NATIONAL HEALTH SERVICE BILL

HL Deb 20 May 1952 vol 176 cc1144-61

3.8 p.m.

Order of the Day for the Report of the Bill read.

Clause 1:

Charges for certain drugs, medicines and 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;

LORD DOUGLAS OF BARLOCH moved in subsection (2) after the first "of" to insert: appliances authorised to be provided in pursuance of a contract or arrangement under which the first examination took place before the commencement of this Act, or in respect of. The noble Lord said: My Lords, this Amendment is related to an Amendment which was moved during the Committee stage of the Bill by my noble friend Lord Milner, who is unable to be here to-day. Upon his Amendment we had a full and interesting discussion, and the noble Marquess the Leader of the House gave an undertaking that the points which he had raised would be fully considered. On that undertaking my noble friend withdrew his Amendment.

The Amendment which I am now moving is somewhat more limited in its scope. It applies only to appliances which are provided under the National Health Service it does not relate to drugs or medicines. The reason why the Amendment is now limited in this way is that it may be assumed that drugs and medicines are provided almost immediately after they are ordered, and there is therefore no question of a lapse of time, or of the expectations of the person for whom they were provided being interfered with or defeated. But the case of appliances is rather different. It often takes some time before they can be delivered to the patient, either because of delays in manufacture or else because they have to be specially made to measurements to suit a particular case. The purpose of the Amendment is to ensure that, where the supply of such appliances has been authorised, under a contract or an arrangement which has been made before the Bill becomes an Act, they will be supplied without charge, as was the expectation when that arrangement was made.

The second difference between the Amendment which is now before your Lordships and that which was moved by my noble friend is that the present Amendment provides exemption from charge where a contract or an arrangement was made before the commencement of the Act. In that respect, the Amendment is precisely the same as the provision which has been made in Clause 2 of the Bill, as drafted by the Government. Clause 2 (3) provides that in the case of dental services there will not he a charge where a contract or art arrangement for the provision of the services was made before the coming into force of the Act. What is applicable in that case, it seems to me, ought to be applicable in the case of appliances which are supplied to patients. In this respect, I can see no difference between, let us say, dentures and trusses. Therefore, I sincerely hope that the Government will be willing to accept the Amendment in the new form in which it appears on the Marshalled List. The whole point is that it is somewhat unfair, I think, that those patients for whom provision was to be made, and in respect of whom arrangements have been made for the supply of appliances without charge, should have that arrangement altered after it has been made. Without embarking upon a discussion of the general merits of the proposals which are contained in the Bill, I think it is clear that there is a very great difference between applying those provisions to new cases and applying them retrospectively to old cases which it was proposed to deal with under existing law. I therefore beg to move the Amendment.

Amendment moved— Page 1, line 10, after ("of") insert the said words.—(Lord Douglas of Barloch.)

3.12 p.m.

THE LORD PRESIDENT OF THE COUNCIL (LORD WOOLTON)

My Lords, when we last met to discuss these questions, while I found myself in the somewhat embarrassing position of not giving anything away I was very conscious—as indeed were the Government—of the importance of maintaining the position of this House as a revising Chamber.

I am very glad to be able to say that, as a result of the undertaking that was given on the last occasion by the noble Marquess the Leader of the House and by myself, we have been able to have consultations with the Minister of Health and we have gone most carefully into the object of the Amendment put down by the noble Lord, Lord Douglas of Barloch. In doing so, we have taken into account what was said during the Committee stage by the noble and learned Earl, Lord Jowitt, and by the noble Lord, Lord Milner of Leeds. We realise that even though there may be no breach of contract, even though steps, we hope, have already been taken to avoid misunderstandings in this matter, nevertheless it might give rise to some sense of grievance, and to some extent might justify the contention that some patients were being penalised by supply difficulties, if charges were made for appliances prescribed before the operative date but supplied after that date.

This is not a permanent problem; it is entirely an interim problem arising from the date when the Act first comes into force. Her Majesty's Government have therefore come to the conclusion that it would be right and proper to accept the principle of this Amendment to charge only for those appliances supplied to hospital out-patients which are prescribed on or after the operative date. It is not necessary to amend the Bill to secure this result; it will be done in the regulations to be made under Clause 1 of the Bill. Regulations will be made, in the exercise of powers under Clause 1 (1), laying down that no charge is to be made for any appliances prescribed before the date on which charges began to be payable. This will, I think, fully meet the points raised on the Committee stage and which have been raised to-day by the noble Lord, Lord Douglas of Barloch. I hope, therefore, that in view of there assurances the noble Lord will feel able to withdraw his Amendment.

3.15 p.m.

LORD DOUGLAS OF BARLOCH

My Lords, as I understand the undertaking, the regulation will, in fact, cover exactly the point which is intended to be covered by my Amendment. I just want, if I may, to clear up one point in the last sentence or two of Lord Woolton's speech. I think he used words which are equivalent to what is on the Marshalled List, but at a slightly earlier point he said: "appliances supplied to hospital out-patients." I take it that his words are not confined to those persons, but will apply to any appliances properly supplied under the National Health Service scheme. There may be other cases besides those of hospital outpatients, and the latter words which Lord Woolton used were not subject to that qualification. I want the noble Lord to make it clear that that is so.

VISCOUNT STANSGATE

Would it be possible for the noble Lord, Lord Woolton, to read out the regulation which he has in mind?

LORD WOOLTON

The noble Viscount has the Bill in front of him.

VISCOUNT STANSGATE

I know that the power to make regulations is in the Bill, but I was speaking about the text of the regulation enabling this to be done. I should like him to read it out to us.

LORD WOOLTON

The text of the regulation enabling it to be done? The noble Viscount has got it in front of him in the Bill.

VISCOUNT STANSGATE

I am afraid that I have not made myself clear. I understand that the noble Lord says he can meet Lord Douglas of Barloch's point with a regulation. I invite him to read out the text of the regulation which he proposes to make.

VISCOUNT HALL

My Lords, may I ask whether the noble Lord, Lord Woolton, can reply to the question which was put to him by Lord Douglas of Barloch?

LORD WOOLTON

The undertaking which I have given applies only to hospital out-patients, because this clause covers only hospital out-patients.

LORD DOUGLAS OF BARLOCH

With all respect to the noble Lord, I do not follow that argument. It may be that, as the clause stands, it applies only to hospital out-patients. I have not had the time to read it again to verify whether or not that is so. But the terms of the Amendment which I have moved do not apply only to hospital out-patients, and I would ask the noble Lord why, if appliances can be prescribed otherwise than for hospital out-patients, the same treatment should not be given to those patients as is proposed to be given to hospital out-patients? What is the reason for the difference? Why should not the regulations be comprehensive and apply to all patients, whether hospital outpatients or not? They might even be hospital in-patients for whom appliances are prescribed.

LORD SHEPHERD

My Lords, I understand that the noble Lord, Lord Woolton, has in mind an Amendment to the regulations to be made under this Bill, but may I remind your Lordships that regulations have to be made under the 1949 Act. Those regulations were never made, and it would be somewhat strange if under this Bill we had one kind of regulation and under the 1949 Act we had another kind of regulation.

LORD WOOLTON

My Lords, may I deal with one point at a time? In answer to the noble Lord, Lord Douglas of Barloch, these appliances are authorised through specialist services and therefore come through the hospitals. His point is completely covered by the answer I gave. He is anxious that everybody who entered into a contract shall be covered, and in fact these contracts come through the hospital services, which covers his point. I hope that the noble Lord will be satisfied.

LORD DOUGLAS OF BARLOCH

My Lords, if that is so, I am completely satisfied. I was not trying to be obstructive.

VISCOUNT SWINTON

My Lords, we have few rules in this House, but we have a rule that one speaks only once on clauses or Amendments, except by leave of the House. I think, within reason, we ought to adhere to that rule.

VISCOUNT STANSGATE

My Lords, these remarks come very well from the Deputy Leader of the House, who has just moved to suspend the Standing Orders to allow the Third Reading to be taken to-day.

LORD DOUGLAS OF BARLOCH

My Lords, if I may, with the leave of your Lordships add one word, I wanted merely to say that I was not trying to be obstructive about this matter. I was trying to save the possibility of the creation of an anomaly which in itself would have been embarrassing to the Government.

In view of the noble Lord's assurance that these appliances are prescribed only in the way he has indicated, I have great pleasure in accepting the undertaking he has given to do this by regulations, and I beg leave of the House to withdraw my Amendment.

LORD WOOLTON

My Lords, I am much obliged to the noble Lord.

Amendment, by leave, withdrawn.

3.24 p.m.

LORD AMMON moved, in subsection (2), after paragraph (b), to insert: (c) the supply of any drug or medicine for the treatment of the chronic sick which term shall be deemed to include a person suffering from malignant disease, or from tuberculosis, or from diabetes, or who is a person in a chest clinic or other treatment centre administered as part of the hospital service and the provisions of this paragraph shall apply to section sixteen of National Health Service Amendment Act, 1949, and to any regulations made thereunder;".

The noble Lord said: My Lords, the Amendment I am moving has relation to the subject of the chronic sick, which occupied a good deal of time during our discussions on Committee stage. It was discussed exhaustively and there was no lack of sympathy on both sides of the House with the sufferers, but there was a division as to the expediency of this proposal, having regard to the economic situation of the country—a matter which was raised by noble Lords on the other side. The noble Marquess, Lord Salisbury, was good enough to make a promise then. He said: I make no pledges and promises except that the matter will be looked into. I gather that the matter has been looked into, and I hope that my Amendment is going to receive as favourable a reception as that of my noble friend Lord Douglas of Barloch. There are one or two points that should like to advance to show that there are practical advantages in my proposal, apart altogether from sentiment. In our previous discussion Lord Webb-Johnson spoke of argument based on sentiment as if it were, in the objectionable phrase, "sob-stuff." I am afraid that, without sentiment, a great deal of fine voluntary work done for cancer and tuberculosis sufferers would never have been done. So great is the popular sympathy for those who suffer from these terrible diseases that they have become a national concern. We are all convinced that everything possible should be done to alleviate this suffering.

There are, however, some practical reasons why this should be done. It is not unworthy of comment that this Amendment proposes to link up cancer, tuberculosis and diabetes and to place them on the same favourable terms as venereal disease. The last-named disease is covered by an international agreement, and it is not difficult to understand why this anti-social and highly contagious disease should be the subject of special safeguards. But there is just as strong a case for special treament for cancer and tuberculosis, which are a tremendous drain on the vitality of our people. I would call attention to the fact that no fewer than 8,000 people die from cancer every year—and they the unnecessarily. If we were to hear that 8,000 people in some part of the world were suddenly to die unnecessarily, public opinion would be roused to try to rescue them. Why should public opinion not demand that these people get the necessary treatment?

While looking in the Library I came across the Report of an Inquiry into Cancer Registration in England and Wales prepared by Dr. Percy Stocks. The Report shows the great necessity of keeping contact with sufferers so that the progress of these diseases can be properly studied. That cannot tie done unless we provide the means and ignore altogether the question whether some trumpery payment should be made. The benefit to our national economy is far greater than any return from the charges made. This Report says: One of the chief difficulties in this scheme is tracing patients for follow-up purposes, since to assess the benefits of treatment it is essential to know whether the patient is still alive. We shall not know that if, for some reason or other, a patient who feels unable to afford the charges we are making fails to apply for help a ad is lost sight of. The Report goes on to say that about 50,000 patients are known and treated, but there is reason to think that there are at least 100,000 to 110,000 cases. That is to say, half the number of people who suffer from this disease do not come under consideration at all.

To show even further the necessity for the continuance of the necessary drugs and treatment, and that nothing should be allowed to stand in the way, is this further statement in the Report. It says: In cancer, perhaps more than any other disease, successful treatment and advances in methods depend upon accurate clinical and pathological records concerning the individual patient. In the majority of acute and subacute illnesses the end results of treatment are known within a few weeks or months, and the absence of certain symptoms and signs proclaims that the patient is cured: the practitioner can complete his case history with all the relevant details still in mind. With cancer, however, there is no end point at which the patient can be said with certainty to be cured … I venture to suggest that, whatever we might suffer economically, that statement alone is a strong argument for ensuring that full contact with these cases, is kept, so that a complete knowledge of the treatment, the growth and the history can be kept and followed up.

I should like to refer to one other point that was raised by my noble friend Lord Silkin on the last debate. He made the suggestion that to exempt these cases from the charges might even save money. The noble Marquess, Lord Salisbury, said that he doubted it, but that he would be pleased to know if it were possible. I believe my noble friend had in mind that there might be some saving on the administrative side. Everybody knows of cases where there have been prolonged illnesses in familities, not necessarily of people who are in the depths of poverty, but people on a fairly decent level of life who have suffered a great deal. At a time like this, when we are so much concerned about the conservation of manpower, and when it is vitally important that the health of the nation should be kept as high as possible, surely some saving is possible in that direction. Even if the saving is not felt directly as a result of this Bill, it certainly will be realised in the health and strength, not only of the patients themselves but also of those who have to provide the administration, the nursing and the accommodation which, in these days, are serious matters. I hope that the noble Marquess, Lord Salisbury, or the Lord President of the Council, will be able to give a favourable reply in regard to this Amendment. I beg to move.

Amendment moved— Page 1, line 14, after ("disease") insert the said paragraph.—(Lord Ammon.)

LORD OGMORE

My Lords, the noble Lord, Lord Woolton, met my noble friend, Lord Douglas of Barloch, in a very handsome manner on the first Amendment. We are hoping that the noble Lord, after the consideration which he and no doubt the Minister of Health and others concerned have given to this matter, will be able to meet my noble friend Lord Ammon in a similar spirit on this Amendment. I am told by those best qualified to judge that the reports of the cascades of medicine of which we have heard have, in fact, been exaggerated. It seems to me, speaking entirely as a layman, that the doctors and the Minister of Health between them could, if they so desired, by administrative methods and without any need for legislation, solve this difficulty and make the necessary reductions in the cost of the Health Service so far as medicines are concerned. It may be that in time past some doctors prescribed large amounts on prescriptions for their patients. We suggest, however, that that is being cleaned up at a quite rapid rate as the months go by.

There is really no need whatsoever for this penalising provision in the Bill. In our opinion, the Government are making a mountain out of a medical molehill. We believe it is part of the doctrinaire approach which was so justly and forcibly commented upon by the noble Viscount, Lord Hailsham, in his speech in your Lordships' House the other evening on the White Paper on transport. Those of your Lordships who were present will remember that the noble Viscount, Lord Hailsham, said that, although he wished this Government to continue in office, he could not see how they could possibly do so if they proceeded with measures which were purely doctrinaire and did not tackle the real, fundamental difficulties of our times. That is what we feel about this measure: we think it is purely doctrinaire. Great Ministers of the Crown, like the noble Lord, Lord Woolton, and humbler people, such as Members of the other place who are not Ministers of the Crown, made suggestions from time to time in their Election speeches that there must be wholesale cuts in the Health Service. This is an attempt to carry out those rather wild and doctrinaire promises, made in an electoral atmosphere, and it is not really governed by the circumstances of the case.

In our Amendment two classes of case are covered. My noble friend Lord Ammon calls them all the "chronic sick," but there are, in fact, two types of chronic sick: the first is the sufferer from the malignant disease, including diabetes, and the second is what I call the sufferer from the transmittable disease, such as tuberculosis. I will deal with those separately. My own doctor is a very able man who was much against the Health Service from its inception: he did his best to prevent its coming into operation both in the Councils of the B. M.A. and elsewhere. As occasionally one is in a rather difficult position in arguing with a doctor who feels strongly against a line one is pursuing, we more or less regarded it as a closed subject and did not discuss this particular problem. But when the Government's provision was brought forward and I went to see him, I thought perhaps it was the time to reopen the question. I said to him: "No doubt you are very pleased that the Government are proposing to make these charges." He said: "No, certainly not." He then instanced diabetes, and said: "I think it is appalling that a person suffering from diabetes, who has to have regular treatment, regular supplies of drugs, injections, and the like, should have to pay a charge every time he goes for treatment." There is no doubt that many doctors would feel that this is a reasonable complaint against this proposal. The charge is, in fact, a real hardship on persons who are suffering from a malignant disease, and particularly those suffering from cancer and diabetes.

The other type of disease covered by the Amendment is tuberculosis. Our objections here are fortified by reason of the fact that tuberculosis and diseases like it are transmittable diseases. Not only is there great hardship to the sufferer, but there is grave danger that these diseases will be transmitted to the public. Sufferers will not come at an early stage and get treatment, and other people will contract the disease as a result. In order to make my case stronger I venture to suggest to the Committee that the Government have included in their provision for treatment those suffering from venereal diseases, and if sufferers from venereal diseases, who may or may not have been guilty of immoral conduct, are to receive their treatment free, I ask why perfectly honourable, hardworking people who have contracted tuberculosis, possibly at their work, should not also receive treatment free. It seems to me to be putting a premium on immorality. The answer given—and it appears to be a very thin answer—was that we are bound by the Brussels Treaty.

THE EARL OF ONSLOW

Does the noble Lord suggest that we should just scrap Treaties straight away when we want to do so because of some political consideration?

LORD OGMORE

The noble Earl must not impute that suggestion to me. I was going to say that is was a very thin reason just because of this Brussels Treaty. What is the object of the Brussels Treaty? It is that there shall be early treatment of transmissible disease. It is no good just saying that we are keeping the Brussels Treaty. What I hope the Government are doing is keeping the spirit behind the Brussels Treaty, and they must at the same time carry that forward into other forms of the fight against diseases of which tuberculosis is one. When I was a boy—and I know my noble friend Lord Hall will remember this perhaps more clearly than I do—we had in South Wales a bad record for tuberculosis. I remember attending lectures, demonstrations and the like in the early years of this century, when there was a movement to reduce the mortality rate of tuberculosis in the mining districts of South Wales. The ravages of the disease are now less than they used to be, but there are still many casualties from miner's phthisis, and the same is true of quarrying and other types of industry in South Wales. I am afraid that what is now proposed is going to have a depressing effect on the people of South Wales when they realise that they are going to be charged for their treatment.

The reasons given on the other side of the House for this charge are that it will reduce the cost of the Service. It may or may not reduce the direct cost, but it will increase the indirect cost; we shall have more tuberculosis; we shall have to provide more hospitals for those dying of the disease, and we shall have a far greater mortality rate from this dread condition. Noble Lords interrupted me in the former debate and said that the charge was equal only to the price of a packet of cigarettes and that, anyway, people spend money on the dogs and horse races. I suggest that the expenditure of more than the nation should be expected to afford on wines and liquors, on tobacco, on consumer goods of various kinds, and on dog racing and horse racing, presents considerable economic, social and moral issues, but the people least likely to be concerned in such issues are these unfortunate sufferers from cancer, diabetes, and tuberculosis. That argument might logically be applied to restricting the racing at Ascot to two days and the Epsom Races to one day, and be used as an argument for rationing cigarettes and for increasing duties on spirits. But the people with whom we are concerned are not those who go to Ascot and are not even the people who can turn up for the Derby in a top hat and a morning coat, which. I understand, is now the prescribed uniform, nor can they buy foreign liquors, or spend a large amount on tobacco. They are people on the borderline of want, and what I am afraid the Government is doing will push them over the borderline into real want.

The suggestion has been made by noble Lords opposite that the people concerned can get National Assistance. I have in mind many people who have been in employment—not perhaps manual workers but clerks and people whom we call the lower middle class—and I feel certain that in many cases that type of person would rather go without treatment, and will go without treatment, than seek National Assistance, having to declare their little income and to go through the quite necessary formalities which are sometimes difficult and troublesome in order to get assistance. To ask sufferers from these particular diseases to go on National Assistance is a thing which we in this country should not tolerate. Sufferers from these diseases who cannot afford to pay for their own treatment will have to go through all this in order to be excused the payment of a shilling a time, or whatever the charge may be. I think that suggestion is unworthy of this great country and I deplore that such a proposal should go out from your Lordships' House. Since the war we have passed great measures, to a large extent according to the unanimous wish of the people of this country; and for this great country now to charge persons suf- fering from cancer, tuberculosis and diabetes at the very time when they are in need of attention, equipment or drugs, is to me a depressing circumstance. I am sure that after what my noble friend Lord Ammon has said and after what I have said, the noble Lord, Lord Woolton, who has a hard head but a soft heart, will agree with me, and that the Government will give way to the suggestions we have made.

LORD WOOLTON

I am gratified by the noble Lord's tribute to my soft heart, but I am afraid that this is not a question of anybody's soft heart. But the noble Lord is quite right in saying that we did listen with great sympathy to the criticisms made in debate. The speeches which have been made this afternoon have not added anything by way of argument. I am glad about that, because I should have been sorry if I had missed anything when I was having consultations with the Minister of Health and his advisers. We spent a long time discussing this matter, quite honestly endeavouring to find some way out of the problem. Let us not exaggerate the problem too much. My trouble about the noble Lord who has just spoken is that his natural eloquence tends to carry me away. But let us get this problem into some perspective.

The fact is that this Bill deals only with the question of making charges for medicines obtained in the out-patients' department of hospitals. In point of fact, that is only a small proportion of the people who suffer from the diseases which have been indicated to us in such moving terms this afternoon. The great majority of people who suffer from these diseases obtain their prescriptions through the family doctor and from the chemists' shops. The noble Lord, perhaps forgetting momentarily, said that by bringing in this Bill we were jeopardising the Health Service. When noble Lords opposite brought in their Act in 1949 they did not make any of the provisions indicated this afternoon. We have heard the accounts of their sympathy in the matter which they gave to the House last week. I am quite certain that the reason why they did not make the provisions they are now advocating, was not due to any lack of sympathy on their part, any more than it is due to any lack of sympathy on our part. In fact, the proposal which has been put forward becomes unworkable when you look at it from the sheer hard job of public administration.

There is no equity in making a distinction between people who go as outpatients to hospitals and people who are treated by their general practitioner. If such a distinction were made, then clearly what would happen is that there would be an added inducement for people to swell the already overcrowded out-patient departments of the hospitals, which would not be a good thing. If any such alteration as is proposed were made, it would in justice have to apply to everyone. Now this would be a responsibility—and I am sure that noble Lords who were in office in 1949 had this consideration mind—which the chemists could not undertake. It is a responsibility which we think ought not to be put upon the doctors, and I do not for one moment believe that they would accept it. After all, their business is to prescribe for a patient's physical needs and not to form a judgment on whether or not the patient is in a financial position to pay for his medicine. I invite your Lordships just for one moment to be severely practical and to keep your hearts in order; to consider the pressure which would be brought to bear on the general practitioner by people who quite inevitably would say: "Doctor, cannot I have it free?"

There is another difficulty, and that is of arriving at what is meant by the chronic sick. It may be that a person who comes under that heading may be any person who is suffering from the ordinary processes of degeneration which come with ageing blood vessels. The noble Lord got carried away when he went from a part of a packet of cigarettes right along the road to Ascot, because we had not mentioned anything about Ascot. We have said that the cost of a prescription amounts to only a portion of the cost of a packet of cigarettes. To get hack to these chronic diseases—and I will mention a few others than those which have a sentimental attraction to us: arthritis, gout, sciatica, chronic bronchitis—they are all conditions not capable of definition that separate them sharply from a great variety of acute illnesses.

I investigated the question as to whether there were certain drugs which could be made free for everybody because of their specific qualities. I am advised that it is not possible to attribute particular medicines to particular diseases in this general way.

There is another factor to which I invite your Lordships' attention, and I am going to repeat what I am afraid I said again and again in a somewhat long discussion last Tuesday. We recognise the need for making proper provision for the sick. I was not quite sure how far the. noble Lord, Lord Ogmore, would have liked to follow his own argument and logic. I know full well that some people do not want to go to any board for assistance, and I have a great deal of sympathy with them. But that is part of the provision that all of us, in our wisdom, have made for people who are in need. I beg your Lordships to give one moment's reflection to the argument I put forward in the first remarks I made upon this Bill, because I put them forward in great sincerity—and. if your Lordships will pardon my saying so, with some knowledge. If people a re in a position in which the payment of these charges is going to be a serious matter to them then, indeed, it is highly probable that their need is much greater than the need of the 1s. I think it is a very wise thing that the State should say to that person: "We will make an arrangement whereby you can have the whole of your needs investigated so that proper provision can be made to enable you to take advantage of these and all the various other things which are provided by the State." Because of the political atmosphere in which this Bill has been brought to the notice of Parliament, it is inevitable that there should, be a good deal of the ordinary political conflict. None of us objects to that. We had rather a long period in which we were able to do it when we were sitting on the Benches opposite. But many of your Lordships have rightly said that all of us in this douse are equally anxious to do what can be clone, particularly in the field of preventive medicine, to maintain the goad health of the nation. Humanitarian instincts have nothing to do with Party divisions.

May I make one other observation? In addition to my conversations with the Minister of Health and his officials, like the noble Lord opposite, took some external advice from medical friends of mine, and this is the conclusion I drew. The really important thing is that we should preserve this health scheme, but there is some danger that its own inevit- ably growing expense might be a burden to its efficiency. Noble Lords opposite had to face this issue when they were in power. We have, I believe, to choose whether in present circumstances—and, if I may, I would underline that phrase—we are to maintain a really efficient Health Service, or whether we are to have one which is less effective but which makes no charges. This is the problem with which we are faced. Whilst the present economic circumstances make us conscious of the importance of keeping the drug bill of the nation within the strict bounds of necessity, we realise that the development of science is constantly producing new and expensive drugs for the cure of disease, and that they are, for the most part, very expensive. But it is important that general practitioners shall be able to prescribe these drugs where there is need. Any measure that tends to keep within reasonable control the cost of this Health Service will at the same time make it easier for these new and expensive drugs to come within the reach of everybody.

I have taken longer than I intended, but I hope that at any rate I have given your Lordships some evidence that my

noble friend the Leader of the House and I have gone to a great deal of trouble to see whether we could meet noble Lords opposite in this situation. We believe that it is in the general public interest that we should pursue the line we are pursuing; and I hope the noble Lord will not press his Amendment, which I regret I am not able to accept.

EARL JOWITT

My Lords, I do not know what line my noble friend, Lord Ammon, intends to take on this matter but I must say that if he is minded to press his Amendment to a Division, he will most certainly have my support and, I think, that of my noble friends on this side of the House. I am bound to say that, with the best will in the world, I did not find that the noble Lord's statement answered the point. I do not want to take up any more of the time of the House, but I want to register our feeling of disappointment on this matter; and if my noble friend decides to ask for a Division I shall, as I say, support it.

On Question, Whether the said paragraph shall be there inserted?

Their Lordships divided: Contents, 25; Not-Contents, 84.

CONTENTS
Jowitt, E.	Burden, L. [Teller.]	Lucas of Chilworth, L.
	Crook, L.	Macdonald of Gwaenysgor, L
Hall, V.	Douglas of Barloch, L.	Morrison, L.
St. Davids, V.	Faringdon, L.	Ogmore, L.
Stansgate, V.	Hare, L. (E. Lislowel.)	Pakenham, L.
	Hungarton, L.	Quibell, L.
Ammon, L.	Kershaw, L.	Shepherd, L
Archibald, L	Kirkwood, L.	Silkin, L.
Bingham, L, (E. Lucan.) [Teller.]	Lawson, L.	Strabolgi, L.
NOT-CONTENTS
Simonds, L. (L. Chancellor.)	Allenby, V.	Carrington, L.
	Bridgeman, V.	Cherwell, L.
Woolton, L. (L. President.)	Davidson, V.	Clanwilliam, L. (E. Clanwilliam.)
	Falmouth, V.	Clydesmuir, L.
Cholmondeley, M.	FitzAlan of Derwent, V	Courthope, L.
Reading, M.	Hudson, V.	Cozens-Hardy, L.
Salisbury, M.	Long, V.	De L'Isle and Dudley, L.
Willingdon, M.	Margesson, V.	Digby, L.
	Maugham, V.	Dorchester, L.
Albemarle, E.	Monsell, V.	Dormer, L.
Alexander of Tunis, E.	Runciman of Doxford, V.	Douglas, L. (E. Home.)
Birkenhead, E.	Swinton, V.	Ellenborough, L.
Dundonald, E.	Weir, V.	Fairfax of Cameron, L.
Fortescue, E. [Teller.]		Gifford, L.
Howe, E.	Ailwyn, L.	Hacking, L.
Iveagh, E.	Allerton, L.	Hampton, L.
Mount Edgcumbe, E	Amherst of Hackney, L.	Hawke, L.
Onslow, E. [Teller.]	Balfour of Burleigh, L.	Hayter, L.
Radnor, E.	Barnby, L.	Hindlip, L.
Rothes, E.	Belstead, L.	Howard of Glossop, L.
Yarborough, E.	Brassey of Apethorpe, L.	Leathers, L.
Llewellin, L.	Remnant, L.	Strathcona and Mount Royal, L.
Lloyd, L.	Ritchie of Dundee, L.
Mancroft, L.	Rochdale, L.	Teynham, L.
Merthyr, L.	Saltoun, L.	Turnour, L. (E. Winterton)
Middleton, L.	Sandhurst, L.	Waleran, L.
Milverton, L.	Sandys, L.	Webb-Johnson, L.
Monck, L. (V. Monck.)	Schuster, L.	Wolverton, L.
Ormonde, L. (M. Ormonde.)	Selsdon, L.	Wright, L.
Palmer, L.	Sinclair, L.

On Question, Amendment agreed to.