HL Deb 20 May 1952 vol 176 cc1164-88

4.26 p.m.

Report stage resumed.

THE EARL OF LISTOWEL moved, 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: My Lords, I am moving this Amendment in order to find out from the Government how they intend to treat the old persons mentioned therein in relation to the charge for prescriptions to be made under the Bill. The noble Lord, Lord Woolton, was good enough to say that he would make a further statement on this subject at this stage. I beg to move.

Amendment moved— After Clause 1 insert the said new clause—(The Earl of Listowel.)


My Lords, the National Assistance Board have agreed that old people unable to pay the normal rate for residential accommodation should be repaid any charges made under this Bill. As a result of consultations that have taken place with representatives of local authorities—I think this is the point which really interests the noble Earl—arrangements have been made for local authorities to act on behalf of the old people, by paying charges on their behalf and obtaining a refund in bulk from the National Assistance Board. This arrangement will apply both where the prescription is dispensed by a chemist and where, as happens in some homes which are adjacent to hospitals, prescriptions are dispensed from the hospitals. It is recognised that arrangements of this kind will involve local authorities and their officers in some inconvenience, but if all concerned will co-operate—and there is no doubt that they will co-operate—the old people themselves will be relieved of any difficulty, which is the main object that the noble Earl and we have had in mind. There is no question of provision in regulations to meet this particular point, since it is not proposed to exempt these people from payment. It is an administrative arrangement made to meet their needs, like those of any other persons in financial hardship, by the use of the powers of the National Assistance Board under Clause 7 (2) of the Bill. I hope that the noble Earl will agree that we have met completely the position that he put to us on the Committee stage.


My Lords, I am extremely grateful to the noble Lord, Lord Woolton, for going into this matter so carefully, with the assistance of his colleague the Minister of Health and the Assistance Board. We are also glad that these old people will be able to recover from the Assistance Board any payments that are made, so that ultimately they will not be out of pocket as a result of the charges made for prescriptions under this Bill. But I am afraid that I must express my dissatisfaction in certain other respects with the Government's reply to my Amendment. In the first place, my Amendment was to exempt these old people from these payments. What the Government have done is to say that the old people must make the payment, which can be recovered after it has been made.


I do not want to interrupt the noble Earl. What I said was that repayments would be made in bulk. The old people themselves will not be troubled with this matter.


I am grateful to the noble Lord for that elucidation. But may I ask him a further question—namely, will the money which is paid in bulk by the local authorities be collected by them from the old people, or will it come out of the local authority fund?


It will not come from the old people.


I am very glad to hear that, because that really relieves old people of any hardship at all.

I have no doubt that, the noble Lord will think me very ungrateful if I make any complaint at all about the Government reply. Nevertheless, I have two matters about which I wish to complain.

The first is that this exemption of old people, on grounds of hardship, from having to make this payment is a matter of principle and of policy, and the exemption should therefore have been made in terms in the provisions of the Bill. It is not just a matter of administrative routine; it is a matter which affects great numbers of people, and which the public generally feel very strongly about. Therefore, under the ordinary procedure, which leaves only matters of purely administrative routine to the operation of regulations and of instructions given by Ministers, this should lave been included in terms in the Bill. I do not know why it has not been done in this way. I sincerely hope that it was not because there was a prior agreement that no Amendment whatever to this Bill would be accepted during the passage of the Bill through this House. I sincerely trust that that was not the case, because that would have been overriding the rights of Parliament, a thing which I think no one, on either side of the House, would regard as being right or proper.

The other complaint I have to make is that this is going to impose a heavy burden of administration on the local authorities. They with have to provide the money; they will then have to apply to the Assistance Board for the recovery of the money which they have provided out of their own funds That is surely a tremendous waste of manpower, a waste of the working time of the officials of these local authorities, just at a time when we want to take as many people as possible out of administration and put them into productive work. It is going to put a very heavy extra burden of work on the local authorities concerned. This burden of work could have been avoided if these old people had been exempted—as, for instance, inmates of hospitals are exempted under Clause 1, or nursing and expectant mothers are exempted from charges for dental treatment under Clause 2—as I propose in my Amendment. If I may venture to say so, I think it is contrary to the usual procedure that a matter of this Importance should. be dealt with administratively rather than by specific provision in the Bill.


I do not know whether the noble Earl is withdrawing his Amendment or pressing it.


I apologise to the House. I should have said that I wish to withdraw the Amendment.

Amendment, by leave, withdrawn.

Then, Standing Order No. XXXIX having been dispensed with (pursuant to Resolution):

4.35 p.m.


My Lords, I beg to move that the Bill be now read a Third time.

Moved, That the Bill be now read 3a.—(Lord Woolton.)


My Lords, as this is the first controversial Bill with which your Lordships' House has had to deal since the General Election, and as a good many of us are working under quite novel conditions, it may be desirable that we should make some short survey of the Bill and of the discussions that have taken place, because matters of very great importance are attached thereto. On the Second Reading of the Bill I rather complained that the noble Lord, the Lord President of the Council, had not given the same explanation of the appearance of this Bill as had been given in another place. Judging, however, from the debates which have ensued, it would seem that the Lord President of the Council is not standing alone, because nearly all other speakers from the Government side of the House have made no claim that the proceeds from this Bill are going to close the dollar gap. The constant loss of gold in our country is not to be stayed by anything that we have been doing.

I am sure, too, that no noble Lord opposite believes for a moment that the proceeds of the Bill are going to enable the Chancellor of the Exchequer to balance his Budget. The Budget has been well and truly balanced without the effect of this measure at all. In the Budget statement this year—I have already made this point, and I want to repeat it—the Chancellor of the Exchequer has relieved the income payer of payments totalling £180,000,000 and he expressed his opinion to the House of Commons that the country was quite able to do that. It is therefore to be supposed that this Bill, which it is suggested may save £9,000,000 of money, has got nothing whatever to do with the favourable circumstances of the Exchequer. We are, therefore, driven back on the speech of the noble Lord, the Lord President of the Council, to find out what this Bill is designed to accomplish. With your Lordships' permission I propose to read a few sentences from his speech. He said (OFFICIAL REPORT, Vol. 176, Col.609): The reason for the introduction of the charges, as your Lordships are well aware, is, primarily, to curb the ever-mounting cost of the Health Service and to keep it within reasonable bounds. Later on, the noble Lord said (Col. 610): I do not think it is unreasonable to ask those who can afford it to make some contribution towards the cost of some of these services with a view to keeping the total cost within some near approach to the ceiling which successive Chancellors of the Exchequer have prescribed … This Bill will not only help to reduce in some measure the estimated expense but may well act as a curb to the extravagant demands on the Service. There we have, according to the noble Lord, the Lord President of the Council—and, I believe, a great many other speakers from the Government side of the House—the reason for the Bill as seen by them. All I can say is that it is quite different from the impression created by the Chancellor of the Exchequer, first in January and then subsequently in his Budget statement.

Now, it may be well if I say a few words about the ceiling, because it is an object of this Bill to maintain the ceiling, and the two Parties in this House, and in Parliament, generally, ought to know what the ceiling means to them. The public, too, ought to know also what the two Parties in the State really mean by the ceiling. In 1950, the late Sir Stafford Cripps—as I mentioned in my Second Reading speech—said that he could not sanction an increase in the expenditure on the Health Service for that year. He believed that in that year a ceiling was necessary, and he suggested to the health authorities that if they had to enter into any new commitments, they must keep their total commitments within the amount of money which they had hitherto received from State. That, I think, is a statement to which we on this side of the House, with some explanation, could give our assent. We do not believe in a ceiling of a permanent character. We do not believe in a ceiling which stretches over a long period of time. But we do believe that each year, when the various authorities send in their estimates to Parliament, the Exchequer and Parliament should make up their minds whether in that year the estimates can be agreed to. If your Lordships think that that is an appropriate ceiling, then we believe in the use of the same ceiling.

We believe, however, that the ceiling should not go beyond one year, and that Parliament itself should decide what the ceiling should be in any one year. As I mentioned in my Second Reading speech, in 1951 we made a slight departure from that standard. We decided that in addition there should be charges on dentures and spectacles, but that those charges should be of a purely temporary character. And, following discussion in the House, it was decided that they should come to an end in 1954. We now know something of the operation of those two charges and we are not quite so satisfied with them as we were at the beginning. We are by no means enthusiastic about their retention. Indeed, when 1954 arrives we shall probably drop them, if we are in office and able to do so. We should like to know where the Conservative Party stand in this matter of charges and of a ceiling. Do they believe, with us, that every year Parliament should decide what should be spent on the Service during the succeeding year, or have they some political concept which says that we ought not to pay more than a permanent ceiling in order to compel those who have to administer that sum to keep within that limit? It is very important that we should know that, because I understand that the new Minister of Health, who like myself was a "back-room boy" at the headquarters of a political Party, holds the view that there should be charges; that there should be charges at any time; anti that if people cannot afford to pay the charges, their recourse is not by way of excuse under the Health Service but by way of the Assistance Board. I hope that is not the view of the Conservative Party, because I should hate to believe that there was a Party in the State wanting to go back to the bad old Poor Law days, when the very poor of our land were segregated from the rest of the population.

I am afraid that my original speech gave rise to one or two misconceptions in the minds of noble Lords. The noble Marquess the Leader of the House said some rather severe things when he followed me in the debate and during Committee stage he made reference to a previous speech of mine. I am going to quote that reference, not because I want to complain, but because it leads me to two figures which are of great importance in considering any ceiling that has to be adopted. 'This is what the noble Marquess quoted (OFFICIAL REPORT, Vol. 176, col. 92,5): 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' That is a quotation from my speech in reply to the noble Viscount. Lord Buckmaster. After some words, the noble Marquess continued to quote from my speech: '… then, undoubtedly, the cost will rise until the Service performs the task we expect of it.' As I say, I do not complain about that, but I want to explain it a little further because it is going to lead me to a real case. What I said was this (OFFICIAL REPORT, Vol. 175, Col 973): I think the noble Viscount was accurate in also saving that costs will continue to rise until the full needs of the nation have been met. The figures and fact, which he has given about patients are indicative of the point that although we are spending a great deal of money, although we have provided a great number of institutions, and although we have enrolled the medical service in our aid, vast numbers of people are still waiting for treatment, and if we are to overcome these shortages and difficulties then, undoubtedly, the cost will rise until the Service performs the task we expect of it. What did the noble Viscount, Lord Buck-master say? I want to quote his figures because they are of importance and they will lead me to a question which I hope to put to the noble Mar Tress at the close. The noble Viscount said (OFFICIAL REPORT, Vol.. 175, Col. 971): So far as the patient himself is concerned, his position is not altogether happy because owing to the congestion t) which I have referred, we have very long waiting lists at our hospitals, and in an out-patients' department it may be six weeks or sometimes two months before an interview with a specialist can be obtained. Then, if an X-ray examination is needed, there is still further delay. That is the first point made by the noble Viscount to which I need refer. This is the second point: So far as in-patients are concerned, there is a waiting list at the present moment—according to the last figures available—of 124,587 people for surgical treatment which involves staying in bed in a hospital. That surgery does not include orthopædic surgery, thoracic surgery, plastic surgery, neurological surgery, or a whole list of other forms of surgery.… If these figures are accurate—and I believe them to be accurate—there is need of a good deal of development in the hospital services to treat these cases, and if that development is to come there is bound to be an increase in expenditure, and not a decrease. We have to remember, as one noble Lord opposite said in answer to my noble friend Lord Burden, that we cannot find £9,000,000 within the Health Service to get rid of this Bill. The case has been examined, but apparently we could not find within the Service the abuses to which attention had been drawn which would give us that amount of money. I want to put this question to the noble Marquess: assuming that the present level of £400,000,000 a year is to be retained by the Conservative Party as a ceiling, what will the noble Marquess and the Conservative Government do about these cases which have been brought to the attention of the House by one of his own supporters and about which I have made comment? Is it appropriate to say now that, because of circumstances, we can sit back and allow these cases to fend for themselves until brighter days come?

I think I should say one other word about finance, because the noble Marquess, referring to something I said relating to the scale of charges, said this (OFFICIAL REPORT, Vol. 176, col. 650): My Lords, at this moment, when the turn is beginning, what does the noble Lord, Lord Shepherd, say? He says: 'If you only let the Labour Party back, there will be an end of any economy. There will be no more charges for the Health Service; there will be unlimited spending.' I challenge the noble Marquess to point to any part of my address where he can say I said those words. I am sure that the noble Marquess spoke without due preparation, and would not, I think, be prepared to substantiate that statement. There will be no unlimited spending, because the estimates of hospitals and the health authorities have to be submitted to Parliament; and when they come before Parliament they will go before the members of the Estimates Committee and the Accounts Committee of another place, all with their glasses upon their noses ready to check any wasteful and unnecessary expenditure. Even if we desired unlimited spending, it could not come about. We ourselves are anxious that the Service should be run efficiently and without waste, and we are prepared to see that expenditure, although it must rise, must bring improved results.

It is sometimes said that any expenditure of this kind must be a waste. Some people will say that people who are in poverty have only themselves to blame for their condition; that they ought to be able to pay for themselves, and that if they cannot (I am not attributing this view to the Lord President) then they should take what is coming to them. But I have taken this line: that whatever may be the cause of the difficulties in which we find ourselves, and whatever expenditure we may have to incur, it does not follow that the expenditure is wasteful—indeed, as I said on the Second Reading, an expenditure on improving the health of the nation may be extremely valuable. I should like to quote two sets of figures not mentioned by me before to indicate the improvement which comes about in the health of the people when poverty is eliminated. It may be that I am digressing somewhat from the theme on which I am engaged, but I consider these figures important, as they back up the point I have made that money expended upon the improvement of health is not necessarily bad in an economic sense.

The first set of figures has relation to Sweden. They show that in the years 1755 to 1756—that is a long time ago—the expectation of life in Sweden was thirty-four years. The increasing state of health and the improved standard of life of the people of Sweden in 1816 and 1840 raised that expectation of life to forty-one years. Continued improvements in the period 1911 to 1940 raised it to fifty-seven years, and at the present time the expectation of life in Sweden at birth is sixty-six years. Those who know anything about the standing of Sweden and the prosperity of its inhabitants will, I think, agree that if the expectation of life there were still only thirty-four, those prosperous conditions would not now exist and Sweden would be on the level of India, Egypt, Ceylon and certain other countries. The figures I want to place beside the ones I have just given relate to those countries. The article from which I am quoting goes on: On the other hand, in countries such as China, India and Egypt, where the average expectation of life at birth is in the neighbourhood of thirty years, only fifty-four out of ever, 100 children born reach the age of fifteen, and of those reaching adulthood all but fifteen die before completing the normal span of working life at sixty. I suggest to noble Lord; in all parts of the House that, when they see the rising cost of the Health Service in this country, they should not stand appalled at the bald figures but should ask themselves, as they are entitled to do, whether this money is being wisely spent, whether it is bringing dividends in its train, and whether this imperial race of Britons, which is endeavouring to teach the world how to govern itself, has the necessary stability and standing to accomplish that purpose.

I want to conclude on what I believe to be a note of great importance—this time of great importance to your Lordships' House. We feel that the two noble Lords opposite who met the noble and learned Earl, Lord Jowitt, and myself concerning the business to-day did their utmost to bring to the attention of the Minister of Health the views expressed in this Chamber. We believe that they both did it, not only out of courtesy, but because they realised that the granting of some relief was of importance to the House of Lords itself. We do not like to see our noble Leader (and I use the term "noble Leader" advisedly, because the noble Marquess is not only the leader of the Conservative Party in this House, but is also the Leader of the House itself, and we all take pride in his accomplishments) being caught out during a debate and in a position where he cannot speak authoritatively. I should like to quote from a speech the noble Marquess made on the Committee stage. This, I feel, shows how injurious the present position may be to this Assembly. This is what the noble Marquess said (OFFICIAL REPORT, Vol. 176, col. 842): I do not think it would be 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. He starts with that, from which it is quite obvious that he has not the authority we should like to see him possess.


I should be grateful if the noble Lord would expound that a little further. I have not a notion of what he means about my not having the authority.


The noble Marquess was trying to meet the claims made from this side of the House, and in particular he was making reference to a particular matter we have been discussing to-day, as the rest of the statement will show. He went on to say: What I would suggest for the consideration of the House is this. I hope the 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 exactly know 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. He then concluded by saying: Therefore, I am sure my noble friend feels that we must stand firm on this Amendment because it does not seem to its that in this case we could make a differentiation. I am sure that others of us a 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 putting in. As I have already said, both noble Lords opposite agreed that they did their best to persuade the Minister of Health to give what we asked of them, and they failed. Most noble Lords opposite do not now believe that this House should possess a veto; most of them believe that this House should continue to exercise a suspensory role. We are not anxious to persuade noble Lords opposite that that power which the House possesses should be used even against itself, because we ourselves do not believe in the suspensory vote. But we do agree with noble Lords opposite that this House has a great function to perform. We believe that it possesses the right of review and that it should have the right of revision also, so that after the revision has taken place the details of the revision may go to another place and Members of the Commons given another opportunity of deciding on the issues involved. I will not say that one swallow makes summer, and I do not suggest that, after one Bill in this House, we are in danger of losing our revisional role, but noble Lords will understand very well that from now on whenever revolutionary Bills come up, we shall watch closely to see whether in connection with these Bills also this House is going to be refused the Tight of revision and the other place refused the opportunity of a second look at the document.

We believe that noble Lords opposite are with us in maintaining the proper standards of this House, but we suggest that if we are to continue, as in this particular Bill, to review the Bill without a dot or comma being altered, we shall not only lose our rights but the British public will think very poorly of us as an institution.


May I ask the noble Lord who has just sat down one question? Are we to infer from what he said that there is a certain stigma or shame attached to the receipt of Public Assistance, and, if so, how is this worse than a payment from the National Health Service for spectacles?


With the permission of the House may I reply to that question? First of all, there are no free spectacles from the National Health Service. The taxpayers of our country—and we are all taxpayers now—contribute collectively to the cost of the Health Service. The patient who goes for a pair of glasses has already paid to his or her tax collector for that Service. It is one of the main quarrels over this Bill that, having taken from the taxpayer the money to provide these services, we are going to ask those who require these services to pay twice. I hope that will satisfy the noble Lord.

5.5 p.m.


My Lords, it would be presumptuous on my part as a new member to enter into the controversy about the future of your Lordships' House. As a "new boy" I would venture only to offer one or two observations, which I hope will not be unduly controversial, on how the debate on this particular Bill strikes a newcomer. The most obvious feature is the great difficulty in which noble Lords opposite find themselves with their criticisms—and for this reason, that the Bill introduces no brand new principle. It is, in fact, an extension of a principle already included in two measures passed by the Party opposite. Therefore, the arguments in all these Amendments which have been moved with so much emotion by noble Lords opposite ought surely to have been addressed to their own Government when they were in office, and when they were laying down the principles that we are now slightly extending. It would be interesting to know whether the noble Lord, Lord Ogmore, who made such an impassioned speech about the chronic sick, ever addressed his own Government of which he was a member, or his own colleagues, upon the desirability of inserting some such clause in their Bill. If he did it must be pretty clear that the answer of his Government was "No," because otherwise no doubt he would have succeeded in his emotional appeal.

The same thing, of course, is true of practically all the Amendments which have been put forward from the opposite Benches. They were not Amendments addressed to the principles of the Bill, they were Amendments designed to exclude certain classes of people from its operation. If these Amendments were sound to-day they would have been equally sound in 1949–50. The fact of the matter is that if they were suggested by noble Lords and their followers during the passage of their Act, clearly they must have been turned down by the Labour Government for reasons that were as valid to them as they have been to the noble Lords on our Front Bench.

The noble Lord, Lord Shepherd, in reply to an interjection at the end of his speech, was guilty, I think, of some very muddled thinking. It is true that the taxpayer contributes the major portion of the cost of the National Health Service, but he contributes the whole of the cost of the National Assistance service; and it is to be assumed that the recipient of National Assistance must, at some time or another, have been a contributor to the taxes and, indeed, probably still is, through his tobacco and so forth. To attempt, therefore, to make a distinction between the two is wholly invalid. But the noble Lord went further in his rather muddled thinking. He set out to give us some figures designed to show, as he said, that increased expenditure on national health might well be economic and to the general advantage of the country—I do not think I am misquoting him. But the late Sir Stafford Cripps did not think that when he said it was necessary to impose a ceiling in 1949 and to impose a similar ceiling in 1950. I should be interested to know whether the noble Lord, Lord Shepherd, in those days when he was a "back room boy," brought those facts to the attention of his learned friend Sir Stafford Cripps and suggested that there were sound reasons against his decision that there must be a temporary ceiling to the National Health Service.


As the noble Viscount has invited me to express an opinion, may I remind him that when I dealt with the case of Sir Stafford Cripps we really took that line? We believed that not only the Chancellor of the Exchequer but Parliament should decide each year what the ceiling should be. What we are afraid of in this Bill is that the ceiling, instead of being reviewed from one year to another, is going to become permanent.


If that is the only objection which the noble Lord takes to the whole Bill, it was dealt with in various speeches of noble Lords on our Front Bench who hoped and looked forward to the day when it might be possible, if the economic conditions of this country improved, to have another look at the whole question of these charges.

I was particularly interested in the quite unconscious tribute which the noble Lord paid to the success, or potential success, of our financial administration of the country, when he predicted with such confidence that by 1954, if his Party got back, they would find the finances of the country in such an excellent state that they would be able to raise the standard of the Health Service and abolish these charges. I am sure it was an unconscious tribute, and I am equally sure that the country will appreciate its value.

5.12 p.m.


My Lords, I regret that have taken no part so far in the proceedings on this Bill. Unfortunately, while the Health Bill was going through the House I was suffering from ill-health and was thus defeated in my efforts to take part. I listened with great interest to what the noble Viscount who has just sat down had to say, because I agree with him in the matter of both this Health Bill and the previous Health Bills which were produced by the Labour Government. I was one of those who tried to dissuade the Labour Government from producing these Bills, because I believed that, once they had started a bad principle, other people who did not view the Health Service with quite the same eyes as did the Labour Government, would step in and, where the Labour Government had used a razor to shave the Health Service, they would take a dagger arid cut its throat. Therefore, I. opposed the previous Bills so far as I could, and I oppose this one most bitterly. I think this is a bad Bill, and I think that any Labour Government who get back into office in the future should make the repeal of this Bill one of their first actions. We, the Labour Party, started a bad principle. I believe that it was one of the worst mistakes we made, and this principle has been expanded when it should have been stopped. That is all I wish to say on this matter. There is nothing new which can be added. I think that the Bill, in its main principles at any rate, has been pretty thoroughly argued, but I could not let a measure, which in my opinion is so damaging to the nation, go through Parliament without at least one kick from me.

5.15 p.m.


My Lords, I wish only to say a word about the remarks of my noble friend Lord Shepherd. He left the Health Bill to deal with the constitutional position, and that certainly is an extremely interesting position. I do not feel in a mood to take up what he said in a controversial spirit, because I have suffered sufficiently by straying from the flock already this afternoon. I would point out to him that if he thinks that our behaviour in this Parliament is going in some way to lay a pattern for your Lordships' behaviour when we come into office, he is making a mistake. This is a conservative House and always will be a conservative House. The certain way in which to keep it a conservative House is to appoint more Labour Peers. I am not saying a word of criticism of my own colleagues—I am talking about the course of time.

Here is a Bill which is decree legislation. As it was issued by the Præsidium—let us use words that really apply—so it is going to receive Her Majesty's assent. It came to this House after a short interval when it was debated in another place, and when it was passed under the guillotine. No amendment was permitted. No amendment had been made in this House. No draft regulations have been laid before this House. That would have been a permissible thing. If the noble Lord, Lord Woolton, had said that he would do this or that by regulation, there was nothing to prevent him. It is very unpopular for Ministers to ask for this, but there was nothing to prevent him from laying his regulations so that we could see exactly how these omissions and modifications for which we have asked could be made by regulation. While I am on that point, I wish to point out one great fallacy in the speech of the noble Viscount, Lord St. Davids. I think the Labour Party passed an enabling Bill but never drafted regulations. It does not lie in the mouth of any critic of the Labour Party to say that, had those regulations come forward, they would not have made provision for the hard cases for which we have been pressing in our Amendments to-day. I make that point, and I think it is a valid point. Furthermore we have had no estimate at all—


Surely one of the points made by the noble Lord, Lord Douglas of Barloch, was that exemptions of this sort ought not to have been left to regulations, but should have been included in the text of the Bill. Noble Lords opposite were influential members of the Labour Party while the earlier Act was being passed, and if what they have been saying to-day is valid, it was equally valid in 1949. The point of my argument is that they did not argue then, and they cannot argue now, that it ought not to be done.


This is a perfectly valid Parliamentary difficulty: should this exemption be put in a Bill or can it be done by regulations? If you are in Opposition you say that it should be in the Bill, and if you are in power you say you will do it by undisclosed regulations. All I will say is that there is no crime to be attached to the Labour Party. I mention that because, in the course of this debate, my noble friend Lord Shepherd dealt with the position of this Chamber. I was brought up in an old Radical tradition; I have said things and thought things—and still say things and think things—about this Chamber which I would not dare to say and which I am sure would not meet with general approval—and probably not with the approval of my noble friend Lord Shepherd. What he does not seem to realise is that every Cabinet wants single-Chamber government. The only difference is that the Labour Party cannot get single-Chamber government while the Conservative Party can. Whenever the Conservative Party are in power they get single-Chamber government. They now have a most unusually rich array on the Front Bench opposite but, of course, they are powerless. My noble friend must not be surprised that the Leader of this House cannot do anything. The Cabinet, or rather the officials, have decided the matter, and the Bill must be passed as it is printed on the Paper, tel quell

So far as reform of the House is concerned—people speak a great deal about the reform of the House. The Liberal Party are the great advocates of the Reform of the House of Lords. The first and most obvious step in that direction would be for the Liberal Party to attend. Therefore, to that extent I am with my noble friend Lord Shepherd. I think that this House can make much more use of Parliamentary draftsmen. People sometimes confuse revision by draftsmen with revision of the sense of a Bill. This House can make a useful contribution in the matter of the revision of the sense of Bills. But if anyone thinks that the Conservative Party are going to use this House for that purpose, let him read the history of this guillotined and telescoped Bill and observe that no single suggestion put forward by the Opposition has been adopted. Some day, perhaps, it may be useful to have a general discussion on where the House of Lords stands. I hope that what I have said will enable us all to co-operate in the good cause of opposing the Government.

5.21 p.m.


My Lords, the Lord President of the Council has led for the Government, if I may use a legal phrase, in the debates on this Bill. As he has explained to the noble Lord, he has unfortunately been obliged to leave before the end of the debate, and he asked me to say a few words in conclusion. They will not be many; but I will say quite frankly that there are certain conclusions to which I have come as a result of listening to the speeches on this Bill. There have been delivered some very sincere and extremely moving speeches, but I am bound to say that, on the general record of the Opposition during this Bill, I am driven to the inevitable conclusion—and I am very sorry to have to say so—that this has been for them very largely a Party stunt. That is the impression made upon me. It has been a good stick with which to beat the Government. The noble Viscount let the cat out of the hag in the very last words of his speech when he spoke of the "cause of opposing the Government" as a laudable thing. That is all that is in his mind. All the crocodile tears he has shed do not mean anything more than that.

The noble and learned Earl, Lord Jowitt, at the beginning of this Parliament made an impressive appeal for the attitude of a Council of State. But there has been little evidence of that attitude in the course of the debates on this. Bill. Moreover, is has not been merely a Party attack made for what the noble Viscount would say is a legitimate purpose. It has been, in my view, very largely a fraudulent attack. Opprobrium has been heaped upon the Government for not exempting the chronic sick from the payment of charges. In Amendment after Amendment on the Committee stage we were castigated for hardheartedness and callousness. But when noble Lords opposite were in power and brought in their own Bill, so far as I know, no member of the Socialist Party in this House suggested that the chronic sick should be exempted from payment of the charges that had to be made. I cannot help feeling, when I recollect that fact, that the present attack, attractive though it must have been in many ways to noble Lords opposite, is a very bogus affair indeed.

The noble Lord, Lord Shepherd, made an agreeable speech, as he always does. He made certain statements and put up some ninepins which he proceeded to knock down again. He said impressively that this Bill will not close the dollar gap. Did he and his noble friends really suppose that this Bill was meant by itself to close the dollar gap? If they thought that was the purpose of this Bill their mathematics must be very strange indeed. But, in fact, the purpose of the measure is to assist awards improving the credit of the country; and, through the improvement of the credit of the country it is hoped that the dollar gap will become narrower. There is a Scots proverb which says: Mony a mickle mak's a muckle. This is a "mickle." You are not going to get great economies except by many "mickles." In the world as it is to-day, if you try to make your economies by saving hundreds of millions of pounds in one sphere of the public services you will find it impossible. What you can do is, where it is necessary, and only where it is necessary, to make the small economies. The total result is then something worth having.

The noble Lord reiterated the suggestion—and so did other noble Lords throughout the discussions—that this charge is to be a permanent measure. "Look at our Bill" they say. "The charge we proposed was only for one year, or at any rate for a limited period, whereas this is a permanent charge." It has already been said from this side that it is not intended to be a permanent charge. The only reason why no date was fixed was because we were not certain when the emergency would be over. It would not have been honest to put in a date without knowing whether that date represented the realities of the situation or not. When Lord Shepherd says that his Party put in a date, I can only say that it was not quite honest to do so if they had no certainty about whether the economy of this country was improving. The noble Lord asked me whether I accepted the view that £400,000,000 should be a permanent ceiling. I do not accept a permanent ceiling for any expenditure in this country. I can well imagine that, just as happened in the last century, the national income may increase—I hope it well—to the point when even £400,000,000 may appear to be comparatively unimportant. But what we equally say is that what you can spend on any object at any one moment depends on the money available at that time. If the general situation today is such that measures of economy are necessary—and I believe that to be true—then we must face the fact and make the economies which the situation imposes upon us.

The remarks which I made, and to which the noble Lord referred, regarding his attitude, arose, so far as I can remember—I am afraid that I have not the quotation with me—from a statement by the Socialist Minister of Health, to the effect that if the Labour Party were returned to power they would immediately remove all the health charges. It was on that basis that I suggested to the noble Lord that, if his Party were returned, we should get back into a riot of extravagance. He said that that is not true. I would ask the noble Earl himself to tell me: Do he and his friends unequivocally and completely support the statement of the late Minister of Health? Do they say here in this House that, if they were returned, all charges on the Health services would be immediately abolished? I should be glad of an answer to that.


Speaking from my recollection, I do not think the Socialist Minister of Health ever said that he would immediately abolish all these charges. I think he said he would do away with them at the first available opportunity, and I think he meant by that much the same thing as the noble Marquess meant when he said that he would take the earliest opportunity when the economic situation permitted.


As I say, I have not the quotation with me, but I am pretty certain that the effect of the words was that, if the Labour Party were returned to power all these charges would be taken off. I think that is the position. The noble and learned Earl does not take that position. He takes very much the position that I am taking now; and in that case I cannot help feeling that it is queer that noble Lords on that side should be so terribly shocked at this Bill and at the very moderate charges which it imposes.

In conclusion, I should like to say this. Reference was made to my own position, I think, by the noble Lord, Lord Shepherd, and to the position of this House by the noble Lord, Lord Shepherd, and by the noble Viscount, Lord Stansgate. The noble Lord, Lord Shepherd, was kind enough to sympathise with me in what I understood him to say was the humiliating situation in which I was placed. He said it was painfully evident that I had no authority to amend this Bill. Of course I have not. I am not the Minister of Health. All I can do, as a colleague of the Minister of Health, representing his views in this House, is to say that I will transmit to him what has been said. The noble and learned Earl will agree with me that that was what he used to say a hundred times during the last Parliament, when he was in power. He said: "I am very sorry to tell you that I am not in a position to give an undertaking myself, but I will, of course, refer it to my colleague." We always accepted that. It seemed to us the only thing to be done in the circumstances. If the noble Lord really feels that I am humiliated, I can assure him that I am not humiliated. The course I recommended to the House was the only course that, constitutionally, I could recommend to it.

Now with regard to the House. There was a sort of suggestion: "What is going to happen in this new, dreadful situation where the House of Lords is turning down every measure that the Labour Party introduces? Can the country go on like that?" I really do not think there is any justification for exaggerated statements of that kind. Look at our record in this House since the war—the record of the House as a whole and the record of the Party to which I belong. When the Labour Government came into power after the war, we were, by reason of our majority, in a position where we could have completely stultified all the efforts and the policy of the Labour Government. It would have been quite possible for us to do that. But I remember that I made a speech in 1945 when I said that we did not intend to do that; we were going to try to regard ourselves as (I think it was the first time the phrase was used) a Council of State—and, in fact, we did. We passed Bill after Bill which we cordially disliked, and which noble Lords opposite knew that we disliked. We opposed the Government only when we thought it was absolutely vital to the country that we should do so. Even then, when we did put in Amendments—usually quite good ones—they were nearly always turned down by the Socialist Party in another place. I remember Bills of which not a single Amendment that we sent down was accepted in another place. They were taken as a list and voted down.


I should be very interested to know the name of that Bill.


I will let the noble and learned Earl know. I think it happened in the case of the Transport Bill. There was a list of Amendments that we sent down, and I am pretty sure that nearly all of them were turned down.


On the contrary, nine-tenths of them, and their number was legion, were accepted.


No, no!


The noble and learned Earl may not accept that; but at any rate he will accept what I said earlier, that we did our best to cooperate in the very difficult situation in which we were placed, and that the course of Government business was not unduly impeded, if it was impeded at all. The noble and learned Earl himself paid tributes to us for our moderation in that respect. That was the position in the last Parliament.

Now we cone to this Parliament. Take the Dentists Bill. We had negotiations during the Dentists Bill over the Amendments proposed by noble Lords opposite. Quite a number of Amendments were found which we could accept. If we have not been able to do it with this Bill, it is because the Amendments which noble Lords opposite have put down are Amendments which would have had the effect of making the Bill unworkable, of driving a cart and horses through it. Noble Lords opposite may not like this Bill; they may wish to destroy it. But they cannot expect us to wish to destroy it if we think it is necessary for the country. In those circumstances, we are bound to take the action we have.

Finally—I have addressed your Lordships quite long enough—I would say this. We have not introduced this Bill (I repeat this for the benefit especially of the noble Lord, Lord Shepherd) because we like charges for health services. We have done it because we consider that in present circumstances it is necessary to impose them. We recognise that there must be, now and for some time to come, charges under the National Health Service, disagreeable though most of those charges may be. I do not wish this afternoon to speculate to your Lordships on the future; but if the economic position of our country dramatically improved, as I hope it will; if, for instance, the number of dentists were adequate, not only for the priority classes but also for the whole of the population; if all those who used the National Health Service showed a fully responsible attitude towards its cost, then, indeed, these charges should be, and would be, reviewed by my right honourable friend the Minister of Health. The alterations made during the passage of the Act of 1951 and of the present Bill are, at any rate, evidence that the Conservative Party, although they hold firmly to the belief that charges now are essential, do not declare in this Bill that charges for treatment under the National Health Service must remain a permanent part of their policy. This is, in fact, a temporary Bill to meet what is, I hope, a temporary emergency. We believe that, as such, it is necessary and we commend it with confidence to the House.

5.38 p.m.


My Lords, I think the speech to which we have just listened calls for a short reply from me. It will be very short. First, I want to say that I derive some consolation from that speech, in this respect. There are obviously two schools of thought in the Party opposite. One school of thought is represented by the noble Lord, Lord Brand, for one, and by the noble Lord, Lord Webb-Johnson, For another, who think it good and right that charges for national health should be imposed. Both those noble Lords sail that they were opposed to a free Service. I am not criticising them at all. I understand the point of view, though I disagree with it fundamentally. They think it a good thing that there should be charges. Then there is the other school of thought which does not think it a good thing at all, but regards it as a regrettable necessity. The noble Marquess, from what he has just said, has plainly identified himself with the latter school and not with the former. He regards it as a reg7ettable necessity, and he has assured us that as soon as the economic clouds are lifted to a sufficient degree he, at any rate" will be delighted to bring in a Bill, if a Bill is necessary, to do away with the charges altogether. That is a satisfactory point of view.

But I want to ask MI it is the object of this Bill, because even at this late hour I am not satisfied. It is true, as the noble Lord, Lord Shepherd, said, that this Bill which brings in £9,000,000, does not close the dollar gap, and the noble Lord, Lord Shepherd, never imagined that that was its purpose. But the point is, does it contribute to the closing of the dollar gap? "Mony a mickle makes a muckle." If the "muckle" is the dollar gap, is this a "mickle"? I do not pose as an economist, and I do not think the noble Marquess poses as an economist either. Therefore, this is probably a case of "deep calleth unto deep." But I should like to ask the noble Marquess this question. If this Bill does not either increase our exports or diminish our imports, how does it contribute to the extent of £9,000,000, or any sum at all, towards the closing of the dollar gap? I do not understand. So far as the closing of the dollar gap is concerned, it seems to me that this Bill is wholly and utterly irrelevant. It is not a question of closing the gap; it is a question of contributing towards closing it. I do not understand how it does so.

If it is not for the closing of the dollar gap, what is the object of the Bill? Is it because it is thought desirable to make people pay charges? The answer to that is, No. The noble Marquess has said that that is not the reason at all. Of course, inevitably he and the noble Viscount, Lord Hudson, have twitted us about the fact that we introduced a similar Bill. So we did. But we never came to promulgate the regulations which were to put the provisions of the Bill into operation. I admit frankly that it is exceedingly difficult to see how, as a matter of administration these people can be exempted, and if they cannot be exempted it may well be right not to charge anybody. That was the practical trouble we were up against.

The only other thing I want to say deals with the question of the position of this House. Speaking for myself, I think it is far too early to judge yet, and all we can see is possible danger signals. I have always said, and I say again, that in the circumstances of the last Parliament, noble Lords on both sides contributed to the House acquitting itself extremely well, and I think it increased in prestige amongst reasonable people of all Parties. That was largely due to the noble Marquess himself. Now we have a new situation, in which the Conservative Party are in a majority in another place, and have a vast majority here. If they are so minded they can, of course, disregard all our suggestions, and if they do, we shall simply become in practice a rubber stamp for passing through Government proposals. To be quite candid, there is a feature in this Bill, or rather in the procedure connected with it, which I do not like. The Government have already announced in their proposal to the hospital authorities that they are to carry on as though this Bill has been passed—that is, to assume that the Bill will be passed and that this House will do nothing in regard to it at all. I humbly suggest that in the future it would be much better not to assume necessarily that this House is going to pass any Government proposal. At any rate, it would be more decent to indicate that this House is perfectly free to accept or reject, as the case may be.

That matter, I believe, concerns us all, because if for the next period of years, if years it be, that the Conservative Party are in power, reasonable suggestions are not going to be considered and discussed and, if necessary, accepted on their merits, then that is indeed something which will not redound to the credit of the House. But I say quite frankly that I think it is too early to make that accusation. I sincerely hope that when controversial Bills come before this House we shall occasionally get Amendments accepted on their merits, and that arguments, if there are sound arguments for an Amendment, will be considered and weighed in the balance, so that under the new situation, as under the old, this House may stake out its necessary place in the legislative system of this country. Those are the only observations I want to make. Although we have not succeeded in making any Amendments to this Bill we have yet obtained two promises in regard to the form of the regulations, and certainly it is the fact that this Bill has provided us with a sounding board for all sorts of arguments and speeches, some of which, at any rate, I am glad to think the noble Marquess found to be speeches of great sincerity and depth.

On Question, Bill read 3a, and passed