NATIONAL HEALTH SERVICE BILL (Hansard, 11 April 1961)

§ LORD BEVERIDGE
My Lords, I accept the Bill now before the House as a logical sequel and completion of the National Health Service Contributions Bill which we discussed in this House, on February 13 and on March 27. On each of those two occasions, I explained that I could not object to the new charges as they affected wage-earners, but I was less happy about their varying effect on others than wage-earners and on old people. Like the noble Lord, Lord Taylor, I welcome the exclusion of certain classes from these charges by Clause I (3) and (4) and the power to vary the charges which is 246 given by Clause 2. Until I hear to the contrary, I shall assume that power to vary includes power to deal differently with different classes of people—for instance, such a class as the old people. If I am wrong, I hope that it will be regarded as possible to put this matter right when the Bill goes into Committee.
When the National Health Service Contributions Bill was before us on February 13, I mentioned my intention to make a study of the aged poor and lonely in our present society my next task, and I wish to lay my conclusions before Her Majesty's Government to-day. My second statement of my proposed study and laying of conclusions, made on March 27, was received most sympathetically by the noble Earl, Lord Dundee, who spoke on that occasion on behalf of Her Majesty's Government. It also received a great deal of publicity in a number of newspapers. As a result, my Easter was largely occupied in opening and reading letters from aged people or friends of aged people, who desired me to take up their problems and put them to the Government. I spent Easter week entirely on studying the conditions and needs of our old people to-day and writing about them. I ought to say that my study was by no means concentrated on these letters. There is much other material about old people which needs study.
I came to certain definite conclusions and I hope that I may lay these conclusions before the House and the Government for their consideration. The main conclusion is that old people in Britain to-day and to-morrow, in many ways, and not in one way only, need more thorough looking after than they get today. I shall be happy to give my reasons for that conclusion to Her Majesty's Government, but I do not think I need trouble the House with them to-day. I have said, "in many ways" —that means things like income, housing, occupation and companionship—but to-day I am concerned only with health.
On the question of health, I Would venture to lay two practical considerations before Her Majesty's Government for consideration. First, I would beg of them to provide machinery to secure the regular visiting of old people by competent persons, in order to discover need of health treatment before illness or 247 failure has gone so far that it is too late for any cure. There is no question at all that many old people suffering from an illness of one kind or another could, and would, have been kept alive if they had been visited, the need for treatment discovered and treatment employed in time. Old people are shy, do not wish to leave home, apt to be careless and make "getting through somehow" the full occupation of their thoughts. I beg for some kind of machinery for regular visiting. That is my first suggestion. My second suggestion is that Her Majesty's Government should set up and announce some body to which the needs of old people—

§ EARL WINTERTON
My Lords, may I interrupt the noble Lord and ask him a question? Where is this reference to the care of old people in the Bill before your Lordships' House?

§ LORD BEVERIDGE
My Lords, the question is before the House now as it was before the House when the predecessor of this Bill was discussed in your Lordships' House. That is the simple answer. I come to the second suggestion: that Her Majesty's Government should set up and announce some body to which the needs of old people coming to the notice of private citizens could be make known, with a view to necessary action. I know that there are many kinds of need which escape notice and I am concerned to-day only with health, but I desire and hope that the Government will provide one address for all the needs. What the visiting machinery and the machinery for receiving information from private citizens should be I leave naturally to the Government. More than one Department may be involved—health, pensions, housing and all the rest of it.
I think there is something to be said for the National Assistance Board as the central agency. Though I regret that, through inflation, the Board has to give assistance subject to a means test to so many old people who ought to have full pensions through social insurance, I know that the National Assistance Board, from its very foundation in 1934, has regarded human welfare as its aim. It would be an excellent central body to 248 entrust with this task. But there is the alternative of local authority bodies. I think that, on the whole, so far as local authorities are concerned, it would be sufficient to deal with boroughs, because I believe that this is more a town problem than a rural one. That again, however, is a detail to be considered by the Government, if they will kindly pay attention to my suggestions. I am not asking them to answer to-day but only to consider these suggestions, I hope sympathetically.
Meanwhile, I would add one small point. I happen to have my Easter letters at hand. They are not all concerned with health, but a good many of them may well deserve an examination. Would it be possible for the Government to suggest to me some address of a person less continually occupied with important things than a Minister of Pensions, of Health, of Housing or whatever it may be? If they will be kind enough to give me that address I will see that the information in the letters is passed on. Let me end with a quotation from a speech made in this House, I think in 1954, by the noble Viscount, Lord Soulbury: The prestige and reputation of a civilised community rest in a high degree upon its treatment of and care for the aged. Let us in Britain set ourselves to pass that test with flying colours.

§ LORD NEWTON
My Lords, the noble Lord, Lord Taylor, told us that the reason why the Opposition were not going to divide against the Motion I have moved was not the fact that he agreed with the principles. That I understand, and I am grateful to the noble Lord for the moderation with which he expressed his disagreement. But perhaps I might also say that I recognise that it is easier for him, on behalf of the Opposition, to put across that point of view, because he was not a Member of either House of Parliament when the 1951 Act was going through. I should like to say again that all this Bill does is to bring the charges of that Act into line with modern conditions. I went out of my way to say that, in my view, for what it is worth, it was a wise decision of the then Government to introduce the Bill of 1951.
249 The noble Lord, Lord Taylor, has said that the welcome increase in the amount of conservative treatment and the decline in the supply of the number of dentures since 1951 could not be wholly attributed to the 1951 Act. In that I should entirely agree with him. He spoke of the "backlog", as he called it, of demand for dentures which was to an appreciable extent worked off by the time the Act came into operation. I do not dispute that either. What I said was that one is forced to the conclusion that the 1951 Act was a significant cause of the trend which I described to your Lordships, and which I am sure your Lordships welcome as much as I do. I am firmly of that opinion.
The noble Lord welcomed the reform in the Bill which provides free dentures far the priority classes when they get them other than as patients of the local authority services, and I am grateful to him for that. He also welcomed the change proposed in the Bill in the arrangements for providing spectacles for children over 10 and until they leave school. He asked me to consider the question of why free lenses could not be provided for this category of children in any frame and not only in a National Health Service frame. That is an interesting suggestion. But if one were to do that, where would one draw the line? There might be attractive young women who have left school and who might take the view that it would be easier to obtain a husband if they wore frames which were not National Health frames. Again, I rather doubt whether there is much evidence to show that the range of National Health Service frames is not attractive enough.

§ LORD TAYLOR
With great respect, I think the recommendation of the Ophthalmic Committee of the Central Health Services Council shows the importance of the attractiveness of frames as a means of getting schoolgirls to wear spectacles. I think that is the basis behind their recommendation, and that is why they have said that these other frames should be available. The noble Lord asks where we should draw the line. I think we should draw the line with children, because the difficulty lies in getting children to wear glasses. 250 That is why I should like to see these young girls, particularly, enabled to have the most attractive kind of spectacles, in order to encourage them to wear them, when these lenses are going to do corrective ophthalmology, as opposed to supporting ophthalmology, which we oldsters have.

§ LORD NEWTON
I do not think it would he quite so easy as that to draw the line; and other categories of people would put forward what they thought were equally good claims. I agree with what the noble Lord said about the reasons underlying the recommendations of the Standing Ophthalmic Advisory Committee; and I did not deny that in my opening speech. All I said was that I did not think there was any evidence to show that the National Health Service range of spectacles (and I am not talking about the steel ones) was not sufficiently attractive to fulfil the purpose which the noble Lord has in mind.
The noble Lord, Lord Beveridge, asked me about Clause 2 of the Bill. The answer to the noble Lord is that Clause 2 does not give power to vary the charges for different classes of people. The reason is that the Government think it would be wrong if alterations in the liability of the particular persons to pay charges were permissible by subordinate legislation, and that any question of discrimination between persons in respect of charges ought to be reserved for Act of Parliament.
The noble Lord told us about the conclusions which he has reached as a result of his study of the problems of old people. We all know the great interest the noble Lord takes in the welfare of these old people, and I certainly, and I think my right honourable friend the Minister, too, will be interested to know of his conclusions in greater detail when he has finally formulated them. If the noble Lord will be goad enough to let me have a copy of his report in due course (if he issues his conclusions, as such) I shall be most interested to read it and to invite my right honourable friend the Minister to do the same. The noble Lord recognised in his speech that what he was saying covered a much wider field than this Bill, which, as I 251 said to your Lordships in my opening speech, is concerned only with charges for dentures and spectacles. But in view of what the noble Lord has said, I know he does not expect me to give any sort of authoritative reply this afternoon to the suggestions which he put forward.
I hope that I have covered the main points which were put to me by the two noble Lords, and that your Lordships will now be willing to give the Bill a Second Reading.