      826
      country are bursting to see the GMC engage in numerous activities and levy fees in order to do so. There is considerable support among doctors for the kind of constitution and independence that the GMC will get under the Bill. But the idea that there will be rejoicing in every surgery and consulting room from end to end of the country and a ready acceptance "Here is something for which we have been waiting for years; just send us the bills and we shall foot them straight away" is far from reality.
      Most doctors going about their ordinary work in general practice or in hospital, having little or no occasion to have dealings with the GMC, will wonder what restraints there will be upon any body of this kind from embarking on a programme of expansion of its activities. What will there be to prevent it from unwise commitment of expenditure? What will there be to discourage it from setting up larger and plusher offices, organising more planning meetings, committees, sub-committees and working parties? All these matters will mean many people spending a lot of other doctors' money travelling round the country from one meeting to another. Doctors getting on with the job will want to know that their money will not be used to excess on activities of that kind.
      The Government have been extremely cautious. They have rightly not tried to pre-empt the GMC's decision on where it wants its money to come from, but they have not said what kind of response there would be if the GMC asked them for money, and they have not offered any indication to the House of what they think the whole thing will cost at the end of the day.
      We cannot be happy about that state of affairs. If the Minister is not prepared to counsel the GMC to watch its funding carefully and to take a cautious view about what expenditure it should undertake, I so counsel it. I am sure that I carry with me many hon. Members who speak on behalf of the doctors who do not want the GMC to rush into extravagant expenditure now that it is embarking on a new range of functions.
      I do not think that it would be reasonable so much to restrict the GMC that it could not cope with the minimal inflation, which we hope to assist the Government in ensuring is all that happens over

      827
      the next few months and, indeed, over the next two years. But we must make it clear that this House, in providing opportunities for a more representative GMC with wider powers, does not want to see that made the occasion for spending a great deal of doctors' money.
      Mr. Crouch: Does not the hon. Member agree that the Law Society, which is a powerful body in regulating the behaviour and practice of solicitors, does not ask the Government for any money? It has wide powers and has the capacity to cause a solicitor to lose his business by striking him off so that he can no longer practice. The GMC has similar—I would maintain even stronger—powers. It would be wrong, no matter what the cost to the GMC, for the GMC to think of the Government—the taxpayer—picking up the tab for these powers. I agree that it is a worry for GPs to consider what the GMC may be taking on on their behalf, but we cannot pass the matter to the taxpayer.
      Mr. Beith: The hon. Gentleman is giving wise advice to the future GMC, which will now have to consider the matter. However, on behalf of the doctors we represent we are entitled to give further advice to the GMC—namely, that it should be very careful not to embark on expenditure that could lead to a considerable increase in retention fees when those fees are not viewed with any enthusiasm.
      With that advice, and knowing that the restriction imposed by the clause will be too great to be placed on the GMC, I beg to ask leave to withdraw the motion.
      Motion and clause, by leave withdrawn.

    Clause 1

      CONSTITUTION OF THE GENERAL MEDICAL COUNCIL
      Mr. Moyle: I beg to move Amendment No. 1, in page 2, line 20, leave out 'five' and insert 'four'.
      Mr. Deputy Speaker (Mr. Bryant Godman Irvine): With this we may also take Government Amendments Nos. 2 to 6.
      Mr. Moyle: I hope that this matter will not detain us very long. It will be recalled that in Committee there was general agreement that overseas doctors in respect of limited registration should be allowed to vote and stand as candidates in election of members to the new General Medical Council after three years, whereas the Bill as it went into Committee said that it should be after four years. Obviously, the Overseas Doctors Association agrees with these amendments. It was generally agreed in Committee that that was a desirable objective, and we are now moving these amendments to put it into effect.
      Mr. Laurie Pavitt: I spoke on this matter in Committee. The undertaking given has been fulfilled and I merely wish to thank my hon. Friend the Minister of State.
      Dr. Vaughan: We welcome this change, too, and I know that overseas doctors will welcome it.
      This involves an important principle. If the period on the temporary register when the doctor can vote for a member of the GMC is to be shortened, there is a strong argument put to me by some of the overseas doctors to the effect that, if the period is to be shortened at all, it should be brought right back to the time when the doctor is put on the temporary register. It seems to some doctors that there is an argument that either he should not vote until he is fully registered, or he should vote as soon as he is on the temporary register. I hope that before we accept these amendments the Minister will answer that point.
      Mr. Moyle: I have not the answer on that particular point. We agreed in Committee that it should be reduced from four to three years of limited registration, which will be the main form of registration for overseas doctors in future. Anything that relates to temporary registration will have only a transitional effect. We are dealing with the main situation for the future. I shall look into the issue and see whether there is anything in it. But I am ensuring here that what we all agreed in Committee shall take effect.
      Dr. Vaughan: Perhaps I have not made myself clear. I was trying to ask whether as soon as a doctor is on any kind of

      829
      register he should be allowed to vote for the GMC.
      Mr. Moyle: I thought that the consensus in Committee was that he should be allowed to vote only after three years of limited registration. That is what I am trying to put into effect.
      Amendment agreed to.
      Amendments made: No. 2, in page 2, line 23 leave out 'four' and insert 'three'.
      No. 3, in page 2, line 27 leave out 'five' and insert 'four'.
      No. 4, in page 2, line 29, leave out 'four' and insert 'three'.
      No. 5, in page 2, line 43, leave out 'five' and insert 'four'.
      No. 6, in page 3, line 2 leave out 'four' and insert 'three'.—[Mr. Moyle.]

    Clause 3

      BRANCH COUNCILS
      Mr. Robin Hodgson: I beg to move Amendment No. 46, in page 5, line 1, leave out Clause 3.
      This amendment would delete Clause 3, the purpose of which is to set up branch councils under the General Medical Council for England, Wales, Scotland and Northern Ireland. We seek further elucidation on this matter because we are not entirely satisfied with the proposals. We are not satisfied for four main reasons.
      First, there is the question of the increase in bureaucracy that may result. We have had a long and, at times, turbulent debate on the National Health Service this evening. Both sides of the House have commented on the tendency of administrators and bureaucrats within the Health Service to proliferate. I know that we are dealing with the General Medical Council in this clause, and this Bill, but we wonder whether a similar tendency might not take place there as well. On this ground at least, we feel that the clause is too widely drawn.
      Secondly, we consider that the clause is not needed. There is no demand for it. England and Wales already have had one branch between them. The council for Scotland has been purely formal and
      830
      meets once a year. There has been no demand from the membership or from Scottish doctors to increase the number of meetings. The Northern Ireland council will be new. So why go to all this trouble?
      Thirdly, we oppose the clause on the ground that it is not effective. I draw attention to the unevenness of the constituencies that will be represented by the councils. Professor Merrison's report points out that there are 63,000 doctors in England, 4,000 in Wales, 10,000 in Scotland and 2,000 in Northern Ireland. That must surely lead to extremely ineffective and uneven branch councils representing hugely different numbers of doctors.
      Fourthly and finally, my hon. Friend the Member for Reading, South (Dr. Vaughan) and the hon. Member for Berwick-upon-Tweed (Mr. Beith) mentioned the question of cost. The setting up of the four additional branches potentially will lead to unnecessary expense.
      Some of these arguments were made during the Second Reading debate upstairs. The Minister then said:
      "We are empowering the General Medical Council to set up these councils. They will have to be set up under the Bill, but the GMC will decide, in the light of practical requirements, whether the branch councils will be used. It will decide that in the light of pragmatic experience. If it comes to the conclusion that there is no justifiable need for the branch councils, it need not use them."—[Official Report, 22nd February 1978; Vol. 944, c. 1669.]
      The Minister seemed by that to undermine the argument for setting up the branch councils. He was dismissive about my speech in the debate on the NHS earlier this evening. I shall now be dismissive about the logic with which he justifies Clause 3.
      Mr. Crouch: I disagree with my hon. Friend. I have consistently disagreed with my own party on the question of devolution, This is a clause which reflects the views expressed by my friends in the other place, who have shown a wisdom about devolution which has not been reflected on this side of the House during recent debates.
      This anticipates the future. It might lead to a little more expense. I am not so much concerned about the expenses of the GMC as I am about doing the right

      831
      thing. These branch councils will not be so wrong if they represent England, Wales, Scotland and Northern Ireland, notwithstanding the enormous differences between those divisions of Great Britain. The numbers game means nothing at the moment because we are not considering a federal separation of the United Kingdom. We are considering the possibility of its separation into its historical parts, which are mentioned in the clause.
      10.45 p.m.
      I advance these opinions without having heard the opinions that were expressed in Committee on this matter. I was not there on the day that this matter was considered. Without wishing to express a divisive opinion, I think that there is some wisdom in what is suggested in the clause. It is because of my deeply held views about the future shape of the United Kingdom, about its being kept together in these historical parts, that I believe that the GMC would not do wrong to follow what I am suggesting.
      Mr. Pavitt: I do not wish to anticipate the words of my hon. Friend the Minister of State, but I welcome the intervention of the hon. Member for Canterbury (Mr. Crouch). In the GMC a few years ago there was a loss of a good deal of confidence when doctors were threatening to withhold their fees. A wide gap was developing between the registered practitioner and the council that was governing him.
      In bridging that gap we must seek all the time to secure greater participation by practitioners. In that sense practitioners must feel that they are part and parcel of the council. They should not feel removed from it and, therefore, the location of branch councils in Belfast and Edinburgh, for example, is preferab1e to the council being tucked away down in London. On that elementary ground, I welcome what was said by the hon. Member for Canterbury.
      Mr. Moyle: I do not want to debate the pros and cons of devolution in a discussion of the Medical Bill. I say only that we do not know what the future of these matters will be. Both the major parties and the Liberal Party are in favour of a devolved Government in Northern Ireland. There will probably be referendums in Scotland and Wales on the future
      832
      of devolution there. We must therefore provide the medical profession with the opportunity of setting up whatever machinery it feels to be necessary to meet any situation that might arise.
      There are three branch councils at the moment, and they are being increased only to four. It seems that the logic of the situation is to accept that we are dealing with a responsible profession and that therefore, we should give it the full powers to react to any constitutional situation it might have to face by setting up branch councils if necessary. We then say that if a different constitutional or administrative situation arises and the GMC does not want to use the branch councils, it will be empowered not to do so.
      Since the Government's position, from the point of view of the medical profession, is more flexible than that proposed by the hon. Member for Walsall, North (Mr. Hodgson), I commend our view of the clause to the House.
      Mr. Hodgson: I hope that before the GMC sets in train this extension of the number of branch councils it will think carefully about it because of the cost, the bureaucracy and so on. However, in view of the Minister's comments, I beg to ask leave to withdraw the amendment.
      Amendment, by leave withdrawn.

    Clause 5

      GUIDANCE ON PROFESSIONAL CONDUCT OR MEDICAL ETHICS
      Mr. Moyle: I beg to move, Amendment No. 7, in page 6, line 36, leave out "guidance" and insert "advice".
      Mr. Deputy Speaker: With this it will be convenient to take the following amendments:
      No. 8, in page 6, line 38, at end insert
      "but failure to follow such guidance shall not be taken into account at a hearing before the professional conduct committee".
      No. 47, in page 6, line 38, at end insert
      "but such guidance shall not be taken as over-riding the doctor's freedom to follow his clinical judgment as to the best interests of his patients".
      Mr. Moyle: We had quite an important debate on the kinds of advice that the

      833
      General Medical Council could give the medical profession in the light of developing technological and social environments in which medicine will have to be practised in the future. At that stage we made provision for guidance to be given to the profession by the GMC. As a result of a debate initiated by the hon. Member for Berwick-upon-Tweed (Mr. Beith), some doubts were cast upon the use of the word "guidance" or the concept of it that was then involved in the clause.
      I have thought about the matter considerably since then. I have come to the conclusion that perhaps "guidance" might be too heavy a term to use for what we have in mind. Therefore, I move tonight that the word "advice" be substituted for "guidance". "Advice" I think, more accurately describes what we wish to achieve under the Bill.
      This idea is acceptable to the existing GMC and the BMA. Therefore, it is likely to be accepted by the profession. I hope that in the circumstances this will be regarded as a suitable compromise, because I am sure that whereas from time to time the members of the profession might resent the leaders of the profession leaning too heavily upon them, situations will arise from time to time in which members of the medical profession will feel that a word of advice from the GMC might help them in solving particular practical problems.
      If we call that help "advice", I think that it will give the flavour of the weight which is to be attached to the GMC's words. I hope that the House will accept the amendment in that spirit.
      Mr. Beith: I welcome the consideration that the Government have given to this matter. I want to refer to the precise wording of the amendment in a moment. Quite rightly, Mr. Deputy Speaker, you have selected two other amendments to be discussed with it. One of them is related to the original amendment that I tabled in Committee, and one has been tabled by the Opposition Front Bench.
      I have had doubts all along about this search for guidance which is thought to exist amongst doctors, this desire to be given clear guidelines from on high. It is not the same thing as legal advice of the kind to which hon. Members referred in Committee where doctors have
      834
      genuine difficulties but would perhaps be wiser to consult their solicitor or their professional organisation, if they are members of the BMA, for example, for specific legal advice related to the case with which they are dealing. No, it is a wider kind of guidance—or "advice", as we may subsequently call it.
      The reason why I have had doubts about this—and they are very much prompted by the points put forward by my noble Friend Lord Winstanley in another place—is that I think it might be thought to circumscribe doctors who have ideas of their own and who wish to extend the frontiers of medicine, and, indeed, doctors who are concerned about the way in which medicine is going and have strong conscientious objections to some of the things that they are invited or encouraged to do. Whichever way one looks at this matter, if guidance becomes too firm and too hard, various categories of doctors could be adversely affected.
      In another place my noble Friend cited the case of the Manchester surgeon, Mr. Wilson-Hay, who first took it upon himself to give to mountain rescue teams the means of administering morphia to severely injured and shocked casualties during mountain rescues. My noble Friend made the point that if Mr. Wilson-Hay had put to the GMC the question "Can I take this unusual step and do this?", he would almost certainly have got the answer "No". If he was to be a good doctor in the terms in which we sometimes seem to be thinking when we set up these advisory systems, he would have accepted that guidance and would not have done something which has become a general procedure since that time.
      As the Minister rightly pointed out, there are many areas in which doctors have to make difficult decisions and in which it would be wrong to suppose that the decisions reached by the GMC ought in any way to be binding upon the doctor who tries to make clinical judgments in new fields in which new difficulties arise related to his own patients and the use of his own judgment. There are great dangers and difficulties with euthanasia, abortion and genetic engineering, for example, but our first temptation should not be to try to narrow the area of professional judgment. It is on those words

      835
      that the Opposition have rested their amendment, and I look forward to comments on that important point.
      In Committee, I sought to limit the effect of this new provision by excluding the guidance from the consideration of a disciplinary hearing. The last thing I wanted was that a doctor should have the book thrown at him for having acted in contravention of the guidance of the GMC. Many people in representative medical circles, and in the BMA, were sympathetic to that amendment but in the end decided not to move in that direction.
      Their reason was particularly strong. They wanted the other side of the coin, so that the doctor who had stuck by the GMC's advice would be able to use that in his own defence and say "I did what you guided me to do and followed the recommended procedure". That is foreign to the tradition of many doctors, but perhaps it is an increasing trend in such circumstances. But if we accept that and do not follow the line I suggested in Committee, we should still at least seek to prevent a disciplinary hearing from being dominated by the argument that a doctor had not followed guidance.
      This has ramifications beyond the disciplinary hearing. Even in the courts, and certainly in public opinion, I should hate failure to follow guidance of the GMC to be taken as evidence of bad medical practice. That would be an unfortunate limitation on the clinical judgment of doctors.
      We must herefore consider the phrasing here. I said that I welcome the Government's decision to change the wording, because "advice" has a different connotation from "guidance". It is possibly summed up in the common phrase "When I want your advice, I'll ask for it". The doctor who wants advice can seek and follow it and perhaps pray in it aid if criticised, while the doctor who says "I shall use my judgment as I have been trained to do so, and I do not agree with the GMC" can go ahead. He is free to say "When I want your advice, I'll ask for it". In those circumstances, I am happy to accept the Government's suggestion.
      Mr. Crouch: I assure the House that this will be my last speech tonight, but I want to comment on all three amendments. I am no authority on words, but
      836
      I think that the hon. Member for Berwick-upon-Tweed (Mr. Beith) is right about Amendment No. 7. He made a wise speech. I agree with his distinction between advice and guidance. I assume that if Amendment No. 7 is carried it will render the other two amendments unnecessary. I like the new word better.
      It was the absence of something along the lines of Clause 5 in the existing rules of the GMC which I noticed, and the arrival of this clause pleased me. Both sides of the House—and the third dimension, in the shape of the Liberal Party—have succeeded in improving the Bill a little more tonight. I agree with the hon. Member for Berwick-upon-Tweed. While I accept the Government's amendment of "advice" for "guidance", I also think that the Liberal amendment is very sensible.
      11.0 p.m.
      I think that the doctor, having heard the advice and listened to it, should be able to do the same as many men have listened to legal advice in the past and have said "I have paid for the advice and listened to it but not necessarily followed it." That is how advice should be received. It should be received on legal matters like that, and I imagine, as a non-medical man, that that is how it might be received by a medical man, that he is able to hear advice given by the GMC and is grateful for it. This is a new departure for the GMC, but the doctor is not necessarily obliged to follow the advice and it will not necessarily be held against him if he does not follow it. That is valuable.
      Equally, Amendment No. 47, in the names of my hon. Friends, is sensible in this sense. It should not necessarily divert a doctor from his independent clinical judgment. This is the great independence of the doctor, whether he is an ordinary GP, an experienced GP or a consultant of eminent experience in the medical profession. In the end, it is his own judgment which matters and he can take what advice he likes. It is helpful that he is getting this advice. I am glad to see that we suggest in Amendment No. 47 the additional precaution to safeguard this precious provision which is given to the medical profession that in the end the doctor has absolute freedom of clinical judgment.

      837
      I welcome this, but, above all, I welcome Clause 5. The amendments will strengthen it considerably and make it much better law. That is what this place is all about. Even though it is late at night and few of us are here, we have given thought to this from both sides of the House. It has greatly improved the Bill, and I commend all three amendments.
      Dr. Glyn: In Committee these matters were considered to be of considerable importance. It is only fair that the doctor should be able to get advice. There is a grey area between the strict legal interpretation of a statute and the ethical way in which a doctor should behave.
      My hon. Friend the Member for Reading, South (Dr. Vaughan) made some good points in Committee and made clear that the whole idea of being able to get advice was that it should be only if it was required. The hon. Member for Berwick-upon-Tweed (Mr. Beith) was right, too. If the doctor wants advice it is there. Then, if he wishes to be able to quote that, he can say "What I did I did with the advice of the BMA". He is able to use it, but conversely if he fails to use it, it is quite right that that should not be held against him in subsequent proceedings.
      In this very delicate balance between getting advice and whether he should take it we have struck the right balance for the doctor in getting the initial advice, and if he is brought before a disciplinary committee he is able to say "I will not use it", or say "I will quote it because I did exactly as I was told."
      Dr. Vaughan: When we put down Amendment No. 47 we did not know that the Government would change the wording of Clause 5. I am pleased that they have and that meets our anxieties.
      Clause 5, as my hon. Friend the Member for Canterbury (Mr. Crouch) said, is an important clause. Many of us did not realise the extraordinary situation that, until this Bill is passed, in medical practice a doctor may be unable to get any advice or guidance. I quoted to the Committee one or two very difficult cases where this arose. A doctor would go, for example, to the BMA or the GMC or one of the defence union protection
      838
      societies and ask "Should I or should I not do this?" One case I quoted was that of a pregnant minor who against the wishes of her family, wished to retain her pregnancy and not to have it terminated. It is extraordinary that those various bodies had to say "We cannot advise you until you have done what you think is right, and then you may or may not be taken to court and criticised for what you have done."
      The clause deals with that, and the new GMC can if it wishes give guidance or advice. Our worry was whether, as my hon. Friend the Member for Windsor and Maidenhead (Dr. Glyn) has just said, if a doctor decided on clinical grounds in the interests of his patient not to follow that guidance, he could be penalised and find himself in difficulties with the disciplinary committee. The rewording suggested by the Minister is admirable. It removes that worry, so we shall want not to move our Amendment No. 47.
      Amendment agreed to.

    Clause 6

      NEW BODIES HAVING FUNCTIONS WITH RESPECT TO PROFESSIONAL CONDUCT AND FITNESS TO PRACTISE
      Mr. Moyle: I beg to move Amendment No. 9, in page 7, line 5, after 'above', insert—

      '(a) shall secure that a person who sits as a member of the Preliminary Proceedings Committee in the preliminary proceedings on any case shall not sit as a member of the Professional Conduct Committee or the Health Committee in any subsequent proceedings on that case; and

      (b)'.

      The amendment is designed to carry out a course of action which was urged upon us in Committee, that any member of the General Medical Council who served upon the preliminary proceedings committee which decided the fate of a particular case would not thereafter sit on the professional conduct committee, because there was a danger that he might be thought to be prejudiced in any decision he helped to reach on the professional conduct committee by using the information he might have obtained by sitting on the preliminary proceedings committee.

      839
      I hope that the House will agree to this amendment.
      Dr. Vaughan: The amendment follows very closely the request which we put to the Minister. I think that it is rather better worded than our amendment in Committee, and we welcome it.
      Amendment agreed to.

    Clause 12

      RESTORATION OF NAMES TO THE REGISTER
      Mr. Moyle: I beg to move Amendment No. 10, in page 15, line 18, leave out
      'or registered with limited registration'.
      Mr. Deputy Speaker: With this we are to take Government Amendments Nos. 11, 22. 27, 52 and 44.
      Mr. Moyle: These are drafting amendments designed to clarify technical matters which we have come across in Clause 12, Clause 30 and Schedule 5 concerning educational qualifications of overseas doctors. I hope that they will be acceptable to the House. It may well be that an eagle-eyed hon. Member will discover a technical flaw in some of the amendments, in which case I give an undertaking to see that those technical difficulties are ironed out in another place, but I have not been able to discover any.
      Amendment agreed to.
      Amendment made: No. 11. in page 15, line 21, leave out from 'registration' to end of line 22 and insert
      'under that provision or, if he was registered under section 23 of that Act and the direction is made after the repeal of that section by this Act, under section 21 below'.—[Mr. Moyle.]

    Clause 13

      PRELIMINARY PROCEEDINGS AS TO PROFESSIONAL MISCONDUCT AND UNFITNESS TO PRACTISE
      Mr. Moyle: I beg to move Amendment No. 12, in page 15, line 41, after "may" insert
      "subject to subsection (3A) below".
      Mr. Deputy Speaker: With this we are to take Government Amendments Nos. 13 and 14.
      Mr. Moyle: The amendments fulfil another undertaking which I gave in Committee. We were able to agree, in response to an amendment put down by the Opposition, that the preliminary proceedings committee should not be able to exercise its powers to impose interim orders of either suspension or conditional registration unless the doctor concerned had been given the opportunity of appearing before the committee or being represented before it.
      As this is a response to the Opposition, I presume that the House is likely to accept the amendments.
      Dr. Vaughan: We welcome this amendment and are pleased that the Minister has accepted our point. Again, I think that he has worded it rather better than we did originally.
      Amendment agreed to.
      Amendments made: No. 13, in page 16, line 1, after "may", insert "subject to subsection (3A) below".
      No. 14, in page 16, line 9, at end insert—
      "(3A) No order for interim suspension or for interim conditional registration shall be made by the Preliminary Proceedings Committee in respect of any person unless he has been afforded an opportunity of appearing before the Committee and being heard on the question whether such an order should be made in his case; and for the purposes of this subsection a person may be represented before the Committee by counsel or a solicitor, or (if rules under paragraph 5 of Schedule 4 to this Act so provide and he so elects) by a person of such other description as may be specified in the rules."—[Mr. Moyle.]

    Clause 17
      REPEAL OF PROVISIONS OF PART III OF MEDICAL ACT 1956 AS TO REGISTRATION OF COMMONWEALTH AND FOREIGN PRACTITIONERS
      Amendment made: No. 15, in page 20, line 6, leave out Clause 17.—[Mr. Moyle.]
    Clause 23

      LIMITED REGISTRATION: ERASURE
      Mr. Moyle: I beg to move Amendment No. 16, in page 25, leave out lines 36 to 42 and insert—
      "(2) If it appears to the General Council, having regard to his performance in a relevant

      841
      employment, that a person registered under section 22 above does not in fact possess the appropriate knowledge and skill, the Council may, subject to subsection (3) below, if they think fit, direct that his name shall be erased from the register.
      (2A) In subsection (2) above, in relation to a person registered under section 22 above—

      (a) 'a relevant employment' means a particular employment or an employment of a description for the purposes of which he is or has been so registered; and

      (b) 'the appropriate knowledge and skill' means the knowledge and skill which was required in his case in pursuance of subsection (1)(e) of that section in connection with the application for registration under that section by virtue of which he is so registered.".

      Mr. Deputy Speaker: With this we may also discuss Amendment No. 18.
      Mr. Moyle: These are drafting amendments designed to clarify the meaning of Clause 23. There is no intention of changing the discretion of the GMC to withdraw limited registration from a doctor if it subsequently appears that he does not have the requisite knowledge and skill for that registration. The safeguard of an appeal to a review board against withdrawal of registration is maintained. We think that the clause will be more elegantly worded if the amendments are accepted.
      Amendment agreed to.
      Amendments made: No. 17, in page 26, line 11 at end insert—
      "(3A) Until the coming into operation of paragraph 8 of Schedule 4 of this Act, subsection (3) above shall have effect as if for any reference to that paragraph there were substituted a reference to section 36(2) of the Medical Act 1956.".
      No. 18, in page 26, leave out lines 12 to 19.—[Mr. Moyle.]

    Clause 27

      THE REVIEW BOARD FOR OVERSEAS QUALIFIED PRACTITIONERS
      Amendments made: No. 19, in page 28, line 13, leave out from "prescribe" to "such" in line 14 and insert—
      "(b) until the succession day—

      (i) one member nominated by Her Majesty on the advice of the Privy Council, being a medical practitioner registered under Part III of the Medical Act 1956; and

      842

      (ii) such number of other members, being members of the General Council, as the Council may by rules prescribe, including at least one member elected under section 4 of the Medical Act 1956 and one member appointed under section 3 of that Act; and

      (c) on and after the succession day.".
      No. 49, in page 28, line 18, after "who", insert "is or".
      No. 50, in page 28, line 19, leave out "is or has been registered".—[Mr. Moyle.]
      Mr. Moyle: I beg to move Amendment No. 20, in page 28, line 20, leave out "21".
      Here again I am responding to a suggestion made in Committee by the Opposition in that the amendment removes doctors with provisional registration from those eligible to serve on the review board under the provisions of Clause 27 (2) (b) (iii). This was what the hon. Member for Northampton, South (Mr. Morris) urged, and on reflection I think that there is some merit in his suggestion since doctors with this type of registration are likely to have limited experience of the medical profession.
      Amendment agreed to.

    Clause 29

      TRANSITIONAL PROVISIONS RELATING TO MEDICAL PRACTITIONERS WITH OVERSEAS QUALIFICATIONS
      Amendment made: No. 21, in page 30, line 7, leave out from the beginning to 'shall' in line 13 and insert—
      '(1) As from the appointed day until their repeal by this Act, sections 18 and 23 of the Medical Act 1956'.—[Mr. Moyle.]

    Clause 30

      DEFINITIONS
      Amendments made: No. 22, in page 30, line 43, at end insert—
      '"the prescribed knowledge and skill", "the prescribed standard of proficiency" and "a prescribed pattern of experience" have the meanings given by section 15(6) above;
      No. 23, in page 31, line 9, leave out from 'registration' to end of line 11.—[Mr. Moyle.]

    Clause 32

      SHORT TITLE, CITATION, COMMENCEMENT AND EXTENT
      Amendment made: No. 24, in page 31, line 34, after 'above', insert—
      ',section (Replacement of provisions of Part III of Medical Act 1956) of this Act'.—[Mr. Moyle.]

    Schedule 4

      PROFESSIONAL CONDUCT AND FITNESS TO PRACTISE: SUPPLEMENTARY PROVISIONS
      Mr. Robert Boscawen: I beg to move Amendment No. 25, in page 36, line 20, at end insert
      "provided that after a person is accused of an offence no matter likely to lead members of the public to identify the accused in relation to that accusation shall either be published in England, Wales, Northern Ireland or Scotland in a written publication available to the public or be broadcast in England, Wales, Northern Ireland or Scotland until the Committee has announced its decision in any proceedings relating to the alleged offence".
      We are glad to be able to return to this subject on the Floor of the House. This issue deals with the reporting of a professional conduct hearing. We felt in Committee, and we still feel, that there should be a restriction on reporting where a doctor is found not guilty. We were concerned in Committee that the reply we received from the Minister was rather thin. We felt that it had not considered fully both the feelings expressed in the Merrison Report and the feelings on the Conservative side of the Committee.
      11.15 p.m.
      The Minister in Committee thought that the broad principle of British justice that publicity is an aid to justice should be the guiding principle in the schedule. However, I feel that the point should be put that this disciplinary hearing is not a court of law. The doctor is not being accused of a crime. He may have been on a previous occasion, but he is not being accused of a crime before the disciplinary committee. He is being tried for professional misconduct of one kind or another.

      Unlike in a court of law, as I understand it, these proceedings are not held on oath; evidence is not given on oath,
      844
      and evidence could be given which is not accepted by the disciplinary committee and which could be very unreliable and extremely damaging to the doctor concerned. Yet, if the schedule stands as it is, all such evidence could be fully reported and the doctor's name attached to it, and, although he might be cleared entirely of any infringement of professional conduct, some of what had been said in the hearing could stick and could damage him for the rest of his professional career.
      We feel that that could be an injustice to the doctor concerned. We were reinforced in our view by the great strength of feeling shown in the Merrison Committee when that committee went some way to try to find a solution, which it called the "middle way". The middle way is as suggested in this amendment, to the effect that there should be no means whereby the name of the doctor can be identified should he be found not guilty as a result of the hearing.
      I understand that in other professions, when an individual is brought before a disciplinary committee—of the Law Society, for example—the proceedings are not held in public. Although I can see that there is a case, because of the public importance of the medical profession and the way it is in contact with the public, that where an individual is found guilty of misconduct the proceedings should be published, I feel that it is in the interests of confidence in the GMC by the profession generally that a doctor who is not found guilty should not be punished a second or third time—perhaps even for the rest of his life—because of something that was said in a professional conduct committee and of which he was not found guilty but for which he has no redress at all afterwards. It could affect his career for the rest of his professional life. I hope that the Government will reconsider their position on this Schedule.
      Dr. Glyn: I support my hon. Friend the Member for Wells (Mr. Boscawen). I think that this is probably one of the most important amendments that we have considered. It is absolutely right that the disciplinary committee is entirely different from a court of law. Things may be said during the proceedings which could affect a doctor adversely throughout his life. Even if at the end of the case

      845
      he is shown to be innocent, there is still a stigma which lingers.
      We all know that sometimes doctors are brought up on charges which prove to be spurious. They go through absolute agony in the period before the case is heard, and even when later the case is dismissed they suffer because of the mention of their names in any report of the case. My hon. Friend put the matter well when he said that first the man has suffered by being brought before the disciplinary committee and secondly by having his name associated with a charge of which he was not guilty. It is quite unnecessary for this to happen.
      I believe that the amendment provides the minimum protection that we can give to a doctor who is proved to be innocent at the end of his ordeal. If he is guilty, of course, the public will know that he is guilty, but if he is innocent at least he will have avoided unpleasant publicity, which could stay with him for the rest of his professional career.
      Mr. Hodgson: I support my hon. Friend the Member for Wells (Mr. Boscawen). When we were in Committee, the amendment related to line 27 on page 25. It now relates to line 20 on page 36. The expansion of the Bill has gone on apace. When we recall the length of the Bill when it first went to their lordships in another place and we look at its present size, we can see what a valuable role their lordships have played. I hope that the Labour Party, when considering the future role of the House of Lords, will bear in mind the valuable work done by their lordships—particularly by Lord Hunt—on this measure and on others.
      The Minister, in supporting the various parts of the Bill, both on Second Reading and in Committee, frequently prayed in aid Professor Merrison. I should like to draw to his attention some of the Merrison Committee's comments, as the committee went further than we have gone in the amendment. In paragraph 323, the committee's fourth and "most important recommendation" was that
      "press reporting of a hearing not resolved in a finding of serious professional misconduct should be banned."
      In other words, the committe was concerned that mud once thrown was never
      846
      washed away completely and that the doctor was left with a slur on his name. We have contented ourselves with the third of the committee's recommendations, which was that
      "press reporting of hearings of allegations of serious professional misconduct should be banned until the completion of the hearing'.
      In paragraph 322 the committee quotes the comments of a doctor who maintained that
      "To subject a man to a week of headlines like 'Sex on the Surgery Couch' is to punish him. The fact that he may be found not guilty at the week's end does not erase the headline from people's memories."
      That says everything that needs to be said on the amendment, and it is with that phrase in mind that I support my hon. Friend.
      Mr. Moyle: I urge the House to resist the amendment, but in doing so I express the hope that we shall be able to reach an accommodation on the different views on this matter.
      I was impressed by the strength of feeling with which Conservative Members argued their case in Committee, and I decided in the interval to look at what happens in other professions in matters of this sort. I found that the dentists tend to have the same procedure as the General Medical Council—in other words, they deal with these matters in public, unless there is very good reason for making an exception.
      The Architects' Registration Council also holds its meetings in public. The Institute of Chartered Accountants has a very peculiar procedure whereby it holds its disciplinary proceedings in private, although there is usually no opposition to members of the public being present if they so wished. I do not quite know how that system works in practice.
      In the senate of the Bar Council the matter is governed by a byelaw of the senate whereby proceedings are held in private unless the respondent barrister requests otherwise. I was mightily impressed by the obvious wisdom of the Bar Council. The Law Society has a very similar provision. It has its disciplinary proceedings in private. The whole argument that we had in Committee might have been totally unnecessary, because in the course of the debate I found that Schedule 4, paragraph 1(2) (d), says:

      847
      "requiring proceedings before the Committee to be held in public except in so far as may be provided by the rules".
      Obviously that gives the GMC powers to hold these matters in private, unless the doctor concerned wishes them to be held in public.
      In the circumstances, I think that there is adequate provision for the protection of doctors' reputations where this is necessary. For that reason, I urge the House to reject the amendment because the Bill as it stands goes a long way towards meeting the points that hon. Members have raised.
      Mr. Boscawen: I drew the Minister's attention to that paragraph in Committee. The GMC can instruct the committee concerned as to how it should carry out its proceedings. We accept that this is some safeguard. We should have liked it to be spelled out in the Bill, but we accept what the Minister has said.
      Dr. Glyn: Surely this would be an unusual procedure. The usual procedure—to which the doctors object—is that the proceedings are held in public.
      Mr. Boscawen: No, I think that the discretion is with the GMC. Perhaps, if I am not correct, the Minister will intervene. The GMC has discretion on whether reporting is restricted. If that is so, we are prepared to accept it, although we would have preferred to see a safeguard written into the Bill.
      Dr. Vaughan: Will the Minister consider conveying to the new body that there was considerable feeling in the House that it should exercise its judgment and hold proceedings in private wherever possible?
      Mr. Moyle: I am always willing to convey messages to the GMC. I think it will be seized of the point because it has taken considerable interest in our debates. It felt that it had a duty to do so.
      The initiative is with the GMC to make its own arrangements in these matters. Having had some experience of trying to get legislation relating to another profession through the House, I emphasise the importance of having the maximum flexibility when considering Bills of this nature. It can never be calculated when amending legislation is being passed through the House. The way the Bill
      848
      is drafted gives maximum flexibility to a responsible profession to order its affairs in its own way and to take account, if necessary, of the points that have been urged in debate by hon. Members.
      11.30 p.m.
      Dr. Glyn: Can the Minister indicate what proportion of cases have been held in camera and what proportion in public?
      Mr. Moyle: I should require notice of that question. My impression is that most of the cases have been held in public, but there has been fairly strong expression that this should not be so and I am sure that the GMC will take note of that in considering future arrangements.
      Mr. Boscawen: I beg to ask leave to withdraw the amendment.
      Amendment, by leave, withdrawn.

    Schedule 5

      TRANSITIONAL PROVISIONS FOR OVERSEAS QUALIFIED PRACTITIONERS
      Amendments made: No. 26, in page 42, line 4, leave out from beginning to end of line 7 and insert—
      '"the repeal date" means the day on which, by virtue of subsection (1) of section (Replacement of provisions of Part III of Medical Act 1956) of this Act, the said section 25 is repealed;'.
      No. 27, in page 42, line 36, leave out 'other' and insert 'approved'.—[Mr. Moyle.]
      Mr. Moyle: I beg to move Amendment No. 28, in page 43, line 6, at end insert—
      'Subsequent grants of limited registration
      4A. In the case of a practitioner to whom this Part applies who is or has been registered with limited registration for a period by virtue of paragraph 4 above and who applies under section 22 of this Act to be so registered for a further period, the following provisions of that section shall not apply, namely, subsection (4) and, in subsection (11), the reference to the permitted period and to section 23(1) of this Act'.
      This is a drafting amendment. At present, paragraph 4 of Schedule 5 does not give full effect to the policy that the five-year rule on limited registration should never apply to a person who was formerly temporarily registered. The amendment ensures that on any subsequent application for limited registration by such a person the five-year rule does not apply.
      Amendment agreed to.
      Amendments made: No. 29, in page 43, line 19, leave out from beginning to end of line 24 and insert—
      Pending applications under s. 26 of Medical Act 1956
      6. Section 26 of the Medical Act 1956 shall, notwithstanding anything in section (Replacement of provisions of Part III of Medical Act 1956) of this Act, continue to have effect on and after the repeal date for the purposes of the disposal of any application under section 26 by an applicant for registration under section 25 of that Act; and where an order Is made under section 26 on the completion of the consideration of an application by virtue of this paragraph, the applicant shall be treated as having applied to be registered under section 22 of this Act and as having satisfied the Registrar of the matters specified in Paragraphs (a) and (b) of subsection (1) of that section.'.
      No. 30, in page 43, line 26, at end insert—
      'Interpretation
      6A. In this Part of this Schedule "the repeal date" means the day on which, by virtue of subsection (2) of section (Replacement of provisions of Part III of Medical Act 1956) of this Act, sections 18 to 24 and 26 of the Medical Act 1956 are repealed.'
      No. 31, in page 43, line 28, leave out from 'date to end of line 30 and insert
      'registered under section 18 of the Medical Act 1956—'.
      No. 32, in page 43, line 34, leave out 'the said section 18' and insert
      'section 18 of that Act'.
      No. 33, in page 43, leave out lines 38 to 40.
      No. 34, in page 43, line 43, leave out
      'appointed day by section 17 of this Act' and insert 'repeal date'.
      No. 35, in page 44, line 10, leave out
      'appointed day by section 17 of this Act' and insert repeal date'.
      No. 36, in page 44, line 15, leave out
      'by the said section 17'.
      No. 37, in page 44, line 29, leave out
      'appointed day by section 17 of this Act' and insert repeal date'.
      No. 38, in page 44, line 35, leave out
      'by section 17 of this Act'.
      No. 39, in page 44, leave out lines 42 to 46.
      No. 40, in page 44, line 52 leave out 17' and insert
      '(Replacement of provisions of Part III of Medical Act 1956).'
      No. 41, in page 45, line 3, at end insert—

    'PART III

      MODIFICATIONS OF ENACTMENTS DURING TRANSITIONAL PERIOD
      Interpretation
      12. In this Part of this Schedule, "the transitional period" means the period commencing with the day appointed for the coming into operation of sections 22 to 28 of this Act and ending immediately before the day appointed for the coming into operation of sections 18 to 21 of this Act.
      Medical Act 1956
      13. In section 54(1) of the Medical Act 1956 (in this Part of this Schedule referred to as "the Act of 1956") the definition of "fully registered person" as substituted by this Act shall have effect during the transitional period as if—

      (a) for the reference to section 18 of this Act there were substitued a reference to section 18 of the Act of 1956; and

      (b) the words "or section 21(5) of the Medical Act 1978" and "or under the said section 21" in paragraph (a) of the definition were omitted.

      Medical Act 1969
      14. In section 3 of the Medical Act 1969 (in this Part of this Schedule referred to as "the Act of 1969"), subsection (2) as substitutedd by this Act shall have effect during the transitional period as if—

      (a) for references to persons entitled or directed to be registered under section 18 of this Act there were substituted references to persons entitled or directed to be registered under section 18 of the Act of 1956; and

      (b) the references to persons directed to be registered under section 21 of this Act were omitted.

      15. Section 7 of the Act of 1969 shall have effect during the transitional period as if—

      (a) in subsection (1), as amended by this Act, the reference to Part II of the Act of 1956 included a reference to Part III of that Act; and

      (b) subsection (3), as so amended, included a reference to an application for registration of persons or qualifications under Part III of the Act of 1956.

      16. Section 8(1) of the Act of 1969 shall have effect during the transitional period as if in paragraph (a), as substituted by this Act, the reference to Part II of the Act of 1956 included a reference to Part III of that Act.
      This Act
      17. Sections 22(13) and 25 of this Act shall have effect during the transitional period as if for the references to section 18 of this Act there were substituted references to section 18 of the Act of 1956.
      18. Section 26(1) of this Act shall have effect during the transitional period as if paragraph (a) were omitted.
      19. Section 28 of this Act shall have effect during the transitional period as if—

      (a) in subsection (2), paragraphs (a) and (b) were omitted and in paragraph (c) for the reference to section 18 of this Act there were substituted a reference to section 18 of the Act of 1956; and

      (b) in subsection (3), paragraphs (a) and (6) and, in paragraph (c), the references to paragraphs (a) and (b) of subsection (2) were omitted.

      20. Paragraph 3 above shall have effect during the transitional period as if for the reference to section 18 of this Act there were substituted a reference to section 18 of the Act of 1956.'.—[Mr. Moyle.]

    Schedule 6

      MINOR AND CONSEQUENTIAL AMENDMENTS OF ENACTMENTS
      Mr. Moyle: I beg to move Amendment No. 42, in page 45, line 32, leave out from 'Any' to 'person' in line 33.
      This is another minor amendment. It limits the number of people who have a right to attend examinations on behalf of the GMC. The current wording of paragraph 3(4) of Schedule 6 would allow any members of the new Council to attend examinations. In accordance with the GMC's wishes, the amendment seeks to limit this right to members of the Council deputed for that purpose by the education committee or other people so deputed.
      Amendment agreed to.
      Amendments made: No. 52, in page 47, line 14, leave out from 'omitted;' to 'or' in line 17 and insert—
      (c) after the word "primary" there shall be inserted the words "United Kingdom"; and
      (d) for the words from "is or will" to "Act of 1956" there shall be substituted the word "does".'
      No. 43, in page 47, line 38, at end insert—
      '14A. Section 33 of the Act of 1956, shall, until its repeal by this Act, apply to a person registered with limited registration whether or not the circumstances are such that he falls within the meaning in that Act of the expression "fully registered person"; and, in relation to a person who is registered with limited registration, references in Part V of the Act of 1956 and section 15 of the Act of 1969 to "the register are references to the register" of medical practitioners with limited registration.'.—[Mr. Moyle.]

    Schedule 7

      REPEALS
      Amendment made: No. 44, in page 56, line 24, column 3, at end insert—
      'Section 15(4) and (5).'.—[Mr. Moyle.]
      Motion made, and Question proposed. That the Bill be now read the Third time.
      11.34 p.m.
      Dr. Vaughan: This is an important and satisfactory moment for the GMC and for doctors generally in this country because the Bill deals with their future conduct and the whole process of registration.
      I congratulate the Government on having brought the Bill before us in the way they did. As my hon. Friend the Member for Walsall, North (Mr. Hodgson) said, the Bill is much more substantial than when it went to another place and it is important to mention what a valuable contribution noble Lords, particularly Lord Hunt, have made to the Bill. I should also like to comment on the considerable help given by the BMA and the professional bodies generally. I hope that the Government will give the Opposition credit for help they have given to get the Bill on the statute book so rapidly.
      11.35 p.m.
      Mr. Beith: We have given the General Medical Council a new basis of independence to carry out a wide range of new functions. We have also thought it right to give it some advice. We have given it advice to keep a rein on its spending and to realise that its own advice is not written on tablets of stone and never should be. We have reminded it that it must recognise that it holds a doctor's reputation in its hands when it considers his case before a disciplinary committee, if it does so in public. I hope that we shall all wish it well in its important work on behalf of both doctors and the public.
      11.36 p.m.
      Mr. Moyle: I respond to the words of the hon. Member for Reading, South (Dr. Vaughan) and record my appreciation of the Opposition's co-operation in getting the Bill through the House. I think that the Bill has been improved as a result of our proceedings. We cannot pronounce a final blessing on it as it has to return to another place before it receives

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      Royal Assent. However, we have concluded our part in considering the Bill. I hope that it will provide a suitable framework for the profession for many years to come. I look forward to seeing the profession working under the Bill's provisions, conscious that we have all played a small part in getting its provisions accepted.
      Question put and agreed to.
      Bill accordingly read the Third time and passed, with amendments.

  COUNCIL HOUSING (INSULATION)
  Motion made, and Question proposed, That this House do now adjourn.—[Mr. Tinn.]
  11.37 p.m.
  Mr. A. J. Beith: In this country we take some pride in the fact that by partnership between central Government and local authorities, the latter having done the major part of the work, we have housed millions of people in modern council houses in the post-war years. Without that action many would now be living in appalling housing conditions. However, it is a worrying fact that a significant number of those who in recent years went into new modern council houses thinking that they had been extremely fortunate and given a wonderful opportunity for a new start in life have found themselves faced with misery—the misery, that is, of cold, damp houses which were supposedly built to the highest modern standards. Some of these houses are a misery to live in because of the damp that they contain and the impossibility of keeping them warm.
  I am glad that the Under-Secretary of State is present to listen to a plea that I put to him on behalf of some of these tenants. I know that the hon. Gentleman is concerned about the matter and has already taken quite a bit of notice of problems of which he is aware in the North-East and other parts of the country. I shall remind him of things that he must know well from his own experience. For example, there are the elderly couples huddled round a one-bar electric fire trying to keep themselves warm in what is supposed to be a centrally heated house. There are young couples buying
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  paraffin heaters and boiling kettles of water for washing in houses that are equipped with the most modern electrical appliances for central heating and water supply. There are those whose supply is cut off because they cannot pay high electricity bills. Perhaps the most horrifying sights of all—I think that all hon. Members have seen this in houses that we have inspected—are green and black walls that are affected by damp, furniture pulled away from the walls because it is being similarly affected by damp, and wet carpets that are sometimes even frozen to the floor. These conditions are found in houses that are modern and built with the advice of experienced architects.
  Some of the problems arise from structural damp. It is worrying that there are so many modern properties that are afflicted by damp caused by faults in the structure. Those in local authorities rarely believe that damp is structural. If a case of damp is reported, it seems that structural damp is never the cause. It is said that there is too much condensation and advice is given to wipe the window sills. It is said that the fault lies with the heating. It is rarely admitted that the problem is due to structural damp However, there is a good deal of it. I think that the Minister must know that. We must learn why there is so much, and I wonder what research the Department is carrying out to ascertain why we cannot ensure that the vast majority of local authority housing is not affected by structural damp.
  Much of the problem of cold and damp housing to which I draw attention is related to systems of electric central heating. Perhaps one of the most notorious problems is ceiling heating, that is, electric heating provided by elements in the ceiling. There are such instances in my constituency in Alnwick in the Cornhill Estate and at Pottergate The Minister will know of other areas in the North-East that have been featured on television and in the news such as St. Cuthbert's Village, Gateshead.
  Ducted air systems have given rise to problems in the The Martins, Wooler, in my constituency. It is a system based on night storage, but the weakness of the system is that the night storage cannot generate enough heat to keep the house warm all the day. Therefore, there has to be a daytime boost. It is that daytime

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  boost on peak electricity prices that immediately puts up the cost and leads to very high bills.
  It is a problem all over the country, not only in council houses. I draw the Minister's attention to the fact that in my constituency there are modern RAF married quarters, built by the Department's Property Services Agency at Longhoughton for RAF Boulmer, which are much appreciated. But they have a heating system which proves to be beyond the resources of an airman's pay. We hope to see improvements in forces' pay. But over the last winter there have been pleas for help from commanding officers' funds and so on because of difficulties arising from heating.
  I have seen bills for between £100 and £150 a quarter in both Wooler and Alnwick in my constituency. This morning I was telephoned and told of a £200 quarterly bill. Those who try to budget and who go to the electricity board and say "How much a week will I have to pay? Let me go on to a weekly basis" are being asked for £9 or £10 a week. I am talking about the people to whom we give priority in filling council houses—people who cannot afford to buy houses in the private sector and many of whom, by definition, are on low wages. I am talking about people in my area with wages of between £50 and £60 a week who are paying £9·20 a week in rent and £9 or £10 a week on heating.
  What do they do? In many cases they abandon the heating, so the houses get colder and damper. Perhaps they get paraffin heaters, but they make the situation worse. I am told, on the best authority, that to burn a gallon of paraffin in a heater creates a gallon of moisture which deposits itself in condensation around the house. The local authority suggests opening a window to let out the condensation. But then the tenants freeze, because the little heat that they generate is lost out of the window.
  We are all used to the traditional system of the fire in the fireplace and the chimney providing the ventilation and letting out the condensation. People in old properties had a fire for heating in one room, hot water from a back boiler and some ventilation. They thought that they would be better off in modern property, but now they find that they have
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  virtually nothing. They have homes in which they cannot afford to live. That is no exaggeration. That is the feeling of many young couples and elderly people who, in different ways, are trying to make a fresh start. I find it deeply depressing to come across so many people, anxious not to get into debt, who cannot cope with the costs involved in these heating systems.
  What is wrong? There are two main things. First, I do not believe that electric heating of this type should have been put into these council houses. It was cheap to install. The capital costs were low. But it is fearfully expensive to run.
  On top of that, insulation in many of these houses is virtually non-existent. Houses on Cornhill Estate in Alnwick have none at all. Houses on Martins Estate in Wooler have enormous windows. They have loft insulation, but enormous windows which are not double glazed. This can be seen in other parts of the country. Looking at the window frames, one sees a groove which was intended for the second glazing. That was not installed. How did local authorities, trying to do their best for their tenants and potential tenants, produce properties which such tenants could not afford to heat? There was too much hard-sell by electricity boards and favourable terms for all-electric houses. I think that the Department of the Environment also played its part in encouraging electric heating. One of my local authorities points to the period in which it was told in letters and circulars—this is some years ago, long before the Under-Secretary occupied his present post—that the Government hoped to rationalise fuel costs and to make sure that all fuels were charged at roughly the same level. Those days are far off now. That was one factor. Many architects seemed to be overtaken with enthusiasm for these systems.
  An equally important factor was cost cutting at the beginning. I pick on one target, namely, the system by which the Government try to control how much local authorities spend on individual houses. It is called the housing cost yardstick.
  What happens when council houses are built? The council or its consultant architects design the houses, and they take advice from many quarters, but one of

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  the most important things they must consider is the Parker Morris standards relating to space and other building features. They design a house to Parker Morris standards, they include central heating, and if it has a certain number of bedrooms it has two toilets, one upstairs and one down. The standards are high and impressive.
  The council then puts the scheme out to tender. It finds that when the tenders are returned the houses cannot be built to those standards within the cost limitations imposted by the yardstick. The council officers and architects then say "Where can we cut?" The first thing they look at is the heating system. They ask "Is there one that is cheaper in capital costs to install?" They then examine the hot-water system and ask "Is there a cheaper type of immersion heater we can put in?" The first victim tends to be the heating system, and because of that kind of decision some switches to electric heating were made.

  The next thing that is said is "we shall have to leave out some of this insulation, and, if there is to be double glazing, we shall have to do without that. We might have to do without loft insulation, and we might have to have cheaper window frames". I can quote many instances of items such as window frames and good quality doors and door frames having suffered.
  The result of this kind of condensation is misery. It is an ironical situation. The houses have two toilets, large rooms and heating the tenants cannot afford. There are lavish standards in one respect, but desperate cost cutting in another respect, which has been a major contributory cause of the difficulty the tenants face.
  What can be done in future to avoid such situations? I suggest to the Minister that the housing cost yardstick is in many ways a menance. One is setting for local authorities high standards of room sizes and the number of toilets they provide and then, when they have started to abide by those standards, one is saying "No, you cannot spend any money on the houses and we shall tell you from the centre exactly how much you are allowed to spend". It has resulted in a situation—inded it has in my constituency—where the houses cannot be built at all within the cost yardstick. Equally, it can result
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  in cost cutting which tenants pay for in the future.
  I should like the Minister to consider dispensing with the cost yardstick. I have put forward this argument in election speeches for five or six years and have come to realise what a menace the yardstick can be. I reiterate my plea that perhaps we should not try to operate a yardstick of that type. Local authorities have no interest in wasting money—or in spending more than they need—in providing a decent house. It is a mistaken approach on the part of the Governments—it is a "nursemaid approach"—for them to say "We need to stop local authorities spending money in this way". They want to build as many houses as they can to meet their needs and do not want to spend any more on them than is necessary. They are answerable to their electors and their ratepayers.
  The Government must review what it is we are trying to build and the costs of upkeep in relation to the potential income of the tenants we are trying to house. That is for the future; it will not help tenants who are now facing difficulties. We must think about the people who are living with these mistakes.
  We shall have to take seriously some of the challenges which are being made on electricity prices. Only today the chairman of the Electricity Consumer Council has challenged the Energy Minister who is responsible for electricity prices because the chairman believes that prices in relation to cost are too high.
  But that alone will not, in my view, solve the problem. I think that many houses will have to be changed to other systems—to solid fuel or gas. It has been done in some areas. It has been done in the constituency of my right hon. Friend the Member for Roxburgh, Selkirk and Peebles (Mr. Steel) and in the Minister's area in County Durham. It is a hard decision for a local authority to take, but it may have to be taken. Alnwick District Council is considering changing the system in some of its houses and is trying to run a pilot scheme by putting solid fuel into one house. The Berwick council will have to consider doing the same.
  The difficulty that all councils face is that they can do that only at the expense of those tenants who are living in much

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  older houses and looking for basic modernisation. Houses in Clayport Gardens, Alnwick, for example, still have bathrooms leading off kitchens. They have waited for years for basic modernisation features. Any council will be concerned about how to spend its limited amount of money in this situation. I believe that the Government must recognise the need for extra help for council's faced with this difficulty.
  We must take the problem of insulation very seriously. It was criminal to leave out insulation in the first place. It must now be installed. I am not talking about a couple of inches in the loft. There is more to it than that. In the Wooler houses there are enormous floor-to-ceiling windows which occupy more than half of the most exposed walls of houses which face the windy Cheviot Hills. Heat loss in such a home is enormous and insulation can be provided only by expensive means.
  Berwick council has only £10,000 available for the year for all house insulation work. That is the amount that it is able to spend and that can attract Government subsidy. How much can the council do with £l0,000? Can it really insulate even 20 houses to a reasonable standard and save a fair amount of heat loss? The Government have rightly given some priority to insulation. In the Budget last week they announced the provision of more money to insulate private houses. That is also necessary.
  However, we must recognise that proper insulation is a costly business and will require many resources. The Department of the Environment must share some of the responsibility, not only for future policy but for past mistakes. They must help local authorities to put right the mistakes and to put an end to the misery which many tenants are now suffering.
  11.53 p.m.
  The Under-Secretary of State for the Environment (Mr. Ernest Armstrong): First, I should like to commend the hon. Member for Berwick-upon-Tweed (Mr. Beith) on his choice of a subject for tonight's debate. He knows, I think, that my right hon. Friends and I share his concern about the problem he has raised, which he has approached tonight, if I may say so, in a particularly constructive and responsible way.
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  It is indeed a very worrying state of affairs to find homes in the public sector which have been built—some in the last 10 years—where serious problems of this sort have arisen and where the replacement of almost new central heating systems is being put forward as a bid for scarce resources in competition with much needed programmes of improvement and modernisation for houses in authorities' stock which may be 50 years or more old.
  High fuel bills are a cause of anxiety for all members of the community. Some of the most acute problems undoubtedly arise with electric heating systems. There are as many as 900,000 public sector tenants in England and Wales who are mainly dependent on electricity for space and water heating. This problem takes on an added dimension for them because they will, in general, have had little or no say in the choice of the heating system for their home.
  One of the causes of abnormally high heating bills in electrically heated homes has been the sharp increase in the price of electricity in recent years compared with the prices of other fuels. This has made domestic electric heating systems a far less attractive proposition to run than they were when many of the decisions to install them were taken during the 1960s and 1970s. At that time the choice of electricity no doubt seemed a reasonable one to local authorities, and they were encouraged by the availability of cheap off-peak tariffs and the low capital cost of electric heating compared with most other heating systems.
  It is also true, however, that in some cases electric heating has been chosen for dwellings without sufficient care being taken to ensure that it is suitable for the dwelling. The result is that the system uses an unreasonable amount of energy to maintain reasonable temperatures.
  In an effort to economise on their use of fuel, some people—especially those with low incomes—use their electric heating systems less or, worse still, are forced to switch them off altogether. As the hon. Member said—and I have seen this in my constituency—they resort to other means of supplying heat such as oil heaters and calor gas. Some of my constituents are so afraid of running up big bills that they no longer use their systems for space heating. That is a very serious state

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  of affairs. The consequent lack of a steady level of heat increases the risk of condensation and damp and can result not only in loss of comfort but, indeed, in a danger to health—especially for the very young and the old.
  Where condensation persists for long enough, it will cause damp patches and mould growth which can damage the structure of the dwelling, as well as spoil decorations and furnishings. I have had recent examples where clothing in wardrobes has been seriously affected. There are cases where design and construction deficiencies also cause dampness.
  I should now like to turn to the ways in which the Government are tackling this problem, which, of course, is not confined to the hon. Gentlman's constituency. During the 1960s we promoted a campaign to advise householders about condensation. We are considering a further publicity campaign in time for next winter. Additionally, in 1975, the standards of thermal insulation required by the building regulations were raised. The insulation in many dwellings built before 1975 has since been increased and, for the public sector, we have the 10-year insulation programme announced in December 1977: £23 million is being made available to local authorities this year.
  Some help will also be made available to the private sector under the scheme recently announced by my right hon. Friend the Prime Minister.
  The only really satisfactory answer to the problems we are discussing is one which prevents them from arising in the first place. Financial help with electricity bills can be regarded as only a partial answer at best, but it is available in some cases. In certain circumstances the supplementary benefits scheme provides an allowance towards heating costs and, over the last two winters, the electricity discount scheme has been operated by the Department of Energy. But longer term solutions are necessary and are being sought and, clearly, the problem is not one that can be solved by the Government alone. Co-operation is needed from all those bodies with local responsibility for public sector housing.
  Because of our growing concern, a joint working party on heating and energy conservation in public sector housing was
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  set up by my Department early in 1977 to look into, among other things, problems arising with heating systems in both new and existing dwellings. The working party consists of representatives of the Department of the Environment, the Department of Energy, the Welsh Office, the local authority associations concerned with housing, the New Towns Association and the Housing Corporation.
  At one of its early meetings, the working party decided that priority should be given to producing advice on problems with electric heating systems in public sector dwellings. Its first advice note on this—domestic energy note No. 1—has been made available to all housing authorities in England and Wales. The main thrust of the note is that where the local authority considers that an electric heating system is to be provided the form and construction of the dwelling must be suitable for it.

  In particular, this means that the dwelling should have the high levels of insulation necessary to ensure that reasonable running costs can be achieved. Although the capital costs of electric heating systems are generally lower than those associated with other forms of heating, the advice note stresses that the first call on any money saved because of this should be the provision of the necessary extra insulation.
  While domestic energy note No. 1 is intended to ensure that, in the future, electrically heated dwellings will not give rise to major problems, the difficulties which have arisen in our existing electrically heated housing stock remain. The working party is therefore concentrating at present on what advice it can give to housing authorities on remedial measures where problems have arisen. A note will be issued in the near future.
  The hon. Member mentioned the com plaint, which I am afraid is a common one, that the housing cost yardstick is so stringent that it forces housing authorities to select electric heating because of its lower capital cost. It is inevitable that accusations of this sort will be levelled at any system of cost control, but the yardstick allows for a choice of heating systems complying with the Parker Morris standards. It provides for an overall sum to cover all the costs of the whole scheme. There is no allowance specifically allo-

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  cated for heating systems. There is sufficient room within the yardstick to install, for example, gas radiator systems. In fact, many authorities are doing this.
  I am aware of the tendering difficulties in the Northern Region about which the hon. Gentleman spoke—indeed, he has referred me to these matters on many occasions—and particularly the difficulties in the smaller projects necessary because of the scattered nature of his constituency.
  As the hon. Gentleman knows, since 1975 the Department has carried out a quarterly review of the yardstick levels relating to the various regions, and over the last year we have taken special steps to respond to difficulties which have emerged in the Northern Region. In the most recent review, the yardstick for the North was increased, taking the increase to the basic yardstick level together with the adjustment to the regional variations, by over 9 per cent. in average terms compared with the national average of 6 per cent.
  I hope that this substantial increase will alleviate many local difficulties. In the meantime, as we said in the housing review Green Paper we would—and I listened carefully to the hon. Member's comments about the yardstick—we are considering new methods of cost control to replace the present system.
  The other difficult matter is the extent to which housing authorities are able to finance any necessary remedial measures
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  from within tightly drawn limits on public expenditure. The new system of housing investment programmes gives local authorities much more freedom to utilise resources to meet local problems and priorities, and this flexibility should help those authorities where this particular problem is causing difficulty. Authorities are able to put additional roof insulation, for which they can receive subsidy, in electrically heated dwellings which have suffered major problems. This will mean that it will be possible to bring loft insulation in these dwellings up to a high standard. Authorities are also able to do this under the new public sector housing energy conservation programme if the dwellings are presently uninsulated.
  Much progress has been made since the war in improving not only the supply but the standards of housing in this country. It is a matter for serious concern—I am glad that the hon. Member has raised it, and I share his concern—when families move into modern homes anticipating better living conditions, including central heating, and they are faced with a combination of excessive costs as well as a lack of comfort coupled with extensive dampness and condensation.
  We are tackling the problem with some urgency. We are working with local housing authorities to find a reasonable solution.
  Question put and agreed to.
  Adjourned accordingly at two minutes past Twelve o'clock.