§ 2.51 p.m.
§ LORD SILKIN rose to move to resolve, That this House condemns the proposals of Her Majesty's Government for increasing the contributions and charges for 606 the National Health Service. The noble Lord said: My Lords, it is not often in this House that we have to put down a Motion such as this, condemning the Government—and let there be no mistake about it; that is the intention of this Motion. Normally, we are content to state our case with such force as we can and then, perhaps after a Division, we agree to differ, usually quite agreeably, as we have done in the measure which we have just passed. But there are occasions— and this is one—where the proposals of the Government seem to us so wrong in principle, so harmful to the community and, as in this case, so clearly a piece of class legislation directed against the less fortunate sections of our people, that no ordinary Motion and debate would be wholly adequate.
§ The statement in this House and in another place last Wednesday on the Health Services shocked the conscience of all sections of the community, regardless of political persuasions, who care about the welfare of our people. The National Health Service came into being following a declaration by the Coalition Government in a White Paper in 1944, when the end of the war was in sight. In had, of course, been preceded by the historic Report known as the Beveridge Report, upon which the later legislation was based; and I am sure the whole House will be glad to know that the noble Lord, Lord Beveridge, the author of that Report, is following me in this debate. The White Paper laid down two fundamental principles upon which a National Health Service should be founded. These were: first, to divorce the care of health from questions of personal means or other factors irrelevant to it; and, second, to see: that all medical facilities were available to all the people.
§ In 1946, the Labour Government sought to implement this all-Party declaration: it introduced the National Health Service Bill. But by then the mood and spirit of the war-time Coalition had begun to fade away. The Bill was opposed and voted against on the Second Reading by the Tory Opposition, and it was voted against on the Third Reading. It was also, at that time, strongly opposed by large sections of the medical profession; but I am glad to say that, after some fourteen years' working, 607 the medical profession are to-day almost wholly in support of it.
§ There are many in the Tory Party who have never really become reconciled to a National Health Service, and who have all through devoted their energies to undermining it. They believe that the individual must pay for his health to the extent of his capacity, and that it is not the business of the community to accept responsibility unless he is devoid of means in such a way as to require and qualify for National Assistance through the National Assistance Board. The Minister of Health, throughout his political career, has made no secret of the fact that he takes this view—the view that, unless a person is devoid of means, he ought to pay for his health services—and to-day the Minister has secured the approval of the Government for carrying this policy into effect. The alleged financial reasons, and especially the proposed hospital programme, are simply a pretext. Mr. Powell was always in favour of transferring as much as he could of the cost of the Health Service on to the shoulders of those least able to bear it. The Estimates for 1961–62 merely provide him with just the pretext he was looking for. He and the Government are obviously concerned less with the question of providing a healthy nation than with the question of who pays for it.
§ What is this question all about? The net Estimates for 1961–62 how an increase, according to Mr. Powell, of 11 per cent. on 1960–61. These Estimates have not yet been approved by the House of Commons. The Minister says, Let the sick pay, by way of increases in charges for medicines, dentures, spectacles and such things as orange juice, cod liver oil and so on, for their treatment and their medicines." We say, "Place the burden on the shoulders of those best able to bear it, on income tax and surtax payers; or impose a capital gains tax." After all, we have to remember that the income tax and surtax payers—those who pay direct taxation—have in the last ten years had relief to the extent of £1,000 million, while those primarily bearing the cost of the Health Service have had their charges steadily going up. The cost of the insurance stamp to the worker is something like 608 four times what it was in 1946. This imposition of the burden on those best able to pay is elementary justice and humanity. The services are, after all, as much in their interests as members of the community as they are in the interests of anybody else. They want, or ought to want, a healthy nation, and they can best afford to pay for it. We do not accept the principle that those who are compelled to take advantage of our health services should necessarily bear the cost of treatment or, alternatively, seek State charity. A healthy nation is a national asset.
§ These proposals are part of a gradual process of shifting these burdens from progressive taxation to a flat-rate, whole tax. It saves no money to the community. The expenditure remains exactly the same. If this proposal is accepted and developed, we shall find the Government further increasing health charges whenever, for budgetary reasons and not for health reasons, they find it politically expedient to do so. We shall find the Government, on the same argument, extending the principle to our education services, if there is an increase in the Estimates. And, on this argument, why not charge parents when new and more costly primary schools are built, or when the cost of textbooks or stationery or teachers' salaries goes up? Is not the argument exactly the same? Indeed, there are many in the Tory Party to-day who are already toying with these ideas, and if they had their way they would already have implemented them.
§ Why did not the Minister of Health employ legitimate means of reducing the costs, if he felt that the Health Service was costly? Why did he not look into the question of the cost of drugs, of the wastage in their distribution, of the free samples that are provided to doctors, and so on? I should have thought there was ample scope for dealing with the question of the cost of drugs. While the Government are placing this burden on the sick, pressure is being put on them by their own followers to enable private patients to secure the benefit of prescriptions under the Health Service. So you have a two-way traffic: on the one hand, imposed burdens on the sick; on the other hand, charge to the National Health Service the cost of providing prescriptions for those who do not take advantage of that Service.609
§ I should like to ask the Government what is the urgency of this matter. Why could not these proposals have formed part of the Budget in two months' time, and been dealt with in the context of the finances of the nation as a whole? We should have seen the matter then in its proper perspective—which, I suspect, is just what the Government did not wish us to do. We should have found if we had seen the matter in its proper perspective, that, allowing for increases in population and in the national income, the proportion of net cost to the Exchequer had remained fairly constant throughout the past ten years. So have the relative costs of the services to the contributors to the National Health Service. In fact, we should have been able to take this increase in our stride without having to burden the sick and the least-well-off section of the community. A discussion might also have found alternative sources of revenue, and, as I have said, of savings. But this would not have suited the Minister's book, because he regards this as a matter of principle and not solely a question of finding the necessary revenue to meet the additional cost of the Estimates.
§ My Lords, the increased charges will create hardship among a substantial section of the community. Let me instance some of them. There are the low-wage earners with dependent families. We are told that the average wage to-day of a worker is £14 to £15 a week. That is the average figure. But we have to remember that, included in that figure are as many persons earning less than £15 as there are persons earning more than £15 a week. About half the earning population is getting less than that figure, and I assert that these charges will constitute to them a hardship. About one-fifth of the population, or about 11 million members of families, have about six guineas a week free, after paying their National Insurance contributions. Six guineas a week for a family! Even then they have to pay for their rent, food, clothing, and so on. That means there is not much left for medicines, spectacles, dentures, and for all the expenses which a family requires.
§ We must consider the effect that this will have on elderly widows, widows of small means and spinsters who are unable to work; upon the chronic sick—people who are in constant need of 610 medical attention and medicines; upon, diabetics who need frequent doses of insulin, which, incidentally cannot be given on a large scale because it deteriorates. All these people will be put to extra expense at a time when money is most needed. It will also affect nursing and expectant mothers and young children who have been deprived of cheap orange juice, cod liver oil and vitamin tablets under the welfare foods schemes. Incidentally, I cannot help recalling that in the debate in another place one honourable Member had the impertinence to suggest that some of this orange juice was used for mixing drinks with which we are well acquainted, and that cod liver oil was being thrown away or used for dogs. I could not help feeling that this was a particularly heartless kind of suggestion to make at a time when we were dealing with the health and welfare of our less fortunate people. These latter items, the orange juice and so on, would save a very trifling sum of money; but, of course, no trifle is too small if it comes out of the pockets of the poorer section of the people.
§ There are certainly a large number of people who would not be able to afford the little comforts that are needed in times of sickness in the home, and which are so valuable and, although perhaps having an intangible effect, nevertheless are vital if you are going to help cure the sick. They have a psychological value. Further, these proposals will have a deterrent effect in a family such as I have described, where every penny counts; these proposals will tend to delay the visit to the doctor, the dentist, or oculist. People will be disposed to leave it till the last moment, or even until it is too late, and this might do irreparable damage, especially in the case of children. Our object should be to encourage people to go to the doctor or the other professional people at the earliest possible moment. We should encourage preventive treatment rather than curative. But in fact we are doing just the reverse and ensuring that people will not go to the doctor until they cannot avoid it.
§ Another mean charge is that of doubling the cost of the amenity beds. There is not a lot of money in it—£125,000 a year—but, as I said., every little helps. These amenity beds are of 611 the greatest value in a hospital and should be used for the benefit of patients who need these beds but can ill afford to pay. The doubling of the cost will mean that a number of patients who really need these beds will not be able to afford to have them.
§ I am well aware that one or other of the noble Lords who are to reply to this debate will refer to the action of the Labour Government in 1950 and suggest that that forms some kind of a precedent. It does nothing of the kind. That happened six years after the end of the war at a time of exceptional financial difficulty. We had the Korean War. It was a temporary proposal, which was to come to an end at the end of three years. And I am bound to say that a great many members of my Party were most reluctant to accept those proposals. They were strongly opposed to them. In fact, we had three resignations from the Government—of Mr. Aneurin Bevan, Mr. Harold Wilson and Mr. John Freeman. I should be very interested to see how many members of the present Government resign in protest against these proposals. Furthermore, my Party pledged itself to annul these charges as soon as we had the opportunity.
The present proposals have been critically received by large sections of the Press, by many individual practitioners, by many consultants, by the Lancet and by all medical organisations. I should like to quote one or two extracts from statements made by these organisations. The British Medical Association, which is surely a non-Party organisation, say:
We have opposed prescription charges since they were first introduced. We feel they create a barrier between the patient and the treatment he may require.
The Medical Practitioners' Union say:
The higher prescription charge must be deplored by every doctor in the country. The increases are disgraceful.
May I quote also from a newspaper, which I am sure will carry great authority amongst noble Lords opposite? The leading article of the Sunday Times of February 5, says this:
If the proposal is looked at purely as one of raising £850 million, the cost of the health service and the different sources as taxation under various guises, it is not good in principle to off-load from a graduated income tax
or from a tax on consumption goods to a poll tax on the gainfully occupied or to a levy on the sick, as the extra charge for prescriptions can be made out to be.
§ I have said nothing about the National Insurance contribution, but similar objections, though not quite in the same degree, apply to these increased charges, as I have already mentioned. We have to bear in mind the cumulative effect of the increased charges on national health and national insurance. These will not only adversely affect the classes of person I have mentioned, but in the aggregate they establish a strong argument for increased wages to meet the increased cost of living, and this, in turn, will have the usual unhealthy effect on our ability to compete in the export market.
§ My Lords, I hope that I have established beyond any doubt that these charges are unfair, anti-social and inhuman; that they will inflict great hardship on many of our people, particularly on those less able to look after themselves; that they are likely to create a precedent for still further charges in future, and that they will tend to have a deterrent effect on many ill persons and will delay earlier treatment and cure. It is for all these reasons that we feel the Government are to be condemned. I beg to move.
§ Moved to resolve, That this House condemns the proposals of Her Majesty's Government for increasing the contributions and charges for the National Health Service.—(Lord Silkin.)
§ 3.18 p.m.
§ LORD BEVERIDGE
My Lords, your Lordships can hardly doubt that I am deeply interested in the subject of this debate. In one sense, I think I may be called the father of the Health Service, through having made it one of the three assumptions of social security under the Beveridge Report. There were Assumption A—children allowances; Assumption C—full employment; and Assumption B—the Health Service. Though, to some extent, I may regard myself as the father of the Health Service, I am by no means whatever its inventor. Invention was the work of Mr. Aneurin Bevan in 1945 and 1946.
I want to point out that, among other things, the Beveridge Report left entirely open the question of whether or not a payment towards the cost of the Health 613 Service should be included in the social insurance contribution. The making of that contribution for the cost of the Health Service was the decision of those who introduced the Bill which led to the Health Service's becoming law. It had nothing whatever to do with me, except in so far as, in asking the Government Actuary to prepare the costs of the whole scheme of social security and Health Service and all the rest of it, I allowed him to work out his estimate of the cost of the Health Service contributions.
Let me say that I am not committed in any, way to-day on the issue raised by the Motion of the noble Lord, Lord Silkin. In so far as the much greater cost of the Service now is due in part to the wage-earners themselves asking for more wages for the same or less work under full employment, so, in combination with their employers, who raise prices to correspond with the increases in wages, causing money to fall in value through inflation, I find it a little difficult to condemn offhand the Government's proposals to meet some of that greater cost to-day by higher contributions from those who will benefit by the Service.
The case of the Government, as they put it in the other place, is essentially that the additional payments they ask for from users of the Service to-day are not larger in relation to the average of wages than the earlier payments were. In so far as that is proved to be correct, it is a good argument, so far as the wage-earners are concerned. I need hardly remind Members of this House that the late Sir Stafford Cripps—whose action as Chancellor of the Exchequer at one stage of putting a ceiling on the total cost of the Service was used rather freely by the speakers for Her Majesty's Government in the other place, and may presumably be used by them again—was as strong an opponent as I am of inflation as a curse to society. It is a thousand pities that, in face of the trade union attitude, he could not succeed. So, on the facts as I have read them (and I suppose, like many of your Lordships, I have read practically the whole of the speeches made on this subject in the other place), I find it difficult to condemn off-hand what the Government are, proposing in this case.
I must remind them, however—and hope the House will not mind my doing 614 so—that the aim of the Beveridge Report under its Assumption B was that no one should continue under illness or disability through lacking means to pay for treatment. Let me quote the actual words, as they are rather impressive at this moment:Restoration of a sick person to health is a duty of the State and the sick person, prior to any other consideration.And previously it says: that the Service should beprovided where needed without contribution conditions in any individual case".That assumption is in accord with the definition of the objects of medical service proposed by the Medical Planning Commission of the British Medical Association.
I want to ask Her Majesty's Government to make sure that they are not failing to ensure that all sick and disabled persons can and will, in practice, get what they need to make them well again, if they can be made well again, irrespective of payment; irrespective, let me say, of knowledge: and irrespective, often, of taking the trouble to find a way to get the treatment. Any proposal that did not guarantee to people that opportunity of getting the necessary treatment, irrespective of their means and of their knowledge, would deserve condemnation.
All of us who take the trouble to discover the facts know that, while most people in Britain are far better off to-day than they were fifteen years ago, and can afford the greater contributions asked for by the Government, by no means everybody is in that position. Many old people are both poor and solitary, trying to live on savings made inadequate by inflation, by what has made others rich. I am personally concerned with two or three organisations designed especially for the help of old people. I may say that, with the help of experts and organisations concerned in this field—that is, the care of old people, their need, and the extent to which they are neglected by the people who ought to look after them: sometimes, as I know, their own children —I hope to make a study of the aged poor and lonely in an affluent society my next main task
But, apart from age, there are other causes why particular individuals miss 615 the medical, surgical or nursing treatment they need. I am old enough to tell your Lordships that often I do not want to bother to go and find a doctor: and there are lots of old people who feel that way. They say: "I will get better somehow without the doctor". They are ignorant of what is available for them. The Ministers who spoke for the Government in the other place on February 8 said that they realised all this and would take steps to put it right. They said they would make treatment accessible to, and indeed would force it on, people who would not take the trouble to get it; and they promised to make known the fact that these people can get treatment and be rid of their disabilities. I hope that those Ministers who spoke in the other place, and any noble Lord who may speak on behalf of the Government in this House to-day, will not mind if, as a very old civil servant with much experience, I remind them that turning the words of Ministers into deeds calls for continuous hard work. It is the function of a civil servant or of a committee appointed specially for that purpose.
I hope that the Government will not just leave us with the persuasive words that they spoke in the other place, but that here they will be able to tell us that they will take positive steps to see that it is the business of somebody—a committee, possibly, of two or three people —working with the local authorities and the medical associations, to make certain so far as possible, that no person need suffer from disability through not getting the treatment which he or she ought to get—indeed, which they ought to have thrust upon their attention, if they do not know about it. I should also like to use that body, or a similar one, to investigate for instance, the costs of the makers of pharmaceuticals, to see whether they are getting too much out of the Health Service. If we are going to put burdens on people who are, after all, wage-earners, and the dependants of wage-earners, we ought to make certain that the makers of profits do not get too much profit by selling.
I shall come back later to my point about trying to make certain that nobody fails to receive treatment through ignorance or poverty. May I now add two small points of detail? 616 First, the Government proposals deal rather specially with dentistry. The remuneration for dentistry in hospitals, for some reason to which I do not know the answer, is on a different basis from that of doctors and surgeons. It is based not on time, not on salary, but on payment by the job. I can assure your Lordships that one very distinguished dentist expressed to me his distrust of that method of payment. He said that all dentists, or most dentists, were perfectly honourable and hardworking, and were not worrying about money, but that the present practice did lead to some dentists doing jobs that were not strictly necessary. I wonder whether, as was reported by the Minister in another place on February 8, the fact that the number of dentists is up by 10 per cent., and that treatments are up by 20 per cent., has anything to do with the fact that they are paid by treatments and not by hours. At any rate, I hope that Her Majesty's Government, now that they are overhauling the Health Service, will consider this particular point.
Let me come to one more reason why I am interested in this debate. Just before Christmas I spent twelve days in St. Thomas's Hospital as a Health Service patient. I had a room to myself, and therefore paid for that; but for everything else I was a Health Service patient. I cannot say how great an admiration I had for the service and the kindness of everyone I saw towards the patients, and the delight in being an old gentleman of 82 who was treated exactly like a small boy of five who came there with his mummy and grandma. I suppose that St. Thomas's, which has a big building scheme, can be made even better than it is, but, personally, I am more than content with it as it is, and I think institutions like that reflect great credit on all successive Governments who introduced the Health Service and carried it out.
I come to my conclusion, and perhaps to some extent the same point—my point of the Health Service being designed to make certain that no one, either through want or ignorance, or through carelessness, shall fail to have treatment that might end his or her disability. I hope that in this House the Government will say, not in general terms, but with some 617 indication of definite administrative action, that they will set up a special committee or body of people who will work continuously to see that that is carried out in practice.