§ 2.42 p.m.
§ Order of the Day for the Second Reading read.
§ THE LORD PRESIDENT OF THE COUNCIL (LORD WOOLTON)
My Lords, the National Health Service Bill now before your Lordships enables charges to be made for certain services provided under the National Health Service. No one likes instituting charges where none existed before, but the Government recognise, as did the previous Government when instituting charges for dentures and spectacles under the National Health Service Act of 1951, that the cost of the Service must be kept within reasonable bounds. On this account, the Government propose to introduce new charges for certain medical and dental treatment. The charges proposed are modest in themselves and should not involve any hardship, as provision will be made to relieve from the charge those in receipt of National Assistance or war pensions.
Your Lordships may remember that Section 16 of the National Health Service (Amendment) Act, 1949, empowers the Government to institute, by regulation, a charge for drugs supplied on each prescription form. The Government propose to use these powers, but since they do not 605 apply to medicaments issued to hospital out-patients it is clearly necessary, if an anomaly is to be avoided, to supplement these powers by enabling the Government to apply the same charges to hospital out-patients. This Clause 1 of the Bill will do. The charges proposed to be made on medicines, dressings and appliances prescribed or supplied by general practitioners are one shilling for each prescription, notwithstanding that the form of prescription may contain more than one item. For example, if a patient were ordered on one form of prescription an ointment and a bandage, and some lint, that would amount to three items but would still cost only 1s. On each occasion on which a doctor who dispenses his own medicine supplies it to a patient, again the charge would be 1s. Higher charges are proposed for elastic hosiery for which the charge will be 5s. or 10s., according to the size of article supplied. It is proposed to make similar charges for elastic hosiery supplied to hospital out-patients.
The estimated saving on all this in a full year is £12,500,000. The charges will be payable by everyone who presents a prescription form to a chemist, or, in a rural area, where the medicine is supplied by a doctor who does his own dispensing. The charges have been fixed at a level which should not normally involve any hardship, but people in receipt of National Assistance will be able to claim the repayment of the 1s. from the office where they draw their assistance, which is usually the Post Office, when next presenting their Order Book, if they produce a special receipt form which the chemist or doctor will be asked to give them on request. War pensioners will similarly be able to reclaim a charge incurred by reason of their accepted war disability. The shilling charge will also be made through outpatients' departments in hospitals when drugs or medicines are supplied for patients to take away with them. When prescriptions are dispensed to out-patients at a hospital, no charge will be made to patients who produce a National Assistance Order Book showing that they are receiving assistance (or are dependants of a person receiving assistance), or Ministry of Pensions out-patients' attendance cards, or who sign a declaration that the drug or medicine is for an "accepted" war disability. Patients 606 under treatment for venereal diseases at hospital clinics will also be exempt from charge for drugs or medicine supplied as part of their treatment.
So far as appliances are concerned, the proposal is to make a fixed flat rate charge of not more than half the cost of certain appliances supplied through the hospital service to out-patients other than children.
Since it is not in the Bill but will be done by regulations, I thought it advisable to give your Lordships some definition of these appliances. The appliances for which there will be charges are as follows: surgical boots and shoes, £3 per pair; surgical abdominal supports, £1; elastic hosiery: anklets, knee-caps or leggings, 5s. each, other types 10s. each; wigs of any type, supplied in duplicate, £5 per pair, the single wig on renewal, £2 10s. No charges will be made for repairs to appliances except for the soling and heeling of surgical boots and shoes, where approximately the full cost of the work will be charged. Nor will any charge be made for appliances supplied to or repairs done for children, persons (or their dependants) in receipt of assistance grants under the National Assistance Act, or for war pensioners in respect of an accepted disability. The only kind of appliance on the above list which is also obtainable on prescription by a general practitioner outside the hospital is elastic hosiery, and it is proposed that this should carry the charges shown above, and not come within the shilling prescription. The estimated yield of this is about £250,000 in a full year.
Clause 2 of the Bill provides for the extension of charges to forms of dental treatment other than the provision of dentures, which is already covered by the Act of 1951. Great care has been taken in trying to work out the form which these charges should take. The method on which the Government have decided is a simple one. It is that, with certain important exceptions, the patient should pay the cost of his treatment up to a maximum of £1, and that the rest of his treatment should be free. In contrast to the possible alternative which has been widely advocated, of giving the patient the first £1 worth of treatment free, the method proposed will encourage patients when they do visit the dentist to undergo complete treatment which will make them dentally fit, rather than to make a visit 607 only when they need emergency treatment. An important element of this scheme of dental charges is that the Bill provides, in Clause 2 (4), for exceptions of those classes which are most in need of treatment, and they are defined as children and young persons up to twenty-one, expectant mothers, and mothers who have had a child within the last twelve months. These mothers, children and young persons will continue to be entitled to free treatment, both from general dental practitioners and under the local authority priority services.
To prevent abuse, the Bill proposes penalties for fraudulent claims by persons who do not in fact belong to the priority classes. It is also proposed not to make any charge for the clinical examination and report on a person's teeth. Nor will charges be made for the repair of appliances, except such as may be prescribed, and in practice few, if any, appliances may be so prescribed. Similarly, no charges will be made for the arrest of bleeding; for a domiciliary visit—that is, a visit by the practitioner to the patient—due to the latter's condition, and the supply or replacement of appliances which are already subject to a charge under the Act of 1951. The charge will apply to treatment by a general dental practitioner in his own surgery or at a health centre. Like the charges under the 1951 Act, it will be paid direct by the patient to the dentist.
The Government have considered very carefully the effect of this Bill upon the dental profession in their endeavours to meet the demands for treatment. A vast amount of dentistry has been carried out—often with great pressure on the dentists—which has undoubtedly contributed to the health of the population, but in the meantime, as your Lordships are very well aware, the school dental service has lost much of its staff. The inducements to dentists to practise under the general dental services and the school dental service respectively have been out of balance. Charges to be imposed under this Bill will, it is hoped, help to put this balance right. If the pressure on general practice slackens as a result of the charges, then there will be a greater inducement to some of the dentists who like to treat school-children to participate, either whole-time or on a sessional basis, in the priority services, and so to ensure 608 that, under a properly manned school dental service, children receive regular inspection of their teeth and are given treatment whenever they need it. The avoidance of hardship has again been very much in the minds of the Government. The principle on which the clause is based is that, apart from the two priority classes of children and young persons under twenty-one, and expectant and nursing mothers (for both of whom there are special clinical reasons, as they are specially liable to dental caries) all other persons should be expected to pay the charges, and that they should receive help, if necessary, from the National Assistance Board. The expected saving from the charges for dental treatment will be in the neighbourhood of £6,000,000 per annum.
The new charges for dental treatment will not apply in hospitals, where treatment required will continue to be given without charge. The charges for dentures under the 1951 Act do, however, apply to hospital out-patients, as to patients treated under the general dental services, and they will continue to apply, with the modification, provided for in Clause 4 of the Bill, that the Minister or Secretary of State may, after consultation with the university concerned, agree to the charges being remitted at a dental teaching hospital, where that is necessary in the interests of dental studies.
The other matter to which I should draw your Lordships' special attention is dealt with in Clause 5, subsections (2) and (3), which will empower local authorities, subject to the Minister's approval, to make such charges for the use of day nurseries as the authorities consider reasonable, having regard to the means of the persons concerned. It is proposed to approve the making of charges within a maximum of the full cost of the service provided, the amount of the charges being adjusted to the means of those who use the service. There are at present in Great Britain some 45,000 places in day nurseries provided by local health authorities, at a total cost of £5,300,000. The charges recovered for food provided amount to some £900,000 a year. It is, therefore, quite an expensive service, and it is not unreasonable to make some charge for it.
The mother who is compelled to go out to work, usually because she is the sole wage-earner, or who is unable to look 609 after her children owing, perhaps, to sickness, might well be unable to pay much in the way of charges—or in some cases might not be able to pay anything at all—but there are many cases where the mother, whose husband is working, wishes to work herself in order to supplement the family income or, it may be, in response to appeals that have been made for women to return to industry. Very often, in these cases, the mother earns good wages, and there is no reason why she should not make some contribution towards the cost of maintaining these very expensive services. And, in fact, she is often quite willing to do so. No firm estimate of savings is possible, as the amount of the charges will be largely at the discretion of the local authorities themselves. The yield might be of the order of £1,000,000 in a full year, of which half would accrue to the Exchequer.
The Bill makes one or two detailed amendments to the Act of 1951 which I ought to mention. First, the charges under that Act apply to dentures, but not to dental bridges. The present Bill, in Clause 5, corrects that omission. Secondly, the Bill, as already mentioned, enables the Minister of Health, or the Secretary of State for Scotland, in the interests of dental teaching to remit the 1951 charges in the case of dentures provided at a dental teaching hospital. Thirdly, under the 1951 Act, the power to charge for the supply of dentures would expire on April 1, 1954, unless continued from year to year by Special Resolution. It is not, in fact, possible to say how long the economic circumstances of the country may make charges necessary, and a more flexible form of variation with no fixed time limit is desirable. The Bill therefore gives power to lessen or abolish any dental charge by Order in Council. This will be done as experience or financial circumstances may suggest. This power applies both to the dental charges imposed under the present Bill and to those imposed by the Act of 1951.
My Lords, I hope that that brief summary has done something to make clear the salient points of the Bill. The reason for the introduction of the charges, as your Lordships are well aware, is, primarily, to curb the ever-mounting cost of the Health Service and to keep it within reasonable bounds.
610 From 1947 to 1951, the number of prescriptions given under the National Health Service in England and Wales rose from 70,000,000 to 229,000,000, and the average cost of a prescription from 1s. 8d. to 3s. 11d. In Great Britain, the estimated cost of the dental service, excluding hospital dentistry and the special priority services run by the local authorities, is about £27,000,000 a year; and the day nurseries, as I have said, cost about £4,500,000. I do not think it is unreasonable to ask those who can afford it to make some contribution towards the cost of some of these services, with a view to keeping the total cost within some near approach to the ceiling which successive Chancellors of the Exchequer have prescribed. The greatest danger to the Health Service is that it should be too expensive for us to maintain. This Bill will not only help to reduce, in some measure, the estimated expense but may well act as a curb to the extravagant demands on the Service. Perhaps, as a nation, we are in some danger of taking too much medicine. I beg to move that the Bill be now read a second time.
§ Moved, That the Bill be now read 2a.—(Lord Woolton.)
§ 3.0 p.m.
§ LORD SHEPHERD
My Lords, as I listened to the speech of the noble Lord, Lord Woolton, I began to lose hope that he was going to give your Lordships an explanation of the reasons why this Bill has taken shape. Towards the end of his speech, the noble Lord had done no more than indicate to your Lordships that the expenses of the Health Service have been mounting up, that it is desirable that something in the nature of a ceiling should be fixed, and that the people who take advantage of the Health Service should make some kind of contribution to it. I do not know whether your Lordships will be satisfied with the introduction of an important Bill of this character in those terms. I have been in this Chamber for five years and I have not listened to the introduction of a Bill when so little has been said about the reasons prompting it and making its introduction necessary. Perhaps I may be forgiven, therefore, if I take the place of the noble Lord for a few minutes and give the reasons for the introduction of this Bill, as indicated by speeches of colleagues of the noble Lord in another place. When 611 I do that, it will be found that their interpretation of the reasons which have prompted this Bill are of an entirely different character.
Before I come to that, perhaps I ought to don something in the nature of a white sheet and explain the position of the Labour Party, in view of our past commitments in matters of this kind, and inform your Lordships' House of the most recent decision which the Party have taken in the matter. In 1950, in a year when there was a surplus in the balance of payments between ourselves and other countries of the world, the then Chancellor of the Exchequer, Sir Stafford Cripps, drew a ceiling for himself because of the Budget position of that year. He indicated that, because of the financial position of the country, a ceiling would be drawn for the Health Service and that if there had to be increased expenditure in some part of the Health Service, there would have to be transfers within the Service, determined by priorities. That, as I say, was in a year when the country had a surplus in the balance of payments between this country and other countries. In 1951, after the retirement of Sir Stafford Cripps, my right honourable friend Mr. Hugh Gaitskell, the Minister of Health of the day, faced with rearmament in all its rigour and with increasing expenses in all directions, decided that he could not find more than £7,000,000 extra for the Health Service, although the claims of the health authorities throughout the country amounted to £23,000,000 extra.
Therefore, the Government of the day decided that for a temporary period—and I want your Lordships to note the words "temporary period"—there should be a charge on dentures and one on spectacles. It will be noticed that this increase was proposed to Parliament to meet the cost of rearmament and the growing expenditure of the period. But my right honourable friend the Minister of Health said this in the course of his speech in moving the Second Reading of the National Health Service Act of 1951 (OFFICIAL REPORT, Commons, Vol. 487. Col. 239):When we considered where to levy charges, we had four criteria in mind. The first was to provide the income required for the maintenance of the essential parts of the Service. The second was to levy the charge as little as possible on any person who was seriously ill. The third was to avoid a high 612 cost of collection. The last was to have regard to the possible deterrence of abuse.I hope to say something about each of the three latter points before the conclusion of my remarks.
My Lords, before the noble Lord goes on, can he tell us, for the benefit of noble Lords who will be speaking later, what the total figure of the ceiling was fixed at?
§ LORD SHEPHERD
It was, roughly, £400,000,000. When the 1951 Act was being considered in another place, the Minister of Health indicated that the Bill was of a temporary character and would normally continue for the period of rearmament. During its passage, however, a demand was made that some limit should be included in the Bill itself. The limit was inserted in the Bill, which was to come to an end in 1954. When we come to examine the Bill now before the House, we find that no limit of time is provided at all, although my colleagues in another place did their utmost to persuade the Government to include it. But one thing will be found in this Bill—that is, that the time limit placed in the Government's Act of 1951 is to be deleted. So that the charges under this Bill and under Labour's own Act will have no time limit so far as the Statutes are concerned. We think that the Government have not played fairly with us in this matter, if they desire our co-operation in times of difficulty. And we have now reached the conclusion that when we return to office, which we hope to do at no distant date, when time and opportunity present themselves we shall clear these Acts out of the road and begin once more to rebuild the Health Service of this country on a co-operative basis and without charging people in the way that is proposed in this measure.
What is the purpose of the Bill? I will now give the views of the Minister of Health, who is Leader of another place. Then I will give the views of the Chancellor of the Exchequer, taken from his statement in January last on the financial and economic situation in the country. This is what Captain Crookshank said on the Second Reading of the Bill: (OFFICIAL REPORT, Commons; Vol. 498, Col. 860.)The fact remains that unless we restore our present precarious situation, unless we can restore confidence in sterling and stop the 613 drain on our reserves it is not the National Health Service which will be destroyed but the very foundations of our economy which will be shaken.That is the danger we have to face and much that all of us together have created and enjoyed would disappear in the twilight of national bankruptcy. Those are the grim facts which, fundamentally, are the justification for the financial parts of the Bill."—I should like to emphasise that last sentence. The Minister went on:The other portion, which tries to turn the emphasis into a slightly better direction than it has been in the last few years, is the more constructive portion of the Bill. …I commend those words to your Lordships. Therefore, your Lordships will see that Captain Crookshank, the Leader of the House of Commons and the Minister of Health, is less concerned about the ceiling on the Health Services, for the sake of the Health Services, than he is about the state of bankruptcy in which he appears to think the country is falling.
I now come to the Chancellor of the Exchequer. The speech that he made in another place on January 29 was especially for the purpose of giving the views of the Government on the situation in which this country found itself. It was there that Mr. Butler indicated the steps he was going to take to rescue the nation from its position; and it was during that speech that almost every item in this Bill was mentioned specifically. Therefore, we have to assume that all that Mr. Butler said about the state of the country covered this Bill also. This is what he said (OFFICIAL REPORT, Commons, Vol. 495, Col. 41):If we allowed our economic strength to deteriorate and to decay, not only would our lives be impoverished, but the whole aspect of the problems confronting the free world as a whole would be irremediably worsened … it is the harsh truth that our economic position in the world has been deteriorating for about half a century. … Our resources have been depleted by two world wars into which we unhesitatingly threw all our resources. The result of this is that in addition to the other burdens which are upon us, we have become the largest debtor country in the world, whereas for generations we had been the largest creditor.I suggest to your Lordships that, when we come to consider whether this Bill is necessary or not, we have to ask ourselves whether what it proposes has any relevance to the situation described by the two right honourable gentlemen in the other place. Is it really the fact that this 614 nation cannot be rescued from bankruptcy unless we charge something to the sick, the lame and the poor?
Let me add one further thing. What is it that is causing so much concern, and that has led to the descriptions of the situation to which I have just referred? It is something that we call the balance of payments. Some people know a great deal about it; most people know nothing. But in the Budget speech it was made crystal clear to those who could read. I have already indicated that in 1950 there was a surplus, and that surplus was in the neighbourhood of £300,000,000. In the following year a change took place, with the result, as again described by Mr. Butler, that in the third quarter of the year our gold reserves were being depleted at the rate of 46,000,000 dollars per week; in the fourth quarter of the year the depletion of our gold reserves had gone up to 58,000,000 dollars per week; and in January and February of this year—these were the last figures the Chancellor of the Exchequer could use on the date on which he made this speech—the weekly loss in the gold reserves amounted to 63,000,000 dollars per week. That is the situation which this Bill, with its charges for prescriptions, belts and elastic stockings, is going to meet. I venture to suggest that if it is an attempt to cure the sorry conditions I have described it is just like using a pill to cure an earthquake. It is not really worth the time of Parliament to bring in measures of this kind for the purposes we have here.
If your Lordships listened to Lord Woolton's detailed description of this measure, you will remember that he calculated that this Bill would save the Exchequer about £9,000,000, made up of £250,000 on surgical belts, on abdominal supports, elastic hosiery and wigs, £75,000 on dental charges, £500,000 on nurseries, and the rest on prescriptions given to the out-patients of hospitals.
§ LORD WOOLTON
The noble Lord cannot be correct there. I gave precise figures, which were £12,500,000 on prescriptions, and £6,500,000 later. The total comes to just under £20,000,000.
§ LORD SHEPHERD
The noble Lord and I are talking about two different things. I am talking about this Bill.
§ LORD SHEPHERD
No, the noble Lord is talking about another Bill in addition. This Bill provides only for a prescription charge on that part of the public which goes to hospitals. The £12,500,000 to which the noble Lord refers would relate to the many millions of people who come under the National Health Service Act, 1949. So that I am approximately accurate—I will put it no higher than that—and I desire to be, because I want to prove that this Bill is one which we should not entertain. Assuming that the total is £9,000,000, how is that to be applied in order to save the nation from bankruptcy? Almost on the first page of the Economic Survey which has just been published by the Government I find a table which seems very useful for my purpose. In 1948 the cost of imported foodstuffs was £826,000,000, whereas in 1951 the total had reached £1,249,000,000. What part of the £9,000,000 which is to be saved by this Bill is going to relieve us of any of those imports? Is any part of that £9,000,000 going to affect that importation at all? Now I come to the next point. In 1948, raw material imports approximated £606,000,000, whereas last year the imports went up to £1,500,000,000. Again may I ask: supposing the whole £9,000,000 to be saved under this Bill represented commodities which had to be imported, how far would that relieve this country from its approach to bankruptcy? But the whole £9,000,000 is not available for that purpose. If you take out the margins of profit; if you take out the wages that are paid; if you take out the cost of factories and the like, the amount of imports—even if it all came from abroad—to be saved by this Bill would be extremely small.
My last word on the finances has reference to the Budget itself. It may be argued that the saving of £9,000,000 will have nothing whatever to do with the approach of the country to bankruptcy through excessive imports, but that it would be a relief to the Exchequer; it would enable the Chancellor of the Exchequer to have a real balance at the end of the year. Before we part with that thought, I think we should look at the Budget itself in order to get a proper comparison. Mr. Butler, in winding up his speech on the Budget debate said this (OFFICIAL REPORT, Commons; Vol. 497, Col. 1307): 616I hope to obtain … £10,000,000 from the Post Office, and £66,000,000 extra from petrol. I hope also to save a net amount of about £80,000,000, as the combined result of reducing the food subsidies but improving social benefits."—that is to say, a total of £156,000,000. But he then ended with the remark that he had granted no less than £180,000,000 in tax reliefs. If you take his savings away from the sacrifices that he has made, your Lordships will find that the income tax payer is left with £24,000,000 extra to spend in any way he likes. I suggest that if the Government really wish to do the right thing by the poor and suffering in this country, instead of putting on new taxes which are involved in this Bill they should have given less away in the form of tax reliefs, so that the broader backs of the well-to-do might bear the major part of the expenditure which is involved.
However, there is a point about this Bill which explains a fear which exists that if money is spent by a Government upon health, that money is economically wasted. I wish to show your Lordships that money spent on health may be a good economic investment. I quite agree that on health, as upon all human activities, there may be wastage which must be made good. I say that the wise expenditure of money upon health has an economic value all its own, and I want to give one or two instances which will support the claim I have just made. In the Monthly Digest of Statistics just published, the following figures for the month of November are available. In that month the number of days of incapacity through sickness amounted to 103 per 100 persons. If one applies that percentage to the working population of our country of 23,000,000 people, one reaches the conclusion that in the month of November 24,000,000 days were lost because of sickness and incapacity. I venture to suggest to your Lordships that we can spend a good deal of money with very great profit to the State if we so improve the health conditions of our country that that great loss of time and labour will be reduced.
The Times of December 10 last had a two-column article from its Geneva correspondent reviewing the monograph of Dr. Winslow, an American physician. The correspondent was reviewing this monograph and giving the readers of The Times important facts about the value of health and the economic gain which 617 comes from it. In that article it is said that a death at fifteen years of age is an economic loss. The boy has not lived to repay either the State or his family for the cost of his upkeep. If, however, the boy lives to the age of forty, then not only has the cost of his upbringing been covered; not only has he been able to look after himself in the intervening years, but there has been an economic return to society. After forty years of age there is an economic return to society. But if a man lives to be sixty-five years of age—that is, twenty-five years longer—then the economic gain at the end of that further twenty-five years is twice as great as it was when the man turned forty. So there would be everything to gain from any expenditure of money which would lead to that great extension of life.
I want to give only one other set of figures in that respect, and they are quite recent figures concerning children who are born into this world of ours and who die before they are twelve months old—a loss to the community, a loss to their parents and a loss to the economic life of our land. I will not go back to the figures of half a century ago, because they were appalling. I will quote the figures merely since the end of the war. In 1945, the death rate of children under one year was 46 per 1,000; in 1946 it was 42; in 1947, 41; in 1948, 33, and in 1949, 32. When the noble Lord is thinking about child clinics; when he is thinking about the foods now given to women expecting a child, and when he is thinking about the money we are expending on looking after children after birth, will he please remember that that money has not been wasted? The children are alive, and one day will add to the economic strength of our land.
Now I wish to deal with only one other matter, and that concerns the subject of deterrents. We can go greatly wrong unless we are careful in handling this very difficult subject. I want, first, to deal with the deterrent effect in regard to teeth which arose out of the Labour Government's Act; and I am going to take as my authority, not some unknown correspondent, but a respected Member of Parliament, a member of the Conservative Party, who, I understand, has just finished a pamphlet to be sold by the headquarters of his Party. Mr. Macleod has reached the conclusion that the 618 deterrent effect in regard to teeth has been far greater than we expected. He says that the damage has been so severe that the dentists have lost 30 per cent. of their income. He then goes on to say that the business of dentists has declined by 50 per cent. since the inauguration of this charge; and he expresses the hope that if this Government remain in office the powers under this Bill will be used for a reduction of that deterrent arrangement that the Labour Government placed on the dentists. Well, my Lords, if this Government remain in office, we shall wish that they will do that, because we think the effect on the dentists has been too severe.
Mr. Macleod seems to justify the deterrent effect in this case because of the switch that he thinks follows from it. Owing to the active service of dentists under the Health Service Act, apparently, the schools have lost the dentists who used to look after their children's teeth. Mr. Macleod thinks it would be a good thing if we saw to it that the men who have been deprived of their livelihood since the inauguration of the charge find their way into the schools to look after the teeth of the children. We certainly want more dentists looking after the teeth of the children, but we should make sure that when we select people for that work it is not merely on the ground that they have fallen out of work, but because they have special aptitude for looking after the teeth of the children. On the Report stage of the Bill in another place, the Minister agreed to an Amendment to preclude from the prescription charges of this Bill men and women suffering from venereal diseases. I myself would not object to an Amendment of that kind. But when the same Minister refuses to put outside these charges persons suffering from tuberculosis, I frankly do not understand the position. When we come to deterrents and to discriminating between one section of the community and another, we find ourselves making these cruel mistakes, which not only affect the population but which, by extra administration, pile up the cost of the Service.
In conclusion, I wish to remind your Lordships of what I said at the beginning. Although we commenced putting these charges upon certain parts of the Health Service, we have learned our lesson and we can take advantage of that 619 lesson. If noble Lords opposite do not themselves get rid of these charges, then we shall take an early opportunity, when we come into office once more, of making sure that a saner condition of affairs is brought about.
§ 3.34 p.m.
§ LORD MATHERS
My Lords, in rising to address you for the first time I am conscious of rather mixed feelings. I am not a stranger to this Chamber, and I am not a stranger to many of those whom I see around me, because, during the period of the war, I sat in this Chamber, and because during eighteen-and-a-half years' membership in another place I came into contact with many who now, like myself, have the privilege of sitting on these Benches. I come here gladly, welcoming the opportunity of still retaining some connection with this great Palace of Westminster and all the associations which it has, and of coming into an atmosphere of debate to which, I must say, I react very favourably.
I rise to-day to deplore the fact that this Bill has been brought in to make permanent a break of principle and to make unfair discrimination between individuals. I am happy to follow my noble friend Lord Shepherd, who has already made reference to the unfair discrimination between individuals. Health should not be subject to the capacity of the individual to pay. At least, an attempt to remedy conditions of illness and disability should not be subject to the individual's capacity to pay. I ask, How did we arrive at the position which we reached when we established the National Health Service, a Service which I consider will be impaired, to some extent at least, by this Bill? Did it not derive from a growing consciousness of our duty to our neighbour? We remember Him who taught us to recognise our neighbour. Was it not His inspiration that led the Church of His founding, many years ago, to follow His example in caring for the sick and thus earning His commendatory:Inasmuch as ye have done it unto the least of these … ye have done it unto Me.Centuries have passed since these words were spoken. Many years ago, following the Church along these lines, the community took a hand. Great voluntary 620 efforts were made; the great voluntary hospitals came into being and, in their time, were very successful. But the impact of two world wars threatened the very foundations of the voluntary system; and it is one of the glories of our country that in the aftermath of war we became the first great nation to put into operation a system whereby we guaranteed to every sufferer, so far as human skill could provide it, the means of health and a full life.
Let us not go back on that ideal, as this Bill causes me to fear we are doing. I give way to no one in seeking to avoid or, if it exists, to remove wasteful expenditure; and I have no doubt that action is necessary to exercise the utmost care in our present difficult financial position. But that this Bill is the right way to secure the best results I question very much. I have had many contacts with the peoples of other lands. I have had associations with international organisations, and they have brought me into touch, both in this country and in other countries, with people from other lands. The feeling that I have found in my contacts with these people has been one of unbounded admiration for this country for its conduct during the menace of war and an equal admiration, not unmixed with a tinge of envy, for the manner in which we tackled the tremendous problems war left in its train.
One of the great things that this country has brought into operation is this great National Health Service. This Bill is pleaded for on the ground of national economy; but, as was indicated by the noble Lord who moved the Second Reading, the economy is comparatively small. I ask: why apply that economy to health? Are there not other sources where saving can be effected to an even greater extent? Are we not as a nation bowing down before false gods? Could we not, with great advantage, save vast sums on the cost of the tribute that, for example, we pay to the god Bacchus, responsible for great danger to life and limb upon our roads and in other spheres? With reference to road accidents, over 2,000 motorists were convicted in 1951 of driving while under the influence of drink. There are pedestrians also who fall into the same category and risk life and limb on the roads. Will anyone deny that the high incidence of venereal disease is made 621 greater because of dangers incurred under the influence of drink?
Noble Lords will see that I am trying to link these remarks of mine to questions of health. If I were to go outside the realm that I have covered already, I should bring in another wasteful expenditure upon which we, as a nation, would do well to economise. It would hardly come into the category that I am establishing. I refer to the god of chance. Every year £650,000,000 is put into the gambling industry. I am not on such firm ground in indicating another god, or rather goddess, by name "My Lady Nicotine," but research is being made into the effect of the enslavement of so many of our population by this seductive deceiver. I use the word "enslavement" advisedly, because it is quite obvious that many people are unable to cast off the chains of that enslaver. And you cannot "get away with it" by using the humorous statement made by Mark Twain when he said that it was all nonsense to say that people cannot stop smoking. He said he had stopped smoking hundreds of times.
The effect of smoking upon health has been proved to me by friends who have renounced the practice of burning incense before the altar of this goddess. Several have told me how they have put on weight as the result of giving up smoking. That condition can be cured, if they wish to cure it, by other means than returning to the slimming process they had renounced. Research is still going on, but one conclusion of a firm character has, I understand, already been reached. It is that women smokers grow old prematurely. When we talk of economy and learn from the latest Treasury Statement on Income and Expenditure (Cmd. 8486) that the estimate of personal outlay on drink and tobacco for 1951 is £1,589,000,000—I cannot give the separate figures as they are not shown separately in the latest Statement; perhaps they are lumped together in this way because they are both narcotic poisons and are taken in that way—I feel I am justified in saying that there are other economies that should be tackled before we run the risk of impairing the national health by what are demonstrably small economies and may well prove to be false economies in the long run.
I do not wish to disguise the fact that the National Health Service costs a 622 great deal and that there is every reason for seeing, in the public interest, that the money devoted to it is wisely spent. There are still many millions that we shall have to spend upon hospitals and other services before we bring all the wonderful resources of medical science promptly to the aid of thousands of suffering people. Much of the disease and disabilities from which they suffer may be more properly a subject for prevention through education in the right ways of living. But to enter upon that great subject would take me far beyond this small, sad Bill. As I listened to the noble Lord, Lord Woolton, I was reminded of a story of a Scottish farmer who set about the task of shearing a pig. The pig made the usual noises that we hear from pigs when they are being manhandled, and the old farmer was led to say that he found what was happening was a case of "Muckle cry but little' oo." This Bill is a case of "Muckle cry but little' oo," a great deal being said but, in the end, not resulting in very much. I do not think this Bill is a credit to the Government responsible for it.
§ 3.48 p.m.
§ LORD WEBB-JOHNSON
My Lords, I am sure you would all wish me, in the first place, to say how glad we are that the noble Lord, Lord Mathers, has broken the ice and made his maiden speech. It is perfectly clear from what he has said that he can make valuable contributions to our debates over an enormous range of subjects. We may look forward to his interventions on tobacco, on alcohol—
§ LORD WEBB-JOHNSON
—on research, and on the shearing of pigs—which was a "new one on me." He enlivened his speech by indulging in more than one language. I enjoyed his speech enormously, and I hope that we shall hear him on many occasions. Of course, I differ entirely with practically everything he said, as I did with most of the things that the noble Lord, Lord Shepherd, said. I think it is idle to pretend that the social services and the health services are not linked with the country's financial position. It is rather unfair to reproach the Government for approaching this subject with the financial aspect in view. In point of fact, the financial side must be their deepest concern at the present time, 623 and to calculate every possible saving as being not worth while will, in the end, lead to no saving. Of course, the smaller savings must be taken into consideration.
I know that noble Lords on both sides of the House will be shocked, as they have been in the past, when I confess candidly that I welcome the Bill, not only as a contribution to economy but also because I believe that it will have a salutary effect. I believe that moderate charges will lead to a more reasonable use of the Service. I believe that it will lead to a healthier approach. It will stop extravagant demands. It will diminish waste and greed. There is always a danger of waste and greed when something is offered for nothing. I believe this, that when the pressure is relieved on the doctors and dentists to a certain extent, when we cut down the quantity of the demand, we shall see an improvement in the quality of the Service. As your Lordships may have gathered from my interventions on previous occasions, I would go even further than the Government. I have never been able to understand why in-patients of hospitals should be exempt from charges. Taken by and large, on the average the in-patients of hospitals to-day are better able to pay than any other people who make claims on the National Health Service. I think it would be quite simple to arrange for relief for those who might find the charges difficult. I will not raise again the question of a "hotel charge," except to seize the opportunity to inform the noble Lord, Lord Shepherd, that I was completely unconvinced by his intervention on a previous occasion, when I said that the Labour Party had accepted the principle of hotel charges for stays in hospital when they cut off a part of a man's sickness benefit while he was in hospital.
§ LORD SHEPHERD
The noble Lord on a previous occasion did not say that. The noble Lord will remember that I dissociated myself entirely from his reading of the matter; and I still do so. What the Government did in respect of that does not commit them to the subject of hotel charges, with which we associate tips, bad beds and all the rest of it.
§ LORD WEBB-JOHNSON
Of course, I was merely informing the noble Lord that his intervention on exactly the same 624 lines on another occasion proved completely unconvincing to me.
I will not detain your Lordships much further, but I would take the opportunity of saying that, without any charges, the taxpayers' money will be spent on all and sundry, and to labour the question of the poor and suffering is to present a quite false picture. Every member of the population is entitled to claim a share in the National Health Service now without payment, and I think it is just nonsense when, either in this House or in another place, the imposition of charges is labelled as likely to lead to a complete disintegration of the social services. I was very sad and sorry to hear the noble Lord. Lord Shepherd, foretell what might happen in the future if there were a change of Government. I was sorry that he should have revealed that he has such fixed ideas. I trust that in the intervening period, when he may have opportunities for considerable thought (who can say how long it may be?), he may decide that this is still an open question. As one of considerable experience in the practice of medicine and surgery I would say that, quite apart from any question of economy, this introduction of charges is likely to lead to an improvement in the health services.
§ 3.54 p.m.
§ LORD MILNER OF LEEDS
My Lords, I desire to preface my short remarks on the Bill by bringing to your Lordships' attention two facts. I do so as a new member, and with great diffidence. The first one concerns the short time which your Lordships' House has had in which to consider this Bill. Apparently it was introduced into your Lordships' House on Friday last, in order that the Second Reading might take place to-day. But on the Report stage in another place as recently as Thursday last, quite a number of important Amendments were made in the Bill, and I respectfully submit that it is unreasonable that your Lordships should not have been given more time to consider the Bill in its amended form. I venture to hope that your Lordships may agree with me that in future a longer opportunity ought to be given to consider such an important Bill.
The second point which I wish to make is that I gather, from the debates in 625 another place, that the Government have already anticipated your Lordships' approval of this Bill. Apparently, they have sent out instructions to hospitals requiring them to obtain from patients signed acknowledgments of the fact that those patients understand they will have to pay the charges set out in the Bill. It appears that a large number of patients, some of whom ordered their appliances many months ago, are now being asked to sign an acknowledgment of the fact that in future there will be payments to make in respect of those appliances. I can understand that it is necessary for any Government Department to make its own internal administrative arrangements, in view of the possibility or probability of a Bill becoming law, but surely it is presuming too much on the acquiescence of your Lordships' House to assume that necessarily your Lordships will accept this Bill, word for word as it has been put forward by the Government, without the alteration of a single charge or a single clause. My Lords, I mention these matters with diffidence, but they appear to me to indicate on the part of the Government some lack of courtesy and consideration for this House, if not, indeed, a constitutional anomaly.
Now I come to the Bill itself. I would remind your Lordships of something of its background. In 1946 those who are now the Government of this country voted against both the Second and Third Readings of the thin National Health Service Bill. I think it is also pertinent to note that this is another instance of a promise deliberately broken, because during the last Election the Chancellor of the Exchequer said in quite definite termsWe shall maintain the Health Services, contrary to any stories you may have heard.Yet within six months of that emphatic assurance we have the present Bill, striking a blow at the very basis of a Service which the Chancellor undertook to maintain. In my submission, that is a complete breach of faith with the electors of this country. And for what reason? From the remarks of the Lord President, your Lordships may have been under the impression that the Bill has been brought in solely to save money. A sum of £20,000,000 has been mentioned. But the Minister in another place disowned that 626 reason completely. On the Second Reading of the Bill he said (OFFICIAL REPORT, Commons; Vol. 498, Col. 845):We are not concerned to-day with the purely financial attempt at retrenchment at all costs. Far from it. When the Government were seeing whether any savings could be made in the Health Service the considerations they had constantly in mind were: are there any obvious abuses to be rectified? Can we sooner or better reach what is the ultimate objective of us all, improving the public health, by pruning or rearranging some of the present services or, indeed, by getting the emphasis altered in the right direction? By this Bill we can make some such Improvements while, at the same time, restraining the expenditure.I submit to your Lordships that although the reason given there is that there are obvious abuses to be rectified, we have not heard one word to-day—nor was anything said in another place, or any evidence given—to that effect. Certainly there is nothing in the Bill which improves public health, which rearranges some of the present services or gets the emphasis altered in the right direction. The only conclusion we can come to, therefore, is that there are no substantial grounds whatever for the imposition of these charges for necessities upon our sick, our maimed and our more unfortunate fellow-citizens.
I do not propose to deal with the Bill in detail, but I should like to submit three or four points for your Lordships' consideration—points which I hope we may have the opportunity of discussing in Committee. In my view, they are incontrovertible points. The first is that the Is. charge on prescriptions, if it be practicable—which is doubtful—will lead to hardship, to adequate treatment being deferred because of the cost, to many suffering from diabetes or tuberculosis or epilepsy not receiving the medicines which would relieve their sufferings and, in the case of tuberculosis, tend to avoid the spread of disease. I also believe that the administrative cost, the inconvenience and the misery, which these impositions will entail must far outweigh any small savings which may result. In any event, it is surely a pitiable state of affairs when savings are to be made at the expense of the sick and the maimed. In the second place, the dentistry charges will not only cause hardship but, quite obviously, will also result in treatment being delayed. The noble Lord, Lord Woolton, said that one advantage of the charge of a sovereign 627 would be that patients would endeavour to have a complete overhaul—or words to that effect. I should have thought it was much more important to ensure that there was early treatment. The fact that there is a charge of £1 as a minimum means that anyone requiring dental treatment will surely delay going to the dentist until he has some quite serious condition so as to get the utmost value for the £1 charge. This surely cannot be good for the individual or for the nation.
The third point to which I would refer is the question of making these charges permanent. My noble friend Lord Shepherd has made clear what was the object of the Labour Party's policy some two years ago. The charge then proposed was, in fact, a temporary expedient to cover exceptional circumstances. Now, largely increased charges imposed by this present Bill are to be made permanent. Surely, it cannot be the wish of this House that these, in one way, very pettifogging, but to many people very substantial and unfair, charges should exist for all time. They make a breach in the National Health Service of which some of us, at any rate, have been proud; and it is a breach which, I submit, must be closed at the first opportunity. For these reasons I hope that the House will give the Bill very serious consideration indeed when the Committee stage is reached.