Lords Sitting of 13 May 1952

Preamble
The House met at half past two of the clock, The LORD CHANCELLOR on the Woolsack.
Prayers
The Lord Bishop of Oxford—Took the Oath.
The Earl Baldwin of Bewdley—Affirmed.

TOTTENHAM CORPORATION BILL [H.L.]
Read 3a, and passed, and sent to the Commons.

CIVIL AVIATION
2.38 p.m.
LORD PAKENHAM: My Lords, I beg to ask the Question which stands in my name on the Order Paper.
[The Question was as follows:
To ask Her Majesty's Government whether they have given or intend to give any new directive to the Air Transport Advisory Council regarding respective activities of the air corporations and the air charter companies.]
THE SECRETARY OF STATE FOR THE CO-ORDINATION OF TRANSPORT, FUEL AND POWER (LORD LEATHERS): My Lords, the Air Transport Advisory Council consider applications from independent air companies to operate scheduled services as associates of the Air Corporations and advise the Minister of Civil Aviation on the acceptance or otherwise of such applications. The Council discharge these duties under a directive from the Minister. The directive at present in use is the one issued by the noble Lord, Lord Pakenham, when he held office as Minister of Civil Aviation. It was, however, modified in one respect by my right honourable friend Mr. Maclay, when he was Minister. As I informed the House on December 5 last, the Minister decided that, for the time being, agreements coming up for renewal should not be extended beyond March, 1953, nor should
796
new agreements be granted extending beyond that date. This is a temporary measure while policy is under review. The directive to the Air Transport Advisory Council is among the questions which the Government are looking into as part of their review of policy. As for our intentions, I would ask the noble Lord to await the general statement on the future policy of the Government for civil aviation which will be made a little later.
LORD PAKENHAM: My Lords, it is obvious that we must give the new Minister of Transport and Civil Aviation a chance to look round. At the same time, I feel that I must point out to the noble Lord that many of us are beginning to become extremely restive and to feel that Civil Aviation is being treated as the Cinderella of the Departments. I can only hope that the new Minister will prove to be the Prince Charming for whom a great many of us are looking.

NEW PRISON INSTITUTION
2.40 p.m.
EARL HOWE: My Lords, I beg to ask the Question which stands in my name on the Order Paper.
[The Question was as follows:
To ask Her Majesty's Government whether it is proposed to establish a branch of the Broadmoor Institution in Surrey; whether the proposed site is within the Green Belt area, and if so, whether they can give an assurance that approval will not be given to these proposals unless all the local authorities concerned are in agreement.]
THE LORD CHANCELLOR (LORD SIMONDS): My Lords, a protracted search has been made on behalf of the Prison Commissioners for a suitable site on which to erect an institution, as recommended in the Report of Sir Norwood East (who is the Medical Commissioner of Prisons) and the late Dr. Hubert, on The Psychological Treatment of Crime, for the care, study and treatment of selected groups of prisoners of carefully defined classes, the majority of whom would require active psychiatric treatment. The institution would be within the prison system and under the control of the Prison Commissioners. It would

797
have no connection with Broadmoor Institution, and persons who have been found insane would not be eligible for admission. A site at the disposal of the Crown near Merstham, in Surrey, within the Green Belt area, has now been brought to the notice of the Commissioners, who are in consultation with my right honourable friend the Minister of Housing and Local Government on the planning aspect. The noble Earl may be assured that my right honourable friend will give fullest consideration to the representations made by the local authorities concerned.
EARL HOWE: My Lords, in thanking the noble and learned Lord the Lord Chancellor very much for the answer which he has given, may I ask him whether Her Majesty's Government do not think it most undesirable to reserve an area of upwards of 300 acres in the North Downs reservation area for the purposes which have been indicated? Does it not seem a pity also that such an institution should be placed so closely to a densely populated area such as this? Furthermore, may I ask whether the noble and learned Lord does not think it essential that the consent of the local authorities must be forthcoming—and at present they are all unanimously opposed to it, already having four mental institutions in this area?
THE LORD CHANCELLOR: My Lords, I have no doubt that those are amongst the points which are being brought forward by the local authorities for the consideration of my right honourable friend, and I have no doubt that he will give full weight to them.
LORD HAWKE: My Lords, can the Government state whether this institution will be a prison with or without bars?
THE LORD CHANCELLOR: I must ask for notice of that question.

LONDON PASSSENGER FARES
2.43 p.m.
THE EARL OF LISTOWEL: My Lords, I beg to ask the Question which stands in my name on the Order Paper.
[The Question was as follows:
To ask Her Majesty's Government whether London will receive the same concessions as the provinces in any
798
new scheme for passenger fares; what proportion of the total loss of £2,500,000 in annual revenue these concessions will represent, and whether, in view of the injustice to Londoners of paying higher fares than travellers in the provinces in the meantime, they will require the Transport Tribunal to review the operation of the present scheme in London.]
LORD LEATHERS: My Lords, it is the intention of Her Majesty's Government that, so far as practicable, the same principle will be applied in the London area as in the rest of the country. The British Transport Commission have been asked to submit proposals, and until these have been considered it is not possible to say what concessions will be made or to give any precise estimate of the loss of revenue in the London area and in the rest of the country respectively. The figure of £2,500,000 which has been mentioned was merely intended to indicate the sort of amount expected to be involved in total. The fact that all the increases outside the London area have been suspended for a short time does not justify requiring the tribunal to review the operation of the scheme in regard to the London area.
THE EARL OF LISTOWEL: My Lords, while thanking the noble Lord for his reply, I should like to ask him whether he can give us an assurance that he, personally, will do everything he can to expedite a new scheme for passenger fares, because every day that passes increases the hardship and injustice to London.
LORD LEATHERS: My Lords, I appreciate that there is an injustice to London until these fares have been put into proper shape, and I am losing no time in pressing to get this matter adjusted. It is entirely a matter for the British Transport Commission to submit their new scheme to us, and they have been requested to do so with all speed. Immediately we receive it we shall proceed to make the necessary adjustments.

EDINBURGH MERCHANT COM PANY ENDOWMENTS (AMEND MENT) ORDER CONFIRMATION BILL
Considered on Report (according to Order).
MOTHERWELL AND WISHAW BURGH ORDER CONFIRMATION BILL
Considered on Report (according to Order).

NATIONAL HEALTH SERVICE BILL
2.46 p.m.
Order of the Day for the House to be put into Committee read.
Moved, That the House do now resolve itself into Committee.—(Lord Woolton.)
On Question, Motion agreed to.
House in Committee accordingly:
[The EARL OF DROGHEDA in the Chair]
Clause 1:
Charges for certain drugs, medicines and Appliances
1.—(1) Subject to the provisions of this section, regulations may provide for the making and recovery, in such manner as may be prescribed, of such charges as may be prescribed in respect of the supply, as part of the hospital and specialist services under Part II of the principal Act, of drugs, medicines or appliances.
(2) No charge shall be made under this section in respect of—

(a) the supply of any drug, medicine or appliance for a patient who is for the time being resident in a hospital;

(b) the supply of any drug or medicine for the treatment of venereal disease;

(c) the supply of any appliances for a person who is under sixteen years of age or is undergoing full time instruction in a school within the meaning of the Education Act, 1944, or the Education (Scotland) Act, 1946; or

(d) the replacement or repair of any appliance in consequence of a defect in the appliance as supplied;

and regulations may provide for the remission or repayment of any charge payable there-under in such other cases as may be prescribed.
(3) Any reference in this section to the supply of appliances shall be construed as including a reference to the replacement and repair of appliances.
LORD MILNER OF LEEDS LORD MILNER OF LEEDS moved to insert as a new subsection (1):
"(1) Notwithstanding anything in section sixteen of the National Health Service (Amendment) Act, 1949, or the following provisions of this section, no charge shall be made in respect of drugs or medicines supplied to a person who is under sixteen years of age or is undergoing full-time instruction in a school within the meaning of the Education Act, 1944, or the Education (Scotland) Act, 1946."
The noble Lord said: In moving the first Amendment on the Marshalled List,
800
I venture to remind your Lordships that this was one of those Amendments which, owing to the operation of the rather rigid timetable in the other place, was not discussed there. For that reason your Lordships may well consider that it is all the more important to discuss it here. The short point of the Amendment is that under this clause of the Bill it is proposed to make a charge for drugs and medicines, and the Amendment seeks to provide that such charges shall not he made in respect of drugs or medicines to be supplied to a person under sixteen years of age or undergoing full-time instruction in a school. I would call attention particularly to the fact that this Amendment would cover drugs or medicines in respect of which authority to charge was given by the Act of 1951; that is to say, it is not limited to charges in respect of hospital or specialist services, but includes the charges which it is proposed to make in respect of prescriptions given by general medical practitioners. I do not think I need labour that point, but I would mention that the Act authorising the imposition of those charges was never implemented, and that, in any event, that Act stated that those charges, if and when they were imposed, would operate for only a temporary period.
Obviously if drugs or medicines are prescribed for a child or young person, that child or young person must be ill, and the prescribing physician must think it necessary for that child or young person to have the medicine. I have not heard any suggestion of abuse in connection with medicines supplied to children and young persons; and, so far as I am aware, no evidence was given in another place of any such abuse. As your Lordships will appreciate, this charge of 1s. would have to be paid by the parent, who naturally would wish to carry out the doctor's prescription and do the best he or she can for the child. That parent would have to pay the amount of 1s. in respect of each form filled up. It may be said by noble Lords opposite that there would be no great hardship here, and that it would be quite competent for any parent to go to the Assistance Board if he or she could not afford to pay for the prescriptions. I should have thought—and I hope your Lordships may agree—that it would be very humiliating for a parent, whose child had to have medical

801
attention and prescriptions, to have to go to the Assistance Board, where, one knows, evidence as to means and so on has to be given, and to ask for a reimbursement of the 1s. (or it may be more). The result will be, therefore, that many parents will not go to the Assistance Board; they will prefer to go short in some necessity of life themselves.
I would remind your Lordships that there are many people in this country who have quite a number of children. There are instances where not one but may be two or three children of a family are ill at the same time. As I understand it, in respect of each of those children it will be necessary to pay 1s. for every prescription. That, clearly, is, or may be, a very great hardship indeed. I gather that one of the reasons, if not the principal reason, for imposing this charge in this Bill is to do away with abuse. As I say, there has been no evidence of abuse, and it would seem to me that where a charge is to be made for a particular article (in this case a drug or medicine) the natural tendency will be to endeavour to get as much as possible for one's money. The parent will say: "Give me a large bottle of medicine or sufficient to last not only for a week or two weeks—"but perhaps for quite an extended period. In that way there is, I submit, more possibility of abuse, because more medicine will be asked for than would be the case if the parent could take his or her child to the doctor every week. The tendency will be, when one has to pay 1s. on every occasion when a prescription is made up, to make the medicine last as long as possible and to get the largest quantity possible. In that way, I submit, there may well be substantial abuse. I invite noble Lords opposite—the Lord President of the Council, perhaps—to indicate how that possibility is to be dealt with.
Finally, I call your Lordships' attention to the fact that the lack of the provision embodied in the Amendment makes this part of the Bill inconsistent with the rest, because your Lordships will see that there is elsewhere in the measure a provision that persons under sixteen requiring appliances are freed from the charge. Similarly, children or young persons (in this case persons under twenty-one) are freed from any charge if they require dental treatment. It seems to me—and I submit the point to your Lordships with
802
some confidence—that it is quite inconsistent to free a young person from a charge for an appliance and free a person under twenty-one in respect of a charge for dental treatment, and not similarly to free a child from paying for a prescription The Amendment would make the Bill more uniform, more harmonious and more consistent. It must be obnoxious to all of us to think that a charge is to be made in respect of medicine or drugs used for the benefit of little children. I do not think there is one of your Lordships here who, in your own affairs, would wish to put such an imposition on the parent of a young child. Having regard to all those facts, which I submit are indisputable, I invite your Lordships to approve this Amendment, which I beg to move.
Amendment moved—
Page 1, line 5, at beginning insert the said subsection.—(Lord Milner of Leeds.)
THE LORD PRESIDENT OF THE COUNCIL (LORD WOOLTON): I think I might reasonably assure the noble Lord at the outset that none of us likes the idea of imposing extra charges on any body; but I cannot follow his line of argument that a child is necessarily a necessitous person, even although I appreciate that the family may have quite a large number of children. There is no real logical argument to lead us to think that, because people have a large number of children, they are therefore unable to pay 1s. for a prescription when the doctor thinks it is necessary. As the noble Lord is fully aware, we have already made provision under the Family Allowances Act to help people with more than one child. I have been through all these Amendments which have been put down by noble Lords opposite. Very many of them, let me frankly admit, nave a very strong sentimental appeal, because they deal with people who are suffering. Let me say at once that we are not unsympathetic to the needs of the several distressed classes of people, but surely it is quite a simple point at issue: if a person is in such a state of financial need that 1s. will debar him from getting the necessary medicine, then indeed he must be in a state where he has other hardships, too.
The Government are already taking steps to relieve those hardships by increasing insurance benefits and pensions

803
If, however, additional help is needed—and this is really what I want to submit for the consideration of your Lordships—the principle on which the Government propose to work is to deal with the indigent family as a whole, not on the basis of each separate need, and to try to deal with it from one source—namely, the National Assistance Board. By that means, we aim to enable each person to use, on a parity with the rest of the community, the services which the State is providing. In this way, we shall avoid, what I think your Lordships all recognise, the demoralising effect of an individual having to seek relief in one form or another from a number of different places. We shall certainly reduce the cost of the administration and—although I do not for a moment suggest that this point arises in the case of children under sixteen—we shall reduce the risk of fraudulent application for relief. I thought it well to make this general statement of our position at the beginning under this particular Amendment, because it will save me repeating it on many occasions as the individual Amendments come up.
I am sorry that I cannot accept the Amendment. I do not think it is a good thing to try to place upon the chemists and the doctors the administrative burden of deciding whether a person is or is not of school age. I think we shall get a very much better result if we follow the line that I have suggested. May I add this? In the exceptions which we are making under the Bill we do not propose that the persons concerned should be exempt from the charges but that they should obtain repayment of the charges from the National Assistance Board. That, of course, could not apply to children. I hope your Lordships will not think it necessary to press this Amendment. I am sorry that I am unable to accept it.
EARL JOWITT: I must say to the noble Lord that I think he made a most singularly unconvincing reply. He has not attempted to deal with the point which the noble Lord made in moving the Amendment. The noble Lord said that, for some reason or other, you have treated children specially from the point of view of appliances—I think rightly—and you have treated children specially from the point of view of dental treatment,
804
again for good reasons. The noble Lord was asked: When you treat children specially from the point of view of appliances and dental treatment, why do you not treat them specially from the point of view of drugs and the like? I listened to the noble Lord, Lord Woolton, and I do not think he attempted to answer that question. He has given no answer at all. I very much hope that the noble Lord will do better than that. He can defeat us quite easily in the Division Lobbies, but that is not the point. What we want is that he should make some reply which satisfies us that he has a case and has considered the matter. At the present moment, he has not attempted to answer our point. I do beg the noble Lord to have a second innings presently and to attempt to make some sort of reply to the case which is put up.
The next thing I want to ask is this. The noble Lord talks about the charge of 1s. Now I may have this Bill completely wrong, and the noble Lord may correct me, but I understand that there is no limitation of the charge to 1s. under this Bill. No doubt the Minister will say: "At the present moment all we have in mind, and all we contemplate, is that the charge shall be 1s." As I understand it, we are asked to pass a Bill under which, if he were so minded, he could charge 2s., 5s., 10s. or any sum. Am I right on that, or am I wrong? When I was in the Government I had some six years of this from noble Lords opposite, Time after time they said to me—and I appeal to them now, because they heard it often—"Put it in the Bill". If I introduced a Bill which gave me power to make all sorts of charges, and then I said: "Well, I am only going to charge 1s." I should have been told: "Put that in the Bill." I ask the noble Lord this question: Am I right in supposing that, if we pass this Bill, the charge will not necessarily be limited to 1s.? That is the figure the Government have in mind at the present moment but next year, without passing any new Act, they could make it 2s. or 4s. I want a categorical answer to that question. If that is the position, and I understand the matter aright—and the noble Lord, of course, knows—then it is no good saying: "This is a very small matter. This is only 1s. and surely people can pay that."

805
It seems to me a lamentable thing that the sort of reply we have just had should be regarded as sufficient, because it is not. Of course, we know that the children's allowances are going up. May I ask the noble Lord whether he has considered the difference between a childless couple and a couple with two children? Does he really think that that difference is surmounted by the payment of 8s.? Let me assure him that you cannot keep one child on 8s. a week; and if the noble Lord does not know that I shall be very much surprised. I suggest that the greatest service the citizens can render this country at the present time is to have children. I suggest that a wise policy for this country is to see that people are not penalised because they have children. If the children get ill, and require appliances or dentists' treatment, or doctors' treatment in the form of drugs, then I suggest that this great community ought to see that that is not a charge on the parents. To my mind it does not meet the point to say that the parents who have to pay the money can go running round to the Assistance Board. In a great many cases they will not do that, and we all know it. I suggest there is a case for continuing for drugs what has already been done in the case of appliances and dentures. Therefore, I ask the noble Lord this question: Why have you treated children differently in regard to appliances and in regard to teeth, and why do you not extend that differentiation to drugs? The other question I ask is this: Am I right or wrong in saying that we are here asked to pass a Bill which confers upon the Government the right to impose whatever charges they think proper in their discretion, or is this merely a matter of 1s.?
3.6 p.m.
THE SECRETARY OF STATE FOR COMMONWEALTH RELATIONS (THE MARQUESS OF SALISBURY): Perhaps it would be useful if said a word in answer to what has been said by the noble and learned Earl. He asked a number of questions, and I will try to answer them to the best of my ability. First of all, the noble Earl asked: Why was a differentiation made between drugs for children and appliances for children? There is a definite medical
806
reason for that. Children, as we know, grow, and appliances which might be quite adequate for them at, say, the age of six would prove to be totally inadequate at the age of nine or ten. Therefore, the expenditure which might be involved by the parents is very much greater than in the case of supplying drugs. Somebody has a cold or influenza, whatever it may be. That is not a continuing and enlarging expenditure. That is expenditure to meet the single disease or emergency which has arisen. The noble Earl may not agree with that, but that is the argument which is produced and, to my mind, it is a valid one. Appliances and drugs do not come into the same category at all.
Then there is the question of the 1s. charge. The noble and learned Earl is perfectly right when he says that the Is. charge is not in the Bill. It is a matter to be settled by regulation. I would remind the noble Earl (perhaps the noble Viscount, Lord Stansgate, will forgive me for one moment) that exactly the same device was used by his own Government in the Act of 1947. At the present moment, at any rate, it is not the intention to consider any increase in the 1s. charge, any more than I am sure it was the intention of the Government of the noble Earl's Party, when they produced their Bill, regularly to increase the charge then proposed. This method is adopted merely for convenience, and it is certainly much less rigid. The noble Earl said: "You may put it up to 2s. or 3s." Equally, the Government might wish to reduce it to 6d. It might go either way, and in that case it would require an amendment of the Act. That is the reason why it is to be done by regulation. The noble Earl's own Party thought it the right way to do it, and we followed their example in that respect.
EARL JOWITT: May I suggest that if you put a limitation in the Bill, "Not to exceed 1s.," that would not in the least prejudice reducing the charge to 6d.? If you like it could be "not to exceed 2s." The mere fact that my Government did it does not mean that two wrongs make a right. I think it was wrong, because I think it is always wrong to confer upon a Government by Act of Parliament far greater powers than they say they want to use. I believe that is a perfectly genuine principle, which I

807
learned in the last six years, and whether or not my Government did it does not enter into the question.
THE MARQUESS OF SALISBURY: All I can say is that the noble and learned Earl used a very different argument when he was on this side of the House. I do not think he can have any complaint against this Government for doing exactly what his Party did in similar circumstances.
The noble Lord also asked why we did not differentiate for children. He said that people might have one child, or two or three children, and might be involved in far greater expenditure on that account. Of course, it is true that people may have small families or large families but it is not necessary to assume—and it is a far too general assumption in many quarters—that because people have children those people are always ill. In fact, the number who are ill is normally very small. This charge of 1s. is regarded almost as a kind of constant charge on the weekly income of the wage earner; but that is not so. The charge, as it will apply, year in and year out, to the average family, is not a heavy one. I have seen this argument used again and again. The assumption appears to be that in any large family the children are always ill and that therefore the parents are very hardly treated by this Bill. That is not true. A 1s. charge, for the average healthy family is, in fact, a very small one indeed.
I must point out again that children were not differentiated in the case of the Labour Government's Bill, no doubt for the same reason that I am urging now. I do not think that it would be possible to make this differentiation. The only effect would be to defeat the whole object of the Bill. That object is, without causing undue hardship, to reduce the national expenditure at a time of great national danger. And if I am told—as I am constantly told—that this saving will be a very small one, I can only urge, as I have urged constantly in this House, in Opposition and when my Party have been in power, that the only way you can make economies at all is by making a number of small economies. It is no good trying to make single economies of £150,000,000 or £200,000,000, because that cannot be done. You have to make
808
small economies where it can be done—limiting, as far as ever you can, the hardship which may be caused. Therefore, I make no apology on behalf of the Government for not making an exception in this case. I am quite certain that the exception would not have been made by noble Lords opposite if they had had to deal with these same circumstances.
VISCOUNT STANSGATE: I venture to intervene because the unofficial members of the Conservative Party opposite seem remarkably and unanimously reluctant to defend this Bill. We are considering the position of children under sixteen years of age at school. The object of the Bill is either to prevent abuses or to save money. Does anyone allege that there have been abuses in the prescribing of drugs of children under sixteen? I cannot imagine that anyone would say that the drugs prescribed for children have led to abuses. That is a point which must be answered, for it is one of the legs on which the Bill stands. There is another point. The noble Marquess spoke of economy. He said that we must have economy. Has he any information how much we are contributing, to the rearmament drive by taxing pills and medicines for these young people? There must be some idea of how much we are saving: is it to be £10,000, £15,000, £20,000? I do not know, but I think some answer ought to be given. Another question was that concerning regulations. The noble Marquess says that these things can be done by regulation. I think my noble and learned friend's point about the charge "not exceeding" a certain sum was a perfectly sound one. It is hard to put in the Bill a definite sum of pounds, shillings, and pence, but suppose that the Government were to introduce a regulation fixing, say, 4s. We could not amend the regulation. We could reject it, but this House would be very reluctant to do that, and so would another place. What is to be the position?
The whole tone and temper of this Government, and their whole approach to this problem, are difficult to understand. We on this side have always said that many and healthy children are the true wealth of a country. Yet the noble Lord, Lord Woolton, spoke of the "demoralising effect" of not having a charge. It is true that he hastened to say that he was not referring to the charge

809
in relation to children. But how can anyone speak of giving medicine to a sick person as being "demoralising"? I remember that in the year 1910 or 1911 (I ant not sure which), at the time when the old-age pension was being discussed, leading Conservative statesmen in Opposition said that a payment of 5s. per week to an old man of seventy would have a shameful and demoralising effect. Whatever may be the truth of that, certainly it is an argument that cannot possibly apply to a sick child. We do everything to assist a child from birth; we attend to its health in its early years; we see that it is sent to school, in a bus if necessary, and so on; but when the child is sick we say "we shall have to charge you 1s.; it would be demoralising for your parents not to have to pay something." I assure the noble Marquess that this Bill can produce very little money and that it will have a damaging effect upon the reputation of the Conservative Party.
THE EARL OF LUCAN: The noble Marquess said that children are not likely to be ill. Would he deny that it is just in the years up to about the age of sixteen that nearly all children have all kinds of diseases?
THE MARQUESS OF SALISBURY: I do not deny that children, like other people, are sometimes ill. I said merely that the assumption among opponents of this Bill was that all children were always ill and that, for instance, if a man had twelve children he would be paying 12s. per week. In fact, we all know that the children are not always ill at the same time. In any case, as I pointed out, this 1s. charge is not a weekly charge for each child. It is a sporadic charge for each child. One or two children may get a bad cold—or even more if there is an epidemic If there is a serious infectious disease, the children will be sent to hospital. But in the ordinary case the charges would be sporadic ones. That was all I said; the noble Earl could not quite have understood it.
LORD GIFFORD: I should think the right way to look at this matter is that tax allowances and children's allowances are given in order to compensate for these payments. The bachelor might well have a serious complaint if he had to pay 1s. for his prescription, when the man next door, who has children, gets it free.
LORD MILNER OF LEEDS: Perhaps I may be allowed to say a word or two. The noble Lord and the noble Lord who has just spoken seemed to think that allowances were given on income tax for people who have children. That is so, but allowance is not made in respect of this particular imposition, which is to be imposed by regulations to be made by this Government. Secondly, the noble Lord, Lord Woolton, seemed to think that everybody should be running to the Assistance Board. He seemed to imply that there were other sources to which they might go and that it was desirable, in the case of all these who are entitled to repayments—
LORD WOOLTON: Indigent people.
LORD MILNER OF LEEDS: Indigent people. Is there any other place to which indigent people can go, except to the Assistance Board?
LORD WOOLTON: Not all people; only the people who are in need.
LORD MILNER OF LEEDS: I speak subject to correction, but so far as know there is no other place to which people can go for relief in one form or another except the National Assistance Board. Therefore, the noble Lord's argument seems to me to fall to the ground. He spoke about the demoralising effect of going to numbers of other sources. There is only the National Assistance Board. Therefore, the noble Lord's argument was a completely false one. There would be no saving in administrative costs, about which he spoke. Surely the very fact that these medicines and drugs are going to be paid for at 1s. a time will increase the administrative charges. It will increase charges tremendously to ensure that all those who want medicines and prescriptions have to pay 1s. on every prescription. That is going to be a tremendous administrative question indeed. It was mainly on that very point that the previous Government felt it was not desirable or practicable to proceed with their proposals. Here the noble Lord comes along and implies, for reasons which I cannot follow, that there will be a great saving in administration. In my view the imposition of these charges will effect hardly any saving at all. We have not been informed what the prospective saving is. Probably, it

811
will run the administration into a great deal of expense.
Then I noticed that the noble Marquess, if he will give me his attention for a moment, mentioned the differentiation between the prescription and the appliance, but carefully avoided saying anything about the dental treatment. Where does the differentiation come in there? What is the difference between taking one's child to the dentist and having its teeth out or having it dealt with in some form or other, and giving it medicine on a prescription? Why do the Government propose to exempt the child in the one case of dental treatment, and not to exempt the child in the other case of medicine and drugs? I submit to your Lordships that all these impositions are—I will not say designed, but will have a deterrent effect on parents and on children. Principally, of course, the effect will be on parents, who will not take their children to the doctor as frequently as they might otherwise do, and as frequently as necessity requires, because there is this charge. To some noble Lords it may be a very small amount, but to poor people in some of the congested streets which I represented for many years, it will be a very serious charge indeed. It will mean that the housewife out of her small monies will have to find at least 1s. or 2s., or it may be much more, in respect of these prescriptions. In my view, the result of these impositions will be to exercise a deterrent effect, to prevent children from being medically attended to as they should be, with the result that the health of our young children, which for some years past has been the admiration of the world, is likely to be seriously affected.
Finally, I would reinforce what the noble Viscount said as to the saving that will be effected. I shall be glad to hear from the Benches opposite what savings will be effected by the imposition of this charge for drugs or medicines on children or young persons under the age of sixteen. How much is going to be saved by the refusal of this Amendment and the insistence upon this charge? Is it going to be £50,000, £100,000 or £1,000,000? Cannot some estimate be given, or is it, like so many of these proposals of the Government, rather a leap in the dark? I hope the noble Lord will give us the answer to that question.
3.25 p.m.
LORD SILKIN: Before the noble Lord replies, I should like to summarise, if I can, the case that has been made so far against this Amendment. First, I gather it is that the Government are doing exactly what the Labour Government proposed, and, therefore, they are perfectly right and justified in what they are doing. I wonder whether they are going to accept that kind of case as a precedent in everything they do? If they can do no better than the Labour Government did, what happens to all the representations that the noble Lord, Lord Woolton, made during the Election, that he could do so much better in every possible respect? We are expecting that the present Government will use their own intelligence, will rectify whatever may have been wrong in the work that the Labour Government did in the past, and will improve upon it; but over and over again we are hearing here that "This is what the Labour Government did, and therefore we are justified in doing exactly the same."
THE MARQUESS OF SALISBURY: We do not say we are justified in doing exactly the same, but, if we do so. noble Lords opposite complain that we have no right to do so.
LORD SILKIN: Oh, no. Surely we are entitled to consider on its merits every measure which the Government introduce, and the mere fact that a year or two years ago a certain line was taken by the Labour Government does not debar the present Opposition from considering this measure on its merits. The case that is made for this measure to-day is not the case that was made by the Labour Government two years ago, when circumstances were quite different. Nor is this measure the same. The other point that was made, both by the noble Lord, Lord Woolton, and by the noble Marquess, is that in practice there will be no hardship on the parent if a charge is imposed on the medicine of the child. "No hardships," says the noble Lord, Lord Woolton, because the parents can pay, and then, if they are indigent or they qualify under the regulations of the Assistance Board, they can get their money back. "No hardship," says the noble Marquess, "because the Opposition have grossly exaggerated what is likely to happen in representing that all

813
children are ill all the time." So far as I know, nobody has ever suggested that that is the case. Of course, children are not ill all the time nor are all children ill at the same time. Noble Lords opposite are very fond of putting up a case which we on this side have not made, and then answering that instead of answering the case that we do make.
The case that I make is this: that this charge is going to fall particularly hardly on parents with a number of children. It is quite a common thing for a number of children in a family to suffer from illness at the same time. I happen to be a grandfather and have gone through this phase in the last six months with one of my sons, who has three young children. It happens that almost continuously for the past few months the children have been ill with whooping cough, with measles, with German measles or with mumps: one thing has followed another. The fact is that, when that happens, a parent does hesitate to go to the doctor and get medicine, if he has to pay these shillings at a time for the medicines. If the charge operates as a deterrent, it is surely undesirable. It is surely in the national interest that parents should seek a doctor's advice when their children are ill, and not be deterred by the thought of having to pay for medicines, possibly regularly over a few weeks. In so far as it acts as a deterrent, I say that this Bill will have a very serious effect on the health of young people.
Then the noble Lord, Lord Woolton, says that if things are as tight as that—they are not tight with every family, but they are tight in a number of cases—the parents concerned can get their money back from the Assistance Board. With great respect, I doubt if they can. I doubt if they would qualify. The noble Lord has referred to the indigent family, but the families I am thinking about are not indigent in the sense that they would be eligible under any conditions that the Assistance Board are likely to make. There is the normal family where the husband is at work and earning a normal wage, of six pounds a week if you like, with two or three children. Such a family may just about manage with a tight squeeze, and every additional penny that the housewife has to pay out can be met only by sacrificing some other small thing which is really a necessity or a tiny comfort. They may sacrifice their summer
814
holiday. They would not be regarded as qualifying for assistance from the Assistance Board by reason of that sacrifice. Suppose a family has saved up seven or eight pounds to enable them to take a summer holiday, and then one or two children become ill. They have no reserves out of which to meet these charges, so they dip into their summer holiday money, and they are not able to take a holiday. They could not go to the Assistance Board and say that they are indigent or destitute. But is it really desirable that people should be pressed as tightly as that? I can assure the noble Lord that that is the position of a large number of families in this country.
This Bill will be regarded with terror by parents who have young children and who, in addition to the rising cost of living, will now have to meet these charges—not all the time and in respect of all the children, but quite often, and particularly in the case of younger children. Therefore, in spite of what the noble Lord, Lord Woolton, has said, I hope the Government will reconsider this matter. They have not met the case that my noble friend Lord Milner has put, distinguishing this from the case of dental treatment. I see the point of what the noble Marquess has said about appliances, but he has not met the case of dental treatment, which is on all fours. If the Government could see their way to reconsider this mater, it would do a good deal to mitigate the great hardship which otherwise this Bill is going to impose.
3.35 p.m.
VISCOUNT SAMUEL: As I understand that the Opposition propose to divide the House on this Amendment, the Committee will perhaps permit me to say a few words to explain the course which will be taken by my noble friends and myself on these Benches. We shall vote for the Amendment, and for these reasons. In the first place, we think that the Bill is rightly framed in its other clauses in exempting children from the charges under the Bill, not only in the case of appliances, but also in regard to dental treatment. In dealing with the point with regard to surgical appliances, the noble Marquess did not, as I think, give a very convincing answer, saying merely that children grow and therefore they need the appliances to be renewed. I do not think that that is convincing on the whole

815
matter, and it certainly does not apply to dental treatment. The reason why children have been exempted from these charges is that the charges are very costly, especially in regard to surgical appliances for which the parents could not afford to pay. That applies less powerfully with regard to prescriptions, but it does hold good, and I think that from the beginning the Government would have been well advised to lay down a rule that this should not be an addition to the cost of bringing up a family.
Everyone knows that the class in the whole community who are the most hard pressed financially are the working people in the early years of their married life, when a number of children are coming along. Very often they are the most poverty-stricken of all and, wisely, the State has, on the one hand, tried to exempt that particular class from the new charges and, on the other hand, to help them by means of family allowances. This is a case in point; and when a poor working class family is put to extra cost owing to the illness of a child—and there are all sorts of indirect costs—it does not seem to be a reason for imposing a charge for prescriptions, and so forth, from which they are at present exempted.
That is the main reason why we shall vote for the Amendment. We do not think that a sufficient answer has been given by saying that family allowances are the means by which such charges should be met, and that family allowances have recently been increased. Those increases have been given owing to the rise in the cost of living, and of course are much more than consumed by the fall in the value of the pound.
The noble Lord, Lord Woolton, said that if the allowance is not adequate, the family can go to the Assistance Board for assistance. I understood him to say that we ought to treat the family as a whole, and that if they are as badly off as all that the time has come for them to go to the Assistance Board. But consider how that works out in practice. There are tens of thousands of prescriptions in these cases. Are a family expected at any one moment, on the first prescription, to say, "We cannot afford to pay this shilling. We are going through all the formalities of applying to the Assistance Board and having our case heard"—for the sake of a shilling? They
816
would not do it. They will get into the habit of paying a shilling as a matter of course, and if there are several children and several illnesses, those additional charges will come at the very moment when they are least able to pay. In general, in all these matters, the right way, in our opinion, is not to impose extra charges on the sick at the time when they are sick, but rather, if it is necessary to raise fresh funds to limit excessive charges on the Health Service, to increase the general insurance charge. The people themselves pay a huge proportion of the millions that are spent upon the National Health Service, and if that is not enough, and if it is necessary to go to the people for more, then charge them at the time when they are in good health, and not at the time when either the bread winner or one of the dependants is sick. Therefore, we shall vote for the Amendment.
LORD WEBB-JOHNSON: The noble Viscount has thought it incumbent upon him to explain why he is supporting the Amendment. Perhaps I may be allowed to explain why I am not supporting it. I think that the Amendments we have to consider this afternoon are all designed to put before the Committee situations which, in many circumstances, can be distressing. The variety is very great. We have heard arguments about the young and about children, and particularly about medicines. The reactions of individuals to prescriptions and medicines vary greatly. I generally seek the first opportunity to empty the medicines down the sink. But, of course, with modern medicine, there are drugs and prescriptions which are specific and which are essential to a cure, or even to the continuance to life. Those cases, however, will not apply particularly to children. If they are requiring treatment with expensive specific drugs, they will almost certainly be in hospital.
VISCOUNT STANSGATE: How will they get into hospital?
LORD WEBB-JOHNSON: Did I hear someone say: "How will they get into hospital?"
VISCQUNT STANSGATE: Yes. I asked that because of my own experience. People come to me and tell me that they have been kept waiting for weeks and weeks because there is no room in the hospitals.
LORD WEBB-JOHNSON: That is very largely the result of the legislation which was passed and which threw the doors of the hospitals open to everybody, from the richest to the poorest in the land. Now, in many instances, a patient who could well afford to pay for treatment outside, is occupying a bed which in the old days would have been occupied by someone who could not afford to pay. But I do not want to enter into an argument. All I wish to do is to justify my attitude on this particular Amendment—an attitude which will apply to many other Amendments, because these distressing situations are going to be paraded during the next few hours. We have heard about the young; we are going to hear about those who have cancer; we are going to hear about the chronic sick; we are going to hear about
persons who are out-patients after they have been in-patients; we are going to hear about the disabled; we are going to hear about those who are getting assistance already under the Workmen's Compensation Act; we are going to hear about people suffering from tuberculosis and we are going to hear about those who have diabetes. That is the programme. In every case argument can be advanced to show that there is special need. But provision is made to meet the special need, either in this Bill or in other enactments. For these reasons I shall not support the Amendment.
3.45 p.m.
On Question, Whether the said subsection shall be there inserted?
Their Lordships divided: Contents, 35; Not-contents, 70…

CONTENTS

Baldwin of Bewdley, E.

Greenhill, L.

Ogmore, L.

Jowitt, E.

Hare, L. (E. Listowel.)

Pakenham, L.

Henderson, L.

Pethick-Lawrence, L.

Hall, V.

Kenswood, L.

Rea, L.

Mersey, V.

Kershaw, L.

Rochester, L.

Samuel, V.

Lawson, L.

Sempill, L.

Stansgate, V.

Layton, L.

Shepherd, L.

Lucas of Chilworth, L.

Silkin, L.

Bingham, L. (E. Lucan) [Teller.]

Macdonald of Gwaenysgor, L.

Sinha, L.

Burden, L. [Teller.]

Milner of Leeds, L.

Terrington, L.

Cawley, L.

Morrison, L.

Winster, L.

Douglas of Barloch, L.

Nathan, L.

Wise, L.

Douglas of Kirtleside, L.

NOT-CONTENTS

Simonds, L. (L. Chancellor.)

Buckmaster, V.

Dormer, L.

Davidson, V.

Fairfax of Cameron, L.

Woolton, L. (L. President.)

Furness, V.

Gifford, L.

Hudson, V.

Greville, L.

Sutherland, D.

Long, V.

Hampton, L.

Margesson, V.

Hawke, L.

Maugham, V.

Hindlip, L.

Cholmondeley, M.

Monsell, V.

Kinnaird, L.

Reading, M.

Swinton, V.

Leathers, L.

Salisbury, M.

Templewood, V.

Llewellin, L.

Lloyd, L.

Albemarle, E.

Aberdare, L.

Mancroft, L.

Alexander of Tunis, E.

Ailwyn, L.

Milverton, L.

Beauchamp, E.

Audley, L.

Palmer, L.

Bessborough, E.

Baden-Powell, L.

Remnant, L.

De La Warr, E.

Belstead, L.

Rochdale, L.

Dundonald, E.

Bethell, L.

Saltoun, L.

Fortescue, E. [Teller.]

Brassey of Apethorpe, L.

Sandford, L.

Howe, E.

Broughshane, L.

Sandhurst, L.

Lindsay, E.

Cherwell, L.

Schuster, L.

Onslow, E. [Teller.]

Clanwilliam, L.(E. Clan-william.)

Somers, L.

Rothes, E.

Teviot, L.

Scarbrough, E.

Courtauld-Thomson, L.

Teynham, L.

Selborne, E.

Cranworth, L.

Webb-Johnson, L.

Selkirk, E.

De L'IsIe and Dudley, L.

Wolverton, L.

Shaftesbury, E.

Dorchester, L.

Resolved in the negative, and Amendment disagreed to accordingly.

3.53 p.m.
LORD MILNER OF LEEDS LORD MILNER OF LEEDS moved, in subsection (2), after the words "in respect of," to insert:
"drugs, medicines or appliances authorised to be supplied before the commencement of this Act, or in respect of".
The noble Lord said: I beg to move the second Amendment on the Marshalled List. Its object is to ensure that these charges for drugs, medicines and appliances, are not made retrospectively. I need hardly remind the Committee that it is very rarely that taxes or charges are made retrospective, and there are no special circumstances, so far as I know, why the charges proposed to be imposed by this Bill should be made retrospective. The contrary is the case. There are instances where, especially in the matter of appliances, a prescription or order has been given by a responsible medical practitioner or specialist for an abdominal belt or surgical boot and, through no fault of the patient, delivery of the appliance has been delayed, it may be for many months. Your Lordships know that many of these appliances are only now being manufactured in quantity, and for some time past there have not been sufficient appliances available. The consequence is that the patient has to pay for something for which he never anticipated paying. That is an additional hardship on the patient or his family. It is almost in the nature of a breach of contract.
Six months ago I was examined and my specialist ordered me a surgical boot. I anticipated getting it for nothing and entered into the transaction on that basis, and when delivery time comes I have to pay £3 for it. That seems to me almost a breach of contract, certainly a breach of the spirit of the arrangements provided in the first Act. Ex hypothesi, the individual concerned is an injured or disabled man, possibly unable to work or only able to work at some ill-paid occupation; but notwithstanding, he has to pay in the case of appliances up to £3, a large sum to such a man. This position has been recognised in connection with dental treatment. Clause 2 (3) of the Bill says:
"No charge shall be made under this section in respect of any services provided in pursuance of a contract or arrangement under which the first examination took place before the commencement of this Act."
820
Clearly, before a person could obtain a prescription for an abdominal belt or surgical boot, he must have been examined by a qualified surgeon or physician. Why should a person who requires dental treatment be exempted from retrospective payment when the person who requires a surgical boot or abdominal belt has to pay? It seems to me that in this respect again the Bill is inconsistent, and I ask for the same concession to the person who has been examined for such appliances before the commencement of the Act as is given by the Bill to the person who requires dental treatment. I submit that otherwise injury is likely to be done to national health. Anyone who requires one of these appliances and thought he was going to have it free now has to pay for it. But he may not be able to pay for it, and the result is that he may struggle on with an old appliance which is dirty or insanitary or does not fit and is dangerous. Here, again, the terms of the Bill, without the exemption for which I ask, form a considerable deterrent to those who require any of these appliances.
There is also the point which I mentioned on Second Reading. The Government have sent out instructions to hospitals, and the hospitals in turn are communicating with persons who have appliances on order requiring them to sign forms to the effect that they know they will have to pay for the appliances when they are delivered. Surely that is anticipating that the decision of your Lordships' House will be in favour of the Bill, that your Lordships will not be willing to give any exemption to retrospective claims. I submit that your Lordships may properly think it right to support this Amendment and ensure that charges are not made in respect of appliances supplied before the commencement of the Act.
Amendment moved—
Page 1, line 10, after "of" insert the said words.—(Lord Milner of Leeds.)
THE LORD CHANCELLOR: I had not intended to interpose, but my noble friend who is in charge of the Bill, having heard mention of breach of contract, thought it would be appropriate for me to deal with that point. There is no question of breach of contract and no similarity between the case we are now discussing and that which arises in respect

821
of dental treatment. In respect of dental treatment, there is a dental estimate form, and the dentist and patient enter into a written contract. If there is such a contract, it is right that it should not be broken, and if there is a contract in this case, it is equally right that it should not be broken. But the noble Lord has not referred to any contract or suggested with whom the contract has been made. If there is a contract, the contracting party will have his remedy; but I do not think there is any contract being entered into here. There may be some kind of informal arrangement and authority. I notice that the words of the Amendment are:
"appliances authorised to be supplied before the commencement of this Act."
Those words are wholly inappropriate if a contract has been entered into. The analogy of the dental treatment on which the noble Lord relies really has no application to this case. If that has no application, and if there is no contract, why should the differentiation be made between the man who wants an abdominal appliance and orders it tomorrow, and one who ordered it yesterday? Both have the same need, and both are required under the Bill to make some contribution. I venture to submit that there is no foundation for the proposed Amendment.
VISCOUNT STANSGATE: I should like to ask the noble and learned Lord a question. The purpose of this Bill is to prevent people from abusing the National Health Service. A man goes and says, quite lightly, that he will have a surgical boot, because he will not have to pay for it; and then he suddenly finds when this Bill is passed that he is going to be charged for it. Is that not essentially a breach of understanding? He entered into the arrangement, but he then says: "I shall do without the boot. It will not help me, and I shall have to limp; but, inasmuch as it is my having a boot or the children or family having something, I will go without it. "Is that not reasonable? What is the objection to putting in words such as we suggest? One hardly imagines that a person goes to a surgeon, has an appliance, and says:" I have a form of contract. Will you have this signed in the presence of witnesses?" He orders the boot because this is the Health Service and he expects
822
to get it free, and then he finds that he is going to be charged perhaps a substantial sum. My noble friend asks that in such a case, if it can be shown that the appliance was ordered under the old Act, that the man shall not be charged under the new Act. That seems to me a reasonable case, and I do not think the Lord Chancellor has adequately dealt with it merely by dealing with a signed and sealed contract.
THE LORD CHANCELLOR: The contrasts are simply between the case put by the noble Lord, Lord Milner, where there is a case, and the present case, where there is not. An authority to supply does not amount to a contract between the parties. The unfortunate man to whom the noble and gallant Viscount has referred is in no different position because he had authority before to have an appliance supplied from the man who goes to-day. One is very sorry for them both, if it means pressure on their finances. But why should a man who, if you like, had one promised before this Bill be placed in a better position than a man who suffers from an abdominal complaint to-day? They are both in the same position. I feel that it would be unfair to provide the appliance free for one and not the other.
VISCOUNT STANSGATE: Perhaps I might ask this question. Supposing a man has said that he will have the appliance, which is worth £5 or £10, and then says: "I entered into this on the basis of it being a free gift from the State. I cannot afford it." Who then bears the loss?
THE LORD CHANCELLOR: He need not take it if he does not want it.
VISCOUNT STANSGATE: Then, does the practitioner who ordered it bear the loss? Who pays the man for making the wooden leg?
THE LORD CHANCELLOR: That is going rather far. I do not think for a moment that the man will be placed under any obligation to take that which was authorised to be supplied to him, But one would have to look at the whole of the circumstances of the case.
EARL JOWITT: I agree that there is no contract involved, but I feel that this is a very hard case. There are many cases where you have the alternative put

823
to you of either having an operation or of having some sort of appliance. Take the case of a man who, in the old days, before the Act was passed, went to the surgeon and was examined, and the surgeon said that he had better have a boot, belt, or whatever it might be. In the circumstances as they then existed the man was entitled to get it free, and said: "Very well; that is what I will do. I will carry on, give up the idea of an operation and look forward to the day when I get this appliance." Owing to delay—for which no one is to blame—the appliance does not come as quickly as it might have; and it so happens that the delay extends over so that the appliance is not delivered until after this Bill has become an Act of Parliament. The proposal here is that this man should not be penalised because of the delay that has occurred. If a man has had authority from the surgeon, who said that the appliance should be supplied, and all that has happened has been a delay, it seems very hard that the man should pay. I should like to ask the noble Lord in charge of the Bill to consider this matter between now and the Report stage to see whether there is not some way in which he can meet what is certainly a disappointment, and something which may in some cases, it seems to me, create hardship. I should be quite satisfied if the noble Lord would say now that he will look into it to see if there is a case, without in any way making any sort of promise. I understand that at the present time he thinks there is not a case, but I would ask him not to bang the door to-day, but to consider it and find out if there is any more in the matter than he seems to think at present.
THE MARQUESS OF SALISBURY: I do not seek to anticipate the answer which my noble friend will give. I rise on a point of elucidation. I am not clear what the noble and learned Earl means. Does he want us to look into the Amendment again with a view to seeing whether we can meet the intention of the noble Lord, Lord Milner; or is he concerned with the limited point of whether a man who had ordered a surgical boot, and afterwards found that it was going to cost him £3 or £4, should shoulder the burden? Clearly, nobody wishes the unhappy man to have to pay for the boot, he having said that he cannot afford it,
824
and having refused to take it. That clearly would not be fair to him. On the other hand, there is, as I am sure the noble and learned Earl will agree, considerable force in the argument put by my noble and learned friend the Lord Chancellor, that there is, in fact, no contract, and that if you give this man a special advantage you will, in comparison, be penalising other people in the same position. What the Government intend is that, if the person wants the boot and is prepared to pay, he should pay the £3 or £4, or whatever it is, but that if he does not want the boot, he should not pay at all. That seems a practical proposition. But the more limited question of who, in fact, over the interim period, between the time just before and the time just after the Act is passed, pays for the boot which the man no longer wants, merits consideration.
EARL JOWITT: Of course there is force in what the noble and learned Lord, the Lord Chancellor, says—there is force in everything that he says. But I should like the noble Lord in charge of the Bill to look generally into the problem that my noble friend Lord Milner has advanced. It may be that as a result of looking into it the only thing that can be done is something on the narrower lines suggested by the noble Marquess. All I should like is some sort of assurance that he will look into the matter.
LORD PETHICK-LAWRENCE: There is one point that I should like to raise, before we leave this question. The Lord Chancellor said, very properly, that when you fix a date it quite clearly brings a hardship on one man who falls on one side of the date and not on the other. That must be so. I venture to suggest that there is involved here between two people a hardship which is very notable. Two men go to a surgeon who is considering giving them an artificial appliance—one man goes in January, let us say, and another man in March. The man who goes in March goes to some place where surgical boots are made quickly; he gets it before the Act and he gets it free. The man who goes in January may have to wait five months before he gets it, and it comes after the Act. In that case, you get a much greater hardship in comparison between the two cases under this Act. I support my noble friend's

825
suggestion that the Government should at least promise to look into this matter, without necessarily giving any undertaking.
LORD WOOLTON: Let me relieve the House. I shall be very glad indeed to look into this matter again.
LORD DOUGLAS OF BARLOCH: I hesitate to disagree with anything the Lord Chancellor said, but I think that my noble friend Lord Milner was correct in drawing attention to the contrast between the provisions of Clause 1 and Clause 2 of this Bill. Clause 2 is not confined to cases in which the dental treatment is supplied under contract. Clause 2 deals also with cases in which the dental treatment is supplied by arrangement, and I do not think, with all respect to the noble and learned Lord, that the word "arrangement" is intended to be synonymous with "contract". It is much more likely to be synonymous with the word "authorised", which my noble friend has used in his Amendment. If there is a good case for exempting people from paying for dental treatments which are to be provided under an arrangement made before this Bill becomes an Act of Parliament, then why should not precisely the same apply in the case of other treatments which have been arranged or authorised before this Bill becomes an Act of Parliament?
Let me put one other point to the noble Lords opposite. This Amendment deals, among other things, with the supply of appliances. It must be well known to noble Lords that thee are cases in which the supply of an appliance is an alternative to having an operation. It is not proposed under this Bill that anybody should be obliged under the National Health Service to pay for an operation. What is the effect of this proposal, as the Bill stands, to charge for appliances? It means that people will be inclined to have operations, where that is the alternative, instead of having an appliance. I am not certain that that will be a good thing for the National Health Service. Nor do I think it is a good thing that a financial compulsion should be imposed upon any person to have an operation rather than to have an appliance supplied to him. I beg the noble Lords to reconsider this matter.
THE MARQUESS OF SALISBURY: I must say that I have never heard a more extraordinary argument advanced by anyone. An appliance would cost, perhaps, two or three pounds, and he puts forward a proposition that people would rather have a severe operation than have an appliance.
LORD DOUGLAS OF BARLOCH: I did not say "a severe operation."
THE MARQUESS OF SALISBURY: Well, an operation. I should have thought that the charges which are to be made for these appliances, even under the present arrangement, are of the most moderate character. To suggest that people would rather go, to the detriment of the country and the Health Service, into operations than to pay a moderate charge, is not, think, a serious argument to put before the Committee. I would point out to the noble Lords that my noble friend has already said he is very ready to look into this question. He said that he would look into all the arguments that have been raised and considerations that have been urged. I do not think that the Government can go further to meet the Opposition.
LORD DOUGLAS OF BARLOCH: Let me make myself quite clear about this matter. I am glad to know that the undertaking which has been given is an entirely comprehensive one, to look at the whole of the proposal which my noble friend Lord Milner has made. I thought it was a more limited one than that. If it covers the whole of the Amendment, then it is satisfactory.
VISCOUNT STANSGATE: I just want to clarify one small point. Lord Milner pointed out that people were being asked to sign in advance a form undertaking to recognise certain charges. If they sign these forms, will they be indemnified in any way in respect of pledges and promises which the noble Marquess has been good enough to make?
THE MARQUESS OF SALISBURY: "Pledges and promises" are a slight exaggeration. What I said was that the whole matter will be looked into. I must say here and now to the noble Viscount that I made no pledges and promises except that the matter would he looked into.
LORD MILNER OF LEEDS: Having regard to the assurances, I ask leave to withdraw my Amendment.
Amendment, by leave, withdrawn
4.18 p.m.
LORD KERSHAW LORD KERSHAW moved, in subsection (2) (a), after "patient" to insert "who is suffering from malignant disease or." The noble Lord said: I am rather hopeful, now that the House has resumed a more friendly atmosphere, that the noble Lord, the Lord President of the Council, will not be unsympathetic with the case I present to him. Before I do present the case for those suffering from malignant diseases, I should like to say that this Amendment refers only to Clause 1 and therefore refers strictly only to people who are out-patients at hospitals and not to the generality of insured people.
Two reasons for the Bill have been submitted and have been mentioned again to-day, both by the Lord President and by the noble Marquess. Those reasons are that it is necessary from an economy standpoint and because there are abuses. Let us take abuses first. It has already been stated that no evidence whatever has been produced to show that there are abuses. I am entitled to remind the House that some years ago, in the early thirties, there was considerable agitation in the Press about the alleged abuses of Unemployment Insurance, and Lord Blanesburgh, who was at that time Chairman of a Committee sitting on the subject, declared at their first meeting that before they went any further in this matter they should discover whether, in fact, there was any truth in the agitation about abuses. An Inquiry was set afoot and, I think, some 400,000 claims were sifted; and at the end of it all, if my memory is right, less than eight cases were found to justify any sort of action against the people.
I have been looking up the last Annual Report of the Ministry of National Insurance. I find there that the average new claims amounted to 137,700 weekly, in the year with which I am dealing. That means, if my arithmetic is correct, that well over 7,000,000 people come every year under the sickness benefits scheme. Then, if I turn to table 30 at the end of the Report, I find that in only 503 cases were legal proceedings instituted. In other words, this terrible abuse which
828
has been spoken of, and which is supposed to justify a Bill of this kind, so far as legal proceedings are concerned, amounts to seven cases in 100,000. I suggest that the excuse that there will be abuse in respect of the whole of the insured population is entirely unfounded, and if we apply it only to those people with whom I am especially concerned in this Amendment, obviously to suggest that anyone would pretend to be suffering from a malignant disease is an argument impossible to justify.
On the question of economy, again I looked up the Report of the Ministry of National Insurance. What do we find there? The Insurance Fund increased last year by £138,000,000 to a total for the Fund and the Reserve Fund of £1,120,000,000. Now I suggest to your Lordships that if economy is really the reason for this Bill, an easy and a sensible way of dealing with the matter would be to increase the 10d. which is deducted from the contributions and credited to this Fund by 1d. or 2d. for the period of the rearmament programme. There would then be no need from the point of view purely of economy to do anything of this nature. There is a very good precedent for such an action. I may remind noble Lords that many years ago—perhaps twenty years ago—the present Prime Minister, when he was Chancellor of the Exchequer, made a raid, as I call it in this case, by reducing the State grant under the National Health Insurance Fund from 2/9ths to 1/7th. From an economy standpoint, therefore, it is perfectly clear that quite a modest rearrangement of the allocation of the moneys from the stamps would do all that is necessary.
Now let me come to the particular section of the community with which the Amendment is concerned. Having regard to what the noble Lord, Lord Woolton, said and to my knowledge of him as a man, I am entitled to assume that he will approach this subject with the humane outlook of which I believe he is capable. I hope that at the end he will be able to assure us that a case has been made out for a review of the Bill in this connection. The Amendment with which I am dealing relates only to people with malignant diseases—cancer and the like. Obviously, similar considerations would apply to quite a number of other classes of people—to tubercular people and the

829
other classes mentioned in some of the Amendments to follow. It must he known, at any rate to those who consider this problem, that some 94,000 to 96,000 people die every year from cancer. The estimated duration of the disease has been given to me—I did not know it myself—as probably ten to twelve months. Again it is estimated that people with this disease will require prescriptions at the very least of about one a month. The, one a month on those figures would cost about £2,500,000, and the amount saved if the 1s. were charged in respect of these unfortunate people could not possibly be more than £100,000 a year.
I know full well that this Bill, as it stands, does not apply charges to the whole class of sick people, but it is reasonable to suggest that great numbers of those suffering from cancer will be hospital out-patients. One of the greatest factors in dealing with people suffering from cancer is the follow-up service after they have been in hospital—the post-operative service to those people. It would seem that 55 per cent. of these people require dressings or drugs. It is important to point out tint a medical officer of health stated that all his nurses had said that people suffering from cancer were suffering unnecessary pain because they were not getting enough sedatives. If you are going to charge for every prescription for sedatives, dressings and things of that kind, you are going to add to the difficulty of dealing with these people. The noble Viscount, Lord Buckmaster, initiated a debate on the Health Service a few weeks ago, and I mentioned that a survey of the social conditions of people suffering from cancer had been conducted. I shall be very glad to give the noble Lord a copy of that report, which shows a condition of things which is really terrible. It would he harrowing to your Lordships if I were to read from that report. It shows without question that if any sort of impediment is placed in the way of these poor people getting all they want in the way of drugs, appliances or dressings, greater suffering will be entailed for them.
There is another point which I wish to stress in connection with this matter. This Amendment is different from the one upon which we divided, because that was concerned with young people and this is concerned very large)/ with old people. It was found that 70 per cent, of the
830
people suffering from cancer were of the age of sixty or over, and that 24 per cent. were over seventy-five years of age. All these people require drugs and dressings. There is another factor which is of some importance in this matter. The inquiries show that the degree of suffering endured by these people—and, remember, the inquiry was conducted under the general direction of the medical officers of health throughout the whole country, together with the Queen's Institute of District Nurses—in the case of 27 per cent. was "slight" or "none at all"; in the case of 37 per cent. was "moderate"; in the case of 31 per cent. was "severe," and was "not known" in the case of 5 per cent. Therefore, some 70 per cent. of the people suffering from cancer were enduring great pain. And these are the people who, for the sake of what I call "fake" economy, are to be called upon to pay 1s., or whatever it may be, for the prescription. I cannot believe that any noble Lord who goes into this subject will be able to justify doing anything to discourage those people from getting all they need
I should like to go to the other end, as it were, of this dreadful scourge. We are doing all we can to encourage education—it is the only term I can use—in cancer treatment. We know the difficulty of avoiding creating what I may call cancer-phobia; and, therefore, the education that is needed in this connection is most carefully arranged and conducted. But is it helping us in our campaign to deal with this dreadful problem if we have a charge of Is. on prescriptions? Obviously, however little effect it may have on the educational side of things, it militates, to some extent, against that education. I hope the noble Lord will be able to give an undertaking that this matter will be considered. It is, I assure him, well worth his further consideration. I feel, too, that it will be quite possible to devise some scheme whereby the difficulties I have mentioned may be avoided.
What I am saying now will apply not only to malignant disease, but perhaps to a few other disabilities that may be mentioned later. I realise the difficulty and danger of excluding charges merely on the grounds of a particular disease. It is possible that information will be conveyed to the patient that might otherwise be regarded as better not communicated

831
to him. But would it not be possible to exclude from this Bill the people I have metioned? We have been asked already to exclude people up to the age of sixteen years; I am now asking the Committee to exclude people over sixty years of age, in order that those who are excluded will not be able, by reason of that fact, to assume that they suffer from a particular disease of whose nature it is better not to let them know. I hope the noble Lord, Lord Woolton, will be able to help us in this matter. I am putting the case very imperfectly, but I assure him that I am putting it from a very long survey of a good deal of work which has been done in connection with people suffering from cancer. I can assure the noble Lord that the imposition of a charge of 1s. in those cases will have a very deleterious effect, not only economically but psychologically, on people who certainly ought not to be caused any further worry in addition to that which they already have by reason of their illness. I beg to move.
Amendment moved—
Page 1, line 12, after ("patient") insert ("who is suffering from malignant disease or").—(Lord Kershaw.)
4.35 p.m.
LORD WOOLTON: The noble Lord has, of course, been dealing with a disease of which we are all frightened and which I think, more than any other human ill, commands our sympathy. He was good enough to say that he thought I would give the Amendment humane consideration. Perhaps he will not mind my mentioning the fact that for over twenty-five years I have been associated with endeavours to find some cure for this terrible scourge. There is, then, no question, I assure the noble Lord, of any lack of sympathy on my part. When I received the brief in connection with this Amendment which was provided for me by the Department which I am representing, the thing that went straight to my mind was the question of notification. I know, from personal experience, the fear that comes into a person's mind if he or she is told that he or she has cancer—or if any doubt is left in the person's mind about it. It is on those grounds that I would ask the noble Lord not to press this Amendment. Let the person who has this terrible disease remain, as long as
832
nature will allow it, in ignorance of the fact.
Many will immediately say: "But will the person be able to get the necessary medicine?" Well, I think we have provided for that. I am not trying to make any Party point in this matter: this question moves me personally so much that I could not do that. But I think I may say that we have made provision that will enable these persons to get the necessary medicine even if they have not the means to pay for it themselves. I beg the noble Lord not to press this matter and thus put people with cancer in such a position that they will be told about it. I am sure that they are very much better left in ignorance—always provided that the State has made some provision whereby they can get the necessary medicine. That is a matter about which I talked for some time with the Department, because on this particular issue I was moved as the noble Lord has been moved. I have stated the conclusion I reached. I hope the Committee will think that it is the right conclusion, and that the noble Lord will not press his Amendment. I have not dealt with the other issue which the noble Lord raised, the question of whether there were abuses or not. Perhaps I can deal with that later on, in connection with other Amendments, so that we can keep this matter of the malignant disease separate from the rest.
VISCOUNT HALL: I am sure we all sympathise with the noble Lord in his very difficult task, but I must say that I cannot for a moment consider that he answered the case so ably put by my noble friend. We all agree that these persons who are suffering from this terrible disease are deserving of all the sympathy and assistance that it is possible to give them. Why the noble Lord suggests that they would be informed of their complaint if they were exempted from the payment of this fee for prescriptions, I cannot understand.
LORD WOOLTON: They would be separated from other people.
VISCOUNT HALL: Why should that mean they would be informed of the nature of their disease?
LORD WOOLTON: I thought the point was that these people should be told that they did not have to pay for

833
their prescriptions because they were suffering from a particular disease. That, I thought, was the point which the noble Lord was putting to me.
VISCOUNT HALL: I did not understand that. There is no reason whatsoever why they should be informed. The only thing is that they would not be charged. They would be an exception. I dare say that every noble Lord sitting in this House has been faced with the tragic situation of having a member of his family who has suffered from this dread disease. When Her Majesty's Government say they cannot consider for a moment the exemption of a very small proportion of the population, it cannot be argued that the charge is to be imposed upon because of any abuse. There is no abuse whatsoever. It is simply a question of not in any way giving way, for fear that other cases might be argued as strongly as the case can be argued in this case. Much of what can be said in relation to the case which was argued by my noble friend Lord Kershaw can be said about other cases, but nothing nearly as strong as can be said about this particular disease.
May I quote one point to the noble Lord and other noble Lords opposite? What justification is there for exempting a person who is suffering from venereal disease and not a person who is suffering from a malignant disease? Can you justify such an exemption? I should be very surprised if you could justify it on its merits, or indeed if you could convince anybody that such a distinction was justified. It may be true that there is an international agreement which asks that tolerant treatment should be given to persons who are suffering from the latter type of disease, to which I have referred, but I beg the Government to show something more than sympathy in relation to this particular case. The amount of money which will be saved is infinitesimal. Let it not be said that there is any Party in this country that is going to impose what I consider a very unjust charge upon the people who are more deserving of our sympathy than almost any other section of the population.
4.42 p.m.
LORD LLEWELLIN: I shall take up only two or three minutes of your Lordships' time. I cannot: see any way out of the dilemma which has been put to us by the noble Lord, the Lord President
834
of the Council. Everyone in future will be charged unless he comes under the exceptions which we find in Clause 1, subsection (2). If, therefore, somebody gets off without a charge, and he is not in hospital and not suffering from a venereal disease and is not a school child, why will he be getting off? If the only exception made is this one, with which we all sympathise, of people suffering from a malignant disease, that will be the only reason why they are not charged by their medical practitioner or whoever else certifies this charge. A patient may go along and speak to a neighbour who, although he or she may not know the terms of the Bill (or the Act when it becomes an Act), may ask, "What did you have to pay for your prescription?" The patient will say: "Nothing." "Oh—have you really got that? How awful for you!"—because immediately that person will be put in the cancer class. Let us realise that that is what is going to happen if this disease is made the only exception.
The noble Viscount asked: "Why except people suffering from venereal disease and not these people, because, as we all know, anyone who is suffering from veneral disease has himself or herself taken the risk arid contracted the disease, which cannot be said to be the case with anyone suffering from cancer?" But the difference is surely that people suffering from cancer are, more likely to cure themselves if they have not the worry of knowing that they have the disease. I know of a case where a person thought that an operation had been successful. The doctors knew that it had not, but they never told that particular patient. She thought it had been a completely successful cure. From that moment, although the doctors had failed, the thing disappeared the cancer left her. That would not have happened unless she had had in herself the faith to think that she had been cured.
On the other hand, if you do not let people off in the case of venereal disease, they may be likely not to go for early treatment—and that is the very worst thing that can happen to anybody who catches a venereal disease. The whole idea there is to make treatment as easy and as anonymous as possible. I think it is quite right that the charge has been remitted in that particular case, but I

835
honestly believe that we might be doing more harm than good if we were to treat as the only exception, out of hospital (I leave out venereal disease, because everybody knows whether or not people have that disease), people suffering from the most grievous complaint of all, people with whom we all have the utmost sympathy. Until it is necessary for them to know, and by that time they are probably in hospital, they should surely be relieved of the anxiety of knowing the truth and should not get the news in the roundabout way in which they would if no charge were made upon them for any medicine. From the practical point of view—I am not a doctor, of course—I do not quite know what medicine or drug peculiar to cancer can be given. If there is one, I do not know of it, but I do not believe that there is any cure of that sort for this disease, so that it is not as though we are dealing with a drug that is specific to the disease itself. For those reasons, I hope that, although we have the greatest sympathy with the people suffering from this complaint, we shall not make them the only exception.
LORD BURDEN: I am sure that everyone who listened to the moving speech of my noble friend and colleague Lord Kershaw must be aware of his knowledge of this problem and that he speaks with a wealth of understanding of what is involved. Speaking for myself, and I think for everybody on these Benches—and. I hope, for some noble Lords on the opposite Benches—I feel that they must be profoundly disappointed with the reply given by the noble Lord, Lord Woolton, particularly as my noble friend Lord Kershaw had foreseen the point which the noble Lord made and pointed out a way in which it could be met. The noble Lord said in that speech, as in his previous speech, that those who really were in need could be provided for. That was the tenor of what was said by the noble Lord in his introductory speech. But before I come to that point, may I just deal with what was said by the noble Lord, Lord Llewellin. Is there any reason to suppose that those who ask people who attend for cancer, and would know that they had cancer if they were exempted from the charge, would not ask those attending for treatment for venereal disease? Is it not just as likely that people suffering from venereal disease
836
may be asked whether or not they have paid for their prescription, and on saying that they had not, would be asked, "Are you _suffering from that?" Is not that rather indulging in logic-chopping?
LORD LLEWELLIN: The whole difference between the two is surely that the neighbour knows that the patient has been to the doctor only by the fact of the patient coming back and saying "I went to the doctor and got some medicine." A person suffering from venereal disease is not likely to start that conversation.
LORD BURDEN: I have never heard such a weak and ineffective argument in my life, particularly when it may concern areas where this may possibly develop. I will not pursue that point, because one realises that it is a matter of logic-chopping, and logic-chopping only.
To get back to the point raised by the noble Lord, Lord Wootton, may I suggest to the noble Lord, in all seriousness, that in basing his case on need he is departing from a principle which has been operative in this country for forty years? He is departing from the principle laid down in the Act introduced by Lloyd George in 1911, and embodied in the 1925 Act. The noble Lord, Lord Webb-Johnson, said that we are putting forward these proposals on sentimental grounds. There is a good deal to be said for these claims on sentimental grounds. But apart from the grounds suggested in the moving speech of my noble friend Lord Kershaw, I would put this forward from another point of view. These charges mean that persons are being deprived, not of what they could expect under a contract but certainly of what they had reasonably hoped for after many years of contribution to the National Insurance Fund and in National Health contributions.
For many years—in fact since 1925—people have been voluntarily contributing towards their expectations at the end of their time. They may have paid 4s, and something a week for benefits, including medical treatment. After that, if they were prudent people, and were self-employed, they would pay 6s. and something a week. They had reason to expect that if these troubles arose in their old age they would receive medical care and

837
attention without further cost to themselves. They were making reasonable provision for that. But the noble Lord says: "No; those who have made reasonable provision for themselves and do not come within the scope of the help which can be given under the National Assistance scale must pay; but those who have not, those who are within the National Health scale, will get help and will not pay." That may not be a breach of contract, but I put it to the noble Lord, Lord Webb-Johnson, that there are hundreds of thousands of people in this country in the category that I have described, who have been deprived of what was a reasonable expectation to them—namely, that in their declining years they would have medical care because they have paid for it. I put it to Lord Woolton that he is introducing once again, and for the first time in this Administration, the Poor Law test. He is bringing back again the principle that help will be given in cases of necessity, but that those who have paid for it are not to have it.
Apart from the moving speech put forward with a wealth of knowledge of the circumstances by my noble friend Lord Kershaw, I suggest, on grounds of equity and reasonable treatment for people who over a number of years have paid in the hope of not having to contribute for any sickness in their declining years—and particularly for this disease which is the dread disease of old age—that the shadow should be lifted from their lives in a way possible without any fear of letting them know. Let the line be drawn at 60, 65, or what you will, but give this help to people who have contributed towards it and who had a reasonable hope of expecting that treatment and help would be given to them in the last days of their lives.
LORD DOUGLAS OF BARLOCH: I gathered from the speech which was made by the noble Lord, Lord Woolton, that he would like to accept this Amendment but for the fact, which has been reiterated by the noble Lord, Lord Llewellin, that it would mean identifying the people who suffer from this particular kind of disease. If that is so, I would suggest that that is all the stronger reason why, when we come to it, the noble Lord should be willing to accept an Amendment in the name of my noble friend Lord Lucan, which would exempt those
838
who are certified as "chronic sick." That would be a means of escaping this difficulty of identification. and of enabling to be done what it seems every member of this Committee would like to see done.
LORD WEBB-JOHNSON: I had not intended to intervene again in these discussions, but the noble Lord, Lord Burden, has more or loss challenged me to take some part. I would take this opportunity to try to keep a better balanced view in regard to the matter dealt with in this Amendment, and to remember that the only effective treatment for this disease is to be obtained in hospital. Treatment that can be given outside hospital, unfortunately, is only palliative. Many people have the idea—I should like to put this crumb of comfort into the debate—that cancer is a painful disease throughout its course, and they paint lurid pictures of the agonies of pain accompanying death from cancer. That is not a true picture. I have had half a century of work particularly with cancer, and I have had to work with cancer patients who were kept in hospital to the very end. It is not the outstanding clinical picture—that picture of pain. It may be great discomfort. Pain can be relieved in various ways, not only by medicine but by nerve section, and so on, so that the part affected is made insensitive. The noble Lord, Lord Burden, suggested that people were going to be deprived of medical care. They are not being deprived of medical care. The only suggestion is that when they require some medicaments they should pay, like other sufferers.
I wish to make only one other remark to the Committee, and that is in order to reinforce the view of the Lord President of the Council with regard to the undesirability of giving to the patient any idea that he has a malignant disease. He must be guarded from that, I think. I know some people take a different view, but my experience has been that it has never done a patient any good to be told, and almost invariably it has done serious harm by undermining morale. I would give the Committee just one illustration. In the whole of my surgical career, when I have had to suggest an exploratory operation, on many occasions the patient has said: "I insist on knowing what you find." If you do not go into their room the next day, or that same evening, and say: "Well, you have

839
nothing to worry about; all is well," they do not ask you. In the course of half a century of practice I was asked only once, and then by a very strong-minded man, and he did not ask me directly. The day before he left the nursing home he said, "I have a lot of loose credits lying about; would you advise me to buy an annuity? I said: "If you cannot manage your own money you are a different type of man than I take you for." I mention that only because to me it has been a most striking fact that in all that time only one man should have asked, and then only indirectly. So I beg your Lordships not to do anything which would make it more likely that the patient would realise that he had a malignant disease.
LORD KERSHAW: With the permission of the Committee, I should like to deal with a few points that have been raised. In the first place, I should like to say that I never thought I should live to hear an eminent surgeon declare that cancer is not a painful disease. I think it is shocking that an eminent surgeon should declare that we are exaggerating the painful nature of cancer.
LORD WEBB-JOHNSON: If the noble Lord, Lord Kershaw, will give way to me for a moment, I should like to explain that I did not go so far as to say that cancer is not a painful disease. I said that that is not a predominant feature of the clinical course throughout the progress of cancer.
LORD KERSHAW: I thank the noble Lord for his intervention. If an ordinary person reading Hansard to-morrow does not get the impression that the noble Lord would place other factors in connection with the disease as being of more importance than the physical suffering of the patient, then I cannot understand the English language. I wonder whether the noble Lord is, perhaps, getting out of date on this matter. There is a very definite movement in hand at this moment to persuade people that if they are suffering from some pain which they do not quite understand they should take early advice. An eminent surgeon who is occupied almost entirely with this subject, and who I am glad to call my very dear friend, tells me that he is quite sure 8,000 people die unnecessarily every year through cancer. That is to say that, if
840
we could persuade them to take early advice on this matter, 8,000 people could be saved every year. When I remember the interests, the very powerful interests, that were aroused some years ago in relation to the fact that some 2,000 or 3,000 women were dying unnecessarily in childbirth every year, I wonder if the public knew that there were these 8,000 people who could be saved, what kind of agitation could be worked up in this country in connection with that matter. This is such a dreadful subject, the suffering of these people is so heartrending, that no one can think of it without being disturbed. I did hope that the Committee would approach the matter from the point of view of a Council of State rather than as two Parties.
LORD WOOLTON: Hear, hear!
LORD KERSHAW: It is all very well to say, "Hear, hear!" The only thing that matters in this connection is action. What are you going to do? The noble Lord, Lord Llewellin, says that it is quite right to exclude people suffering from venereal disease, because it is so desirable that they should take early treatment. God bless my soul! the very thing we want in connection with cancer sufferers is that they shall take early advice and treatment.
LORD LLEWELLIN: If the noble Lord would kindly give way to me for a moment, I should just like to say that I was not approaching this grave and important matter in any Party spirit. I hope that the noble Lord will acquit me of doing that in a serious case like this. I believe it would be wrong to tell these people by an indirect way: "You are suffering from cancer" I really believe that, and I hope that the noble Lord will give me credit for it.
LORD KERSHAW: I think I made it perfectly clear, in moving this Amendment, that that was the difficulty—that if you exclude people on account of their having a malignant disease, then it might be that they would discover that fact through not having to pay for their certificate. But in my time I have had a good deal to do with our wonderful Civil Service, and I am satisfied, in my own mind, that even if cancer sufferers alone were to be excluded—and as the Committee knows, there are later Amendments which would exclude other sufferers, and the more

841
other classes of sufferers are excluded, the more the danger that Lord Llewellin referred to will be diminished—our Civil Service could devise a system of prescribing which would not entail a payment every week or month by people suffering from this and similar diseases. All I ask the noble Lord, Lord Woolton, to do is to take this matter back and think about it.
I am not approaching it at all from a Party spirit. I know of many noble Lords on the other side of the House who are as keen as I am on this subject and spend as much time as I do on it, and I claim no Party advantage for this Amendment or anything connected with it. But I say, with all the knowledge I have of this subject, that it is worthy of further consideration by the noble Lord. I am satisfied that ways and means could be devised that would avoid the disclosure of this disease to the patient, and I hope that the noble Lord will find himself able to respond in this matter. I appreciate that where a Minister in charge of the Bill is not in charge of the Department from which the Bill emanates, it is difficult to give a reply, but if the noble Lord will undertake to discuss the matter with his Minister, I shall be most grateful to him, and I think he himself will feel that he had done something good for these people.
EARL JOWITT: Before the noble Lord replies, may I make this suggestion? I appreciate the difficulty which the noble Lord, Lord Llewellin, mentioned about having to disclose to a patient that he has this sort of disease and that that is what influenced the mind of the noble Lord. The last Amendment on the first page, No. 7, reads,
"or is certified by a medical practitioner to be one of the chronic sick."
Might that not be a way out, if the noble Lord, Lord Woolton, saw his way to accept this Amendment? Then, if a man suffering from cancer, who needs all kinds of sedatives and other medicines, is treated as one of the "chronic sick," he will not be labelled to his own knowledge to be suffering from a malignant disease. It seems to me a very unpleasant task for any Minister to have to impose a charge on these unfortunate people. If the noble Lord wants to help them, as he said he did—arid I am sure he does, as we all do—is there not a possibility that
842
by accepting Amendment No. 7, he may get out of this difficulty and meet Lord Llewellin's point?
LORD CHORLEY: Before the noble Lord replies, may I ask a question? The noble Lord has indicated that the Government would be prepared to accept this Amendment if it were not for the fact that it would involve disclosing to sufferers from this terrible disease that they are suffering from it. In many of these cases it is perfectly well known to the patient and there is no question of secrecy at all, but in those cases where the patient does not know he is suffering from this disease, it is the doctor handling the case who is in the best position to judge. If the doctor thinks he should not know, then the doctor need not give him the prescription. If this Amendment were accepted as it stands, would it not leave the matter in the hands of the medical practitioner in charge of the case?
THE MARQUESS OF SALISBURY: This is one of those cases where any House of Parliament would find itself in great difficulty, and I frankly confess that we on the Government's side find ourselves as much moved by the issue as anybody else in this House. It is a difficult question. The noble Lord, Lord Kershaw, said that if only we could accept this Amendment, that at any rate would give ease and comfort to a number of people. He seemed to indicate that if we accepted this Amendment, he would not press for any others. There are other similar Amendments on the Order Paper. For instance, there is one dealing with those suffering from tuberculosis. It has been my sad misfortune to know people in the last stages of tuberculosis, and I cannot believe that the suffering from cancer is very much greater than that. There are other Amendments dealing with other serious diseases, and there are other diseases which are not included in the Amendments and which might well be included. For example, there are no references to any disease of the heart, and some of those are just as painful and just as unhappy as this terrible disease we are discussing now. I do not think it would he possible to accept this Amendment without considering the acceptance of a great many others. I do not know where this would stop. With the best will in the world, it puts us in a difficult position.
What I would suggest for the consideration of the House is this. I hope the

843
noble Lord will not press this Amendment or any others, and when we come to the omnibus Amendment dealing with those suffering from chronic diseases—although I do not know exactly what a "chronic disease" is—that is a matter which might be considered before the Report stage, although I should not like to give any great encouragement. I should be dishonest with the House if I were to do so. I do not think it would be possible for us to accept this Amendment without accepting a large number of others, about which the noble Lord, Lord Kershaw, does not care so much, but to which other noble Lords attach equal importance. Therefore, I am sure my noble friend feels that we must stand firm on this Amendment because it does not seem to us that in this case we could make a differentiation. I am sure that others of us would be willing to consider some sort of wider Amendment, but I could not give very great encouragement about accepting it, because it seems to me to drive a cleft in the Bill and cause such injury to it that it would be hardly worth while putting it in.
VISCOUNT STANSGATE: No one who has heard this painful debate can be unaware of the fact that the question has entered a third phase. First, nobody says it is to save money. Secondly, nobody says that a man is humbugging, that he is shamming cancer to create an abuse. The new argument is that we must charge a man a shilling in case he should find out that he has cancer. That is the argument. The effort of the noble Marquess to get out of that is to say that we are moving an Amendment which is not anything so direct. If he can reject this Amendment, then it is clear that
when he comes to the chronic sick Amendment, all the arguments advanced on this Amendment can be fortified ten times and that chronic sick Amendment can be rejected. The fact of the matter is that this Bill is a thoroughly wicked Bill. It is a wicked Bill because it is charging money to people who are poor and people who are sick. That is the basis of our objection to the Bill, and it is focused on that particular point. Of course, we all sympathise; but what is the good of sympathy? Here is a person who is poor and suffering from cancer, and you pinpoint him for a charge: and you say that you should charge him because he has cancer. That goes also for the man who is a diabetic, and for the man who is tubercular. It means that the person to be charged is the person in the direst danger. Therefore, I think the Amendment is a good one, and that the mover should insist on it.
THE MARQUESS OF SALISBURY: I feel that the noble Viscount's speech is a most ungenerous one. I should have thought that it was clear to all noble Lords that we are very sincere in our attitude to this matter. For the noble Viscount to suggest that this is a pure Party manœuvre—
VISCOUNT STANSGATE: I never said a word about that.
THE MARQUESS OF SALISBURY: That was the implication. I thought it an ungenerous and an almost indecent speech to make.
On Question, Whether the said new words be there inserted?
Their Lordships divided: Contents, 31; Not-Contents, 70.

CONTENTS

Baldwin of Bewdley, E.

Chorley, L.

Macpherson of Drumochter, L

Douglas of Barloch, L.

Milner of Leeds, L.

Jowitt, E.

Douglas of Kirtleside, L.

Morrison, L.

Greenhill, L.

Ogmore, L.

Hall, V.

Hare, L. (E. Listowel.)

Pakenham, L.

Stansgate, V.

Henderson, L.

Pethick-Lawrence, L.

Kenswood, L.

Quibell, L.

Ammon, L.

Kershaw, L.

Rochester, L.

Archibald, L.

Lawson, L.

Shepherd, L.

Bingham, L, (E, Lucan.)[Teller.]

Layton, L.

Silkin, L.

Lucas of Chilworth, L.

Wise, L.

Burden, L. [Teller.]

Macdonald of Gwaenysgor, L.

NOT-CONTENTS

Simonds, L. (L. Chancellor.)

Davidson, V.

Foxford, L. (E. Limerick.)

Furness, V.

Gage, L. (V. Gage.)

Woolton, L. (L. President.)

Harcourt, V.

Gifford, L.

Hudson, V.

Greville, L.

Margesson, V.

Hampton, L.

Wellington, D.

Maugham, V.

Hindlip, L.

Monsell, V.

Leathers, L.

Cholmondeley, M.

Rothermere, V.

Llewellin, L.

Reading, M.

Swinton, V.

Lloyd, L.

Salisbury, M.

Mancroft, L.

Willingdon, M.

Aberdare, L.

Milverton, L.

Ailwyn, L.

Parmoor, L.

Alexander of Tunis.

Aldenham, L.

Remnant, L.

De La Warr, E.

Amherst of Hackney, L.

Ritchie of Dundee, L.

Dundonald, E.

Audley, L.

Rochdale, L.

Fortescue, E. [Teller.]

Bethell, L.

Rockley, L.

Howe, E.

Blackford, L.

Saltoun, L.

Onslow, E. [Teller.]

Brassey of Apethorpe, L.

Sandford, L.

Rothes, E.

Cherwell, L.

Sandhurst, L.

Scarbrough, E.

Clanwilliam, L. (E. Clanwlliam.)

Schuster, L.

Selborne, E.

Cranvvorth, L.

Selsdon, L.

Selkirk, E.

De L'Isle and Dudley, L.

Teviot, L.

Shaftesbury, E.

Dorchester, L.

Teynham, L.

Ellenborough, L.

Webb-Johnson, L.

Bledisloe, V.

Ennisdale, L.

Wolverton, L.

Buckmaster, V.

Fairfax of Cameron, L.

Resolved in the negative, and Amendment disagreed to accordingly.

BUSINESS OF THE HOUSE
5.30 p.m.
EARL FORTESCUE: My Lords, with your Lordships' permission, I have a statement to make with regard to future Business. There are already seven speakers on the Motion on the Order Paper for to-morrow in the name of the noble Earl, Lord Cork, and about thirteen or fourteen on the Transport Motion, Therefore, it has been arranged through the usual channels that we should take Lord Cork's Motion first, which will probably continue until half-past four or five o'clock. It is then proposed to take the Transport Motion, to adjourn the House at seven o'clock, and to continue the debate on that Motion on Tuesday next.
EARL JOWITT: My Lords, the noble Earl says that it has been agreed "through the usual channels." Is he sure that he is right? What happened, so far as I am concerned, was that my noble friend Lord Shepherd came to me and told me of this proposal and asked what I thought about it. After seeing those concerned with the Transport Motion it was obvious that they were reluctant to do this. Therefore, I said that I would not agree. I cannot think that after that Lord Shepherd would have agreed, and I feel that there must be a
846
misunderstanding. I feel this would be a most inconvenient arrangement. It is unfortunate that we cannot start our discussion on the Transport Bill earlier. Personally, I should rather have had a full day of it, even if it meant going over to Tuesday. I think it is most unsatisfactory to have a debate in two parts. I do not think, after you have had the first "bite at the cherry," so to speak, that it is possible to get the debate satisfactorily going again. I am inclined to think that it would be better to put off the whole matter until Tuesday. May I make this suggestion? The machinery seems to have broken down. Would noble Lords consent to the matter being mentioned again to-morrow, and in the meantime we will get busy, through the usual channels, and try to make an arrangement that will satisfy everybody?
LORD REA: My Lords, may I support the noble and learned Earl? One noble Lord who was corning to speak tomorrow will not now be able to come. The normal channels have been blocked in this direction. I should appreciate it if the noble Earl's suggestion could be considered.
EARL FORTESCUE: I understood from Lord Shepherd that he had agreed on behalf of noble Lords opposite to this arrangement. We will look into the matter again and I will make a statement early to-morrow.
EARL JOWITT: I am sure that there must be some misunderstanding
THE MARQUESS OF SALISBURY: I would say this to the noble Earl. Of course, we will revert to the matter tomorrow, but there is no Business on the Paper for Tuesday, and I am still doubtful whether we shall be able to complete the debate on Transport in a single day. That I do not know. This seemed to me a possibility—and I am putting it to the noble Lords only so that they may consider it overnight: we could have, say, the first part of the debate, to include a statement by my noble friend, Lord Leathers, to-morrow. That would give an opportunity to the Opposition and to the noble Lords on the Government side to consider what he says. That would be half a day. Then there would be a full day to finish the debate on Tuesday, for which day, as I say, there is at present no Business.

NATIONAL HEALTH SERVICE BILL
5.35 p.m.
Committee stage resumed.
LORD SILKIN LORD SILKIN moved to add to paragraph (a) of subsection (2): "or is under twenty-one years of age." The noble Lord said: On behalf of my noble friend Lord Shepherd, I beg to move the Amendment standing in his name. The purpose of this Amendment is to ensure that patients who are out-patients of hospitals and who are under twenty-one years of age will not be liable for any charge in respect of the supply of drugs, medicines, or appliances. This, again, is a very special and limited case. Of course, it will apply to children and, although the question of children has been dealt with in an earlier Amendment as regards those who have to purchase drugs and medicines as the result of a prescription from their doctor, this is a much more limited case of children who are outpatients at hospitals and require drugs or medicines.
The intention of this Amendment is that they should not be subject to any charge. Of course, it goes further than children; it applies to young persons under the age of twenty-one. The justification, to my mind, for exempting persons under twenty-one, is two-fold. In the first instance, they are clearly people
848
whose earnings are low and who may be trainees or apprentices, just beginning to make their way in the world. A charge may be a hardship to them. Secondly, in any case, by the very fact that they are attending as out-patients of a hospital, they are suffering a certain amount of disability because normal treatment at the hospital is in the daytime and they have to get time off from their work, presumably losing pay. So there is a double hardship in the case of persons under twenty-one, who are of an earning age: first, that their earnings are low and, secondly, that they are, by the very fact of their attending hospital as out-patients, losing pay. This is a limited class of persons who, I would submit, are deserving of special sympathy. I would further submit that the cost to the Exchequer is bound to be very small. There cannot be large numbers of young persons under twenty-one who are attending as out-patients at hospitals: but those who are will suffer some hardship if they have to pay this charge. For those reasons, I hope that this Amendment will receive more sympathetic treatment than its predecessors. I beg to move.
Amendment moved—
Page 1, line 12, after ("hospital") insert ("or is under twenty-one years of age").—(Lord Silkin.)
THE EARL OF ONSLOW: I cannot quite see the argument of the noble Lord that people who are being treated as outpatients should have special treatment which would be different from that received by people who for other reasons, probably by arrangement, go to their doctor's surgery in the evening. I think that would be most inequitable. Also, I feel that it might tend to encourage people to attend hospitals and, therefore, to overcrowding the out-patient departments, if they thought that by going to an out-patient department, rather than to their family doctor, they could get their medicines or appliances free. Of course, so far as the appliances are concerned, a large proportion of the people under twenty-one are already exempted—that is to say, children who are under sixteen or who are still receiving full-time education at school. I do not think the arguments here are even as strong as those raised in support of what I may say were more serious cases. I am afraid that I am unable, on behalf of Her Majesty's

849
Government, to accept the Amendment, and I hope the noble Lord will not press it.
VISCOUNT HALL: It is not our intention to do anything other than express our point of view upon this Amendment. It is not intended that we should divide, but we protest against this as a part of the Bill which is objectionable.
On Question, Amendment negatived.
5.42 p.m.
LORD GREENHILL LORD GREENHILL moved to add to paragraph (a) of subsection (2):
"or in a chest clinic or other treatment centre administered as part of the hospital service ".
The noble Lord said: I know that it is customary to say that I hope the Government will accept this Amendment in a non-controversial spirit, and will agree to it. I do so quite seriously, however, because I think there is nothing in my Amendment which conflicts in any way with the intention of the Government. The Government have said that, owing to the fact that the country is rather hard up, they expect a contribution from the National Health Service Fund. However, they say that, in spite of the country's being hard up, there are certain cases in which no charges will be made. One of those charges is as indicated in lines 11 and 12 of subsection (2) (a):
"The supply of any drug, medicine or appliance for a patient who is for the time being resident in a hospital;"
All I am asking is that you add to that:
"or in a chest clinic or other treatment centre administered as part of the hospital service."
I cannot believe that what the Government are saying, in effect, is that a charge shall not be made for somebody resident in hospital but that the exemption shall not apply to a person in a clinic.
I say this not on any grounds of sentimental appeal. I say this because I have been in touch with the Medical Officer of Health for Glasgow. My information is that considerably anxiety is felt about this particular matter by the Western Regional Hospital Board and by the Executive Council there. In Glasgow, for example, tuberculosis clinics were formed a quarter of a century ago, and no charges have been made to people receiving treatment there. Even now, the Regional Hospital Board supply certain foods, such as malt, cod liver oil, and so on, and dis-
850
infectant to those attending, for which no charge is made. Since 1948, everyone placed on the list of a general practitioner can get that service free. The question is: Why should we make a special charge on these people? Is it the case, for example, that this Bill will now require dispensaries to make a charge for medicines? If so, certain difficulties will arise. For example, as noble Lords will appreciate, this matter of disinfectants is of very great importance. Disinfectants, I understand, are on the drug tariff, and are therefore regarded as a prescription. Since it is of the utmost importance that these vessels should be kept absolutely disinfected, does it mean that every time a disinfectant is prescribed the sufferer will have to pay his Is. for the prescription?
Again, there are the substances given by way of nourishment to people suffering from tuberculosis. As noble Lords will know, when the Sir Henry Cohen Committee reported, they advised that there were certain substances which could be given to persons such as those who were losing weight. These substances could not be called drugs, but were called foods and, therefore, would not be liable for the 1s. prescription fee. One would like to be clear about that point—that is, whether these foods, as the Report calls them, or drugs, as medical men are inclined to call them, are to go on to a prescription; and, if so, whether 1s. is to be charged. When one considers the numbers involved, particularly in the Glasgow and South-Western area, one finds that the numbers are very considerable. In respect of definite drugs, I am told that the number of prescriptions in any year would amount to 60,000. Each of these prescriptions covers a period of about two weeks for the drugs supplied; and if a prescription were also necessary for the disinfectant that would add a further 96,000 prescriptions, making a total of 156,000 prescriptions per annum. At a cost of is. per head, I am told that that would involve E. figure of £7,800. Assuming that some intention not to demand payment is included in this Bill, I would ask whether the noble Lord, Lord Wootton, cannot see his way to include these additional words in that particular part of the Bill. I beg to move.
Amendment moved—
Page 1, line 12, after ("hospital") insert ("or in a chest clinic or other treatment centre administered as part of the hospital service.")—(Lord Greenhill.)
LORD WOOLTON: I am sorry that I cannot agree with the noble Lord. I do not know whether there is a misapprehension, but if the noble Lord will be good enough to look at subsection (2) (a) he will see that it reads as follows:
"the supply of any drug, medicine or appliance for a patient who is for the time being resident in hospital."
and, then, according to the noble Lord's Amendment he wants to add "or in a chest clinic.…" Have I got that right?
LORD GREENHILL: Yes, that is the wording. I confess that that did occur to me, and I wonder whether it would satisfy noble Lords if I were to ask leave to amend my words and have "or who attends a chest clinic," rather than "resident in."
LORD WOOLTON: Thank you very much. I did not want there to be any misapprehension because, of course, if a person is in a hospital, then the whole question which the noble Lord has raised does not in fact arise, because the patient gets all these things free. It arises only if he is not in hospital but is being attended by his doctor or going to one of these institutions which the noble Lord mentions—
LORD KERSHAW: Or as an outpatient.
LORD WOOLTON: Or as an outpatient in a hospital. I do not think it would be just to say that the person who goes to a doctor shall pay for his prescription, but that the person who goes as an out-patient to any of these institutions shall not pay. As I am sure your Lordships realise, the result of that administratively would mean that one would have still further overcrowding of hospitals, clinics, and the like. And on those grounds we did not think it would be a good thing to do.
The noble Lord raised the question of prescriptions. I do not think it need be quite so hard as the noble Lord indicated in the figures he quoted: because, of course, these disinfectants are required all the time by people in this condition: and it is perfectly proper for the doctor to give a prescription for a quantity which would cover quite a long period. The noble Lord also raised the question of whether a patient would have to pay for the drugs and the foods that were involved and were prescribed by the doctor
852
in his prescription. The answer is that the Bill does apply if they are attending an out-patients' department or a private doctor. It may be that the noble Lord had in mind people who were resident as patients in rehabilitation centres. If so, since, by the definition in the Act of 1946, these places are "hospitals," those people do not have to pay. I regret that I am not able to accept the Amendment.
LORD GREENHILL: Perhaps I may be allowed to ask a question, based on my experience in this House. I should like to have some clarification on this matter. On May 1 in another place, Commander Galbraith, who, I think, was speaking for the Ministry of Health said:
"I want to make it clear to the hon. Member that treatment at the clinic does not come into this matter at all. but it is only where a prescription is given to be taken away from the clinic that the charge is made …"
What exactly does that mean?
LORD WOOLTON: It is always difficult to interpret what someone else means.
VISCOUNT STANSGATE: But Commander Galbraith read his whole speech. It was an official brief.
THE EARL OF ONSLOW: He might have written it himself.
LORD WOOLTON: My interpretation was that Commander Galbraith was assuming that this was a clinic in which people were resident, where the prescription was taken away from the clinic. If it is administered in the clinic then people do not pay, because the doctor there is doing the administration. It is when you take the prescription away that you have to pay for it. I think that that is the correct interpretation, though I am taken a little at a loss by not having had notice of the question. If I am wrong I will apologise at the proper time.
LORD KERSHAW: I think the noble Lord will find that out-patients, even though they get their prescriptions dispensed at the hospital, will have to pay for the prescription.
LORD WOOLTON: It depends whether they are consumed on the premises.
LORD KERSHAW: Not consumed: taken away.
VISCOUNT HALL: We certainly need a little more information in connection with this matter. I should advise my

853
noble friend to withdraw the Amendment and, if the noble Lord will agree, we may have a talk between now and Report stage and see whether something can be done.
LORD WOOLTON: I am delighted to accept that suggestion.
LORD GREENHILL: In the circumstances, I beg leave to withdraw my Amendment.
Amendment, by leave, withdrawn.
LORD BURDEN LORD BURDEN moved to add to subsection (2) (a):
"or is an out-patient following on a period of resident treatment
The noble Lord said: I hope this Amendment will not be rejected by the noble Lord, Lord Woolton. I think that everyone will agree that the modern technique in our hospitals is to get the patient up and out as quickly as possible. Whether that is right or wrong from a medical point of view it would be presumptuous for me to try to determine, and I should not in any way try to do so. But I think that everyone is aware of the great pressure on our hospitals to take in cases, and it is natural, therefore, that they should try to get patients out as quickly as possible. In these circumstances, I suggest that the illness should be regarded as a continuous illness and that there would be no payment for treatment or for anything involved following the stay in hospital.
There is under the Bill a curious contrast with the former practice. Under the 1929 Act, which was passed by a Conservative Government, people were compelled to pay—or, rather, it would be more correct to say that local authorities were compelled to render an account for full costs for the stay in hospital, and then the various committees of the council would determine what charge should be made, or whether no charge at all should be made, for the stay in hospital. But we now get the curious anomaly that a person who has had a stay in hospital and. is sent out, quickly or otherwise, has to pay for anything which arises—including, as I understand it, appliances. Surely this is putting a great strain on human nature. Let me give an example. "A" goes into hospital
854
and requires certain surgical appliances for which, under the Bill, if he were not in hospital a charge would be made. Now "A," fortunately for him, gets the appliances while he is in hospital. But "B," in the next bed, requiring perhaps similar appliances and not getting them, owing to a time lag in the supply, goes out and then has to apply to the hospital again, and has to pay for the appliances. Surely there should be parity of treatment in cases of that kind, and not the unfairness which arises through difference of treatment between two persons who may be in hospital at the very same moment.
There is another point. As I understand the Bill, it will apply also to mental hospitals. It is the practice in mental hospitals that some patients, for various reasons, are let out on licence. It is not unknown for a patient in a mental hospital to require some sort of appliance, not necessarily connected with his mental trouble but connected with some physical trouble or disease. If he is in the mental hospital, as I understand the Bill, that appliance will be supplied, but if he or she is out, then it will have to be paid for, whether it is a surgical belt or whatever article it may be. I believe that already it has been suggested that that problem might be overcome' on the "cat and mouse" principle, which some of your Lordships may remember operated many years ago: "Let them out, bring them back in, and then let them out again" The idea is to let him out and, if he requires an appliance, bring him in and then let him out again on licence—an ingenious way of getting over the difficulty, if the doctors in the institution lions care to apply it. I do not know—it may be going too far to suggest that that has been indicated as a way out. I am not sure of my facts in regard to that matter and I prefer not to develop the point. But I beg the noble Lord to realise that, so far as an illness is concerned, it should be treated as continuous and steps taken to bring the person concerned to health and to enable him to return to industry as quickly as possible. I am sure that can be done only by the acceptance of this Amendment. I beg to move.
Amendment moved—
Page 1, line 12, after ("hospital") insert the said words.—(Lord Burden.)
6.1 p.m.
THE EARL OF ONSLOW: Here, again, by the noble Lord's Amendment, a difference—I do not think it is a right difference—would be created between those who for some reason carry on the remainder of their treatment as outpatients, after being in hospital, and those who return home and are treated by their doctor. We have heard much about equity and fairness from the Benches opposite this afternoon. Why should noble Lords opposite suggest now that a certain class of person, because he or she prefers to be treated by the family doctor at home, should pay whatever it is that he or she is required to pay, and those who choose to go to the outpatients' department should get it free? I may be stupid, but I fail to see why that difference should exist. I cannot accept the Amendment.
VISCOUNT HALL: Is there not another point to this matter? What my noble friend had in mind, very largely, was the fact that there is a scarcity of hospital beds in this country. There is scarcely a district in which there are not hundreds on the lists waiting to get into hospitals, while a substantial proportion of persons who really ought not to leave the hospitals are persuaded to leave and continue their treatment at home. If that is so, of course they are serving a very great need. Is it fair and equitable that those people, in the event of their requiring what was suggested by my noble friend, should pay because they have accommodated the hospital authorities and had their treatment at home for a week, or a month, perhaps for six weeks? I have known of many people who, with their consent, have left hospital within a very short time of a serious operation, solely for the purposes of making room available for others to come in. I do not quite know what the circumstances are or what the position is, but it would be very unfair for those people to be called upon to pay simply because they had met the request of the hospital authorities.
THE EARL OF ONSLOW: The noble Viscount misunderstood me, because that really was the theme of my argument. Lord Burden's Amendment covers only those people who, when they come out of hospital, are treated in the out-patients' department. Those who go home and are treated by the family doctor would
856
not be excepted. That is the whole of my argument. Admittedly, both classes have said: "We are prepared to get out of our beds earlier than possibly is wise, in order to give way to other people in need of in-patient treatment." One goes to the family doctor because it is more convenient, and the other continues in the out-patients' department. By this Amendment, you would give free treatment to those who, for whatever reason, were treated in the out-patients' department, but not to those who went home. That is not equitable. We cannot accept the Amendment.
LORD BURDEN: We should be happy to extend the Amendment to cover those who go home, and to dispose of the anomaly in that way, if there is an injustice. That is quite simple.
THE EARL OF ONSLOW: The noble Lord has not that Amendment down on the Paper.
LORD BURDEN: I know, but the point surely is this: that a person who is requested to attend as an out-patient, and attends as an out-patient, does not elect to attend as an out-patient. Obviously, there is something in his trouble that the hospital staff require to have under care and supervision. For that reason—it may be the journey involved in travelling to the hospital, or all sorts of other conditions of that kind—while we have not been able thus far to do away with the anomaly of charging at all, we do suggest that where, obviously for the convenience of the hospital, a person is asked to go home, and it is said: "You must come here regularly for two or three months," that should be regarded as part of the treatment and not charged for. This is really also a matter of business. There are plenty of people on the hospital management committees who will say: "Very well, if that is the line that is being taken, and people who for our convenience are sent home are going to be mulcted in charge when they come to the outpatients' department or in some way are brought into the hospital purview, then we will keep them in."
THE EARL OF ONSLOW: May I interrupt the noble Lord? He has gone slightly wrong, because, if they are

857
receiving treatment in the out-patients' department, they will not pay for the treatment.
LORD BURDEN: No.
THE EARL OF ONSLOW: It is only if they take a prescription away to get a bottle of medicine. They will not pay for the treatment.
LORD BURDEN: I know; that is the point. They have to go there in order to get their trouble attended to.
THE EARL OF ONSLOW: And they get it free.
LORD BURDEN: But, to the best of my knowledge, there are few out-patients' departments that administer medicines or anything of that kind. People go there for consultation, they are advised there, and also there may be an examination by a doctor there. They may be put to all sorts of inconvenience in going there. I suggest that this is a minor Amendment. There is little money involved in it. It is an administrative matter which might help hospital management committees to continue their present practice—because there are involved not only treatment but also appliances. The noble Lord has not dealt with the point in regard to appliances which I raised—namely, that "A" may be in hospital and get his appliance free, while "B" is sent home and then will have to pay. Surely, that is an injustice, too. Will not the noble Lord look at this point and see whether anything can be done to remedy what I believe is a real defect which might be adjusted with little difficulty?
LORD DOUGLAS OF BARLOCH: I understood the noble Earl, Lord Onslow, to say a few minutes ago that, although a charge would be made on a person who was attending as an outpatient at a hospital for any medicine which was given to him there, it was only in the case where he took away a prescription that he would be charged. Would the noble Earl explain how he reconciles that statement with the provisions of subsection (1) of this clause and also with the provisions of subsection (2) paragraph (a), which we are now discussing?
LORD WOOLTON: I think there is a mistake. I did not hear precisely what my noble friend said, but I am quite sure
858
of the facts of the position, and they are these. If the patient going to hospital under the conditions that the noble Lord, Lord Burden, has indicated, has to have treatment there involving the use of medicaments, then he is not charged for those. On the other hand, if he gets a prescription at the out-patients' department and has to take that elsewhere to be made up, then he is in precisely the same position as if he had not gone to an out-patients' department but had consulted what we call the family doctor.
LORD BURDEN: What about appliances? I am not satisfied, but we are not carrying this Amendment to a Division. We shall probably wish it to be considered again in a different form on the Report stage. I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
6.11 p.m.
THE EARL OF LUCAN THE EARL OF LUCAN moved to add to subsection (2) (a):
"or is certified by a medical practitioner to be one of the chronic sick''.
The noble Earl said: The Amendment I now propose to move falls into the category which was mentioned by the noble Lord, Lord Webb-Johnson, when he spoke some time ago. It is one of those for which the main grounds are sentimental. I have yet to learn that it is any reproach to be actuated by sentiment in questions of the sick and the elderly. In fact, although I am no anthropologist, I should doubt whether there are many savage tribes in which the care of the sick and elderly does not arouse sentiment and sympathy. The chronic sick are, almost by definition, amongst the poorer people in the community, because chronic sickness does not arise shortly; it presupposes a long period of illness during which the patient or sufferer is not able to earn as well as his fellows. He is probably someone who has been in hospital and has been discharged as incurable. Sometimes he may still continue to attend hospital for the advancement of medical science. The doctors may require that the patient should continue to attend hospital in order that the progress of the disease may be watched. Generally, such people need medicines at more or less frequent intervals. That, shortly, is the case for this Amendment. There is a genuine class of person who will suffer under this Bill. Only a day or two ago, two old ladies

859
to whom I was talking were almost in despair at the prospect of having to make frequent regular payments for their medicines. The case is simple. It is founded on the same arguments and, I consider, the same strength of case as many others. I beg to move.
Amendment moved—
Page 1, line 12, after ("hospital") insert ("or is certified by a medical practitioner to be one of the chronic sick").—(The Earl of Lucan.)
THE LORD CHANCELLOR: The noble Lord in charge of the Bill has asked me to reply on this Amendment, possibly because he feels that he can give only the same answer and would like to hear somebody else give it. It is only the same answer that one can give here. Already it has been indicated that we must resist the Amendment in regard to a class of persons which commands our full sympathy—namely, those who are suffering from a malignant disease. We have excluded children, for whom so much sympathy has been called. I am afraid that we shall have to oppose an Amendment in regard to those who suffer from diabetes; and we must oppose the Amendment which deals with those who are certified to be of the chronic sick—I understand that to be a technical expression. No doubt it covers those who are suffering from diseases to which at present the medical profession has found no cure, such as rheumatoid-arthritis and some forms of paralysis. But precisely the same answer must be given.
VISCOUNT STANSGATE: Which answer?
THE LORD CHANCELLOR: The answer that Her Majesty's Government are not able to accept the Amendment. I am sorry. I did not appreciate the noble Viscount was not able to hear. Her Majesty's Government cannot. I fear, accept this Amendment. If there are real cases of hardship, once again one must say that there is assistance available. One must say this, too, in regard to this class of illness; that doctors will be able on one prescription to provide a large quantity of the drug or other medicament that is necessary for those who suffer from a chronic disease. The Committee will not, I hope, think that either I or any other noble Lord on this side of the House is wanting in sympathy for any class of
860
persons who suffer. But the position is just impossible. If we make an exception in favour of this class of person, and we make an exception in favour of another, so we go on until the exception becomes the rule. On behalf of Her Majesty's Government, I regret that I cannot accept this Amendment.
LORD BURDEN: I am surprised at the reply of the noble and learned Lord, the Lord Chancellor. The noble Marquess did indicate that he was prepared to look at this matter. He would not make any promise, nor did we expect any promise to be made. I do not dispute the overwhelming sympathy of noble Lords opposite; nobody has said that there is no sympathy in the noble and learned Lord. But sympathy does not "butter any parsnips"; it does not deal with the issues involved. May I beg the noble and learned Lord Chancellor to—I will not say honour the pledge which the noble Marquess gave, but the noble Marquess indicated that he felt there was something that might be looked at here, to alleviate cases which come within the category of the chronic sick. If anything can be done in this direction I beg Her Majesty's Government to do it. Do not let us have the stigma that all that can be done now is to tell people they will either have to pay, or go to the National Assistance Board, which is still regarded by hundreds of thousands of people in this country as the old Poor Law. Do not have that stigma on this Bill. Please do something for the chronic sick who, in the main, are men and women over the age of sixty and in the declining years of their lives. Please do something to show practical sympathy as far as these people are concerned.
THE EARL OF SELBORNE: There will be nothing to prevent noble Lords opposite putting down this Amendment again on the Report stage if they want to, but I venture to think that what the noble and learned Lord, the Lord Chancellor, has said is true. Noble Lords opposite must appreciate the fact that any responsible Government in this country have got to economise. We can argue about the form of economy, but all economies are very unpleasant. A great amount of beneficial social work will continue under this Bill, but it is the task of this Government—and the necessity for it was admitted by the previous Government when

861
they were in power—to see that expenditure on the National Health Service, which has so greatly exceeded all estimates, is limited.
VISCOUNT STANSGATE: May I ask the noble Earl a question? Has he any idea, or has anyone supplied him with any idea, as to what amount is to be saved by rejecting this Amendment?
THE EARL OF SELBORNE: It is easy for the noble Viscount to take one particular case and say: "What you are going to save on this matter is so paltry, so unworthy, that you cannot resist the plea I am making." I have been listening to noble Lords using that argument all this afternoon. It is easy to make a plausible case for any one Amendment. But the Government have to draft a Bill which is consistent, and which has the cumulative effect of making important economies I personally am satisfied that they cannot depart from the line indicated by the noble and learned Lord, the Lord Chancellor without sacrificing the principle for which this Bill stands.
THE LORD CHANCELLOR: The noble Lord, Lord Burden, made an appeal to me. I do not want to "butter any parsnips"—which, I think, was the expression he used. Why should I? The Government have come to the conclusion that in the interest of economy it is necessary to impose these charges, and I ventured to point out that to make exceptions which lead to other exceptions would absolutely defeat the policy upon which they have embarked. I cannot say any more than that. This is not a case in which an exception, in our opinion, ought to be made. If I have been guilty of any indiscretion or any lack of courtesy to the Committee I beg to be forgiven. But, I repeat, I do not want to "butter any parsnips." I face the realities of the position, and I beg noble Lords opposite, instead of making these appeals in one case after another, to realise what the position is—that, in our view, we have to do this unpopular thing in the interests of economy. We do not like doing it, but we have come to the conclusion that it has got to be done.
VISCOUNT STANSGATE: I am not sure about "buttering any parsnips." I have never quite understood what that
862
expression means, but I will not do it if it is not approved of in this Committee. We have had an argument brought forward by the noble Earl, Lord Selborne, to the effect that we need not move this Amendment now because we can put it down at the Report stage. That is the only new argument which I have heard advanced. I should like to recall to the memory of the Committee where we are in this Bill. This is a Bill which everyone dislikes. I think we are all agreed about that. It is always apologised for by occupants of the Government Front Bench and no one on the back Benches has defended it except Lord Gifford, whose interesting contribution has so far been unanswered. This is a Bill which has never been debated fully in the other place—it was produced under guillotine. It was put forward in the "People's House"—I call it the "People's House" speaking in the old Liberal tradition. We here pride ourselves on being a revising Chamber. What revision have we made so far? We have sat here for four hours, and we have moved, with a considerable wealth of argument, a number of Amendments, but not one concession of any kind has been made to us. The noble Marquess, Lord Salisbury, it is true, did give a benevolent reply in one instance, but he did not indicate that the further consideration which was to be given to the matter in question was going to result in any amendment of the Bill. Two arguments which have been presented were, first, that economy was needed, and the other that abuse must be stopped. Then we came to the cancerous patients and in that connection a third argument was produced—namely that we must not tell them what was wrong with them. That was the only new argument. It was a shock to me. I never thought I should hear that argument advanced here. No doubt it was put forward quite sincerely.
LORD WOOLTON: It was put forward by the medical profession.
VISCOUNT STANSGATE: It was put forward by the noble Lord, Lord Webb-Johnson, who went on to say that cancer was not so serious a disease as many people imagined.
THE EARL OF ONSLOW: He never said that. That is a complete misrepresentation.
VISCOUNT STANSGATE: Those are the only three arguments that have been produced. We ask if it is not possible to get round this awful necessity to impose a charge on a person who has some dire disease—diabetes, tuberculosis, or cancer. Cannot we get round the difficulty that by not charging them a shilling we should inform them that they had the disease? We say that if you made these exclusions more general the people would not know what disease they were suffering, from. They would simply know that they came within the excluded classes and that they were saved money. And even a shilling is a very serious matter for people with small incomes. When we came to this Amendment the noble and learned Lord the Lord Chancellor said: "I give the same answer." I ask the question whether he based his answer on economy, on abuse, or on pain to the sufferer, because pain to the sufferer was a strong argument used against the cancer Amendment. Then despite what the noble Marquess, Lord Salisbury, had said, the Lord Chancellor said it was purely a question of economy and he did not refer to what the noble Marquess, Lord Salisbury, promised he would consider.
There is one practical suggestion which I should like to make. The Lord Chancellor has based himself squarely on economy. He would not speak from the Treasury Bench and make this statement without having a built-up figure in mind. May we know something about that figure? There is a department which goes into all these things and knows the costs of the different matters; that department knows the cost of dental treatment, of artificial limbs, and all the rest of it. Could we not have, at the Report stage, some considered statement, so that we may know that the chronically sick must pay for their medicines because we want to save £250,000 or whatever it may be? I think that is only fair. Of course the noble and learned Lord may say that every little saving counts—cheeseparing, candle-ends and so on: that is good Gladstonian dictum. But it should be possible to obtain some reasonably accurate figures. I therefore beg the Government to consider producing a break-down of the global figures of economy which this Bill is expected to effect, so that we may know which suggestions of ours would be expensive, and
864
which might be considered at a later stage.
LORD WEBB-JOHNSON: I presume that the noble Viscount who has just sat down was referring to me a few moments ago. The intervention of the noble Earl, Lord Onslow, has, I hope, brought to the notice of the noble Viscount that he has grossly misrepresented what I said.
VISCOUNT STANSGATE: I had no desire at all to do that. I understood that the noble Lord had given us what he called a "crumb of comfort" in that aspect of the matter. I for one was grateful.
THE EARL OF ONSLOW: The noble Viscount always does misrepresent.
LORD SILKIN: I hope that it may be possible for the Government to give the Committee some information in response to the plea which has just been made by the noble Viscount, Lord Stansgate, because we are in a difficulty. The speech of the noble and learned Lord the Lord Chancellor has rather accentuated that difficulty, because he has treated all these Amendments alike. He assumes that they all have equal merits or demerits, and that whatever the position may be about them the Government must reject them all. I would submit that that is not really the position. For instance, the noble Marquess the Leader of the House, in a reply on an earlier Amendment, said it was not true that people were constantly having to get medical attention. Illness among children, he said, was relatively rare, and on the few occasions when children had to get medical treatment it was not a great hardship to pay for their drugs. It is a matter of opinion as to how frequently parents with young children have to resort to the doctor. In this case, it is admitted, by definition, that the chronic sick are constantly receiving medical attention, to relieve pain, to keep them alive or to keep them in some degree of comfort. They are constantly in the hands of the doctor.
The argument that this is an occasional charge, which can be met by going to the Assistance Board, if necessary, is not correct. The majority of the chronic sick are in pain most of the time, and many drugs are given to them for the purpose of alleviating pain. I should have thought

865
this was a case which could be differentiated from the others and not rejected out of hand, particularly if it were found that the cost to the community of making this concession was not very great. If the Government went into the cost of giving this concession, allowing for the fact that a great many of the chronic sick would be entitled to a refund because they are not in a position to work and earn money, might not the noble Lord find that the cost to the community of making this concession would be small and would be justified by the economy in administering refunds to patients? Therefore, I hope that this Amendment will be given more sympathetic consideration than has been given to the others. In the circumstances I have outlined, I hope that this general bar against all Amendments will be lifted, if only to a small extent, and that the Government will be prepared to give further consideration to this Amendment.
LORD WOOLTON: I am glad the noble Lord has made his case in a reasonable speech. He pointed out, that a considerable number of the chronic sick would already be given some form of financial help from the State. The point I tried to make in my first remarks was that where there was financial need, we wanted to meet that need by help from the State. In all the cases to which the noble Lord, Lord Silkin, referred, that need would be met. But there are many other people who have the misfortune to be chronically sick and who are able and willing to pay for medicaments prescribed for them. The issue has been much confused this afternoon by noble Lords opposite. We are not hard-hearted people who do not care for health. Look at our record! Of course, we care for the public health and want to do things to help the public health, but this Bill has been forced on us by the need for economies which we are bound to make. It will save something like £20,000,000. We need quite a few sums of £20,000,000 to get out of our financial difficulties.
Noble Lords opposite are just as anxious as we are to get out of these difficulties, and we are as anxious as they are to help people who are sick and in need. Need we really have these continuous arguments about it? The noble Lords opposite do not like the Bill. Neither do we. We wish the circumstances in which
866
we came into office had not forced this Bill and other unpleasant Bills upon us. Perhaps if the Party opposite had been returned, they would have had to do something similar to this; I do not know. But they would certainly have had to take some drastic and unpleasant actions. I appreciate the sentiments expressed, but we must realise what the Bill is trying to do. We are making provision for the needy, but saying that the rest of the country must pay for their prescriptions. That is why we are resisting these Amendments against very great pressure. We have heard heart-rending cases brought before us, one after another, and all our inclinations are to wish that we could agree and avoid contention. So far as I am concerned, I am fastened on this issue; I have to save £20,000,000; and very disagreeable I find it.
LORD SILKIN: I hope the noble Lord will forgive me if I return to the attack once more. I do not think he has quite met the point I have tried to make. Although I believe that this Amendment has great merits, I was arguing less on the merits than on the question of administration. From practical experience we know that the vast majority of the chronic sick are not in a position to pay and that they will have to come back and make a request for repayment or go without their medicine—which nobody wishes them to do. It is the one comfort they have. It may turn out to be not worth while to make a charge on these people. I am putting it only on the question of administration. Would it not be worth while for the noble Lord to have a look at this point to see whether it is true that the majority of these patients will get their money back? Rather than take the money and give it back, and go through all the paraphernalia of filling up forms and employing people to do it, would it not be better to let by a few cases of those who could afford to pay? We are all out to economise. Might it not turn out to be an actual economy to accept this Amendment? All I ask is that the noble Lord should keep an open mind on the subject and be prepared to look at it, to see whether I am right or wrong. It is largely a question of fact. If I am right, then I shall have made some contribution to national economy. If I am wrong, the noble Lord can still proceed with charging the chronic sick. There-

867
fore, I would ask the noble Lord to keep an open mind, to look at this again and let us know the result on the Report stage.
LORD WOOLTON: I am most anxious that I should not deceive the noble Lord by saying that the people who have advised me—obviously this is not my Department—have not been into this question very thoroughly. The noble Lord has asked me whether I will look at the situation. I hope that I shall never be in a position where I shall refuse when noble Lords opposite ask me to look at something. Of course, I will look into it. But in saying that, I must not be understood to be giving any undertaking beyond the precise meaning of the words. I do not know whether that is agreeable to the noble Lord.
LORD SILKIN: I was asking the noble Lord to look at it and tell us the result on the Report stage.
VISCOUNT HALL: I have no desire to prolong the discussion, and I dislike very much having to deal with each of the points brought forward in the Amendments, because I realise that we are dealing with subjects which must be painful to noble Lords on whatever side of the House they sit. Noble Lords opposite have a difficult task but, if I may say so, I think they are creating some difficulties for themselves. The noble Lord, Lord Woolton, said that the Department advising him have gone carefully into these matters. I should like to repeat the question put by my noble friend Lord Stansgate, to ascertain what would be the actual cost of the concessions, if concessions were given, which are asked for in these Amendments. The cost must be very small.
A great deal of general matter has been discussed upon this particular clause. It must be realised that we are dealing with people who, as a result of sickness or accident, have had their income reduced by something like 50 per cent. The most generous benefit given by the State will not reach much more than, say, £3 10s. or £4 per week. I know men who are sick, who have families dependent upon them and whose average earnings are something like £7, £8 or £9 a week. Immediately there is this serious reduction. It is said that
868
provision is made for a refund of even the 1s. charge upon the prescription. If there is a refund, that at once takes away from the Exchequer part of any savings which might accrue as a result of charging for prescriptions. Then there are other difficulties. Take the chronic sick, or the malignant disease cases. Those people just cannot go to Assistance Board offices to collect the money. As a matter of fact, in my own home it costs more than 1s. in fares to get to and from the office of the Assistance Board.
The noble Marquess the Leader of the House, when we were discussing the third Amendment, suggested that we might take the Amendment now before your Lordships with that Amendment and look at them between now and the Report stage, to see whether there could be any accommodation. May I suggest that we take the other Amendments dealing with cases of this kind, say, up to Amendment No. 12, and carefully consider them to see whether any accommodation can be given in respect of any of them? If not, then we can debate these matters upon the Report stage. If the noble and learned Lord, the Lord Chancellor, is correct in saying that the Government have come to the conclusion that nothing can be done, and that none of these Amendments can be met, that presents a closed door, whatever arguments may be adduced from this side. I think it was wrong for the Government to adopt that attitude; it takes away from Parliament much of the power of persuasion—because persuasion there can be—and it limits the power of noble Lords in charge of the Bill. I would ask the noble Marquess whether it is possible to hold over the other Amendments: the Government will not commit themselves, but it will give an opportunity for a thorough consideration of those Amendments. After all, this Bill has been rather rushed, both on Second Reacting and on the Committee stage. It was only a week ago that the Bill was brought to your Lordships' House and it has been impossible to give it the consideration which a Bill of such consequence deserves. I do not think any of the Amendments moved in Committee this afternoon were discussed in another place, because of the application of the guillotine. If my suggestion could be accepted, it would mean that progress could be made, and it would give

869
an opportunity for discussion to see whether some of the points which we desire could be met.
THE MARQUESS OF SALISBURY: Of course, we are anxious to meet noble Lords opposite, so far as possible. But I must remind the Committee of the purpose and genesis of this Bill. It is purely and simply to make a necessary economy. It is not for the pleasure of reducing the health benefits—nobody wants to do that. It is because, in the situation in which the Government found themselves—I do not expect the Opposition to agree with the measures we have taken, but that is our position—we have to economise in every way possible, and this is one of the methods that we have chosen. Therefore, if it were found that the Amendments which noble Lords suggest meant, in effect, destroying the purpose of the Bill, clearly it would be impossible for the Government to accept them. I feel sure that that will be understood. Moreover, it may well be that there are technical difficulties which would have to be overcome. We talk, broadly speaking, of the chronic sick. I do not know exactly what diseases or what number of patients would be covered by that term—it is a technical term. We have been told by the noble Lord, Lord Silkin, that, in his view, we should almost make money by accepting this Amendment. I find that a little difficult to believe.
LORD SILKIN: I asked the Government to see whether they would.
THE MARQUESS OF SALISBURY: I should be very astonished if that turned out to be the case, much though I should like it. I think I can go as far as to say this. Without giving any undertaking, or, indeed, any encouragement—because, quite frankly, I cannot do that—I feel that we should be justified in transmitting what has been said to-day to my right honourable friend the Minister of Health for his information and consideration before the Report stage. However, I should be willing to suggest that only on the basis that I cannot give any encouragement if what is proposed would destroy in any way the financial purpose for which this Bill has unhappily had to be brought forward.
VISCOUNT STANSGATE: Really we have a great concession! The whole debate is worth while if only to extract from
870
the noble Marquess the undertaking to transmit to the Minister of Health what has been said in this House! I presume that would mean giving him an early copy of the Hansard report of our debate. He said another thing: that these Amendments might well destroy the whole purpose of the Bill. These Amendments do not strike at the wider economies. They deal with cases—and I am sure noble Lords opposite feel the same about them—of real hardship, diabetes, tuberculosis and cancer. I venture to repeat the request. We have been told, especially by the Lord Chancellor in a very "hefty" interjection, that the purpose of this Bill is economy. Lord Woolton said: "I have my mind on the £20,000,000." It has been repeated by the noble Marquess. In view of the fact that this matter has not been discussed in another place, would it be too much to ask the noble Marquess to give us his firm undertaking that the Department which has prepared the Bill and which has supplied him with information about all these promised economies, will supply the same information to this House, so that we may know what is the exact estimate of the economies effected in these particular cases? If that could be done, I think we should be in a better position on the Report stage to decide which of these Amendments might be moved again.
THE MARQUESS OF SALISBURY: The noble Viscount rather ridiculed my statement. Nobody has ever asked a noble Lord opposite to do this. My noble friend cannot give promises affecting another Department; all he can do is to transmit, and we will do that. I said I cannot do any more and I will not do any more. Whether it is possible to give the noble Viscount the accurate break-up of exact figures which would be saved here and there is much more doubtful. But I return to my point. I will transmit what has been said before the Report stage. I cannot do more than that, and I will not do more than that.
EARL JOWITT: I had great experience of this kind of thing for six years. I was in a different position from that of the noble Marquess. Whereas I always knew I had a majority in the House against me, I had every inducement to be ultra-reasonable, and I did not say, "I will transmit"; I used to indicate that I was greatly impressed by the arguments

871
which had been advanced. Of course, I had a very stern task-master in the Minister of Health—whoever it might be—or the Minister concerned. All I could say was that I would see whether I could not operate upon his mind and impress upon him the arguments which noble Lords had advanced in this House, and try to get him to consent. But I must say the noble Marquess does not give us much hope. I think he regards in his own mind that this thing is rather jejune. If it is so in his mind, will it not be much more so in the case of the Minister of Health? Frankly, I do not think that in this way we shall get anywhere. I think we had better continue the discussion of the various Amendments to this Bill. I realise the difficulty of the noble Marquess. Of course, he is the last man in the world to lead us "up the garden path" by saying things he cannot make good. I am not making complaints. I am inclined to think that he has done the best he can. I think we had better proceed with the discussion of the Bill.
LORD STRABOLGI: I think in any case we should have a little more definition of what is going to be put before the Minister of Health. I imagine that, in a discussion of this kind, the proceedings in your Lordships' House are very carefully studied by the experts in the Ministry of Health. I presume, therefore, that the noble Marquess proposes only to underline certain arguments which apparently affect him and the noble Lord, Lord Woolton. They seem to have been touched, shaken and disturbed by some of the arguments coming from these Benches. Having listened to most of them, I am not a bit surprised. I am going to add even one more, and it is this. I have not followed the arguments on this Bill very closely because I have been away, but when I saw the Marshalled List I took it for granted that this particular Amendment would be accepted as rectifying an oversight. I took it for granted that the chronic sick would be given free treatment. Consider the actual position to-day. If we had not had a great war and there had not been a great shortage of labour, materials and money, we should have had many more hospitals and many more hospital beds. We all know that we need at least 500 additional
872
hospitals at the present time. That is an established fact. If we had them, a great many of these people would be in hospitals. It is far better that they should be in hospital than living at home in unsuitable surroundings, with no hope of recovery. Yet, because of the situation in which we find ourselves, these people who should be in hospital are not in hospital. I honestly thought when I looked at these Amendments that they were meeting a real oversight and would be accepted almost automatically by the Government.
I rose to ask for a little clearer definition of what the noble Marquess meant by consulting his right honourable friend the Minister of Health. On which Amendment—the one so far discussed or, as my noble friend suggests, the Amendment No. 12? I think we should know just where we are. I would say, in passing, that the arguments—no doubt, very cogent ones—which will be advanced on the other Amendments, including several that deal with quite different aspects of this whole problem, have not been presented to the House at all. I do not think it is unreasonable to ask for a little clearer definition as to what the noble Marquess means by consulting his right honourable friend the Minister of Health.
VISCOUNT STANSGATE: Do I understand that the noble Marquess has not the information as to what the proposals embodied in these Amendments would cost, or do I understand that he has the information and will not disclose it to the House?
THE EARL OF SELBORNE: Before the Leader of the House replies, may I ask the noble Viscount whether he could tell us how many scores of millions of pounds the Labour Government were out in their estimate of what this scheme was going to cost? My recollection is that they were about £100,000,000 wrong in their estimates.
VISCOUNT STANSGATE: I will look it up and send it to the noble Earl.
THE MARQUESS OF SALISBURY: I have two questions to answer—one from Lord Strabolgi and one from Lord Stansgate. Lord Strabolgi asked what I was going to transmit to my right honourable friend. What I meant to transmit was

873
Amendment No. 7, which we are discussing. With regard to the point raised by Lord Stansgate, the answer is that I have not got the information.
VISCOUNT STANSGATE: How is the total figure made up, if you do not know the elements of the total?
LORD STRABOLGI: This is quite a new situation. Am I to understand that the Leader of the House is to consult the Minister of Health about all these Amendments?
THE MARQUESS OF SALISBURY: I do not think the noble Lord was here in the earlier part of the discussion, otherwise he would know. We have discussed a number Of Amendments covering certain individual diseases. With respect, I may say that it would be impossible to make concessions in regard to these individual diseases. If we were to make a concession on cancer, somebody would at once come along and say: "What about tuberculosis?" If we were to make a concession on tuberculosis, somebody would come along and say: "Why not include a concession on another disease?" Therefore, we made it clear that we should have to resist these individual Amendments; and we did. There was a question of an all-embracing Amendment which seemed to cover the chronic sick. It was on that point that I said I would transmit to my right honourable friend what had been said in the House to-day. I think that covers the questions I was asked, and I feel it is the most that we can do. I do not think the noble Lord was here when I spoke, but I made it clear that I could give no undertaking and wanted to raise no hopes. But as the feeling in the House seemed to be in favour of giving the Minister of Health another opportunity of considering what was said in this place, I felt it right that I should do what noble Lords wished in that respect.
EARL JOWITT: In view of what has been said—I have not much hope, but while there is life there is hope—my noble friend will take this course: he will not withdraw his Amendment, on the other hand, he will not put your Lordships to the trouble of a Division but will allow the Amendment to be negatived, so that there will be an opportunity to transmit the information.
THE MARQUESS OF SALISBURY: The noble Earl will vote on this Amendment?
EARL JOWITT: Not in view of what the noble Marquess has said, if that suits my noble friend.
THE MARQUESS OF SALISBURY: There is just one point which I should make clear to the House. This puts us in a certain difficulty. I am anxious to help the Opposition over this, but I must be frank with them. We all know that if no Amendments are made there will be no Report stage. If we adopted our normal procedure, the last step we should take to-night would be to move that the Report be now received. That would be agreed, and the Report stage would be over. In view of what I have said, I do not want the Government or the Opposition to be put in that position. I understand that it would be possible not to move to-night that the Report be now received, and retain that until the next stage. That would give me time to transmit to my right honourable friend the proceedings in this House. That is the best I can suggest.
There is one matter that I think ought to say to the House. I will be quite frank: if this Bill is to be passed it is important that it should be passed as soon as possible. The whole object of this Bill is to make rather disagreeable but necessary economies; and therefore we wish to get it by a certain date. For our purposes this Bill must have received the Royal Assent by May 23. We will do what we can. I will institute these communications to my right honourable friend as soon as I can, and I have no doubt that the Opposition will co-operate in completing the further stages of the Bill after I or my noble friend Lord Woolton have made the Government statement. That is the best I can suggest, and it is clone with a genuine desire to meet the difficulties of the Opposition and our own difficulties.
EARL JOWITT: I am grateful to the noble Marquess, and I accept that. I may say at once that we have not the slightest intention to attempt any sort of obstruction. It is quite outside the capabilities or the sense of this House. We do not want to do that at all, and we shall certainly be glad to co-operate. On the other hand, let us face this fact. Owing to the operation of the guillotine—

875
and I am not making a Party point at all; it may have been necessary, although I do not know—there are large portions of this Bill which have not been discussed at all. Therefore I feel that this House would be failing in its duty if it did not go through this Bill carefully. I think we ought to go through this Bill and discuss all these matters. I am glad to see that I am receiving the assent of the noble Lord, Lord Woolton. I am grateful for what the noble Marquess has said, and although I have no doubt that we shall not succeed in carrying any of our Amendments, at any rate we shall make our position plain and see where the two Parties in this country stand in this matter. Although economies are certainly necessary, I do not believe that these particular economies are necessary.
THE MARQUESS OF SALISBURY: That is a matter of opinion. I am very grateful to the noble Earl, and I agree that we should have whatever discussion is required. We are not in the least anxious to limit discussion in any way. In reply to what the noble Earl said about the guillotine, I will say only that it was not unprovoked.
VISCOUNT STANSGATE: Since we are discussing the affairs of another place—which I understand is totally out of order—may I say that the guillotine was made necessary merely by the fact that the Government so overcrowded their programme that they were not able to operate the normal procedure of the Standing Committtee?
On Question, Amendment negatived.
7.8 p.m.
LORD KERSHAW LORD KERSHAW moved to add to subsection (2) (a):
"or is a person registered under the Disabled Persons (Employment) Act, 1944, as handicapped by disablement."
The noble Lord said: I have been asked to move the two following Amendments on behalf of my noble friend Lord Crook. The arguments which can be used in connection with the first Amendment are very much the same arguments which have been used in connection with the other Amendments. There may be just this slight difference—that the people who come under this Amendment are largely
876
victims of road accidents and the like. I appeal to noble Lords opposite to treat these matters as matters of State rather than as Party matters. I have come to the conclusion that my appeals have fallen on stony ground, and therefore I do no more than move this Amendment and leave it to the House.
Amendment moved—
Page 1, line 12, after ("hospital") insert the said words.—(Lord Kershaw.)
LORD WOOLTON: I am sorry that the noble Lord finds the ground a little stony on this side. As he anticipated, I cannot accept this Amendment. It would exempt from hospital out-patient charges all registered disabled persons, quite regardless of the degree of their disablement. If they are disabled war pensioners then, of course, they are already provided for. It might be that the disability was only a slight disability. I hope the noble Lord will not press his Amendment.
On Question, Amendment negatived.
LORD KERSHAW LORD KERSHAW moved to add to subsection (2) (a):
"or is receiving or is a dependant of a person receiving compensation under the Workmen's Compensation Acts."
The noble Lord said: On behalf of my noble friend Lord Crook I beg to move this Amendment. I would add to the other arguments that have been advanced only that it is not long since we passed an Act dealing with pneumoconiosis and byssinosis. The people there dealt with are the people who would come under this provision—the only people who could come under it—from the old Workmen's Compensation Acts. I beg to move.
Amendment moved—
Page 1, line 12, after ("hospital") insert the said words.—(Lord Kershaw.)
LORD WOOLTON: I regret that I cannot accept this Amendment. I can only suggest, as I did in the somewhat long speech I made before, that people in this position should get the financial relief they need—if they do need it—from another source.
LORD MACDONALD OF GWAENYSGOR: I should like to say a few words in support of my noble friend Lord Kershaw. There is a slight difference here. The noble Lord, Lord Woolton, referred to the fact that provision has been made for those incapacitated by war service. But here

877
we are dealing with men in the coal industry—by far the larger majority come from that industry—who were not allowed to enlist for active service and whose injuries were sustained in their country's service, though in the coal industry. I am glad that provision has been made for men who suffer their disability through war service, but these men in the coal industry served their country just as well as did the soldier who was incapacitated. These men who were not allowed to enlist should be placed in she same category as the soldier. The number is very small.
On Question, Amendment negatived.
LORD GREENHILL LORD GREENHILL moved, in subsection (2) (b) after "treatment of" to insert "tuberculosis and." The noble Lord said: I am aware that in the course of this afternoon's debate arguments have been raised against dealing with a particular disease under this general heading, but I would ask the noble Lord opposite to bear in mind that, whatever may be the case with such diseases as cancer, we are not dealing now with a disease of that kind. I put this Amendment on the very grounds which the noble Marquess himself emphasised, and that is the grounds of saving further expenditure. I am prompted to do this, first because I come from a place which is described, even in the Report of the Department of Health, as "one of the black spots for tuberculosis." Those are the exact words. The numbers in Scotland affected by respiratory tuberculosis reach the enormous figure of 34,963, according to this same Report. The question of pinpointing the individual who suffers from a particular disease does not arise in the case of tuberculosis, because already local authorities are providing special housing facilities for those suffering from that complaint, and many steps are being taken in favour of those who are known to be suffering from it.
When this matter was being discussed in another place and it was asked why venereal disease was included in the Bill and tuberculosis was not, the answer given, so far as my memory serves, was, first, that venereal disease came under the Brussels Agreement of 1924; and, secondly, that nowadays drugs were obtainable which, taken early enough,
878
cured this disease very rapidly and therefore prevented its spreading. I would ask the noble Lord whether in the event of a drug being obtainable which would similarly provide a speedy remedy for tuberculosis he would be prepared to insert "tuberculosis" in this Bill. Surely the reason which was applicable to venereal disease ought to be applicable to tuberculosis. But there is another reason, and this is an economic reason. The direct cost might, in the opinion of noble Lords opposite, be very great. I am suggesting that if that money were not saved by refusing to include this, you might save very much more in an indirect way by including tuberculosis under this heading, for the reason that, in the case of an infectious disease—and this is an infectious disease, as we all admit—it is not only the one individual who is suffering: it is all those with whom he comes into contact. Therefore, if you give him certain facilities which tend to prevent that spread of infection you are thereby saving a fair amount of money. It seems to me, therefore, that in the long run, by including this man and making no charge in his case you would be saving money.
There is another reason which will appeal to the noble Lord, Lord Woolton, because of his interest in and knowledge of psychology. These suggestions are not being made in respect of those who can afford to go, for instance, to Switzerland to be cured. They are made in favour of those who cannot afford to go abroad for their cure. These people take their prescription week by week, or month by month, and pay their shilling. These are the people whose condition is chronic. This regular process, on purely psychological grounds, must in itself tend to retard the man's recovery The thing is always on a man's mind: another shilling to pay, another prescription to go for, certain drugs to get, certain vessels for sputum and so on, to obtain. You are doing this for what reason? You are doing it merely in order that the country may be saved a little money. Is it not reasonable to say that the amount saved would be greater by preventing this man's anxiety and by preventing the spread of his disease, which tends, to infect others? By so doing we should benefit both the country and the individual at the same time.
LORD OGMORE: I should like to say a word on this proposal, because, like the noble Lord who has just spoken, I come from a part of the country where in the past tuberculosis has been rife and may well become rife again. I remember that, when I was a boy in South Wales, rather more than thirty years ago, there was a big drive by the authorities to try to limit the incidence of this dread disease. It is particularly rife in South Wales, partly because of the nature of the work that the people do, and partly, perhaps, because Welshmen of a certain type seem more likely to contract it, than do many other types of people. There is a narrow-chested type of Welshman who seems to contract tuberculosis easily. Be that as it may, about thirty years ago the authorities decided to have a great drive to reduce tuberculosis in South Wales. That drive had some effect, but even to-day South Wales has one of the greatest percentages of tuberculosis of any district in the whole of the United Kingdom, or, I believe, in Europe.
If I understand correctly the arguments of the Government, they are, first, that venereal disease is a social disease—in other words, if a person contracts venereal disease he is able to transmit that disease to other people, maybe innocent people. Therefore you enable him to have treatment and drugs for nothing, not because you want to benefit him but because you want, if possible, to prevent him from transmitting this disease to somebody else. If that is not the case, then of course, as in many cases of which we know, where it is the man's own fault and the result of moral turpitude that he gets venereal disease, he should be the last person to have free drugs. Why should he have free drugs and the unfortunate person who contracts cancer or tuberculosis have no free drugs? If we are still a moral people with moral reasoning, we should not, as in fact this Bill does, bestow the benefit upon the immoral person, the person who has committed an immoral act, or has been unfortunate in committing an immoral act, when we are not prepared to give any benefit at all to someone who has lived a perfectly good life but who, through misfortune, has contracted a disease such as cancer.
If that is the argument of the Government—and there is something to be said for it—then I would say that, by that
880
same argument, tuberculosis must come under the same rule. In other words, tuberculosis is also a social disease. It is a disease which can be easily transmitted, and if we do not enable a sufferer at the early stage of the disease to get relief or remedy then we are putting a number of people in peril. I would ask Her Majesty's Government to realise that point, and to realise that there is a very serious case here. It is not the same as diabetes and, with respect, it is not the same perhaps as cancer. I understand that we do not quite know how cancer is caused. I myself believe that the Government should give way both on cancer and on diabetes. I believe that sufferers from cancer and diabetes should have relief. But even if, taking the Government's case, we say: "No, those people, however much they may suffer and however poor they may be, cannot have relief," then I would say that tuberculosis comes, not in the category of cancer or of diabetes, but in the same category as the social disease, as venereal disease. I would ask the Government to look at it from that aspect and to realise that they may be "penny wise and pound foolish" over this; that in fact failure to include this Amendment in this Bill may have the result of spreading this frightful disease of tuberculosis which already, both in Scotland and in Wales, takes a heavy toll of the population.
THE EARL OF ONSLOW: I should like it to be known straight away that I have great sympathy with what the mover of the Amendment and the noble Lord, Lord Ogmore, have said on this subject If I may say so, I think that they are speaking from the point of view of the nation rather than of Party. At least, that is the way I looked at it. But I do feel that it would be wiser to leave this disease again to be discussed, as the noble Marquess the Leader of the House has suggested, under the omnibus Amendment originally moved by the noble Earl, Lord Lucan. Before I sit down, I may perhaps say a word or two in answer to what the noble Lord, Lord Ogmore, said on the question of these two social diseases. The noble Lord said that those suffering from venereal disease may be anti-social people, whereas in the case of those suffering from tuberculosis it is through no fault of their own that they have caught the disease. Of course, an

881
important reason for the exemption of those suffering from venereal disease is our commitment under the Brussels Agreement of 1924. A difference between these two diseases is that prompt treatment for venereal disease kills the disease, and quickly stops its transmission through infection, whereas the present drugs and treatment that are prescribed for the tuberculosis patient do not, at least for some time, immunise that person from passing on the infection to others. So in that way there is a difference between the treatment of the two diseases from a social point of view.
There is another point that I might make which I think probably covers some of these other Amendments as well. The noble Lord, Lord Ogmore, mentioned the worry caused to a person who knows that every so often, every week or fortnight, he has got to provide 1s. for his prescription. I do not think it has been brought out this afternoon on either side of the House that, of course, in the case of many of these diseases or illnesses that last for some time, or are even chronic and will go on to the end of the patient's days, doctors will be able, at their discretion, to dispense medicine in quantities which will last for a considerable time. For instance, there are certain illnesses which are kept in check by drugs in tablet form, the tablets lasting for two or three months. I understand that a man could get tablets which would last him for two or three months for the 1s. he pays on one prescription form. I think some of our discussions this afternoon have rather led the House to believe that every week, or every two or three days, a person will go to the doctor and will have to pay 1s. on an amount just for that time. That is not quite so, particularly with these long-drawn-cut illnesses. I hope the noble Lord will not press his Amendment.
EARL JOWITT: That seems to me an extraordinarily bad argument. The whole case is given away on that.
THE EARL OF ONSLOW: I cannot see it at all.
EARL JOWITT: I do not know what the treatment is or what kind of drugs there are. But supposing you could get a year's supply and that the supply would not go bad, is the suggestion that the
882
medical man should give a year's supply for 1s.?
THE EARL OF ONSLOW: Not a year's supply.
LORD WOOLTON: Perhaps the noble Lord has exaggerated the length of time, but I think my friend is replying to the noble Lord, Lord Greenhill, who referred to the psychological effect on a man who had constantly to go and get his prescription and produce his 1s. I do not know whether he thought that the psychological effect was in the production of the 1s. or in having to go frequently to the chemist.
LORD GREENHILL: If I may say so, it is the mere awareness of this atmosphere of the prescription; the 1s., and the drugs and so on.
LORD WOOLTON: Yes, he must have the awareness of the need to take the medicine—that we cannot get away from. What my noble friend was saying was that the medical attendant, whether he be in hospital or whether he be a private doctor, is at liberty to give in his prescription something that will last over a considerable period, so that the man will not have to go once a week or once a fortnight to get the prescription. I think that was all that he was trying to convey to the House.
EARL JOWITT: But how is this going to work out? Has it teen thought out at all? Let us assume that the drug is something which is not deteriorating in point of time. There would be different considerations. Could the man give a couple of years' supply for 1s.? Are you going to have regulations about this?
LORD WOOLTON: I think from the regulations and from the medical man's knowledge, quite obviously it would be foolish to give a year' supply; it would not be foolish to give three months' supply. I hope that that answers the point that the noble Lord, Lord Greenhill, made.
THE EARL OF ONSLOW: It is happening already under the present system. It is recognised as the economical and sensible way of dispensing in certain cases. Doctors are already giving a fairly long period of supply of certain medicines.
EARL JOWITT: Are they giving a year's supply?
THE EARL OF ONSLOW: I would not say a year—in fact I know that this is not done because I asked that question myself. I do not think there is any medicine yet which is known to last for a year.
LORD KERSHAW: Does not the noble Earl know that this habit on the part of some doctors of giving medicaments and the like to cover a long period has been frowned upon by the Ministry, and that we in the hospitals have already urged the doctors to give a much smaller supply, because clearly so much of it was wasted? Again, economy has been used as a reason for this Bill, but it looks to me as though you are going to lose far more by giving larger quantities of medicine at a time than you are going to save by the charge for the prescription.
THE LORD CHANCELLOR: Is it not really a question of degree? The argument on this side was addressed to the suggestion made on the other side, that it was a matter of paying 1s. a week, and that sort of thing. Really it is nothing of the kind. The doctors, in their discretion (which of course must not be exercised too generously), can give a supply which will last a substantial time. I am sure the noble Lord, Lord Kershaw, would not suggest that the doctor should never prescribe an amount which would last for more than a week. It is a question of degree.
LORD KERSHAW: With all respect, I was saying that the policy of the Ministry which had filtered down through the hospitals with which I am connected, recommended that supplies of medicine should be smaller than had been given.
THE LORD CHANCELLOR: No doubt it has been abused in the past but, on the other hand, it is a gross exaggeration to suggest, as I think was implied in some speeches that I have heard to-day, that the patient will have to go to a doctor once a week to get 1s. worth of medicine. Doctors must use their discretion properly, and if there has been abuse, then the Ministry has been quite right in giving them directions which have filtered clown through the hospitals with which the noble Lord is connected. It is a matter of degree.
EARL JOWITT: Wherever you give discretion, you run the risk of an indiscretion. I understand that the doctors are to be given a free hand to use their discretion, and for some reason which is inscrutable to me, whereas three months is perfectly all right, one year is too long. Whose edict is this? Is this the edict of the noble Lord, Lord Woolton, or that of the Minister of Health?
THE EARL OF ONSLOW: It has been going on.
EARL JOWITT: The noble Earl says it has been going on; but, as I understand it, the present tendency is that the Minister of Health has been using all his persuasion in trying to get shorter periods by limiting the amount of drugs given at any one time, which seems to me to be wise. In the so-called interests of economy you are leaving it to the discretion of the doctors greatly to extend the time. Apart from that, do let us consider this Amendment. This measure is supposed to be in the interests of economy. I put this to the Committee, and we have got to face up to it: is it really necessary to say to an unhappy person who has tuberculosis that he must pay for these things? Do you want tuberculosis cured? Obviously, yes. You want it cured because, first of all, you have ordinary, decent, Christian, humanitarian feelings; and secondly, because it is a disease that spreads. Therefore, in the social interest it is immensely important to try to stop it, to cure it, to eradicate it if you can. That is common ground between us. Then do you believe that these drugs are useful to stop or to control tuberculosis? Obviously you do, otherwise you would not have them. Then, if you want to stop tuberculosis and you believe that these drugs are one way in which to do it, is it a sensible thing, on the ground of economy, to make it a little more difficult for a man to get the drugs which are going to cure the disease? I do not see the logic of it at all. People do not go as a matter of fun to get drugs to cure or try to keep in check tuberculosis. There has never been any abuse in relation to this matter. No one has ever gone and asked for too many drugs for tuberculosis.
Is it really the fact that the Tory Government say that because this country is in difficulties (and we all know it is), because we have got to do unpleasant

885
things, which any Government would have to do, then we must do this particularly unpleasant thing? Are you really saying to the country, "It is necessary for us in our troubles of to-day to make it more difficult for patients suffering from tuberculosis to go and get their drugs"? What in the name of reason is the sense in that? It means to say that you are taking a step—a small step it may be, but still a step—not in the interests of stopping the incidence of this dreadful disease, but in the interests of making it a little more difficult for people to cure this disease, by making them pay a little more money for the remedy. Do you think that that is an economy? From the economic point of view, let alone the time point of view, I suggest that the fact that the disease exists is a great disadvantage to this country. If this disease could be cured we should save ourselves thousands of millions of pounds. What in the name of economy is the sense of saying, "In future the patient who is suffering from tuberculosis must pay for his drugs"? In that way, he will be rather more reluctant to go and get them and get cured. I know perfectly well that if this Amendment goes to a Division we shall be beaten. But I venture to say that there are many noble Lords opposite who, if they could be free to vote as they liked, would say, "This country may be hard up, but we are not going to put a special handicap on those who already suffer the great handicap of tuberculosis."
LORD WOOLTON: No one would have thought, listening to the noble Earl, that he was talking of logic. It is a long time since I learned any, but I believe there was a fallacy called the Fallacy of the Undistributed Middle, and I cannot help feeling that the noble Earl suffers from it. We are not trying to prevent people from being cured of tuberculosis, as the noble Earl knows perfectly well. What we have said is that we want people to go and get all the treatment they need. If they are able to afford to pay for it, they should pay for it. If they cannot afford to pay for it, then the resources of the State are available for them. I do not know whether these are curative drugs or not—it is beyond my knowledge. We are not trying to prevent people from getting these drugs. if they are the drugs that the people with tuberculosis need. Let
886
us face up to the financial situation. What you are suggesting is that if people go into hospital, then they have treatment free there; if they go to their own doctors, they must pay for it. That is not a position that we are prepared to accept. I am sorry. If the noble Lord feels that he must divide the House on the matter, then he must. I cannot do anything more.
LORD SALTOUN: I have known a good many people with tuberculosis and have worked beside them in offices. Some of them have been very poor people, but I think it is an absurdity to suggest that to pay 1s. for their medicine is to put an obstacle in the way of their cure. I am perfectly certain that all those with whom I have worked will agree with me in saying that. It so happens that for some time past I have been attending a doctor and he has prescribed various medicines for my condition. He has given me three prescriptions which would have meant a charge of 3s. for amounts of medicines sufficient to cover the period necessary for me to take the medicine. That has already been mentioned here to-day, but I thought the Committee might as well know what is actually happening "on the ground," as it were.
LORD OGMORE: The noble Earl touched on the point that I made, and the point to which, by inference, the noble Lord, Lord Greenhill, made reference, but unfortunately the noble Lord, Lord Woolton, did not touch upon it at all. My point is quite simple. The Government say, in effect, "Because venereal disease is a social disease, and with social implications, then we will give this treatment and any drugs free." That is a perfectly sensible argument, so far as it goes. My point, which the noble Earl appreciated, is that tuberculosis also is a social disease and, from that point of view, should be treated in exactly the same way as a venereal disease. If you do not treat it in that way, you are in fact benefiting the man who possibly has been immoral, and you are penalising the unfortunate man who has perhaps worked in the collieries in South Wales, where the disease is very common, and has contracted this disease—an honourable, honest man. That, surely, is lunatic logic. That is the point which I made. The noble Earl understood it but the noble Lord, Lord Woolton, did not. Nor did the noble Lord, Lord Saltoun, who is

887
very good op these points as a rule. I am surprised to see him to-day not on the side of the angels. Usually he will support a matter to this kind even against his own Government. The noble Lord, Lord Saltoun, says: "It is only 1s. I have bad three prescriptions and they cost me 3s. That is nothing." The point is that to many of these people—
A NOBLE LORD: Three shillings is the price of a packet of cigarettes.
LORD OGMORE: A packet of cigarettes for whom? Believe me, a person suffering from tuberculosis cannot afford to buy cigarettes nor can he afford 3s. The point is that there is a repeated charge of 1s. a time. Lord Saltoun says that a shilling does not matter. Nor does 3s. matter. Nor, apparently, does 20s. matter. But it does matter to a person suffering from a dire disease and who may be in very poor circumstances. The other argument advanced was that they can go to the Poor Law—
LORD WOOLTON: We do not call it the Poor Law now. In this new, refined State we call it the National Assistance Board.
LORD OGMORE: I stand corrected. They can go to the National Assistance Board and get National Assistance from the National Exchequer. But there are many people who hate going to the National Assistance Board, even in these days of the Welfare State, when the money comes from the National Exchequer and not from the board of guardians. There are many people, elderly men and women who have lived decent, honourable lives, who would rather die than ask for National Assistance. The noble Lord probably thinks that is not an argument which I should bring forward, that that attitude of mind shows that such people should not be considered in your Lordships' House.
LORD WOOLTON: I did not say so.
LORD OGMORE: That attitude of mind is entirely irrational but people are irrational, as the Committee knows. The noble Lord, Lord Woolton, is no doubt aware from his experience in the Manchester district, and I know from my own experience in South Wales, that there are many people, even among the working classes, who do hold that view. There are many very decent, honourable
888
people who would not go and get this money from Public Assistance. What they would do would be to stint themselves of food in order to pay for the drugs, so that in fact, instead of people being cured by the power of these drugs, the effect of lack of food might well be to make them so debilitated that in the end they would probably die not of tuberculosis but of anæmia. That is the case I am putting. And I am not putting it from a Party point of view. I regard this matter from the national point of view.
The last argument put by the other side is the financial one. The noble Lord has said that the country is in a very serious financial position. We know that only too well. These matters are being included in a Bill, it is said, because they are matters upon which it is felt the country can economise. I am pointing out to the noble Lord that, so far from economising, if this is enforced it may well cost the nation vast sums of money. It is a false method of economy to economise in preventive medicine as against curative medicine. I would say that the same holds good for curative medicine, but for the moment we are discussing preventive medicine. To economise as regards preventive medicine I would submit is—using the term in its medical sense—most reactionary. So I ask the Government to look at this again and reconsider it, for I believe that they are making a great mistake.
The noble and gallant Earl the Minister of Defence has had great experience in this connection. He knows of the vast scale on which preventive medicine is used in the Forces—a scale on which it is never used in civil life. I am sure that in his heart of hearts he agrees with the view that to cut down preventive medicine, whether in the case of venereal disease, tuberculosis or any of these other killing diseases, is really to commit a great error. Would he, when he commanded in the Mediterranean during the war, ever have allowed any of his medical officers in any way to cut down the supply of drugs, equipment or anything else of a preventive character when there were people about who suffered from tuberculosis? The first thing he would have said, I am sure, would have been: "You must never do a thing like that, because of the danger of others contracting the disease from the sufferer. You must never do anything

889
of that kind." I am sure that the noble Earl would have been among the first Commanders to take that view. I ask the Government to take the same point of view, otherwise they may be leading us into very difficult and deep waters indeed.
LORD GREENHILL: I had not meant to continue this debate, but there is one point which strikes me particularly and on which I should like to reinforce what Lord Ogmore has said. I hope the Committee will forgive my intervention, and that the writer of this letter which I am about to quote will also forgive me. With your Lordships' permission I should like to quote just a couple of sentences from the letter of one who, it happens, is not only a medical officer of health but also a specialist in tuberculosis. He writes:
"It also frequently happens that a patient suffering from tuberculosis has more than one child attending the dispensary for observation or treatment. The child is obviously at risk, especially in the small homes so common in this city. It does not seem logical to spend money on B.C.G. vaccination and yet possibly withhold these medical extras which help so materially to build up the child's resistance to infection."
That, I suggest, most effectively supports the noble Lord's argument that if the State, in such circumstances, helped
the sufferer by giving him relief the State in the long run would benefit.
LORD SALTOUN: I rise again only because the noble Lord, Lord Ogmore, has pressed me on one point. I intervened earlier only because I was indignant at the suggestion that this charge of 1s. would tend to prevent the cure of cases of tuberculosis. I know well that the real trouble which the tuberculosis subject experiences is the difficulty of getting a job because people do not like working alongside him. That is the real difficulty from which he suffers. The 1s. charge is neither here nor there, and that charge is not going to prevent a cure.
LORD HAWKE: No one has yet mentioned in these debates that a vital part of the treatment of tuberculosis is extra food for the sufferer—eggs, milk and so on. That is expensive food which the patient has to have. To suggest that the charge of 1s. for three weeks is going to tip the scale and force a man on to the National Assistance Board, to which he would not have gone before, is to my mind a reductio ad absurdum.
On Question, Whether the proposed new words shall be there inserted?
Their Lordships divided: Contents, 21; Not-Contents, 61.

CONTENTS

Jowitt, E.

Chorley, L.

Macpherson of Drumochter, L.

Greenhill, L.

Milner of Leeds, L.

Hall, V.

Hare, L. (E. Listowel.)

Nathan, L.

Stansgate, V.

Henderson, L.

Ogmore, L.

Kenswood, L.

Pakenham, L.

Archibald. L.

Kershaw, L.

Shepherd, L.

Bingham, L. (E. Lucan.)

Lucas of Chilworth, L.

Strabolgi, L. [Teller.]

Burden, L. [Teller.]

Macdonald of Gwaenysgor, L.

NOT-CONTENTS

Simonds, L. (L. Chancellor.)

Hudson, V.

Hampton, L.

Margesson, V.

Hawke, L.

Woolton, L. (L. President.)

Monsell, V.

Hindlip, L.

Swinton, V.

Kinnaird, L.

Cholmondeley, M.

Leathers, L.

Salisbury, M.

Aberdare, L.

Llewellin, L.

Ailwyn, L.

Lloyd, L.

Albemarle, E.

Aldenham, L.

Merthyr, L.

Alexander of Tunis, E.

Amherst of Hackney, L.

Monk Bretton, L.

Buckinghamshire, E.

Audley, L.

Palmer, L.

Dundonald, E.

Blackford, L.

Remnant, L.

Fortescue, E. [Teller.]

Brand, L.

Rochdale, L.

Howe, E.

Brassey of Apethorpe, L.

Rockley, L.

Lindsay, E.

Cherwell, L.

Saltoun, L.

Onslow, E. [Teller.]

Clanwilliam, L.(E. Clanwilliam.)

Sandford, L.

Scarbrough, E.

Cranworth, L.

Sandhurst, L.

Selkirk, E.

De L'Isle and Dudley, L.

Selsdon, L.

Shaftesbury, E.

Dorchester, L.

Teviot, L.

Yarborough, E.

Ennisdale, L.

Teynham, L.

Fairfax of Cameron, L.

Waleran, L.

Davidson, V.

Gage, L. (V. Gage.)

Webb-Johnson, L.

Furness, V.

Gifford, L.

Wolverton, L.

Resolved in the negative, and Amendment disagreed to accordingly.
LORD BURDEN LORD BURDEN moved, in subsection (2) (b), after "treatment of" to insert "diabetes and". The noble Lord said: May I congratulate the three noble Lords who are now occupying the Government Front Bench, and sympathise with the other noble Lords who are now going to get some refreshment? I hope it will satisfy their souls. I am sure the Amendment which I am submitting will be steam-rollered in the same way as previous Amendments have been. The Government have their serried ranks.
LORD HAWKE: Where are your serried ranks?
LORD BURDEN: Obviously, we have not the same numbers as the Party opposite. With due respect to the "Overlord," Lord Woolton, it would have been gracious and helpful if some consideration had been given to the arguments which have been advanced from this side of the House. I am sure that if there had been any Party approach to this matter, particularly by myself, the noble Earl would have been ready to call attention to it. As he said in his last contribution to the debate, this has not been approached by us in a Party sense. I have not a long experience of your Lordships' House, but I am sure that when the Government were on this side of the House, in spite of the fact that we had overwhelming strength in numbers in another place, we made every effort to meet some of the points which were put forward by the Opposition of those days. There has not been a single attempt to meet us in any way. But there it is. In this Amendment I am asking for consideration to be given to diabetic cases. Surely the argument of the noble Lord, Lord Woolton, cannot apply in this particular instance.
LORD WOOLTON: Which argument?
LORD BURDEN: The argument that doctors can prescribe in sufficient quantities for a supply of insulin. As everybody knows, so far as the diabetic is concerned, insulin is necessary to maintain anything in the nature of a working stamina and strength for him to continue his daily avocation. I am advised that it would be dangerous for more than what
892
is regarded as a normal dose to be prescribed by any doctor. It is a regular, continuing treatment, and they must have it throughout their lives. I do not suppose the greatness of our Empire will depend on the diabetic making his contribution, but that does not prevent me from moving this Amendment and endeavouring to commend it to the favourable consideration of the noble Lord opposite. I beg to move.
Amendment moved—
Page 1, line 13, after ("of") insert ("diabetes and").—(Lord Burden.)
THE EARL OF ONSLOW: This is another class of persons suffering from a serious disease. The noble Marquess, the Leader of the House, stated in regard to the omnibus Amendment that he would see what could be done, although he did not hold out much hope. Therefore, it would be ridiculous for me to accept this Amendment, if all the others are to be looked at separately. But I would tell the noble Lord that this is one of the cases where the doctor may, and often does, give a large amount of insulin to last a long time. I am sorry that the noble Earl, Lord Jowitt, is not here and I cannot say it to him. I am quite unashamed about that. He did not seem to get the point of the story at all. This method has been going on all the time, and it is accepted. It is where doctors have issued unimportant drugs and medicines from sheer idleness that there is wastage—where people are more or less making up their family medicine chest free. But where a responsible doctor is treating a particular case of a chronic disease, it is recognised by the Ministry and by the profession that it is often more economical to give a man a large supply which will last him for some time; and it diminishes the number of shillings he is asked to pay. With those few remarks, I am afraid I cannot accept this Amendment.
VISCOUNT STANSGATE: The noble Earl spoke about the undertakings given by the noble Marquess the Leader of the House. I wonder whether he could enlarge on that a little.
THE EARL OF ONSLOW: The noble Viscount heard it said, but if he did not understand it I think he had better wait until to-morrow and read it in Hansard. It was perfectly plain.
VISCOUNT STANSGATE: To-morrow will be too late, and it never comes; we are going to finish to-night. The noble Earl, as a member of the Government, receives with gratitude and deference everything that comes from the noble Marquess. But we on this side of the House are in the position of an Opposition. I could not gather what the noble Earl says from anything the noble Marquess said, and he is certainly the most charming Leader of any House I have known
THE MARQUESS OF SALISBURY: I think perhaps that I had better tell the noble Viscount. I shall probably tell it to him on every single Amendment to this Bill. As a very old Parliamentarian it is clear that his object is to try and make the noble Earl, Lord Onslow, say something different from what I said, and more far-reaching. What I said on this omnibus Amendment was that I would transmit everything that had been said by the noble Viscount and other noble Lords to my right honourable friend the Minister of Health for his consideration. The noble and learned Earl, Lord Jowitt, who leads the noble Viscount's Party, was perfectly satisfied with that statement, and it is only the noble Viscount who still remains agonised and doubtful.
VISCOUNT STANSGATE: I must follow what the noble Marquess says. First, he says that I am anxious to make trouble between himself and the noble Earl, Lord Onslow. He is practically charging me with being a co-ordinator.
THE MARQUESS OF SALISBURY: I would never do that.
VISCOUNT STANSGATE: He goes on to say that he will transmit what was said to the parties in the other place. That they can find out for themselves by reading Hansard. I could not understand the trusting simplicity of the noble Earl, Lord Onslow, who said that inasmuch as the noble Marquess said on a
previous Amendment that these matters would be considered, why debate the Amendment?
THE MARQUESS OF SALISBURY: That is something that I am constantly wondering—why noble Lords on the Benches opposite continue to debate all these Amendments, in view of the assurance which I have already given. It is they who are raising these debates, not we.
VISCOUNT STANSGATE: This is also called a debating Chamber at times. I imagine that, as a revising Chamber, it is our job. Now we see the whole Government design. First, we have a most obnoxious Bill. I am sure it is hateful to them to have to bring in this Bill. It is a revelation of niggardly behaviour which no one would like making. In the other place they get over it by having a guillotine. But when we come down here, no Amendments are to be accepted, with the effect, as the noble Marquess generously pointed out to us, that we do not get a Report stage. I suppose we get a Third Reading but I do not know what the Government will do about that. The fact is that each of these cases is showing clearly the meanness and wretchedness of this Bill. The Government must know how many diabetics there are; and they must know whether the economy is £5,000, £10,000, or what it is. But they will not tell us. The result is that people in the country are considering this a very bad Bill, because it strikes at people who cannot defend themselves. So far from desiring to hide these things, I think it is the duty of the Opposition to publish them, courteously but firmly, to the House and to the country, so that they may know just what legislation is being passed.
On Question, Whether the said words shall be there inserted?
Their Lordships divided: Contents, 22; Not-Contents, 62.

CONTENTS

Jowitt, E.

Chorley, L.

Macdonald of Gwaenysgor, L.

Greenhill, L.

Macpherson of Drumochter, L.

Hall, V.

Hare, L. (E. Listowel.)

Milner of Leeds, L.

Stansgate, V.

Henderson, L.

Nathan, L.

Kenswood. L.

Ogmore, L.

Archibald, L.

Kershaw, L.

Pakenham, L.

Bingham, L. (E. Lucan.) [Teller.]

Lawson, L.

Shepherd, L.

Lucas of Chilworth, L.

Strabolgi, L.

Burden, L. [Teller.]

NOT-CONTENTS

Simonds, L. (L. Chancellor.)

Hudson, V.

Hawke, L.

Margesson, V.

Hindlip, L.

Woolton, L. (L. President.)

Monsell, V.

Kinnaird, L.

Swinton, V.

Leathers, L.

Cholmondeley, M.

Llewellin, L.

Salisbury, M.

Aberdare, L.

Lloyd, L.

Ailwyn, L.

Merthyr, L.

Albemarle, E.

Aldenham, L.

Monk Bretton, L.

Alexander of Tunis, E.

Amherst of Hackney, L.

Palmer, L.

Buckinghamshire, E.

Audley, L.

Remnant, L.

Dundonald, E.

Blackford, L.

Rochdale, L.

Fortescue, E. [Teller.]

Brand, L.

Rockley, L.

Howe, E.

Brassey of Apethorpe, L.

Saltoun, L.

Lindsay, E.

Cherwell, L.

Sandford, L.

Onslow, E. [Teller.]

Clanwilliam, L. (E. Clanwilliam)

Sandhurst, L.

Scarbrough, E.

Cranworth, L.

Selsdon, L.

Selkirk, E.

De L'IsIe and Dudley, L.

Teviot, L.

Shaftesbury, E.

Dorchester, L.

Teynham, L.

Yarborough, E.

Fairfax of Cameron, L.

Tweedsmuir, L.

Gage, L. (V. Gage.)

Waleran, L.

Buckmaster, V.

Gifford, L.

Webb-Johnson, L.

Davidson, V.

Hampton, L.

Wolverton, L.

Furness, V.

Resolved in the negative, and Amendment disagreed to accordingly.

THE EARL OF LISTOWEL THE EARL OF LISTOWEL moved, in subsection (2) after paragraph (d) to insert:
"( ) the supply of any drug medicine or appliance (not being an article of a kind for which a local health authority has, at the time when the article is supplied, a power to make and recover a charge under section twenty-two of the principal Act) to a woman who is an expectant mother or who has borne a child within the previous twelve months;"
The noble Earl said: I note that this is the thirteenth Amendment, I and venture to hope that that may be a lucky number for this side of the House. I think I am raising a new point, against which the arguments of the noble Lords opposite have not yet been deployed. I hope I may receive their consideration both on the policy issue of this Amendment and on the issue of administration. The policy point is this. My Amendment is to exempt expectant and nursing mothers from the new charges for appliances and prescriptions for drugs imposed by Clause 1—charges they will have to pay if the Bill passes into law in its present form, if they are treated as out-patients and sent to obtain their prescriptions from a chemist. I think it is generally recognised that expectant and nursing mothers are a special class of persons. It is recognised that their health is the responsibility of the community and not merely a private responsibility. It is for that reason that special provision out of public funds is made for those people in many different ways.
I draw your Lordships' attention to the fact that the recognition of expectant and nursing mothers as a special class is already embodied in this Bill. Your Lordships will observe that these persons are exempted from the charges that will be made for dental treatment under Clause 2 of the Bill. All I am asking is for the noble Lords opposite to pursue the logic of the Bill and to extend this exemption from dental treatment to charges that will be made for drugs, medicines and appliances under Clause 1 of the Bill. This is extremely important from the point of view of public health. There is no doubt that these charges will be a discouragement to many of the women concerned to take the necessary measures for their health and the health of the child that they will have. For that reason, if these charges are made, it could hardly be regarded as an economy in the medical sense, or as socially desirable.
There is another point of administration which I want to raise. I think I am introducing something of a novelty in this debate, if it is possible so to do, after six hours of the most continuous discussion; but it is the first time a matter of pure administration has been raised. I think it is extremely desirable—and I am sure noble Lords opposite will agree—that such points should be raised, because no mention of them was made when this Bill was discussed in another place. There was little enough time, on account of the closure procedure, for the matter of policy to be discussed, but

897
there was no time at all for matters of administration to be discussed. I am sure that, whether we like or dislike the Bill, we are anxious that there shall be no inconsistency or muddle which can possibly be avoided. If the Bill goes through as it stands, there will be one very curious anomaly. My attention was drawn to it by the London County Council which, of course, is the largest local health authority in the country. They are very concerned about it, and I hope noble Lords opposite will consider it extremely carefully.
May I give your Lordships an example of what will happen, under the Bill as it now stands? A woman who is expecting a child goes to a maternity centre of a local authority. There she will get her vitamins, cod liver oil, fruit juice or whatever may be required, entirely free of charge. I understand that the London County Council is only one of many local authorities who are in the habit of providing these things for the women who take advantage of these health centres. On the other hand, if this same woman goes to a hospital or ante-natal or postnatal clinic provided by the hospital, and she is told that she needs this, that or the other to help her, and is given a prescription and goes to a chemist, under this Bill she has to pay the full amount of the charge. It is surely very undesirable that a woman who has to go to a hospital, perhaps through some abnormality which a specialist has to examine, and is then sent out with a prescription to get what site needs, should have to pay the charge, whereas another woman who is in perfectly normal health and can get exactly what she needs from a local authority clinic will get what she needs without having to pay for it.
That is a matter of administration, and the Government might say: "Perhaps we can improve on this by making the authority charge for the things which they now supply free of charge." I very much hope that noble Lords opposite do not suggest that, although it would be one way of overcoming this difficulty and bringing both types of case into line. I am very glad to see that the noble Lord indicates that he will not take that line. I have been told by the London County Council health officers that it would be a very great handicap to them in their work if this charge had to be made by the local clinics.
The only other logical way I can see out of this difficulty—perhaps the noble Lord will suggest some other way—is to enable women who go to the hospital or the clinics provided by the hospital to get the same sort of drugs, medicines, or whatever it may be, free of charge. That seems to be the other way of doing it. The position is quite understandable because local health authorities are not included under the hospital and specialist services under the principal Act. If your Lordships look at Clause 1, you will see that it refers to services under the Act
"as part of the hospital and specialist services under Part II of the principal Act.…"
That is why local authorities are excluded and make these charges. Both on the grounds of giving the same treatment to mothers when they need medicines as when they need dental treatment, and on the ground of administrative logic, I hope that this Amendment will be carefully examined. I beg to move.
Amendment moved—
Page 2, line 2, at end, insert the said new paragraph.—(The Earl of Listowel.)
8.26 p.m.
LORD WOOLTON: I am sorry that I cannot help the noble Earl here, but with great respect to him I think he is suffering from a fundamental error in his argument. Having a baby is not a disease. It may be unpleasant, but that is a subject on which we are not very competent to form any judgment. But when it comes to the issue of preventive medicine, then we say that there are certain things which may follow from the period of pregnancy, particularly regarding the teeth, where it is most important for the maintenance of the health of the mother that attention should be given to them. Therefore we say that that shall be free. Similarly, but not in this Bill, the State says that it is very important that during this period a mother should have certain foods provided for her. It is one of the prides of my life that I was able to do that when I was Minister of Food during the war. I think it was a very good thing to do, and I can assure the noble Earl that I should very greatly regret it if any part of that welfare work were taken away. I am entirely with him in this respect. But that is not the argument. The argument the noble Earl puts

899
before us is this: that if a woman who is pregnant is ill from some other cause, then she should be treated as a separate class, different from the rest of the community.
THE EARL OF LISTOWEL: No. I am quite certain the noble Lord does not wish to misrepresent me, but this is not concerned with a woman who is ill, but with a woman who is simply suffering from the ordinary consequences of having conceived a child. That is the sort of case I had in mind. Her treatment will differ entirely according to whether she avails herself of the welfare service of the local authority or the services provided by a hospital which may, of course, include a midwife.
LORD WOOLTON: I am afraid that I had not quite understood. From what disease is this lady suffering? If she is suffering from any of the ordinary diseases or illnesses—let us use a more pleasant word than diseases—then, if she goes to a hospital and is treated as an out-patient, she pays for her prescription in precisely the same way as if she did not go to a hospital but called in a family doctor. Why should there be a difference between the two cases because a woman has had a baby—
THE EARL OF LISTOWEL: I am quite sure the noble Lord does not wish to misrepresent me, but there is a genuine misunderstanding here. Take, for example, an ante-natal clinic provided by the hospital. If a woman goes there because she is going to have a child and the doctor says: "You need cod liver oil," and she goes to the chemist to get it, she then pays a charge on that prescription. But if she goes to the nearest clinic or health centre she will get the cod liver oil free of charge. That is an anomaly which I am sure the noble Lord will think quite ridiculous.
LORD WOOLTON: I do not see what I can do about it.
THE EARL OF LISTOWEL: Will the noble Lord look into it? That is all I am asking.
LORD WOOLTON: The woman is suffering a disadvantage even on the arguments from the other side. There is provision made by the State for her
900
to get the medicine free. I take it that the question is whether she could get it under this Bill free or under the local authorities free. I do not mind as long as she gets the medicine.
THE EARL OF LISTOWEL: Of course, I want her to get it free. But if she goes to an ante-natal clinic run by a hospital, she will not get the same stuff free. It depends on where she is living. Not all local authorities are able to produce these supplies or provide them in the neighbourhood in which the woman lives. What I am asking is that, if the noble Lord has not had his attention drawn to the point, he will examine it and let me have his view on the next stage.
LORD WOOLTON: I did not get the noble Earl's Amendments until late. Probably the noble Earl knows that they came in late—a whole number of them. I am not blaming the noble Earl; I am just stating a fact. I will most certainly look at the point. But in saying that I must not be misunderstood: I am not entering into any commitments.
VISCOUNT STANSGATE: The noble Earl has asked the noble Lord to look into the matter. He thinks that this means a great deal. I have listened a good deal this afternoon to talk about "looking into it" but, so far as I can see, it means nothing at all.
LORD WOOLTON: It might mean something. The noble Viscount must not make this a debating point. If I say I will look into it, why should he say that he thinks it means nothing at all? Suppose I looked at a thing and became convinced that what the noble Earl said was right, does the noble Viscount mean to tell me that I would not say so? Of course it means something: it means precisely what it says—and that is a great advantage in words.
VISCOUNT STANSGATE: I am greatly stirred by the manly way in which the noble Lord has replied. But I have also heard the noble Marquess the Leader of the House say we were not going to have a Report stage. How could there be an Amendment?
LORD WOOLTON: Would the noble Viscount rather that I said I would not look into it?
VISCOUNT STANSGATE: Not at all. I am delighted at the noble Lord's charm and willingness, but it does not amount to anything. We have been told that things will be looked into, but we have also been told that we are not going to have a Report stage; so no amount of "looking into" things will mean an Amendment
LORD WOOLTON: I am wondering whether the noble Viscount might address himself to the noble Earl, Lord Listowel, because it was the noble Earl who asked me to look into it.
VISCOUNT STANSGATE: When the noble Earl asked the noble Lord to look into it, he thought that some Amendment might be made. But what are the Government going to do? We know that this Bill is going to be passed into law. In order to exercise the noble Lord's powers of "looking into it," I suggest he publishes information about what the birth rate is in this country. Could he make a rough calculation and tell us what would be the cost of the concessions which the noble Earl has suggested? If he would do that, that would not commit him to any Amendment or to any divergence from Government policy, but it would be gratifying to certain people.
LORD WOOLTON: No, I will not.
VISCOUNT STANSGATE: This is amazing. Here is a Minister in charge of a Health Bill imposing charges on expectant mothers and he says that he will not—
LORD WOOLTON: The noble Viscount is making a debating point. He knows perfectly well that I cannot get the detailed cost of this hypothetical concession. He knows that that is true. He asks me at half-past eight in the evening to find out these figures and give them to the House later in the debate. He knows perfectly well that it is impossible for anybody to give that sort of information or to get it at this hour.
VISCOUNT STANSGATE: There is nothing criminal about the clock. This is a revising Chamber. I am asking whether, on the basis of the birth rate, which is a well-known figure, and of the charges on prescriptions, which are set out in the Government policy, though not in the Bill, he will make a calculation and tell us what this concession is likely to
902
cost. But the noble Lord was very straightforward. He says he will not do it at all. I asked the noble Marquess the Leader of the House this afternoon about malignant diseases, and he declined to tell me. The inference is that the Government could find out, but the noble Lord has said that they will not.
LORD WOOLTON: The noble Viscount has no right to misinterpret me in that way. He asked me if I could get him certain information and I said that I could not, because I knew I should not be able to get the information to-night.
VISCOUNT STANSGATE: Well, will the noble Lord give a date on which he can tell us? Can he tell us what the amount of the saving will be? Once we can get that we can break down the more harrowing phases of the Bill—which seems a thoroughly bad Bill. I have asked a simple question: "How many people are born in this country every year?"; and because it is half-past eight, he says he cannot tell us. What would the cost of the concession asked for in the Amendment be? The noble Lord cannot tell us, and we must draw our own inferences. There is not a soul behind who will give us any information. It is for the public to decide. All this is being written down. This is a revising Chamber and the public must and will make their own decision on the matter.
LORD HAWKE: The noble Viscount says that there is no one behind who is prepared to give information, but I can give him this information, as one who has had to compile figures. I cannot conceive any method whereby the breakdown of the costs of accepting these various Amendments could possibly be obtained with reasonable accuracy. Perhaps it may be easier in the case of diabetics—you could find out the total amount of insulin used in the country and issued to National Health Service doctors, and after that you could find out the average doses given and how many weeks' supply the doctor gives the patients, but in other respects the final result would be a guess and not an estimate at all. How are we to estimate precisely from the information at our disposal how many cases there are of people afflicted with eczema or any other disease in the country? It is imposible. The noble Lord could give a detailed figure

903
of the saving with reasonable accuracy, but he could not possibly break it down into these particular things.
VISCOUNT STANSGATE: I am grateful to the noble Lord for a most helpful speech. But how can you make the total if you do not know the components?
LORD HAWKE: The total comes in the total bill which accrues to the Chancellor of the Exchequer. You know what the flood of medicine costs in a year, and the total number of prescriptions. Then you estimate that there may be some slight abatement for people who have been abusing the Service and who are no longer applying for prescriptions. But you do not know the number of people suffering from these various diseases. You cannot possibly break that down.
VISCOUNT STANSGATE: I asked how many babies were born, and the Lord President was not able to say. The noble Lord, who is a statistician, knows how many diabetics there are and how many tubercular people there are. Why cannot we have the break-down, by giving us the exact percentage of those suffering from cancer, of expectant mothers, and so on, who are suffering so much? We are only asking for information; we are not putting forward arguments. The arguments can follow from the information. Why we cannot get the information I cannot imagine. I think it is being concealed.
LORD HAWKE: If the noble Viscount considers carefully what is being said, he will realise that it cannot be broken down unless each doctor categorises the disease for which he is prescribing each prescription. Only on that basis could a reasonably firm estimate be made. As for the latter point made by the noble Viscount, I do not believe that this particular Amendment depends in the slightest degree on the birth rate at all. It depends on which ladies happen to be living nearer one sort of clinic than another, and what proportion of the ladies are prescribed particular drugs. Some of them have their children without any drugs at all being prescribed. It is absolutely nothing to do with it.
THE EARL OF LISTOWEL: I think I derive more comfort than does my noble
904
friend from what the noble Lord, Lord Woolton, has said. From what he has said—he will contradict me if I have misunderstood him—I take him to mean that he will look at this point, that he will see whether or not in this an evident anomaly exists and, if he thinks there is an anomaly, that he will say how he proposes to remedy it. I assume that he will be good enough to make a statement when this clause is discussed on the Report stage of the Bill. In fact, I think it is not going too far to say, that for the first time this afternoon, we have found some common ground between the two sides of the House. Noble Lords opposite think that this is a good Bill, but they also think that the removal of administrative inconsistencies would make it a better Bill. We think that this Bill is a bad Bill but we also think that the removal of administrative inconsistencies would make it a less bad Bill. It amounts to a measure of common ground between noble Lords opposite and ourselves. I am glad that the noble Lord has undertaken to look into this point and to make a statement.
On Question, Amendment negatived.
THE EARL OF LISTOWEL THE EARL OF LISTOWEL moved in subsection (2) after paragraph (d) to insert:
"( ) the supply of any drug, medicine or appliance for any person for whom residential accommodation is being provided under Part III of the National Assistance Act, 1948, and who is not paying the standard rate fixed for that accommodation under section twenty-two of that Act."
The noble Earl said: This Amendment to exempt a certain class of person from the charges under Clause 1 raises rather a different point from any that have been raised up to now. It differs in this respect from the proposals that have been made to exempt people suffering from certain diseases. The arguments on the opposite side of the House were, or at least one of the arguments was, that many of the sufferers from these diseases could afford to pay the charge. I am dealing with a class of person who cannot afford to pay a charge of even 1s. on a prescription. I am asking the Government to exempt from the charges under Clause 1 of the Bill the old people living in houses provided by local authorities if, and only if, of course, they are unable to pay the standard rate for their accommodation.

905
That covers the great majority of the people who live in these homes.
Because it is essential to my argument, may I just describe the financial circumstances of these old people? They are people whose only source of income is either a small pension or an assistance grant from the National Assistance Board. That comprises the whole of their income. For that reason, they cannot afford the standard payment charged by the local authority for their board and lodging. What the local authorities do is this: they deduct as much as they can from the total income of these old people, leaving them with 5s. a week as pocket money for themselves. Mind you, this 5s. a week has to cover all of their needs and enable them to meet the rising cost of living. These people are literally the poorest of the poor, and for them it is a real hardship to pay even 1s. on a prescription. A few of these people are treated as outpatients at hospitals, and the arguments I am using now are just as applicable—indeed, applicable with greater force—to an Amendment I have after Clause 1. I shall not repeat them. If your Lordships will be good enough to remember what I say now, that will be good enough. But even if under this Amendment a small number of cases are affected, the hardship in these cases will be no less great than in the great majority of cases of old people who get their prescriptions made up at the chemist's and go to the chemist's on the instructions of the general practitioner.
The Minister said in another place—and this is, I think, an exceedingly important administrative point to which I should like to direct the noble Lord's attention—that these old people receiving grants from the Assistance Board would be eligible to claim repayment of these charges from the Board. The first question I should like to ask is: did the Minister mean only the old people living on grants—
LORD WOOLTON: Did the noble Earl say "grants"?
THE EARL OF LISTOWEL: —living on a grant by the local representative of the Assistance Board, or also old people living on small pensions, retirement pensions or whatever they may be, but not able to make the full contribution to-
906
wards their board and lodging? That is the first question I should like to ask the noble Lord. Now let us assume that the Minister would include both as eligible for repayment of these charges on application to the Board. What I want to suggest is that this is an extremely inconvenient and unfortunate administrative method. What is wanted is not repayment but, as I am venturing to suggest in this Amendment, remission of payment, exemption from payment May I mention to your Lordships the difficulty of the method of repayment of the amount paid in the charge on a subsequent claim to the Assistance Board? This will mean hardship for the old people because, even if they are going to get 1s, back in a month's time or in two months' time, the loss of that 1s. in the meantime will mean a sacrifice of some real necessity.
Five shillings a week is not enough for more than the bare necessities and, if they have to lose 1s. because they are sent to a chemist for a prescription for one of their infirmities, that is an encroachment on the necessities of life. Furthermore, it is a great worry to these old people to know that they can get their money back only by filling up a form and making an application to the local representative of the Assistance Board. Some of these old people are ill. Many of them are nervously ill, and it adds to their worries if they have to cope with something that they find is difficult, such as making a repayment claim.
From the point of view of the officials of the local authorities, this puts a tremendous burden upon them. They will find that in many cases they will have to make the repayment claim. It is the officials who will have to make the claim to the Assistance Board. They will have to keep accounts to show what claims have been made, and at a time when we want to save manpower we shall be thrusting a lot of extra work upon these hard-pressed officials of the local authorities. I am expressing the view that is taken by a very large and responsible authority—namely, the London County Council. I have not had the opportunity of consulting other local authorities, but I should imagine that many of them would share the views of the London County Council. But all this extra burden of work thrown upon these busy officials, and the hardship for the old people, could be avoided if they were simply exempted

907
as a class, in the same way as the inmates of hospitals have, as a class, been exempted from the charges made under Clause 1 of the Bill. I hope that the noble Lord opposite will consider this matter very carefully, both from the point of view of the welfare of these old people and from the point of view of the most efficient administrative method of preventing undue hardship. I beg to move.
Amendment moved—
Page 2, line 2, at end insert the said paragraph.—(The Earl of Listowel.)
LORD WOOLTON: I am advised that the National Assistance Board, with whom this issue has been raised, have agreed that people in the category to which the noble Earl refers are entitled to relief on grounds of hardship, and that administrative arrangements are being made to ensure that either they should not be asked to pay the charge for drugs supplied through the hospital, or if they are asked, that they should be entitled to a refund. I hope that that administrative step will meet the argument that the noble Earl has put forward.
THE EARL OF LISTOWEL: I am very much obliged to the noble Lord for his reply. I see that the matter has been considered very carefully by the Government. I presume that the Minister will make regulations under Clause 1 of the Bill. I am perfectly prepared to accept the alternative of making regulations under the Bill. At the end of Clause 1, subsection (2) (d) there is a provision to this effect:
"regulations may provide for the remission or repayment of any charge payable there-under.…"
There is a world of difference between "remission" and "repayment," and from what the noble Lord has said I am not sure of the type of regulation which the Minister will issue under the Bill—whether it will provide for remission, for exemption, or for repayment. It did not seem to me to be very clear.
LORD WOOLTON: I will repeat the words I used. Administrative arrangements are being made to ensure that either they should not be asked to pay the charge—
THE EARL OF LISTOWEL: That is remission.
LORD WOOLTON: That is the first thing for which the noble Earl asked.
908
They should not be asked to pay the charge for drugs supplied through hospitals, or they should be entitled to a refund—either one or the other.
THE EARL OF LISTOWEL: I entirely appreciate what the noble Lord has said. I should be very much obliged if he would say which of those methods is likely to be used. May I ask one other thing? Would he be good enough to ask his colleague, the Minister of Health, to consult with the local authorities before administrative arrangements relating to this matter, or any regulations under the Bill, are made? I am not sure what the procedure will be, of course, but I am quite certain that these people who will have to administer this Bill will find it much easier if they are consulted before any final arrangements are made.
LORD WOOLTON: I will ask the Minister.
LORD LAWSON: May I ask the noble Lord whether this depends upon the person concerned claiming that it is a matter of hardship for him? Is this based upon the ground that there is going to be a claim of hardship by the person concerned?
LORD WOOLTON: No.
LORD LAWSON: Is the noble Lord aware that that is the very thing that causes all the trouble with people concerned in matters of this kind?
LORD WOOLTON: I think the noble Lord has misunderstood, and I do not wonder at that. The noble Lord asks whether it is automatic. The answer is, that it will be automatic. The words are very clear—namely, "They should not be asked to pay."
THE EARL OF LISTOWEL: Or what? We have got to know which of the two methods are to be used.
LORD WOOLTON: There may be variations, depending upon the particular case.
VISCOUNT STANSGATE: It is surprising to learn what can be read into the last two lines of subsection (2) of Clause 1. I understand that the point raised by my noble friend can be provided for by the words
"regulations may provide for the remission or repayment of any charge payable there-under.…"

909
It is under those words that the regulations to which the noble Lord has referred are to be made. These regulations will come under a later clause of the Bill before the Committee. If that is so, all the Amendments that we have been moving, about the sick and the poor, might also have been covered by the regulations under this subsection. I should have thought that the word "thereunder" was in some way a limiting word. But if there is so much which can be brought in under the last words of subsection (2) then, when the Lord Chairman puts the question whether the clause shall stand part of the Bill, I think we shall have further questions to ask as to whether some of the matters that we have been discussing cannot be dealt with on the pledge of the Government to make regulations, without any Amendments in Committee at all. This has certainly taken me by surprise.
LORD WOOLTON: I did not say that this came in under the regulations; it was the noble Earl who said so.
VISCOUNT STANSGATE: But: the noble Lord reassured my noble friend that what he desired would be done. The noble Lord read out from a paper some assurance on this matter. When my noble friend asked, constructively and helpfully, "I presume you mean under the last words of subsection (2)?", the noble Lord appeared to assent. He either did assent, in which case what I have said is correct, or he did not assent; and, if he did not assent, will he tell us under which part of the Bill the regulations will be made?
LORD WOOLTON: I merely gave the assurance which the Minister had given on this issue. I did not say how he was going to do it. I did not say under which regulations he was going to do it. I think perhaps noble Lords might be satisfied with the assurance of the Minister that he will do this.
VISCOUNT STANSGATE: I do not understand the point of having Acts of Parliament if they are not to direct the conduct of Ministers. I understood that is what legislation is for. Surely the noble Lord can tell us under what section of the Bill the provision which he has promised, in reply to my noble friend Lord Listowel to make, will be made.
The EARL OF LISTOWEL: I am obliged to the noble Lord, Lord Woolton, for what he has said, on the authority of his colleague, the Minister of Health. I certainly do not propose to press this Amendment, but I should be obliged if the noble Lord could further clarify what he has said on the next stage of the Bill. I think the points upon which we should like clarification are first: How is this going to be done? Will it be a regulation of the kind I have suggested, or will it be in some other way? Secondly, which method will be used, and in what circumstances will the one method or the other be used? Thirdly, will there be a further consultation with the local authorities before the administrative arrangements, which cannot be concluded until the Bill becomes an Act of Parliament, are finally settled?
LORD WOOLTON: I think it would be easier if I were to say that the consultations about this are now going on with the local authorities.
On Question, Amendment negatived.
9.0 p.m.
LORD MILNER OF LEEDS LORD MILNER OF LEEDS moved to omit subsection (3). The noble Lord said: As the Committee are aware, Clause 1 provides that charges shall be made in respect of the supply of certain appliances. Subsection (3), which my Amendment seeks to remove, indicates that:
"Any reference…to the supply of appliances shall be construed as including a reference to the replacement and repair of appliances."
The purpose of my Amendment is to relieve those who have surgical appliances from the cost of repairing them. I need hardly point out that surgical boots, which are the principal item concerned, wear out very much more quickly than do ordinary boots and shoes. Moreover, of course, any repairs have to be of a rather special nature. The repair is not an ordinary one. Surgical boots, presumably, have either thicker or thinner soles or heels, or both, than ordinary footwear. They are made in some patent fashion which the repairer has to follow. Therefore, in my submission, in view of the fact that these boots have to be repaired very frequently, and that the repair has to be of rather a special character, to compel wearers or users of surgical boots under the National Health

911
Scheme to pay for their repair will inflict great hardship upon them. It will be a severe imposition on these people. Not only that, but clearly it must be dangerous for men and women to go on wearing surgical boots or other appliances which are not in good repair. The imposition of this charge will create a tendency for people to go on using appliances which are not in good order, which are possibly dirty and insanitary and a danger to the health of the person wearing them. Because of the cost of the repairs, many men and women may endeavour to cobble up their surgical boots or other appliances themselves. Again, that cannot conceivably be a satisfactory way of dealing with them.
In this connection, I should like to refer your Lordships to a picture which I happened to come across in a report of the Ministry of Pensions. It does not refer to surgical boots, but I think the same principle applies. This picture shows some of the fearful contraptions which are worn by people who either buy or make their own artificial limbs. They are unsightly, injurious, inconvenient and, quite obviously—as this picture shows—dirty and insanitary. I submit that precisely the same position would arise in the case of surgical boots. The question of expense and saving has been raised in many cases during this debate, and one can make some rough computation here. I notice that during the Second Reading debate the Minister said that the whole saving, by reason of the imposition of a charge for appliances—not repairs—would be in the neighbourhood of £250,000 a year. That is to say, in respect of the elastic stockings and surgical boots and all the rest of it the saving expected from that particular provision in the Bill is only about £250,000 a year. Quite clearly, the economy effected from making a charge for repairs will be a great deal less than that. I have no definite idea, and there are no facts on which to form an opinion, but I should have thought that repairs to surgical boots which probably cost something like £150,000 or £200,000 to purchase, could not exceed, perhaps, £50,000 a year. That may be the case. But in any event the sum involved is very small, and I hope that the Committee will feel it right to relieve those who suffer from the disability of wearing surgical boots and other appliances from
912
the onus of paying for the repair of them or of making a contribution towards the cost of repairing them. The saving would be trivial and the hardship caused would be great. I invite your Lordships to do away with subsection (3) of Clause 1. I beg to move.
Amendment moved—
Page 1 line 6, leave out subsection (3).—(Lord Milner of Leeds.)
THE EARL OF ONSLOW: Of course, even if this Amendment were accepted, it would still be possible, under the 1946 Act, to make a charge for replacement or repair due to lack of care on the part of the patient. I would, however, point out that under this Bill any replacement needed owing to a defect would be free of charge. In the case of replacement required by reason of neglect on the part of the patient, I can see no harm in the person responsible for the neglect of an appliance paying for his negligence. There is the further case of an appliance wearing out through sheer old age. If we remove this charge, in effect it would mean that only the first appliance would be paid for; the rest would be supplied free. I do not really think that that is logical. As regards the question of a charge for the repair of surgical boots, I do not feel that it can be said that this is any greater hardship or is likely to entail anything but slightly greater cost than the ordinary person has to meet when he has to pay for the repair of ordinary boots. Ordinary boots and shoes need repair from time to time, and the cost of repairs to-day is not by any means cheap. In view of what I have said, I am afraid that the noble Lord's Amendment cannot be accepted.
VISCOUNT HALL: May I put one point to the noble Earl? Let us assume that an artificial limb has been supplied to a person, and that that artificial limb is absolutely essential to enable him continue his employment. Let us further assume that he has not the means to pay for replacement or indeed for repair. Will the consequence of that be that the man will not be able to have replacement or repair of something which is so essential, so absolutely necessary to him?
THE EARL OF ONSLOW: Certainly not. On the general point, I am sorry I have not the actual figures, but of

913
course, if the person's circumstances are such that he could not afford to pay he could get the money from the National Assistance Board.
On Question, Amendment negatived.
9.9 p.m.
LORD BURDEN LORD BURDEN moved to leave out subsection (3) and to insert:
"(3) No charge shall be made under this section or the next following section if after investigation it is found that the cost of the Health Service can be reduced by an amount equal to that estimated to be raised by such charges as are referred to in section one and section two of this Act."
The noble Lord said: This Amendment may on the face of it seem somewhat difficult to follow. But it answers the points which have been made repeatedly by the Government as to what alternative there is to the charges which they have so successfully insisted—in Division, or otherwise—throughout the debate this afternoon should be imposed on our people. That is the purpose of this Amendment, but before dealing with it I want to recall a little history. I want to recall what was prornised during the war to our people who were fighting, to those who were working in the factories and workshops, and to those in Civil Defence. The promises to which I refer were made by the Government of which the present Prime Minister was then Prime Minister. This is what was promised. I take it from a document issued in 1944 on the subject of a National Health Service. Here is a summary of what was promised:

"1. To ensure that everybody in this country, irrespective of means, age, sex or occupation, shall have equal opportunity to benefit from the best and most up-to-date medical and allied services available.

"2. To provide, therefore, for all who want it, a comprehensive service covering every branch of medical and allied activity, from the care of minor ailments to major medicine and surgery; to include the care of mental as well as physical health, and all specialist services for tuberculosis, cancer, infectious diseases, maternity, fracture and orthopædic treatment, and others; to include all normal general services—the family doctor, midwife and nurse, the care of the teeth and the eyes, the day-to-day care of the child; and to include all necessary drugs and medicines and a wide range of appliances.

"3. To divorce the care of health from questions of personal means or other factors irrelevant to it; to provide the service free of charge—apart from certain possible charges in respect of appliances; and to encourage a new
914
attitude to health—the easier obtaining of advice early, the promotion of good health rather than only the treatment of bad."

That was what was promised to the men and women of this country who were fighting at home and abroad. The Labour Party implemented that promise—I agree with the assistance of other Parties—by putting the National Health Service Act on the Statute Book. It is no good noble Lords opposite saying that they are not involved in that promise. The noble Lord, Lord Woolton, who has been stonewalling us this afternoon, said on a previous occasion:
"Having begun with the positive plan for wiser feeding which deals with the general mass of the people, I then consider the exceptional people whose bodies fail to function normally, and who require medical advice and assistance. That knowledge is available; we have to make the medical service into a health service, rather than a sickness service, and I believe the system of Health Insurance outlined in the Government's White Paper indicates the proper way for the State to come to the help of the individual in misfortune."
The noble Lord is committed up to the hilt to the White Paper issued by the Coalition Government, with Mr. Winston Churchill as Prime Minister. I make it clear that, in building up our Health Service in this country, the Party to which I am proud to belong has no claim over and above any other Party, except that it put the coping stone on what had been done by other Parties since the beginning of the present century. I recall what an honoured member of this House, who was Prime Minister in the First World War, said: that a society is judged by the minimum physical and mental and moral health it prescribes for its citizens. I ask your Lordships to notice the words, "prescribes for its citizens."
With that background, let us be clear about what we are saying to the Government in this Amendment. We admit—and it has been admitted repeatedly from these Benches—that as a result of the war and of having to grapple with the problem of rearmament and the balance of payments, disagreeable things have had to be done and would have had to be done by any Government. What I suggest in this Amendment is that before we break into the National Health Service by making those who are suffering contribute in the way laid down in this Bill, we should see what economies can be effected by departmental efforts. There are ways of saving in this Service which

915
the Department well know, which I need not particularise, and which may effect a saving without penalising the sick. This Amendment asks the Government to postpone the operation of these charges until they have had an opportunity of surveying the whole layout of the Health Service to find where economies can be made, to see where we could save without imposing upon people when they require medical treatment the indignities which are imposed by this Bill. I hope your Lordships will accept this Amendment, which I move and recommend to the House.
Amendment moved—
Page 2 line 6, leave out subsection (3), and insert the said new subsection.—(Lord Burden.)
THE LORD CHANCELLOR: This Amendment has been the peg for an interesting speech by the noble Lord, but I cannot think that he can expect such a provision as this to find its place in an Act of Parliament. See what it commits the Government to—this or any other Government, because this will find its place permanently in the Act of Parliament if the Amendment is accepted. The proposed new subsection says:
"No charge shall be made under this section or the next following section if after investigation it is found that the cost of the Health Service can be reduced by an amount equal to that estimated to be raised by such charges as are referred to in section one and section two of this Act."
Who is to investigate? Does the noble Lord imagine that there has not been full investigation already before these charges were imposed? Of course this has been the matter of closest scrutiny by the Department, and it is perfectly impossible to suppose that in this Bill we can insert a provision which will mortgage the future. How can he impose on this of any other Government the obligation to see whether, after investigation—by whom and in what circumstances, Heaven knows!—because it is found that the cost of the Health Service can be reduced by such and such an amount, it is really necessary to impose further charges? No such provision was ever found in an Act of Parliament before, and on behalf of Her Majesty's Government I cannot possibly consent to accept it.
VISCOUNT STANSGATE: The noble and learned Lord says that the closest investigation has been given to every clause of this Bill and its details laid
916
before the Government. What is the reason therefore that we cannot be told what the savings are? I have repeatedly asked this question.
THE LORD CHANCELLOR: I think the noble Viscount has misunderstood me. What I said was that the proper Minister has investigated every possible way of making economies. He will not be able to make economies. That is what the noble Lord, Lord Burden, is referring to when he says, "If the cost of the Health Service can be reduced by an amount equal to that estimated to be raised by such charges." What I meant was that all possible sources of economy have been investigated, and we have not been able to find them.
LORD BURDEN: I take it, then, from what the noble and learned Lord has said, that, apart from the economies and savings which will be effected under the provisions of this Bill when it becomes an Act, it is not anticipated that there will be any further saving on the National Health Service.
THE LORD CHANCELLOR: Nobody can possibly foretell the future. All I am saying is that up to date we have made all possible inquiries and have not found any such economies as will enable us to put any other provision in the Bill.
VISCOUNT STANSGATE: I am afraid that I did not make myself clear. I was not dealing with my noble friend's Amendment, but with an obiter dictum of the Lord Chancellor, in which he said that the closest possible investigations had been made of all possible economies. If that is so, I can conceive the drafting committee of the Ministry saying: "What shall we save on surgical boots? Is it worth while putting in dentures?" and so on. That must have been laid before the Ministers when the Bill was being drafted. The only people who must not know what the economy is are the public or this House. I repeat the point only because evidence has accumulated as the Committee stage has proceeded that these facts are known, but not to be revealed, because, as I think, they will prove unfortunate for the Bill. That only came from what the Lord Chancellor said. I shall reserve the other points I have until the question is put that the clause stands part. I have some questions to put about regulations and

917
how they are made. I merely make this point, and I should be glad to get an answer. When I asked before what the reason was, all I received was a rather strong, I will not say tart, reply from the noble Lord. He simply said: "We will not do it." I was then asking what the financial reason was. If we cannot know, we cannot know. But the public will want to know how much is being saved by a man walking about in a surgical boot which needs repairing. This Bill is exciting almost more interest than any other Bill that has been before Parliament for a long time.
VISCOUNT BUCKMASTER: The noble Viscount was good enough to say that he was not addressing himself to the Amendment of his noble friend. I should like to address myself to what the noble Lord, Lord Burden, said. If my memory serves me aright, when I introduced a Motion dealing with the Health Service the noble Lord, Lord Burden, to whose speech I listened with interest, said then that, with his long experience of hospitals, he could positively assure me—
LORD BURDEN: I did?
VISCOUNT BUCKMASTER: I thought so.
LORD BURDEN: No.
VISCOUNT BUCKMASTER: I have not the copy of Hansard before me, and I accept the noble Lord's statement. But I have a strong recollection that noble Lords on the opposite side who have experience of hospital management assured me that every conceivable economy had already been exercised. I think Hansard will show that. May I also, with respect, point out to the noble Lord that both the present Chancellor of the Exchequer and his two predecessors have endeavoured to impose a ceiling on this Service of £400,000,000. I do not wish to repaint a picture I have painted before, but already that amount has been exceeded. As the Service improves and new drugs are invented, the cost is ever rising. It reaches a point where some step must be taken. That was a principle which was recognised by the predecessor of the present Chancellor of the Exchequer. I assure noble Lords that the only possible form of economy that I can see—and I have talked to those who
918
use the Service in a big way, and to those in humble circumstances—is to instil some sense of responsibility into the more extravagant patients.
LORD BURDEN: Neither the Party to which I belong nor its Chancellors have ever fixed a permanent ceiling.
VISCOUNT BUCKMASTER: They tried to.
LORD BURDEN: They have dealt with the position as it was necessary to deal with it on each Budget.
VISCOUNT BUCKMASTER: They tried again and again. Every Chancellor has tried to fix a ceiling, but none has succeeded. That is the truth.
LORD BURDEN: The noble Viscount is misrepresenting my point. I said that no Chancellor of the Labour Party has fixed a permanent ceiling. I wish that would he firmly in people's minds when they talk and misrepresent the attitude of my Party in this matter. My second point is this. The present Government have been working very rapidly within the six months or so in which they have been in office if they are able to say that in a Service spending £400,000,000 or over there is no passible field for economy. I do not like to particularise that in a way in which it ought to be particularised. What we say on this side is that we accept the need for the most rigid economy and the need for sacrifices; but, first of all, see whether you can make those economies in a way which will not impair the Service. It is because we regard the charges which are imposed in this Bill as mean, squalid and despicable that we have fought it all the way along the line.
THE MARQUESS OF SALISBURY: I must say a few worth in answer to the noble Lord who has just spoken and made a very eloquent series of remarks. I was not clear as to what he said. Is he in favour of any ceiling for a Health Service? I should like the noble Lord to answer that question.
LORD BURDEN: I am not the Chancellor of the Exchequer, and it is not my responsibility to answer that.
THE MARQUESS OF SALISBURY: As he made such tremendous praise of his own Party, I am entitled to ask whether he or his Party are in favour of a ceiling.
LORD BURDEN: I have already said, with as much emphasis as I command, that the Labour Party fixed a ceiling according to the circumstances of the year, but they have never yet fixed a permanent ceiling. That is the important point.
THE MARQUESS OF SALISBURY: What I was going to say was that that is exactly what we are doing at this moment: we are fixing a ceiling in accordance with the circumstances of the year. If circumstances changed and our financial position became better, does anyone doubt that necessary and unpleasant economies would be reversed? The noble Lord also said: "Why have there been no investigations?"
LORD BURDEN: I did not say that. What I said was that you have worked very rapidly to have been able, in the brief time that you have been in office, to say that in a Service of £400,000,000 there is no ground at all for economy.
THE MARQUESS OF SALISBURY: I beg the noble Lord's pardon. But the Amendment to which he has put his name says:
"No charge shall be made under this section or the next following section if after investigation it is found.…"
The implication of that is that there has not been an investigation.
LORD BURDEN: No, it is not.
THE MARQUESS OF SALISBURY: Certainly it is; it cannot bear any other meaning. The noble Lord also implied that there were very large economies to be made in other spheres, as he said, without impairing the efficiency of the Service. Why did not his Party do it? They were in power for six years. If there are these spheres in which unnecessary extravagance has taken place, they are seriously to blame. He cannot blame this Government if now it is found necessary to make economies.
LORD BURDEN: I do not want to keep on interrupting the noble Marquess, but I would assure him that if he takes the opportunity of turning to the files of the Ministry of Health—my assurance is from people who were in the Ministry and responsible—he will see that very important steps were taken to effect economies in the Service, and those steps are bearing fruit at the present time. But
920
all the steps taken have not borne the fruit which would enable this Service to be carried on without these charges.
THE MARQUESS OF SALISBURY: That does not answer my question. I said: Where was there avoidable extravagance? It appears that there was.
LORD BURDEN: I did not say that. The noble Marquess has a trick of putting words into other people's mouths in his controversial methods. I never said that there was extravagance.
THE MARQUESS OF SALISBURY: I listened to the noble Lord with great patience, but he interrupts me after every sentence. However, I am quite happy about that. He did say there were spheres in which economies were made. If that is so, there must have been avoidable expenditure, and I think that his Party were very much at fault not to put that matter right at the proper time. In the situation in which our country is placed at the present time some economies are necessary, and I can show the noble Lord that very careful inquiries were made to see if any other economies could be made which could cause less hardship than these; but, on the whole, we found that this was the inevitable way of doing it. The noble Lord may not agree, but that was the result of inquiries which we made. I can assure him, therefore, that the investigation for which his own Amendment calls has been made. It was after and following on that investigation, that the present Bill was introduced. The noble Lord may not agree with the steps we are taking but, at the same time, I assure him that what he seeks to achieve by his Amendment has already been accomplished.
On Question, Amendment negatived.
On Question, Whether Clause 1 shall stand part of the Bill?
9.32 p.m.
LORD PAKENHAM: Like other noble Lords, I spent a happy six or seven hours listening to the discussion of this clause. Perhaps the House will allow me to offer a few observations about its general character. If I speak rather plainly, I am sure noble Lords will acquit me of any desire to suggest they are hard-hearted. I am sure they are just as soft-hearted as we are, but I am afraid

921
the softness extends a little further throughout their anatomy: there is a lack of clear headedness on the Benches opposite. One point has emerged from these discussions—that the sole argument for this clause (the argument used by the Lord Chancellor) is the need for economy. Nobody, I think, will challenge that, and nobody has seriously suggested that this will improve the Health Service. I do not think that that argument has been submitted from the other side. But there is a much more disputable point. The noble Lords opposite claim that the quality and quantity of the Health Service will not be reduced. We on this side question that, but that is their argument—that there will be still the same provision of service in spite of these regrettable cuts. So it all boils down to an economic argument, because clearly something is happening on the Health Front.
What is the economic argument for the clause? It has been referred to by the noble Lords opposite almost as something sacred, something perhaps of a mystery, too deep to discuss in public. Nobody has explained this argument. With great respect to the noble Lord, Lord Woolton, the noble Marquess and the noble Earl, it was not explained the other day. The noble Marquess did advance one particular argument but, like myself, he was speaking "off the handle" and I daresay neither of us said exactly all we meant. Certainly the noble Marquess brought forward one argument when he used a rather peculiar expression on the Second Reading. He said:
"… we are dependent on them"—
that is, the foreigners—"
for our very existence. Our existence depends on whether these foreigners will allow their money to stay here, will send more money here, and will close the dollar gap. It depends upon them"—
that is still the foreigners—
"whether we have a decent standard of living here at all."
I do not want to pin the noble Marquess down to words, but there is an argument of a kind. Surely the noble Lords opposite and the noble Marquess on reflection are not going to say that this deplorable Bill is rendered justifiable because of the attitude the foreigners apply to it? I am sure the noble Marquess will agree that if the clause is unjust and ineffective in other respects, it is not rendered just and
922
effective because of the particular feeling of affection that foreigners may entertain for it. So, with great respect to the noble Marquess, I brush that argument rather lightly aside.
The noble Earl, Lord Onslow, on the Second Reading—and generally it has been the tenor of the argument to-day—claimed that we have to impose these unfortunate charges (and nobody on the opposite side likes them, I quite appreciate that) because of the economic situation. That is what the noble Earl said the other day and it has been stated again this afternoon. I did not take down the exact words, but the noble Marquess assured us that if the economic situation improved this clause would be scrapped and that these charges would, in fact, be removed. So it all boils down to the economic situation and presumably to the external balance of trade. Are there any noble Lords on the other side of the House who, if I may say so without impertinence, trooped in such a docile fashion into the Division Lobby all the afternoon, who are prepared to get up after I have finished and explain the economic argument that has proved so convincing to their heads and has overcome the impulses of their hearts? Before this clause is finished with this afternoon, I feel that we must have some explanation why they have suppressed their nobler feelings in the cause of a hard economic realism.
Well, what is the argument? We are told that there would still be the same provision of medical services, the same number of surgical boot; and good abdominal belts, that everything, would be the same in the medical sphere—no better, no worse—but that there would apparently be some transfer of income. In future, the sick will pay, whereas previously they have gone scot free when they were sick. As I understand it that is the only change that is going to take place. I do not know who is going to reply In me—perhaps nobody is. This may go by default: it has done hitherto. I wonder whether any noble Lord will explain how that particular transfer of income inside the community is going to help the trade balance. We all speak plainly to one another in this House. Nobody has even attempted to give us a reason or an explanation as to how this munificent process they have in mind will

923
take place. How can it possibly take place?
We could carry on a long economic argument about that matter. It has been very much simplified by the Budget. Before the Budget you could argue this matter one way or another. I argued it one way in the House, somebody else argued it the other way; but now we know, since Mr. Butler's Budget, that there is to be no cut in the general consumption of the country this year. That is a very important fact. I will not begin to pursue what the position was when we were in power, but in this year, in Mr. Butler's view (and I am not arguing tonight whether it is right or wrong; he has more information and ability than I have) there should be no cut in general consumption. Yet there is to be this special penalisation of the sick. I ask the noble Lords opposite how they justify singling out the sick for these special penalties. In the absence of any economic justification, I say that this is a rotten clause, and I hope that the House will divide against it.
LORD TEVIOT: Before the noble Lord sits down, may I ask him this question? What was the incentive which induced the late Government to begin cuts on the Health Service and the dental service?
LORD PAKENHAM: The position at the time of the late Government was very much more inflationary than it is to-day. I am not going to carry on with this at length, although I am quite prepared to do so. In this particular year it is evident from Mr. Butler's statement that he does not regard the position as inflationary to the extent it was previously. That is the short answer.
LORD TEVIOT: The noble Lord has not answered my question. My question was: What was behind the idea of the cuts which the late Government proposed? After all, they had been in power for eighteen months. They had three years to run, and if their policy was so much better than ours, why did they not go on and carry it out?
LORD PAKENHAM: The short answer to the noble Lord on the medical side is that it was thought desirable to remedy
924
certain abuses. That argument has not been pressed this afternoon (I call the House to witness that) in my hearing, and I have been here most of the time. The case is based solely on economics, and in the circumstances I look to noble Lords opposite to provide some economic justification for something which, in my opinion, has no justification at all.
VISCOUNT BUCKMASTER: With respect to the noble Lord, I did say that unless some charges were imposed and patients were disciplined in that way, it would be impossible to keep the cost of the Health Service within reasonable limits. I have always taken the view that it is necessary to discipline patients by making charges, much as I dislike the principle.
LORD PAKENHAM: But that has not been the case for the Government—that it is necessary to discipline patients. If that is the case I should be very much surprised.
VISCOUNT BUCKMASTER: I am only expressing my own view.
VISCOUNT STANSGATE: I am surprised to hear the noble Viscount saying that. I have heard the fiercest defence of the Bill coming from the Lord Chancellor and the Lord President. The Lord President said: "I am keeping my eye on the £20,000,000," and the Lord Chancellor reproved me severely for suggesting any other motive. I think that what my noble friend Lord Pakenham has said was fully justified.
9.44 p.m.
THE MARQUESS OF SALISBURY: I do not propose to enter into a long economic debate with the noble Lord. He said, and says every time he speaks I think, that no economic case has been made out by noble Lords on this side of the House. I am afraid that is because he does not listen. He has heard speeches made by the noble Lord, Lord Balfour of Burleigh, and he has heard speeches made by the noble Lord, Lord Brand, one of the most experienced of economists in this country. He does not listen to him. The noble Lord is here, and I hope he will reply to what Lord Pakenham has said. I will certainly give way to him. I am not going to expound economics in the presence of the noble Lord, Lord Brand. The noble Lord, Lord Pakenham, always

925
takes the attitude that he knows and that nobody else does. So far as I know, he has never been in any bank or City office. He sat all the time in Oxford, and although he has a good academic knowledge he really has very little more.
I can only tell him—this is the point I am making, and the point I made the other day—that when you are trying to create a sense of confidence in the country in my view it is impossible entirely to divorce internal expenditure from external expenditure. The way you manage your internal affairs is bound to have a profound effect upon the nations with whom you have to deal. We all know that in our private lives. I know you cannot draw an exact analogy between the life of a private individual and the life of a nation, but there is a certain analogy to be drawn. We all know perfectly well that a man who lives up to the very limit of his income, and over his income, and thinks it does not matter how much he overdraws, gradually loses the confidence of his fellow man and ultimately suffers serious detriment. It is the same with the nation, and there is no doubt at all that the attitude which has been adopted in this country—I do not want to make a Party point; perhaps many Governments are responsible—is that of saying "What we ought to have we must have, whatever the economic expenditure involved."
I have here a speech made on March 26 of this year by Lord Shepherd, and replying to the noble Viscount, Lord Buckmaster he said (OFFICIAL REPORT, Vol. 175, Col. 973):
"I think the noble Viscount was accurate in also saying that costs will continue to rise until the full needs of the nation have been met."
Then he went on to say:
"… then, undoubtedly, the cost will rise until the Service performs the task we expect of it."
I do not dissent in the least from what the noble Lord, Lord Shepherd, said about the object which we seek to achieve. We all have the same object in view. But I do say that the cost cannot rise above a certain point without seriously damaging the credit of the country. The noble Lord, Lord Pakenham, may not agree with me, but that is my view, and I think that the policy which the present Government are pursuing—an unattractive, painful and
926
extremely unpopular policy—is better calculated to restore our name in the councils of the world than the policy adopted by his Party when they were in power.
LORD BRAND: As my name has been mentioned, perhaps I may be allowed to say one word in reply to the noble Lord, Lord Pakenham. My attitude, I am afraid, is totally different from his. I regard the burden of taxation in this country as the most important and most difficult problem and as the matter that weighs on this country more than anything else. I am not in the secrets of the Government, and I cannot say whether the £20,000,000 saved by the Bill under discussion is the best way to save money or not. I look on any £20,000,000 of taxation saved as great importance. If the Budget expenditure is lessened by £20,000,000, then either you can reduce taxation by £20,000,000 or you need not increase it by the same amount.
As regards the free Health Service and these particular charges, I had a calculation made in my office the other day as to what proportion of the taxation to meet the cost of the free Health Service is paid by taxpayers of this country with incomes from £500 downwards—not upwards. The calculation resulted in a figure of £132,000,000 a year as being the taxation paid by those income taxpayers with £500 a year and less. I should think it would be better that the Opposition should give some sympathy sometimes to the taxpayers, as well as to other members of the population. I made a speech a day or two ago in Edinburgh, which one or two of your Lordships may have read, in which I made the statement that in my view the taxation in this country is so severe that there are now no personal savings at all. In fact, the personal savings in the country are minus, and I regard this fact as a highly serious matter for the future of the country and for the industry of this country, and for our keeping our place in the world. I do not see where sufficient capital for private industry is to come from. For these reasons and many others, I support any measure which will result in a reduction of taxation in this country, since I consider that the present burden of taxation will, in the long run, be found intolerable. This position can

927
be remedied only either by the Government itself or by the force of economic circumstances, in the most unpleasant way of further inflation.
EARL JOWITT: May I ask the noble Lord a question? I do not understand this matter. Of course taxation is an evil, but the noble Lord would obviously not save taxation by cutting, shall I say, education. There must be some wasteful features in education, but he would not want to do that. He would weigh up in each case the gains which would come from the reduction in taxation against the losses which would accrue from cutting the social services. Does the noble Lord accept that?
LORD BRAND: I believe that when I first spoke in this House I said that I was against the free health services because they involved a taxation of £400,000,000 a year. Some noble Lord on the opposite side said "But we have free education; why should we not have also free health and free food?" I said "Well if you like to have a system where the whole of your income is taken from you by the Government and part of it returned to you in the form of free food, free health, and so on, you can have it; but in my opinion it would be a disastrous form of government: in fact, practically the Russian form." The cost of the free Health Service is partly responsible, among all other taxes, for instance, for the tax on undistributed profits, for taxes which ultimately diminish the power of our industry to prosper; and on our industry all social services and everything else depend. I see that I interest the noble Viscount, Lord Stansgate—he is apparently very pleased with my speech. I am very glad of it. But I say that all taxes together hit the productive element in the community so hard that the foundation of all the social services will be endangered by the consequences.
LORD LLEWELLIN: I did not intend to intervene in this debate, but I wish to draw your Lordships' attention to the fact that we are getting somewhat far from the question, "That Clause 1 shall stand part of this Bill." We are getting into a big economic debate. We were all delighted to hear the noble Lord, Lord Pakenham, make his speech: many parts of it I recognised from Second Reading. But is not the Second Reading really the
928
time and proper place for a discussion such as this?
VISCOUNT STANSGATE: As everyone is a judge of matters of order in this House—that is the rule—may I make a modest contribution? The reason that all this is being discussed at such length is that this Bill is such a shameful document and the Government have done their best to conceal it. When it was taken in the other place it was not debated at all—the guillotine was applied. We know that no Amendments are going to be accepted. We have been told that there is to be no Report stage, except by the generous grace and favour of an arrangement made by the noble Marquess the Leader of the House. These reasons alone, in my view, justify completely the wider debate—apart from the fact that Clause 1 is really the taxing clause, which is the gist of the whole Bill. Therefore I think that the noble Lord, Lord Llewellin, is misjudging the point of view, and I make my contribution in the opposite sense.
EARL JOWITT: I should have thought that this discussion was plainly in order. Everyone dislikes this Bill, including the Government, but they say that in the interests of economy it is necessary. Therefore, surely, we are entitled to a discussion on the economic side. I am astounded to hear a noble Lord of the experience of Lord Llewellin say that this discussion is out of order.
9.55 p.m.
LORD SHEPHERD: There are just one or two brief points that I should like to make, as my name has been mentioned. The first is this. It is assumed that this Bill, when it has become an Act, will save this country £9,000,000 a year. But is that a fact? Is it not nearer the truth that this Bill merely transfers the expenditure upon sickness from the broad back of a fairly healthy community to the weakened frames of the sick and lame? Noble Lords opposite have repeatedly said to-day that they do not wish people to go to the doctor less often; they all agree that people's teeth should be attended to as regularly as possible. Nothing will be done by this Bill—according to their speeches—which will reduce the health of the nation. Well,

929
if that be the case, the expenditure is to continue But it is, as I have already said, an expenditure laid on the sick and the lame and not on the broad back of the community.
I wish to touch upon one point which the noble Lord, Lord Brand, made. I am a simple man in matters of economics, but there are certain things that I hear from time to time which I clearly understand. One is that taxation and the expenditure from taxation are not necessarily an evil. Taxation is not necessarily an uneconomic thing, and it is not necessarily a loss to the nation. On the contrary, it may pay dividends. If the noble Lord, Lord Brand, were to say to me that a good deal of the expenditure of the Government of this country is wasteful I might agree with him, and I might join in the search for some remedy. But when he tells me, as he seems to have done to-night, that taxation is an evil and must be reduced, then I do not agree.
LORD BRAND: I said too great taxation—not taxation itself.
LORD SHEPHERD: The question of what is too great taxation is a matter which we shall have to decide in some other way and not in a debate on a sum of £9,000,000.
There is one other point. We are told that this sum of £9,000,000, small as it is, it will be a welcome relief which will assist the Government in balancing their accounts, and will contribute to the strength of the nation. I think that is the argument. But in the Budget to which this is a companion document the Government have decided to relieve direct taxation by no less than £180,000,000. Now, the Government did not do that because they thought the nation was going towards bankruptcy. According to the Chancellor of the Exchequer it was done because, in Mr. Butler's words:
"I consider that we can well afford the £l80,000,000 which these reliefs will cost in the current year."
So, in a year when the Chancellor of the Exchequer is expressing the view that relief of taxation to the extent of £180,000,000 is within our ability to afford, the Government are asking us to increase the burden by a transfer of £9,000,000 from the broad
930
backs of the community to the weakened frames of the lame and the suffering.
VISCOUNT STANSGATE: I apologise for continuing the debate but it is the only opportunity we have. I want now to draw attention to a totally different matter, namely, the question of the regulations to be made under this Bill, because we are not at all clear as to what they are and how they are to be enforced. The only two references that I can find to regulations in this Bill are in subsection (2) of Clause 1, and an enlargement of the scope of the regulations in subsection (6) of Clause 7. My noble friend Lord Listowel moved an Amendment which permitted remission to be made in the case of old people who were living in hostels provided by local authorities. In his reply, the noble Lord, Lord Woolton, I understood, made two suggestions: either that it was already covered—I may be doing him wrong; If so, I am sure he will correct me—or that he could do it by regulation.
LORD WOOLTON: I did not say "by regulation." I am sorry the noble Viscount did not hear me aright. I deliberately said not. It was his noble friend who suggested that it might be done by regulation. I made no comment upon it. This is the second time I have made this particular speech.
VISCOUNT STANSGATE: Then how is it to be done if not by regulation? Is it in the Bill?—because I understood the noble Lord to say that he accepted the principle of the Amendment and that it was possible to do it. When my learned friend said "By regulation?" I understood the noble Lord to assent, but apparently he did not assent. How is it to be done?
LORD WOOLTON: It might be by agreement.
VISCOUNT STANSGATE: With whom?
LORD WOOLTON: Without being in the Bill.
VISCOUNT STANSGATE: Agreement with whom? Is this not Parliament? Where are these private agreements where public money is transferred from one pocket to another?
LORD WOOLTON: I deliberately said—I am sorry to repeat myself; we are all getting most tired—
VISCOUNT STANSGATE: Not at all.
LORD WOOLTON: Well, I am. I congratulate the noble Viscount on his stamina. I deliberately said that there were discussions taking place at the present time between the Minister and the local authorities, and that it would be on that basis that agreements might be made.
VISCOUNT STANSGATE: I am sorry that the noble Lord is tired. But we are only just finishing Clause 1. There are nine clauses, and I think we can all say that the first stage of the Committee discussion on this Bill has been, in our own phrase, what we may call a profitable afternoon.
LORD WOOLTON: All I said was that I was tired of repeating myself, of making the same speech twice over.
VISCOUNT STANSGATE: I am glad to hear that, because we are never tired of hearing the same speech over and over again by the noble Lord, Lord Woolton. But what I want to know is: if he is going to do it by agreement, is it some extra-legal agreement, or how will it be done? Because when my noble friend referred to regulations, naturally one's eye was sharpened to see what could be done under those regulations. If the Lord President says that this arrangement about the old people in hostels will be made, that in fact at present the question is being discussed. I want to know whether a conclusion will be arrived at before this Bill becomes law? I see that the noble Lord is reading his paper, but we are supposed to be legislating. We are passing a Bill now, on the sole Committee stage discussion that is open to us. The Bill will later go to Third Reading and, in the meantime, we are told, an important Amendment is going to be accepted. Then, somehow, there is to be agreement between the Government and the local authorities—the noble Lord seems to think that he evades his responsibility to Parliament properly by saying that this is a matter for discussion between the two authorities. It is not satisfactory and is not a proper exercise of Parliamentary control. If that is going to happen, I should like to know what is covered by the words—that is why I
932
raise this point on whether the clause shall stand part—in subsection (2):
"… and regulations may provide for the remission or repayment of any charge payable thereunder in such other cases as may be prescribed."
Could regulations be made giving remissions in the special cases which we have asked for in our Amendments? If that is so, it raises a very interesting point. I think it is a question that it is reasonable to put. I would beg the noble Lord if he would be so kind, or the noble Marquess who is leading the House, to tell us exactly what is the scope of the power as permitted to the Government in those words on page 2 of the Bill?
LORD WOOLTON: The answer to the last question is that regulations on charges for drugs from hospitals will be made under the Bill and will be subject to a Negative Resolution of both Houses.
VISCOUNT STANSGATE: Of both Houses, of course—yes.
LORD WOOLTON: Referring to the question raised by, I think, the noble Earl, Lord Listowel, the answer is that regulations on the charges for doctors' prescriptions will be made under the Act of 1946—
VISCOUNT STANSGATE: I know that.
LORD WOOLTON: —as amended by the Act of 1949. Therefore, the Act already exists. It is one of your Acts and they will be subject, of course, similarly to a Resolution of both Houses.
VISCOUNT STANSGATE: Then I understand that the answer to my question is that, as regards hospital prescriptions, the Government already have power to remit or repay the charge to people for whom we have been pleading in our Amendments.
THE MARQUESS OF SALISBURY: As I understand it, the charges for drugs from hospitals to which the noble Viscount is at present referring will be made under this Bill and will be subject to Negative Resolution, the ordinary procedure.
VISCOUNT STANSGATE: Yes, the remission and repayment—that is so. The noble Marquess has been speaking about the last paragraph of subsection (2) of Clause 1 of the Bill—that is to say, that they could be remitted so far as hospital charges are concerned. I do not know

933
whether regulations would be required for the old Act of 1949, but these charges could be remitted under the existing powers of the Act. If that is so, I think we might I have been told that when we were discussing the cases of these various diseases.
THE EARL OF LISTOWEL: May we be quite clear about this matter, because it is of considerable importance? The fact is, of course, that the power to impose the charges for prescriptions which will be paid by these old people is a power existing in the 1949 Act and does not come in this Bill at all. They are powers which we did not apply and which noble Lords will apply in other cases. Is there
Resolved in the affirmative, and Motion agreed to accordingly.
10.20 p.m.
THE EARL OF LISTOWEL THE EARL OF LISTOWEL moved, after Clause 1 to insert the following new clause:
Exemption of expectant and nursing mothers from charges for pharmaceutical services.
". No charge shall be made under subsection (3) of section thirty-eight of the National Health Service Act, 1946, or under subsection (3) of section forty of the National Health Service (Scotland) Act, 1947 (which
also in that Act power to remit or repay charges of this kind?—because that is the point we are on. Under what power is the noble Lord going to remit or repay charges on prescriptions, made out for old people for whom local authorities are responsible?
LORD WOOLTON: I understand that it is under the 1949 Act.
THE EARL OF LISTOWEL: I thank the noble Lord.
On Question, Whether the said clause shall stand part of the Bill?
Their Lordships divided: Contents, 56; Not-Contents, 22.

CONTENTS

Simonds, L. (L. Chancellor.)

Buckmaster, V.

Hampton, L.

Davidson, V.

Hindlip, L.

Woolton, L. (L. President.)

Falmouth, V.

Kinnaird, L.

Furness, V.

Leathers, L.

Hudson, V.

Llewellin, L.

Cholmondeley, M.

Margesson, V.

Merthyr, L.

Salisbury, M.

Monsell, V.

Monk Bretton, L.

Swinton, V.

Palmer, L

Albemarle, E.

Remnant, L.

Alexander of Tunis, E.

Aberdare, L.

Rochdale, L.

Buckinghamshire, E.

Ailwyn, L.

Rockley, L.

Dundonald, E.

Amherst of Hackney, L.

Saltoun, L.

Fortescue, E. [Teller.]

Audley, L.

Sandford, L.

Howe, E.

Blackford, L.

Sandhurst, L.

Lindsay, E.

Brand, L.

Teviot, L.

Onslow, E. [Teller.]

Brassey of Apethorpe, L.

Teynham, L.

Scarbrough, E.

Clanwilliam, L.(E. Clanwilliam.)

Tweedsmuir, L.

Selkirk, E.

De L'Isle and Dudley, L.

Waleran, L.

Shaftesbury, E.

Fairfax of Cameron, L.

Webb-Johnson, L.

Yarborough, E.

Gifford, L.

Wolverton, L.

NOT-CONTENTS

Jowitt, E.

Chorley, L.

Macdonald of Gwaenysgor, L.

Greenhill, L.

Macpherson of Drumochter, L.

Stansgate, V

Hare, L. (E. Listowel.)

Milner of Leeds, L.

Henderson, L.

Nathan, L.

Ammon, L.

Kenswood, L.

Ogmore, L.

Archibald, L.

Kershaw, L.

Pakenham, L.

Bingham, L. (E. Lucan.) [Teller.]

Lawson, L.

Shepherd, L.

Lucas of Chilworth, L.

Strabolgi, L.

Burden, L. [Teller.]

provide for the making and recovery of charges in respect of pharmaceutical services) in respect of any pharmaceutical services provided for any woman who is an expectant mother or who, within the previous twelve months, has borne a child, except of the supply to such a woman of any article of a kind for which a local I health authority has, at the time when the article is supplied, a power to make and recover a charge under section twenty-two of the principal Act."
The noble Earl said: The night is getting late and I do not intend to weary the Committee by repeating the argu-

935
ments which I have used at an earlier stage of the discussions on this Bill. The object of this Amendment is to exempt from charges for medicine and drugs those expectant and nursing mothers who get their supplies through general practitioners as distinct from those who get them through the hospitals, which are a class with which I dealt earlier on, in another Amendment. I shall not repeat the arguments because they are exactly the same as I used before. I think that this is a class of person who deserves separate treatment, and I very much hope that the Government will view the claims of these people with a good deal of sympathy and kindness. I beg to move.
Amendment moved—
After Clause 1 insert the said new clause.—(The Earl of Listowel.)
THE EARL OF ONSLOW: I am afraid that I am unable to accede to the noble Earl's request to accept this Amendment. One main reason why I cannot do so is that which I think was stated by the noble Lord, Lord Woolton—that reproducing one's species is not a disease. It may be that some of the species produced may be regarded by some future generation as a disease but, normally and generally, this process of reproduction is not a disease. As the noble Lord said earlier, we poor males, however august we may be in certain parts of this House, do not know of the difficulties. But it is not considered that these ladies can be classed as special cases suffering from hardship and therefore I am unable to accept the noble Earl's Amendment.
VISCOUNT STANSGATE: Does that mean that under regulations made under subsection (2) it will be impossible to remit charges on these people?
THE EARL OF ONSLOW: I am not going to be drawn by the noble Viscount any further to-night.
VISCOUNT STANSGATE: The noble Earl has used the phrase "not going to be drawn." That is what Ministers are for. That is why they come here; that is what is called Parliament. They come here in order to explain to the public what their legislation means. I am perfectly certain that the Deputy Leader of the House would not use an expression
936
of that kind. He would have told us plainly whether remission in this particular case is covered by the last three lines of Clause 1 (2). It is a perfectly simple and, I am sure, quite legitimate question.
On Question, Amendment negatived
10.23 p.m.
THE EARL OF LISTOWEL THE EARL OF LISTOWEL had given notice that he would move after Clause 1 to insert the following new clause:
Exemption of certain persons in welfare homes from charges for pharmaceutical services
". No charge shall be made under subsection (3) of section thirty-eight of the National Health Service Act, 1946. or under subsection (3) of section forty of the National Health Service (Scotland) Act, 1947 (which provide for the making and recovery of charges in respect of pharmaceutical services) in respect of any pharmaceutical services provided for any person for whom residential accommodation is being provided under Part III of the National Assistance Act. 1948, and who is not paying the standard rate fixed for that accommodation under section twenty-two of that Act."
The noble Earl said: This is another application of the principle which was embodied in the Amendment I moved at an earlier stage of the Bill. This Amendment applies the principle of exemption to old people who go for their medicine or drugs on the instructions of a general practitioner. The former Amendment applied to old people who went to a hospital. The noble Lord, Lord Woolton, made quite a long statement when I moved my first Amendment on this subject, and I am looking forward to what he has to say on the Report stage. I shall not say anything more by way of argument in support of this Amendment. I should like, by leave of the Committee, to refrain from moving it in view of the undertaking given by the noble Lord, Lord Woolton, on my previous Amendment.
Clause 2:
Charges for dental treatment.
2.—(1) Subject to the provisions of this section, a charge of the amount authorised by this section may be made and recovered, in such manner as may be prescribed, in respect of any services provided as part of the general dental services under Part IV of the principal Act, not being—

(a) the supply or replacement of appliances described in the Schedule to the National Health Service Act, 1951;

(b) the repair of appliances other than prescribed appliances;

937

(c) the arresting of bleeding; or

(d) the clinical examination of a patient and any report thereon.

(2) The amount of the charge payable under this section in respect of services provided in pursuance of any contract or arrangement shall be the current authorised fee for all services so provided in respect of which a charge is payable under this section, or one pound, whichever is the less; but where any services in respect of which a charge is payable under the National Health Service Act, 1951, are provided in pursuance of the contract or arrangement, the charges payable under this section and under that Act in respect of all services provided in pursuance of the contract or arrangement shall not exceed four pounds five shillings in the aggregate.
10.25 p.m.
Lord MILNER OF LEEDS Lord MILNER OF LEEDS moved, in subsection (1) after "made" to insert "before the first day of April, 1954." The noble Lord said: The point of this Amendment is really to limit the operation of the Bill. As your Lordships know, the operation of the previous Act was limited to April, 1954. Under the provisions of the present Bill, in this clause,
"a charge of the amount authorised by this section"—
I am reading now from page 2, line 10—
"may be made and recovered, in such manner as may be prescribed…"
I am proposing to insert the words "before the first day of April, 1954," so that the line will read:
"… a charge of the amount authorised by this section may be made before the first day of April, 1954…"
That is the date up to which the original Bill ran. It seems to me that this is a reasonable Amendment. I do, however, provide by the following Amendment on the Marshalled List that:
"if at any time before the first day of April, 1954, an Address is presented to Her Majesty by each House of Parliament praying that this section be continued in force for a period of one year from the time at which it would otherwise expire, Her Majesty may by Order in Council direct that this section shall continue in force for that further period."
So it is made possible for these provisions to operate not only up to 1954, as provided for by the original Act, but, on an Order in Council made by Her Majesty, for a further year. It seems to me that that time should be sufficient. We have been given to understand by the noble Marquess to-night that if conditions improve not only these provisions but
938
other provisions also will be done away with and that there will be, in fact, a free Health Service. I do not know, but it seems to me unlikely that conditions will improve during the period the present Government are in power, and, in any event, 1954 is not a very long way ahead. Having regard to the extra year provided for in the following Amendment, I hope the Government will accept this one. If they do not do so, it seems to me that that will be evidence of very little confidence on their part in their ability to improve the position of affairs generally before 1954. I hope, therefore, that the Amendment will be accepted. I beg to move.
Amendment moved—
Page 2, line 10, after ("made") insert ("before the first day of April, 1954").—(Lord Milner of Leeds.)
10.28 p.m.
THE CHANCELLOR OF THE DUCHY OF LANCASTER (VISCOUNT SWINTON): The noble Lord who has moved this Amendment has supplied several reasons for rejecting it. In fact, I did not in the course of his speech apprehend any significant reason why it should be accepted. I should not accept all the premises on which he based his argument, that nothing good could come out of this Government and that the situation could not improve. Happily, the situation has greatly improved since noble Lords opposite vacated their position. The situation has clearly improved. What the noble Lord is seeking to do is to insert something on the basis of the 1951 Act—which, of course, was the Act under which his Government imposed, and quite rightly imposed, tile charges which for many hours to-night noble Lords who I thought supported the Government in those clays have been objecting to. But we have to remember that when the Socialist Government invited Parliament to impose these charges in 1951 the situation was far less serious than that which we encountered when we came into office. It is true that my noble friend, the Leader of the House, has said that we take power in this Bill to reduce or abandon these charges if conditions improve.
That seems to me to be quite right, and it would be entirely inconsistent with it to adopt the noble Lord's proposal, which is not that if conditions improve (as I trust

939
they will) we shall reduce or abandon these charges, but that if conditions have not improved sufficiently we shall then, having abandoned these charges, perhaps having raised false hopes in the breasts of the people, do what I do not like doing by Order in Council, and extend the period of the operation of the section. I am sure it would be said by the noble and learned Earl the Leader of the Opposition that the right way to impose charges is not by Order in Council but by legislation. Surely the sensible thing to do is to adhere to the provisions in this Bill which assimilate the Act of 1951, and, by this Bill, which will presently be an Act of Parliament, take powers to abandon or reduce both, if we find in future that circumstances permit. Therefore, I cannot advise the House to accept the Amendment.
On Question, Amendment negatived.
LORD AMMON LORD AMMON moved, in subsection (2), after "shall be," to insert "ten per cent. of." The noble Lord said: Perhaps it will be for the convenience of the House if I take the next two Amendments together, as they are complementary. I am not going to say, as the noble Viscount suggested, that no good can come out of this Government, because here is an opportunity for them to do some good. I am not going to interfere in any way with the make-up of the Bill. All this Amendment asks is that some modification shall be made in the interests of those who can least afford these expenses. Attention to the teeth is something more than extraction and dentures, and this subsection concerns what we might call the conservation of the teeth of our young people. It would be an economy if charges were lessened in order that there should not be any deterioration in the teeth of our young people through their being unable to obtain the necessary attention to keep their teeth in good condition. Up to the age of sixteen years they get free attention, and after that they are called up for National Service, but in the intervening time their teeth do not have the attention they might have had during a period when it is most necessary. When they come back from the Forces and enter university or apprenticeship, they are not likely to have much money in hand to pay this increased amount for dental treatment. That is why I move this Amendment, which proposes that there should
940
be a reduction to 10 per cent. in the charges and, in the following Amendment, that the charges should not exceed £2 5s.
Amendment moved—
Page 21, line 22, after ("be") insert ("ten per cent. of").—(Lord Ammon.)
THE EARL OF ONSLOW: Once again I am sorry to say that I cannot accept this Amendment. It is not expected that the full charge in many cases will be up to the £1 limit, and if the charge is reduced to 10 per cent. this would prove to be a more or less wrecking Amendment, because the saving would be nil. On this ground I am afraid I cannot accept the Amendment.
VISCOUNT STANSGATE: I am moved by my noble friend to draw attention to a most objectionable feature of this Bill. To a large extent we may call this a taxing Bill. It was not founded on a Money Resolution in another place but it required a Money Resolution. As your Lordships know, we in this House are not entitled to impose a charge. Any Amendment we may make would have to be put in italics in the Order Paper of another place and Mr. Speaker would have to call the attention of another place to the Amendment and a special entry would have to be made in the Journal. In general, I support my noble friend's suggestion. I am surprised that the Government have not made any comment on what this type of thing is forcing on the Constitution. In another place they guillotine what seems to be a taxing Bill and force it through the House, so that, if it is to be amended, we are forced to put in Amendments which are privilege Amendments—a thing that in my judgment should be avoided at all costs. They are tending to increase the financial powers of this House. I draw attention to this because it might arise in other cases. The noble Earl has made his usual reply and I suppose we must accept it.
On Question, Amendment negatived.
10.35 p.m.
On Question, Whether Clause 2 shall stand part of the Bill?
LORD MILNER OF LEEDS: I should like to say a few words on Clause 2. Here I particularly wish to call in aid the noble Lord, Lord Teviot, in support of my contention that charges for dental treatment ought not to be made in this

941
Bill. When I have read this extract from the Report of the Committee over which the noble Lord presided, the noble Lord should vote with this Party on the question of whether the clause shall stand part of the Bill. This is what the Committee said:
"The greatest single step forward which in our view could be made at the present juncture is the acceptance of the principle of a comprehensive service which, while perhaps not wholly adequate, will be equally available to all who demand it and which will be paid for by the community as a whole."
The Report went on to say:
"We want to divorce dental health care from question, of means and thus begin to build up demand. Then can come the wider and longer process of increasing enlightenment about dental health."
During the war the noble Lord, Lord Teviot, and his eminent Committee proposed that there should be a free dental service, the cost of which should be met by the community as a whole. In this Bill Clause 2 provides for a charge up to the sum of £1 on persons who would otherwise have been entitled to a free service. I submit that here again all these charges are deterrents. Whether intended or not, they will have the effect of prevailing upon people who require dental treatment not to take it until their condition is so bad that perhaps it cannot be remedied, or so bad that certainly their £1 will be well spent in going to the dentist. That is not desirable, either from a personal or from a national point of view. The imposition of a charge of up to £1 will be a great hardship on many thousands of people. The last thing we in this House ought to do is approve of payments in respect of dental treatment, which in some instances have been free for many years. I hope the House will not pass this clause.
VISCOUNT SWINTON: I hope the noble Lord's Party will pay due regard to the strictures that he has passed on Mr. Gaitskell and other members of the Government who were responsible for imposing charges under the Act of 1951. They are hardly usefully addressed to us on this Bill, on the question of principle. The argument that people will let their teeth go and will never go to the dentist is most carefully met by the provision we have made in the Bill that inspection shall be free. That seems to me to knock the bottom out of the noble Lord's argument. There is also provision for treatment for those of younger years.
EARL JOWITT: Before we part with this clause, I want to say this. We have had an interesting discussion this afternoon, a discussion which has brought us practically nothing. Of course, it is within the power of noble Lords to use their majority and turn us down in every single respect, but if this goes on, discussions of this sort in this House in these circumstances are pretty well useless. At a time when everybody is looking at this House and wondering if it performs any useful function or not, I cannot help thinking that that is regrettable, because I believe in this House and want it to go on. In the old clays when I was sitting on the Bench opposite, noble Lords now in the Government had a huge majority against me. I had to be very conciliatory, and in every case I had to see what I could afford to give away. I quite agree that the circumstances to-day make it completely unnecessary for noble Lords opposite to be conciliatory, or to consider what they have to give away, or to give away anything. They can simply steamroller us and heat us on every single Amendment, all through every discussion. If this goes on, the discussions in this House become more or less useless. Therefore I would urge your Lordships, before we leave this clause, to approach the matter in this way. Here we have an important Bill which was not discussed in the other place, and we have had an interesting discussion on the Bill, as I have said. We are greatly indebted to noble Lords for the information given to us, but I may say that we are indebted to them for very little else—and I regret that. I hope that when we come to the next Amendment the Government will be able to give us something which will make our discussions worth while.
LORD SALTOUN: I was sorry to hear the noble and learned Earl who leads the Opposition make that speech. I spent many weary days in the House on Bills of the last Government. He said that we had a majority, and that he had to use extreme forbearance to conciliate. But on many occasions after a Bill was passed the noble and learned Earl thanked us for the improvements we had made to the Bill.
EARL JOWITT: I am not disputing that. I would do it now. I do not dispute that your Lordships improved Bills, as I hope that we also may do.
LORD SALTOUN: I would remind the noble and learned Earl of one incident which shows how flexible and entirely non-Party our opposition was. I think it was on the occasion of our discussions on the National Insurance Bill. The friendly societies were to be put back in the Bill that afternoon, and the noble and learned Viscount (as he then was) rose and made a speech. It was a matter on which I had strong opinions, which were not those of my Party, and I agreed with the then Government. The noble and learned Earl, Lord Jowitt, made a speech—not one of his great speeches in which he magnified a weak point to make it appear a strong one, but a short, simple and direct speech. I saw my leader, the noble Marquess, look round and realise that the whole of his Party had melted away, convinced by the noble Earl's reasons. The noble Marquess will probably bear me out. We did not divide. That was very much the spirit in which our Opposition was carried on, and I do not think it is a proper reward for that spirit to say that sort of thing now.
EARL JOWITT: The noble Lord has completely failed to understand everything that I have said. It is late in the evening, I know, and sometimes even the clearest brains get a little woolly. If he will forgive me for saying so, he has completely failed to understand what I said. I have often said in the past, and I say it to-day, that I think the character of the Opposition in this House when the Labour Government were in office was most useful and helpful. I thanked them then, and I thank them now. I do not say that it was always non-Party; that would be a ridiculous over-statement, as there was a good deal of Party in it. But, apart from that fact, they gave us great help in improving our Bills. I have not suggested anything to the contrary. All I said was that I went out of my way to try to be conciliatory to them, so that the two minds met. All I suggested in what I said to-night was that I hope the present Government, now that the situation is reversed, will go out of their way to be conciliatory, so that minds may meet, and we in our turn will try to make helpful and useful suggestions. But if the Government are not going to meet us at all and if all our suggestions are to be turned down flat in the present circumstances, because the Government have a
944
great majority here, then I feel that discussions in this House will be rather useless. The noble Lord has completely misunderstood every word I said, and if he reads his own speech to-morrow I think he will realise it.
VISCOUNT STANSGATE: Before this clause is passed, I should like to ask the noble Marquess what are the concessions that we have received. He generously drew our attention to the fact that, as no Amendments have been accepted, there will be no Report stage, but he made a further suggestion which I did not quite understand. If he could explain that clearly it might result in curtailing our debate now, although I for one should never agree that it was useless.
THE MARQUESS OF SALISBURY: I have explained the situation about three times to the noble Viscount, but if he would like to have it again he is entitled to his pleasure. I felt that I must tell your Lordships about this difficulty of the Report stage; otherwise, if something should be postponed to the Report stage, or it were agreed that there should be consultation before the Report stage, and it turned out that there would not be a Report stage, we should have "double-crossed" the Opposition, which I did not want to do. I understand that when we move "that the Report be now received" I shall on that occasion he able to make a statement. This is a rather difficult matter, because that is a most unusual procedure and one which is not usually adopted. The Lord Chairman will report the Bill to the House without amendment, and the normal thing would be that I should then move" that the Report be now received. "But I shall not do that; that Motion will not be moved to-night, but at a later date, when we resume the discussion on this Bill. I understand that when I move "that the Report be now received" there will be an opportunity for a debate. As your Lordships can see, I find this unusual procedure rather difficult to follow. The Bill will appear on the Paper for Consideration on Report, and on that the Bill can be reconsidered on Report; Amendments can be moved, and noble Lords can put down what Amendments they wish. In effect, it creates a Report stage which would not normally be there; we are recreating a Report stage to enable noble Lords to have an opportunity of

945
further consideration of the Bill. In the meantime, as I promised, I will transmit to my right honourable friend the Minister of Health what has been said to-day on what I call the "omnibus Amendment," and. I hope to be able to report on that occasion the result of my inquiries. The Amendment will then be put down again by the Opposition on the Report stage, and I or my noble friend Lord Woolton will speak on it. I think that is now clear. It is a very unusual procedure, and we are adopting it on this occasion only to get out of the difficulty which would otherwise arise.
VISCOUNT STANSGATE: I thank the noble Marquess. I think he will admit that the question was justified, because it was not quite clear what would happen. I should like to thank him for the generous way in which he drew our attention to the fact that there would not be a Report stage. I think we owe something to him for his generous treatment of the House, and for giving us this opportunity of further discussing the matter.
Clause 2 agreed to.
10.50 p.m.
THE EARL OF LISTOWEL THE EARL OF LISTOWEL moved, After Clause 2 to insert the following new clause:
Exemption of expectant and nursing mothers front charges for dentures
". No charge shall be made under section one of the National Health Service Act, 1951 (which authorises the making and recovery of charges in respect of certain dental and optical appliances) in respect of the supply of a denture to a woman who, at the date of the contract or arrangement for the provision of the dental services in connection with which the denture was supplied, was an expectant mother or had borne a child within the previous twelve months,"
The noble Earl said: I cannot help feeling slightly aggrieved that before he had had the chance of listening to the argument I desire to put forward on this Amendment, the noble Marquess has just said that, the Bill having been reported, without amendment, he intended to move "that the Report be now received." My grievance is all the more keen because I regard this as being an extremely moderate and sensible Amendment. Noble Lords opposite have, up to now, not accepted any Amendments, and the only concession they have made—for which we are grateful—is about exempting old people who do not pay the standard rate in, homes maintained by local authorities but that is to be done administra-
946
tively and nothing will appear in the Bill. Here I should hope there might be an opportunity for some concession which might go into the Bill.
The object of this Amendment is to exempt from the charge that can be made under the Act of 1951 nursing or expectant mothers who require dentures. If this Amendment were accepted it would put those people, in respect of dentures, in exactly the same position as they would be under this Bill in respect of dental treatment, because under Clause 2 (4) of this Bill expectant and nursing mothers are specifically exempted from the charge that will be made for dental treatment. Subsection (4) says:
"No charge shall be made under this section in respect of the services … provided for any person who, on the date of the contract or arrangement for the services …
(b) is an expectant mother or has borne a child within the previous twelve months."
So an expectant mother who goes to a dentist to have a cavity mended or to have an extraction will not pay any charge, whereas any other person who goes to a dentist for other purposes will have to pay a charge. It seems rather illogical, in view of what the Government seek to do under the Bill, that these people should, nevertheless, have to pay for dentures. It looks as though, if an expectant mother wants a tooth extracted or subtracted, it is done for nothing, whereas if she wants teeth added she will have to pay for them. I cannot help thinking that that is rather an illogical situation, quite apart from the importance of the care of the teeth from the point of view of the expectant mother and her child.
The other point in this is an administrative one. There is an extraordinary anomaly here. If an expectant mother goes to see a visiting dentist at a maternity centre run by the local authority, the dentist can provide the denture free of charge. That is not affected by the 1951 Act. On the outer hand, if the same person goes to a dentist under the Health Service and asks for a denture, she will have to pay up to the limit prescribed in this Bill. That is surely an anomaly which must be put right, whatever the Government decide to do. I should like to hear what the noble Lord who replies may have to say on that point, apart from the wider and more important issue that I have already raised. I beg to move.
Amendment moved—
After Clause 2, insert the said new clause.—(The Earl of Listowel.)
VISCOUNT SWINTON: I am afraid that I cannot ask the Committee to accept this Amendment. I will not rest simply on saying what I think indeed is true—that subtraction and addition are not exactly the same thing. I could not quite follow the argument that the extraction of your teeth was the same thing as being supplied with a complete set of dentures. I think the short answer to the noble Earl is this. Under the Act of 1951, there were no exemptions. Much as one would like to make exemptions here, the principle of no exemption in these cases was an essential feature of the Act of 1951, and I am afraid that we must carry on with it. But there is a way in which help can be given here and I understand that nursing and expectant mothers are entitled to dentures without charge under the priority services run by the local authorities.
THE EARL OF LISTOWEL: That is exactly the point I made.
VISCOUNT SWINTON: These services are not as fully developed as we would wish to see them. I think one result of the present Bill will be an expansion of the priority services run by the local authorities, both for expectant mothers and children.
On Question, Amendment negatived.
Clauses 3 to 5 agreed to.
Clause 6:
Evasion of charges.
6. If any person for the purpose of evading the payment of any charge under the National Health Service Acts or this Act, or of reducing the amount of any such charge—

(a) knowingly makes any false statement or false representation; or

(b) produces or furnishes, or causes or knowingly allows to be produced or furnished, any document or information which he knows to be false in a material particular,

he shall be guilty of an offence and liable on summary conviction to a fine not exceeding one hundred pounds or to imprisonment for a term not exceeding three months or to both; and whether or not he is convicted of an offence under this section the charge, or as the case may be the balance of the charge, may be recovered from him as a simple contract debt by the person by whom the cost of the service in question was defrayed.
10.58 p.m.
LORD MILNER OF LEEDS LORD MILNER OF LEEDS moved to omit all words from "exceeding" down to and including "both" and to insert "twenty pounds." The noble Lord said: The object of this Amendment is to reduce the penalty for evasion of the payment of any charge under the National Health Service Act to what I think is a more reasonable figure and one more appropriate to the offence. We have always understood that, in matters of this sort, penalties should be made to fit the crime, and here the penalty laid down in the Bill would appear to be grossly excessive. I am fully aware that it may be said that this is only the maximum, and that it will never be enforced; but it is surely excessive to provide for a penalty of a fine of £100 or three months' imprisonment, or both, for what at the most can be a very small offence. Indeed, it seems very difficult to conceive of what the offences can be under this clause. There may be a misrepresentation by a man that he is under twenty-one, in the case of dentures, or under sixteen in the case of prescriptions, or something of that sort. But what can he obtain? A few prescriptions, maybe a denture or something of that sort. The penalty is grossly excessive.
I think I am right in saying that the maximum penalty under the National Insurance Act is not so much as, and certainly does not exceed, the penalty laid down by this Bill. It is not the case here that a person can obtain hundreds of pounds by misrepresentation, and it is not a case of misrepresentation to a medical man. This is not a penalty for an applicant who goes to a medical man and represents that he has some complaint or other which entitles him to an appliance, or to a prescription or anything else. This is a penalty for a false representation made for the purposes of evading payment of charges prescribed. The only instance that occurs to me (and I shall he happy to learn whether the Lord Chancellor, if he is to reply, can give any further instances) is where an effort might be made to obtain exemption from charges laid down in this Bill on some misrepresentation that the person came within these various exemption clauses. There are, however, few of those. The amount involved must be trivial, and I submit that the fine of £20 would be adequate to cover any offence which might be committed under this section. I beg to move.
Amendment moved—
Page 4, line 24, leave out from ("exceeding") to ("and") in line 25, and insert ("twenty pounds").—(Loral Milner of Leeds.)
LORD LLEWELLIN: I had a little spare time while the debate was going on, and I took the opportunity of reading from the 1951 Statutes, and I came upon the Workmen's Compensation (Supplementation) Act, 1951, introduced by the late Labour Government. If your Lordships would follow the words in the Bill before us I will read from this Act:
"If any person, for the purpose of obtaining any allowance or payment under this Act, whether for himself or some other person—

(a) knowingly makes any false statement or false representation; or

(b) produces or furnishes, or causes or knowingly allows to be produced or furnished, any document or information which he knows to be false in a material particular;

he shall he liable on summary conviction to a fine not exceeding one hundred pounds or to imprisonment for a term not exceeding three months, or to both such fine and such imprisonment."
Of course there are, as the noble Lord said, maximum penalties. I would not follow every precedent set by the late Government, but in this one the present Government seem to be following pretty faithfully the words to meet very similar circumstances under the Workmen's Compensation Act.
LORD MILNER OF LEEDS: That is a different offence.
THE LORD CHANCELLOR: My noble friend, Lord Llewellin, has in some measure taken the words out of my mouth. I can supplement what he has said from two other Acts passed in recent years by the Socialist Government in which exactly the same form has been followed. For instance, in the National Assistance Act, 1948, Section 52 (1) provides substantially the same penalty, in substantially the same words: that in the event of anybody knowingly making a false statement for the purpose of obtaining benefit under Part II or Part III of the Act he shall be liable to a fine of up to £100 or three months' imprisonment, or both. In another case—not quite the pari materia with this Act—the Coal-Mining (Subsidence) Act, 1950, the same penalty is applied to persons making false statements with a view to obtaining benefits under the Amendment. That Act, of course, relates to damage caused to dwelling houses by subsidence. It really
950
has become substantially the common form adopted by the Socialists to impose a penalty of £100 or three months imprisonment (as a maximum, of course) for attempts which I think are particularly mean, to get benefit out of this welfare legislation. I would suggest to the House that it is a particularly mean kind of crime to try to get benefit, by false statements, to which you are not entitled. Of course, this is a maximum penalty, and the maximum would be imposed only in the ease of real gravity.
LORD MILNER OF LEEDS: The noble and learned Lord has not compared the offences, which is the essential thing. He has given a case under the National Assistance Act of misrepresentation to obtain a payment. That payment might be £10 over a period of years it might be a benefit of £100 or it may be £1,000. The Lord Chancellor has not told us what the evasion may be under this particular Bill and what amount is involved. Similarly, he has spoken about the Coal-Mining Act, 1950. There again, there is a penalty of £100 and three months imprisonment for making false statements to obtain payment. As I indicated, those payments may be a very large sum indeed, but there is no large sum involved in the Bill at present before the House. I invite the Lord Chancellor to indicate where the evasion of payment might involve such a sum as might be involved under the National Assistance Act or the Coal-Mining Act. If he can produce any evidence of that I should be happy to reconsider the proposal.
THE LORD CHANCELLOR: In all cases like this, it is a mean attempt to obtain money by false pretences.
VISCOUNT STANSGATE: I do not suppose that anyone who is not a lawyer has any right to speak, but what appears to me to be the case is that some lazy draftsman has a handy paragraph which he "pops in" anywhere as suitable for any offence. For example, a woman may be going to have a baby, and she is told: "You are making a fraudulent statement. You are like coal-mining people or something else." To say that the penalty has been imposed for a whole gamut of offences, and that therefore it is the standard penalty, and if any new offence is committed it is the suitable penalty to impose, seems to me to be without any sort of weight to laymen.
THE LORD CHANCELLOR: I suppose the noble Viscount has not yet realised that it is a maximum.
LORD GREENHILL: Is not the real question whether there is any relation between the offence committed and the penalty to be imposed?
VISCOUNT STANSGATE: Would the noble Lord say that the penalty of hanging might be put in because it is only a maximum and would not be imposed in every case?
On Question, Amendment negatived.
Clause 6 agreed to.
11.8 p.m.
Clause 7 [Supplementary and consequential provisions]:
On Question, Whether Clause 7 shall stand part of the Bill?
EARL JOWITT: I wish to ask a question as to the meaning of subsection (6). I do not understand what it does. Will the noble Lord, Lord Woolton, explain to me in simple language what is the object of this subsection. It reads:
"Regulations made under the principal Act or this Act providing for the making and recovery of charges in respect of any services may provide for the reduction of the sums which would otherwise be payable by a Regional Hospital Board, Hospital Management Committee, Board of Management, Board of Governors or Executive Council to persons by whom those services are provided by the amount of the charges authorised by the regulations in respect of those services."
I am bound to say that, those words convey absolutely nothing to my very limited intelligence, and I should be grateful if the noble Lord would tell us, in simple language, what is the effect of that clause.
VISCOUNT SWINTON: The effect is to ensure that the charges are right and proper.
EARL JOWITT: What charges are they? I do not understand what this is doing at all. Would the noble Lord, Lord Woolton, find out? Does anyone know? Surely somebody knows the answer to this question? I invite anybody who can find out to get up and tell us what the subsection is all about. To me, it is absolutely unintelligible.
LORD LLEWELLIN: Do any of these authorities, by any chance, pay any of the doctors or anybody else? Who will collect these charges? I do not know—I
952
am just as much in ignorance as the noble and learned Earl, but I assume that some monetary transaction goes through these bodies. If so, it will be a good thing to find out what has happened, because it may be that some regulations will have to be made in order to ensure that they do not reimburse people who have already taken a shilling from a patient.
LORD WOOLTON: May I reply to the question of the noble and learned Earl? It has taken me a little time to understand the language, but it really seems so simple. I am advised that it is to enable the chemist's remuneration to be reduced by the shilling that he gets from the patient. Perhaps the noble Earl did not gather that.
Clause 7 agreed to.
Remaining clauses agreed to.
Bill reported without amendment.
House resumed.

BUSINESS OF THE HOUSE
11.13 p.m.
EARL FORTESCUE: My Lords, before the adjournment of the House, I should like to inform you that it has been agreed to that the business shall be as follows. To-morrow, Wednesday, we shall take the Motion of the noble Earl, Lord Cork, as First Order after Questions. Then we shall take the Motion of the noble Lord, Lord Lucas, on Transport Policy and continue the debate until about 7.30 p.m., as may be convenient to your Lordships. We shall then adjourn the discussion until the next day, Thursday, when we shall meet at 2.30 p.m. The first business will be the Second Reading of the Empire Settlement Bill and after that we shall resume the debate on Transport Policy. The other orders of the day will be discharged and taken on Tuesday of the following week after the Report and Third Reading of the National Health Service Bill.

PRESTON CORPORATION BILL [H.L.]
Reported, with Amendments.

NOTTINGHAM CORPORATION BILL [H.L.]
Reported from the Select Committee, with Amendments.
House adjourned at fourteen minutes past eleven o'clock.