HL Deb 09 May 1951 vol 171 cc812-28

2.53 p.m.

Order of the Day for the Second Reading read.


My Lords, I beg to move the Second Reading of this Bill, and I do so with great pleasure because it enables me to pay tribute to what I consider the wonderful achievements of the National Health Service. I think it is not inappropriate that I should spend two or three minutes pointing out to your Lordships (and no doubt many of you are familiar with this fact) the tremendous changes which have been made in the medical services of this country by the organisation of the National Health Service, and the tremendous advantages which, as a result, are accruing to the population. Those of your Lordships who read the surveys of hospital regions which were made in the 'twenties, and which were detailed inspections of the conditions of hospitals in those times, will recall the very different picture given by the health service of that time compared with the present service. For example, in the South-West region—the centre of which was Bristol, and which included the counties of the West—the only hospital with individual specialist services was one hospital in Bristol itself; and one other hospital had partial specialist service. I remember this very vividly, because when I was in another place I took the opportunity of bringing the matter forward in order that the need of great changes might be impressed on the Members of that other place. Those changes have now been brought into effect, and the result is that we have in this country a National Health Service unexampled anywhere in the world.

It is true that it has been necessary for the Government—because of the calls of National Defence, with which I think everyone in this House concurs—to fix a ceiling of £400,000,000 for expenditure on the National Health Service. I would remind the House that that is £7,000,000 more than it was last year. It has also been essential, because of the needs of National Defence, to make certain economies in the Health Service, as in other services, in order to bring our Budget within workable limits. That means that economies have to be made in order to make it possible for the National Health Service to contribute a quota to the needs of national defence. It has, regrettably, been found that the only way to enable expansion to continue in other directions is by shifting some of the expense to the patients. All other alternatives were explored and reviewed, and, of course, economies are always being made. In any case, every possible economy in the next two years will be needed. The reductions already made in hospital estimates are imposing severe difficulties on many hospital authorities, and we can well use for their benefit—especially in the many out-of-date institutions—all savings we can make. In selecting the services for which charges are to be made, the Government tried to choose the field where charges would obviously do least harm, and they chose the field of spectacles and dentures, because to a large extent they affect people who are well in health and able to make their own way and, therefore, able to make a con- tribution as opposed to those who are sick and unable to do so.

I should like to remind the House that although it is true that 60 per cent. of the total expenses of the dental service was for dentures, 15 per cent. of the patients were children, and that this was almost entirely conservative dentistry. There is evidence, of which I know myself, that the charges for spectacles and dentures will slow up the rate of replacement, and make people more careful and less liable to lose their spectacles. Charges for appliances under the National Health Service are not new: I wish to emphasise that point. It is suggested that these charges are a departure from the principle of the National Health Service Act, and that no charges should be made. But charges have been made for appliances, some since the inception of the Service. The Government already have power to charge for medicines. That power has not been used, but charges are made for other things.

The Bill also makes provision—and this is a very important point—not only for charges on dentures and on spectacles, but also for an extension of the service in the way of providing for the treatment of respiratory tuberculosis—for which, unfortunately, there is a deficiency of accommodation in this country—by enabling patients suffering from that complaint to be treated in countries abroad. The first country to be dealt with is Switzerland, where the treatment has been developed over a period of many years and is very good. It is not better than the treatment here, but they have what we lack in this country: the extra beds which are necessary for the patients who cannot be treated as quickly as the medical practitioners in this country would like them to be treated. This clause is restricted to respiratory tuberculosis for the simple reason that respiratory tuberculosis is the most dangerous form of the disease. It is infectious and spreads tuberculosis, whereas bone tuberculosis and other forms do not; they can be treated in this country more easily, and with less danger to the general population, than can respiratory tuberculosis.

Those of your Lordships who have consulted the Bill will know that Clause 1 deals specifically with the charges to be made for dentures and spectacles to be supplied, both by hospitals and under the family practitioner service, and the amount corresponds roughly to half the cost to the Exchequer of supplying the appliances, including, in the case of spectacles, the cost of sight testing. No charge, however, is to be made to any in-patient. In the hospital services the charge will be made to out-patients when the article is supplied. In the family practitioner services the charge will be made by the dentist or optician, whose remuneration from the executive Council will be reduced by an equal amount. That is a simple and straightforward way of collecting the charge. Apart from the provision for in-patients, there will be no exemptions to the charges. Anyone who cannot afford to pay them without hardship will, however, be entitled to apply to the National Assistance Board for help.

The charges will apply to all cases where the examination or testing of sight leading to the supply of dentures or glasses under the Hospital Service takes place after the date on which Regulations to be made under the Bill come into force. In the case of the family practitioner services, the charges will apply where the contract or arrangement with the dentist or the sight test, in the case of spectacles, takes place on or after that date. Replacements of dentures or spectacles which are lost or broken owing to carelessness will continue to be dealt with in the family practitioner services, under Section 44 of the principal Act, and the corresponding provisions in the hospital service will also continue.

Clause 2 provides that the charges may be reduced by Order in Council, subject to an affirmative Resolution in each House of Parliament, but there will be no power to make increased charges. Increased charges would need an additional Act of Parliament. Clause 3 contains provisions empowering the Ministers to make arrangements for the treatment of respiratory diseases abroad, in the first place in Switzerland, but also in other places. Clause 4 extends the powers of the National Assistance Board to enable assistance to be given to those who are unable to pay the charges without hardship. The restriction by which the Board were precluded from granting assistance in respect of any medical, surgical, optical, aural or dental requirements is waived in respect of charges to be made under the Bill. The Board are also specifically enabled to assist people engaged in full-time work, whom they are otherwise precluded from helping. These are concessions which, in my view, go to the limit of fairness, and make quite sure that no hardship will be imposed on those who get spectacles or dentures. Clause 5 was inserted as a Government Amendment in another place to meet strongly expressed arguments that the power to charge ought not to continue indefinitely. The clause provides that the charges will come to an end by April 1, 1954, unless extended by Order in Council, following an Address in both Houses of Parliament. In my view this Bill is necessary. It fulfils a very useful purpose and, I believe, will contribute substantially to the national health. For this reason I commend it to your Lordships, and I beg to move that it be read a second time.

Moved, That the Bill be now read 2a.— (Lord Haden-Guest.)

3.4 p.m.


My Lords, I am sure it will be the wish of your Lordships on all sides that we should congratulate the noble Lord who has just moved the Second Reading of this Bill on what is, I understand, the first occasion on which he has stood at the Box for the purpose of introducing a Government measure. The noble Lord started his speech by paying some tribute to the great achievements of the National Health Scheme. I should like to echo his words and, at the same time, remind him that we can all share in the satisfaction and reward that come from that good piece of legislative work, for the National Health Scheme was born of the National Health Service White Paper of 1944 isued by the Coalition Government.

The Bill which he has moved divides itself into two parts. One part— provision for treatment overseas for respiratory tuberculosis—I am sure is welcomed by all who have knowledge of this dreadful scourge of humanity. This matter in the past year has been pressed persistently upon His Majesty's Government by Opposition Members in another place, and it is therefore only right that there should be a feeling of satisfaction on this side, as well as on the Government Benches, that this provision has now been introduced. As regards the other part of the Bill, providing for charges to be made for spectacles and teeth, I understand that it is the wish of the Government that the Bill should pass through all its stages forthwith, because since advance notice of these charges has been given there has been a great rush for spectacles and teeth, and this is causing a great burden on the Exchequer. There is a sort of "festival of spectacles and teeth" going on at present, and the sooner this Bill is passed, the more quickly will that be regulated.

Our support of the National Health Ser-vice does not bind us, any more than it binds members of the Labour Party, to support a "free-for-all" scheme. In the view of the Government the cost is rising beyond the nation's ability to carry it. It is perhaps worth while to consider for a few moments what the bill for the National Health Service has been. For the first twelve months it was running at the rate of £273,000,000 a year. In the next twelve months, to March, 1950, the bill was £358,000,000—a rise of £85,000,000. For the third year, to March, 1951, the bill was £393,000,000 a year, a rise of £35,000,000. This is contrary to the assurance of the late Minister of Health, Mr. Bevan, that after the initial making good was completed the costs would start to drop.

The Government, through the mouth of the Chancellor of the Exchequer, have now had to announce that the ceiling must be £400,000,000, and that by imposing these proposed charges the total bill will be kept approximately within this sum. But if £400,000,000 is to be the ceiling, and if the administration of the scheme continues as at present, I believe that the Government may find themselves in a difficulty within twelve months from now. If there is to be a ceiling, that ceiling must be related to our productivity, otherwise the country will not be able to carry the tremendous weight of the scheme. There will have to be economies in the administration. We all know there is a great amount of waste going on. Mr. Herbert Morrison recently made in another place the suggestion that it would be a good thing if every three or four years nationalised industries were, so to speak, reviewed by Parliament, and possibly by some outside surveying point. If that is right for nationalised industries, I wonder whether it would not be a good thing to consider something of the same sort for the National Health scheme, to see whether there could not be, from independent, outside and authoritative men's brains, suggestions for improvements and economies in the administration. Perhaps the noble Lord opposite will take note of that particular suggestion which I make with all humility.

For myself, I cannot see that any sacred principle, either of Socialism or of any other "ism," is violated by this charge for teeth and spectacles. The opposite view to that was put by a member of the Socialist Party in another place when he said: Enshrined in the Act is the cardinal Socialist principle: 'To each according to his need'. Those were his words. Surely, if that is a sacred principle, it implies a means test to determine what is the need of each person, and I thought that the means test was one of the things to which the Party opposite were very much opposed. The Bill says that in certain cases benefits may continue free, and that in others the people must pay part of the benefit obtained. It seems to me that the only question is: At what stage should the charge commence? The Government have laid down in this Bill at what stage that charge should commence, and we on this side of the House do not quarrel with the Government decision on that particular point. I wonder how Mr. Bevan and those who follow him manage to defend heavy taxation on all members of the community, the better off and the poorer, in order that the comparatively well-off people—and the only class of people now comparatively well-off are the heads of the national corporations— may obtain free teeth and spectacles. It seems to me a somewhat inconsistent viewpoint. It is peculiar politics, a sort of Alice in Wonderland economics, to increase still further, as they would do, the burden on the poor in order to allow the better-off section to have a free issue of things for which they can well afford to pay in part, if not in whole. We on this side of the House have no delight at these charges, but we consider them necessary at the, present time and we shall not oppose them.

I have listened to distinguished members of the Government, noble Lords and noble and learned Lords, moving the Second Reading of a considerable number of Bills. It seems to me that there is a certain technique which the Government spokesman adopts. He starts off in one of two ways. Either he describes the Bill in terms of restraint but of definite approval, or he describes the Bill as regrettable: he says that it is not a very good Bill, that he hopes he will never have to introduce such a Bill again but that, nevertheless, the Bill is necessary in the circumstances. It is not the second technique which we have heard to-day. It is usually followed by an exposition backed by supporting statistics of formidable kinds; and, finally, all Ministers, using both methods, always ask for the full support of the House in commending the Bill to them. I feel that I cannot conclude without conforming to this particular pattern of Government procedure. Let me say at once that we accept the Bill as a regrettable necessity, brought about by a too hurried introduction of the full scheme before the professions, the hospitals and the institutions were administratively ready to undertake the full burden.

As regards the statistics, let me say this. Seven and a half million sets of dentures have been supplied, and—again to conform with this need for making the statistics formidable—a short calculation will show that, on the basis of three meals a day for 365 days of the year, National Health teeth are chewing 7,515,000,000 meals a year. As regards the statistics on spectacles, 22,000,000 pairs of spectacles have been supplied, which is almost equal to one pair for every two persons of the population. If you take a pair of spectacles, you will find that they have roughly eighteen inches of frame, so these 22,000,000 pairs of spectacles are absorbing no less than 6,250 miles of spectacle frame material, which I think it may interest your Lordships to know, is approximately the same distance as from London to Wadi-Halfa and back. Finally, if I cannot enthusiastically support the Bill, because I feel that the causes which have made it necessary might have been to some ex-tent avoided, we accept the Bill, and we shall not hinder its passage through your Lordships' House to-day.

3.18 p.m.


My Lords, I should like to begin by joining with the noble Lord who has just sat down in congratulating the noble Lord opposite on moving the Second Reading of this Bill in such an excellent and explicit way. We have to welcome this Bill with mixed feelings. One of the features about Clause 3 is that it provides treatment abroad for people suffering from respiratory tuberculosis. That seems to me an entirely admirable provision, which I feel sure will cause great pleasure to every-one. If we can say one rather unpleasant thing about it, it is: why was not such a provision brought in a long time ago? Anyhow, it is here now, and we are very pleased to welcome it.

My second point is rather sad, because one cannot help feeling sorry that it has proved necessary temporarily to depart from what was a fine principle in the National Health Service Act. I think we have to agree that some such move is probably necessary at the present time, in view of the commitments which our country has to face. One of the things that worried us until the Bill came along was that, if some charge were not made for something, the general standard of the Service might deteriorate; we felt that we might be left with a second-rate Service, rather than a nearly first-rate Service, with a charge for one or two little things. I am not sure why spectacles and dentures were chosen as the appliances to be charged for, but one reason may be that they were the appliances where a good deal of extravagance could be indulged in. In just the same way that there is a very great incentive to work if people are paid something, it is a great encouragement to economy if some small charge, no matter what size it is, has to be paid for the things which one needs. I feel that the fact that the National Health Service can be said to be in a financial danger is not due to the Service itself, but rather is it due to the extravagant way in which certain of these facilities have been taken and used, both by the patients and by the hospitals. With those few words, I should like to add my welcome to the Second Reading of this Bill.

3.21 p.m.


My Lords, like my distinguished colleague who has just sat down, I rise to support this Bill, and I join with him in congratulating the noble Lord (a distinguished member of my profession) who moved the Second Reading. It is naturally a source of satisfaction to me that there should be a Fellow and a Member of my College entitled to sit on the Front Bench—I am not committing myself as to whether it should be the Government Front Bench or the Opposition Front Bench, but certainly on the Front Bench. I give my support to this Bill, not only because of the immediate need for it, which seems to me an unfortunate thing, but because I have always thought the first part of the Bill was desirable. Unless there is some charge, even if it is only a token charge, for medicines and appliances, there will not only be what has been called a grave extravagance, where there is criticism of the rearmament programme, but there will be wanton waste.

We know from long experience that there will always be waste if people get something for nothing; and proper care will not be taken of appliances so received. It is, I think, unfortunate that appliances should be obtainable without charge if the individuals have the means to contribute towards that charge. It has been the universal experience of hospitals and doctors from generation to generation that they must make some token charge if, for instance, in a minor matter like the care of a medicine bottle, precautions are to be exercised. In the old days, unless the hospital;, which were dispensing freely and without charge to anyone, asked for a penny on the bottle, the bottle was never brought back. It was hung up on a string and then the wicked boys of the family threw stones at it. It was no hardship to the individual patient that he had to contribute. Moreover, unless there is some contribution in regard to medicines as well as appliances, people will become medicine-minded—asking for another bottle of medicine and expecting always to get it; and again there will be wanton waste. I am not going to follow the noble Lord, Lord Balfour of Inchrye, into statistics, nor will I try to ascertain how much string it takes to reach from St. Paul's to Moscow. I would, however, remind noble Lords that it is very difficult for a doctor to refuse another prescription. If a patient says that he feels that only by another bottle will his cure be completed, the doctor may not be convinced, but it is not easy for him to refuse it. If, however, the patient had to pay a token fee, the demand would not then be so insistent.

There is one point with which I should like the noble Lord who moved the Second Reading to deal, and that is the reason for subsection (2) of Clause 1. It seems to me to put forward a curious criterion. What is the reason for selecting an in-patient of a hospital for a free issue, when his need may be much less than that of an out-patient? In fact, to-day the in-patients of a hospital are often of a higher income group than the out-patients. The universal application of the National Health Services Act has thrown open the doors of the hospitals to all, whatever their income may be; whereas in the old days a patient, to obtain admission to the hospital, had to satisfy the authorities that he could not afford to provide for his treatment out-side. Now the weekly wage-earner is in competition for his hospital bed with many who can quite well afford to provide the treatment for themselves. Why should this particular class, which may include many who are well able to pay for their appliances, be selected for a free issue? I am not intending to move any Amendment at any stage on that particular point, because I realise the importance of this Bill, whatever imperfections I may think it contains. This Bill has to reach the Statute Book as promptly as possible. However, I should think that the proper policy would be to give freely to those who need it. That, of course, would again be exposed to attack by the slogan of "No means test." But noble Lords have to submit to the most meticulous means test ever devised by man, and it is to be further strictly tightened by proposals in the present Finance Bill. We are supposed to accept the idea that there should be no means test for the man who wants to take something out of the "kitty," while there is the most meticulous means test for the privilege of being allowed, or rather compelled, to put something in.

One other reflection passes through my mind, and that is in regard to visitors. Why should these appliances be provided to visitors to this country? It is a great pleasure to noble Lords to entertain visitors from other countries in your Lordships' convenient premises. It is all very well to invite two distinguished visitors from the United States to lunch, as I have done to-day, but I do not expect to have to provide them with dentures to eat the lunch and with spectacles to see what is on the menu. I should have thought there was a possible line of economy there. I agree with the argument that the introduction of charges may lead to a more reasonable use of the Health Service, but to build up statements that this represents a complete disintegration of the social legislation is just absurd. The situation is made difficult at the moment by the fact that the former Minister of Health is obviously trying to secure the leadership of the Conservative Party—and with the worst brand of conservatism. He has devised a service, and now he says, "Noli me tangere; ipse dixit"—"I have created this thing; leave it alone. I am a last-ditch man. Nobody must touch this. The status quo is what I stand for." If that is not ultra conservatism, I must leave the Cross Benches and try to find out on which side of the House I should sit.

3.29 p.m.


My Lords, I should like to join in the congratulations which have come from all sides of the House to my noble friend on his maiden speech from the Front Bench. Unfortunately, I feel compelled also to condole with him, for I am quite unable to join in this happy agape of agreement which your Lordships are enjoying this afternoon—I say "agreement," but the last speaker, the noble Lord, Lord Webb-Johnson, was, I thought, perhaps a little out of tune in his enthusiasm. The other speakers have all regretted the necessity which has arisen; whilst recognising it. I, myself, rather regret that the noble Lord, Lord Haden-Guest, who introduced the Bill did not choose the second technique which was spoken of by Lord Balfour of Inchrye and say that the Bill was a thoroughly bad and beastly Bill which could not be avoided and, there-lore, we had better take our medicine and make the best of it. Frankly, that is the most charitable feeling that I, personally, can have towards the Bill. I am one of those who believe that in this Bill there has been a serious loss, or rather a sacrifice, of principle. It is for that reason that I condole with the noble Lord who has introduced it. Probably he has been somewhat consoled by the provision for special foreign treatment for some cases of tuberculosis, but I cannot believe that he feels any more enthusiasm than I do for the introduction of charges in respect of dentures and glasses, for the noble Lord, like myself, must have declared from many Socialist platforms that a free health service was an essential part of the Socialist attitude towards the happiness and good health of our people.

That is the principle which is sacrificed. It may be that it is only slightly sacrificed, and it may be that, as the result of sacrificing it, certain abuses will be avoided. But I take leave to doubt somewhat the extent of those abuses. I have never had it made completely clear to me of exactly what they consist. It is said there is carelessness in the use of glasses. That some carelessness does exist is, no doubt, true; but I doubt very much if it is extremely extensive. I have a pair of glasses, and I am at pains not to break them, because if I do so I am then at a great disadvantage for a considerable period afterwards. Those who obtain their glasses through the Health Service must, presumably, be under the same disadvantage. Moreover, I do not think that many people can go casually to the dentist and have all their teeth out for the joy of having a denture fitted. It is true that all of us who have had toothache have thought, from time to time, that we should like to be rid of our own teeth and have no more pain, but by the time we have had the one offending tooth treated, that view fades away. So, as I say, I am doubtful of the extent of the abuses. If abuses exist, I suggest that it is the business of the Department to find methods of com-bating them without a complete sacrifice of principle.

This is a very sad occasion for those who feel as I do—and I know I am far from being alone in the country. The noble Lord, Lord Balfour of Inchrye, and I think also the noble Lord who introduced the Bill, mentioned the ceiling of expenditure which has been set on the Health Service. All expenses, all prices, are rising at the present time, and as Lord Balfour of Inchrye said—and I agree—in a year's time those expenses will presumably have gone up still further, which means that the ceiling will have become more inadequate. Where are we to go from there? What is to be the next victim of this cheese-paring system? I do not know. But the principle has now been abandoned and there can, it seems to me, be no consistent limit if the ceiling is set at £400,000,000. If the service for which the £400,000,000 is to be paid is to become increasingly expensive, then, clearly to the charges for dentures and spectacles we shall have to add charges in respect of artificial limbs, hearing aids and so on. There can, it seems to me, be no end to this. I am therefore very deeply alarmed.

It has been said that this is a necessary economy in this time of stringency and of vast expenditure on armaments. I feel that that is a contention which cannot be taken seriously. The total Budget expenditure this year is in the neighbourhood of £4,000,000,000. The economies to be made—these contemptible economies on dentures and spectacles—are to amount, in the present year, to £13,000,000 and to £25,000,000 in a whole year. I really cannot think that that is a serious contribution to our rearmament. I say emphatically that I cannot accept that point of view. I know that when one is making economies, every economy that is made is resisted by someone, and often the reason, or, at any rate, one of the grounds on which it is resisted, is that it is so small. Really, what are we doing on this occasion? What we are doing is taking a very small amount for our rearmament programme. And from whom are we taking it? We are taking it from those who are less blessed than some others in either teeth, or sight. This is, in effect, a special tax on those to whom fortune has been less kind than it has been to others. In that sense, I cannot believe that any of your Lordships really welcome this measure. It has been described in another place as a "mean, cruel little Bill." Those are hard words. I do not believe that any of my colleagues on the Front Bench are either mean or cruel. My knowledge of those whom I know well leads me to believe exactly the opposite. I therefore would extend my condolences to them on the necessity which they are under of supporting this mean Bill.

3.37 p.m.


My Lords, the House will, I think, have been greatly interested in the speech which has just been delivered by the noble Lord. Lord Faringdon. He has shown that by his eloquence, as well as by his principles, he is qualifying for a post in an alternative Government which, no doubt, will take the place of the present admirable representatives on that Front Bench—after a pretty long interval. I am not concerned to defend the Government, or to take part in a "civil war," but in the speeches to which we have listened reference has been made to expense and a great deal of waste and extravagance, and if the noble Lord's principles were carried out, then indeed the Welfare State would be in danger. In fact, it would be completely undermined. After all, what did the noble Lord say? He said, in effect: "A mere economy of £25,000,000! What is the good of £25,000,000?" If that is the way in which economies are regarded I am not surprised that the total Budget Estimates go up year by year until they touch over £4,000,000,000. Before the "noble Lord comes to occupy—if he ever does—an important administrative post in whatever Government he may be offered one—and I say this without any Party rancour—I trust that he will begin to learn the first element of sound administration. Whether you are a Socialist, a Liberal or a Conservative, it is economy in administration; and the spirit which finds expression in such remarks as: "What is £25,000,000? That is not worth taking," is going to damn all administration and make any Welfare State or any other sort of State quite impossible.

After all, what is this principle of the free service? There is no difference between us as to the value of the Health Service. The whole of the structure was largely worked out by us when we were together, and, whatever Government had come in, a National Health Service would have been introduced. But we have to maintain it, and it is absurd to talk about it as a free service. It is not a free service in the loose way in which the noble Lord has been talking about it. It has to be paid for in contributions by the contributors to National Insurance, the workers and employers, and by a large Exchequer contribution, which comes out of taxation, and that to-day means very largely out of indirect taxation upon the same people who are contributors to the Service. The noble Lord will better further the interests of the National Health Ser- vice, which we have every intention of maintaining, and maintaining efficient and intact in the truest sense of the word, by not girding at what in these days are necessary economies, which, carefully ad-ministered, will make the burden much less onerous on the people who are served than either extra taxation or extra contributions. Perhaps it is unnecessary for me to defend the Government against their own—should I call them?—supporters in the way I have been doing, but I care too much about this Service, its maintenance and its efficiency to let pass unanswered the kind of speech which is going to make this Service quite impossible.

3.41 p.m.


My Lords, I had not intended to intervene in this debate, but since my noble friend Lord Faringdon made his speech, although he was alone on this side of the House in taking the line he did, I would now say that he is speaking for a large volume of opinion in the country, in your Lordships' House and in another place. There are a great many of us who, as a matter of principle, sincerely regret this breach in the policy of a free health service. When the noble Viscount, Lord Swinton, takes it upon himself to belabour my noble friend, I feel it necessary to intervene. When the noble Viscount talks about loving the Health Service, I am reminded of the walrus and the carpenter before they devoured the oysters. Our whole case is that this is only a beginning. If a Conservative Government unfortunately and miserably took office, this is a precedent which could be followed almost ad infinitum. I shall not delay your Lordships. I wish only to say that my noble friend is not alone, and I am grateful to him for the courageous stand he has taken.

3.42 p.m.


My Lords, I should like to thank noble Lords who have spoken for their kind references to myself. I agree that there is a case for investigating economy in administration, in management and costing generally. That is in course of being done; but though economies are to be made in that direction, they could not have contributed to the present Budget. That is one reason why provision for making these charges which could be levied now had to be chosen, and not something that would bear fruit in the future. I thought that when my noble friend was talking about the yards and miles of spectacle material, he had the Festival spirit in him. I hope he will continue it at the Festival on the South Bank. My noble friend Lord Webb-Johnson, whom I also thank for his kind reference to myself, regretted the charges. But, of course, there have been charges since the beginning. This charge is a small one, and will not fall on anyone out of work or sick who cannot pay it. In the present state of full employment, I do not regard it as a serious burden on anyone. I think this matter has been exaggerated, and I do not feel that I stand here, or ought to be standing here, in a white sheet. I think it is a reasonable charge to be made in the present circumstances. There is an old proverb—and it is a good one—that a man must cut his coat according to his cloth.

With regard to the second point raised by my noble friend Lord Webb-Johnson, this applies only to patients who are in hospital. Patients who are under treatment in hospital are not necessarily surgical cases, or patients in hospital for a short time. They include, for example, mental patients and other classes of patient whom it would be impracticable to charge, as I think my noble friend will agree on reflection when he sees the complete list. I do not think that I need further extend my reply. On the whole, the House agrees with the Bill. There have been expressions of regret. But I do not feel that when I stood up on the street corner as a Socialist with the noble Lord (or did we stand together?), and he and I made speeches to the general public—consisting of two men and a small boy—we were expressing views in contradiction to those which we are expressing at the present time. This is a great Service. In helping to back up the National Defence, we are performing a service to the National Health Service, an essential service to the nation and I think that needs no apology.

On Question, Bill read 2a: Committee negatived.2

Then, Standing Order No. XXXIX having been suspended (pursuant to the Resolution of May 2), Bill read 3a, and passed.