NATIONAL HEALTH SERVICE CHARGES

HL Deb 13 February 1961 vol 228 cc618-702

3.38 p.m.

Debate resumed.

LORD NEWTON

My Lords, at the beginning of his speech, the noble Lord, Lord Silkin, said that the Opposition do not often table Motions of censure upon Her Majesty's Government. Although I have many recollections of debates on Motions of censure in another place, I certainly have never been present when there has been one in your Lordships' House, let alone taken part in one. Ever since I knew that it would be my task to-day to speak on behalf of the Government, I have been wondering what it would be like. I suppose I shall know the answer by the end of the debate or, perhaps, before the end of my speech.

The noble Lord, Lord Silkin, made his case with firmness and clarity, and with his customary fairness. I hope he will think that what I am going to say is equally fair. The noble Lord, Lord Beveridge, I suppose, is more entitled to speak on matters of this kind than anybody else in your Lordships' House. I was therefore grateful to listen to the qualified sympathy which he expressed for the Government's proposals which we are debating to-day. The noble Lord expressed in moving terms his fear that there may be people who, for one reason or another, are not getting, or will not get in the future, the treatment which they need. I hope that the noble Lord will feel reassured by what I am going to say, or, at any rate, if not, by what my noble friend the Leader of the House will say later on.

The heat of the public discussion of the Government's proposals for increasing the charges and contributions for the National Health Service has, I think, rather obscured what it is that the Government are actually doing. The details were, of course, announced in this House by my noble friend the Leader of the House on February 1, but in order that the nature and scale of the charges may be quite clear to your Lordships I should just like to repeat them briefly.

The charges for dentures will be increased by amounts ranging from five shillings to fifteen shillings, but children and expectant and nursing mothers will be relieved of charges which they now pay for dentures. The charges for spectacles will be increased by five shillings a pair, with a higher charge for bifocal and multifocal lenses, but children from the age of ten will no longer be charged for lenses in adult types of National Health Service frame. The maximum charge for amenity beds in England and Wales will be doubled. The prescription charge will be increased from one shilling to two shillings per item. Orange juice, cod liver oil and vitamin tablets will in future be sold at cost price. The National Health Service contribution will be increased by one shilling a week for the employed man, of which ten-pence will be paid by the employee and twopence by the employer. Those are the proposals, and I do not wish to belittle those increases, but I want to suggest to your Lordships that they should be viewed with a sense of proportion. They are not, I submit, of such a kind as to introduce any fundamental change in the conception of the Service or in the tremendous benefits which we all receive from it.

What, then, are the reasons for making these changes? If the National Health Service is to expand and develop with progress in medicine, and in conformity with changing needs, we must from time to time see what can be done to limit expenditure already being incurred so as to ensure that the money which can be made available for the Service is spent to the best advantage on the new developments, and we must not allow past commitments to mortgage future progress. The resources which can be devoted to this Service, as to any other, are not unlimited, and the Government have a duty to see that whatever sums can be made available are spent to the best effect. This cannot happen if all present arrangements must be regarded as unalterable no matter what the need may be to limit expenditure in some directions in order to provide resources for expansion in others.

We have reached a point where there are tremendous opportunities for further progress in three main directions: first, the expansion of the great programme for the better care of the mentally ill and mentally subnormal which is taking shape following the Mental Health Act, 1959. Over the next ten years there will be a special capital allowance for the modernisation of mental hospitals. Perhaps I may be allowed to say that this is a scheme which gives me great personal satisfaction. I suspect that the care of the mentally ill is, if not the biggest, at any rate very nearly the biggest, of all the problems confronting the National Health Service, and I very much doubt whether there is a single adult in this country to-day who does not know, either directly or indirectly, of at least one person who is or has been mentally ill. Such is the scope of the problem as I see it.

For more Than ten years I was a member of the management committee of a large mental hospital group, and I had necessarily to resign a few months ago when I was given the task of speaking in this House about health matters for Her Majesty's Government. But ten years was long enough for me to know the problem of old buildings, the difficulty of staffing mental hospitals and, above all, the exceptional degree of patience and compassion which are required from those who care for the mentally ill, and particularly the senile. But, my Lords in those years we were able to improve our hospital all the time: we improved the wards, we improved the various amenities for the patients, we provided better opportunities for occupational therapy and many other things as well.

This is the point which I wish to make and why have indulged in this brief personal reminiscence—that we should not have been able to improve that hospital in the way I have outlined if Her Majesty's Government since 1951 had been actuated by that hatred of the National Health Service which some of its critics like to make out. If further progress along those lines is going to be made possible, as I am confident it will be, by the kind of arrangements which we are discussing to-day, then I have no hesitation in saying that in my opinion, for what if is worth, those arrangements are fully justified.

The second direction for further progress is to be seen in the far-sighted ten-year programme for rebuilding or improving our hospitals launched by my right honourable friend the Minister of Health last month. And the third is the expansion of community care needed as a supplement to the hospital building programme. These advances will depend partly on capital development, on the hospitals, hostels and homes provided by the hospital authorities and the local authorities; and partly on the number and quality of the staff, the doctors, nurses and all the many other workers who will be caring for the sick and others in need of help, both in hospitals, in other residential institutions and in their own homes.

The hospital authorities throughout the country are now drawing up their ten-year programme in response to the request of the Minister. The task is a heavy one but it can give a most helpful stimulus to the whole hospital organisation. The capital to be provided includes, as I have already said, a special allowance for the modernisation of mental hospitals. The Government cannot enter into commitments at this stage as to the rate of future expenditure, but the basis on which plans are requested shows that it is expected to be generous, and your Lordships may possibly recall that on February 8 my honourable friend the Financial Secretary to the Treasury gave in another place the details of schemes which have been approved. It is a long list; I have it here.

The local authorities are already well embarked on the expansion of their mental health services. Training centres for both children and adults are being provided on an increasing scale. A start has been made on residential accommodation both for some of those attending training centres and also for other mentally disordered, such as those recently discharged from hospital who are not yet ready to live on their own in the community. Old people who are mentally confused are being received in suitable cases into old people's homes, which are also being provided at an increasing rate. The home visiting services are being expanded.

We are also on the threshold of great opportunities for making long-awaited improvements in the organisation and calibre of the staff of the Health Service, on whom progress depends even more than on the quality and quantity of the buildings. The Report of Sir Robert Platt's Working Party on the Medical Staffing of the Hospital Service, which has been so eagerly waited, should be published next month, and it will be immediately followed by consultations between the Health Ministers and the medical profession. On the local authority side we have the Report of Miss Eileen Younghusband's Working Party on Social Workers, which has been recognised as an epoch-making document in this field. The intention to introduce legislation to give effect to its recommendations has already been announced, and Sir John Wolfenden has agreed to act as Chairman of the National Training Council for Social Workers and of the associated training Council for Health Visitors. This is a fact which in itself should go a long way to ensure the success of the work of these Councils which will determine the future of the professions for years to come. Among the social workers will be the mental welfare officers who have so large a part to play in the community care of the mentally disordered and who attach great importance to a proper and officially recognised training.

I have been putting some emphasis on the training of all these officers, because anyone who is acquainted, as I am sure many of your Lordships are, with the day-to-day operation of what is called community care—that is, the care of a patient in his own home—knows how essential they are to its success. Indeed, the whole pattern of successful community care turns on the proper training of those who will be responsible for it and the proper organisation of their work. I hope that what I have just said may strike the noble Lord, Lord Beveridge as being appropriate to what he said in his speech. I have gone at some length into the great opportunities for development and progress now facing us because what the Government have done is intended to ensure that resources will not be lacking to make the most of these opportunities and to keep the emphasis on progress and development, which is surely where in any lively and vigorous Health Service it ought to be.

I now turn again to the changes in charges and contributions which are the subject of this Motion of censure, because your Lordships will wish to know, and obviously it is my duty to explain, why these particular items have been selected for increase. Both Labour and Conservative Governments have recognised that dentures, spectacles and prescriptions constitute a field where the patient is in a position to exert a certain amount of pressure on the dentist, optician or doctor to go perhaps a little beyond his better judgment. Consequently, both Labour and Conservative Governments have thought it right to place on the patient a measure of financial responsibility.

LORD TAYLOR

My Lords, could the noble Lord explain how a dentist, in supplying dentures, goes beyond his natural responsibility as a result of patient-pressure?

LORD NEWTON

My Lords, I should have thought that it may be possible to bring pressure to bear on a dentist to do rather more than he thought was absolutely necessary.

LORD TAYLOR

My Lords, if the noble Lord would allow me once again to intervene, may I say that I do not think a dentist would really take out teeth and fit dentures unnecessarily because a patient brings pressure. I do not think there is any evidence of that.

LORD NEWTON

Well, my Lords, perhaps I could go on to say that when, on October 24, 1949, the Government announced that it was proposed to impose a charge of up to 1s. for a prescription, the Prime Minister, the noble Earl, Lord Attlee, said that the purpose was to reduce excessive and in some cases unnecessary resort to doctors and to chemists. The Labour Government did not, in fact, carry out its intention. But what I am concerned with at the moment is the argument in favour of a prescription charge used by the Government of the day in 1949.

Charges for dentures and spectacles were first introduced by the National Health Service Act, 1951, and it seems clear to me that those items were selected largely because charges upon them would not generally have to be paid by people who were sick. I would remind your Lordships of the speech made by the late Lord Haden-Guest when moving the Second Reading of the Bill in this House on May 9, 1951. He said—and I quote from Columns 813 and 814: It has, regrettably, been found that the only way to enable expansion to continue in other directions is by shifting some of the expense to the patients. All other alternatives were explored and reviewed … In selecting the services for which charges are to be made, the Government tried to choose the field where charges would obviously do least harm, and they chose the field of spectacles and dentures, because to a large extent they affect people who are well in health and able to make their own way…Charges for appliances under the National Health Service are not new: I wish to emphasise that point. It is suggested that these charges are a departure from the principle of the National Health Service Act, and that no charges should be made. But charges have been made for appliances, some since the inception of the Service. The Government already have power to charge for medicines. I submit that these are substantially the same arguments that I am using this afternoon, and I would particularly ask your Lordships to note two points made by Lord Haden-Guest: first, that all other alternatives to the charges were explored and reviewed, which must mean that the alternative of raising more money for the National Health Service by direct taxation was considered and rejected—in other words, the Government decided that there was a point beyond which rises in the cost of the Service should not be borne by general taxation. The second point to which I beg to invite your Lordships' attention is that, in the view of the Labour Government, to impose charges was not to change the principle of the National Health Service.

There will be a fuller opportunity to discuss these higher charges which the Government now propose when the Bill already introduced in another place comes before your Lordships' House. I should, however, like to say that the new charges for both dentures and spectacles do no more than reflect the increase in their cost. The power to impose and vary prescription charges by regulation is provided by Section 16 of the National Health Service (Amendment) Act, 1949. When one contemplates that date one is immediately struck by the fact that it was very soon after the beginning of the Health Service that the Labour Government of the day decided that it was necessary to take power to impose a charge.

I have already mentioned the Government statement about the proposal to impose a charge of up to 1s. and the reason given by the Prime Minister. The increased prescription charge now proposed is still a modest proportion of the cost of the average prescription, and I would suggest to your Lordships that it is not an unjust imposition when one remembers that since 1949. when the 1s. charge was first proposed, benefits and wages have more than doubled, and that since 1952 when the charge of 1s. per prescription form was imposed they have nearly doubled.

I should like to speak a little later about the arrangements for the relief of hardship, but I will now turn to the welfare foods. The position of these foods must be seen against their history. They were first introduced as an insurance against the inevitable restrictions on diet in time of war; they have become progressively less necessary as the variety of the diet available and the financial resources of the average family have improved. The stage has now been reached when it seems clear to Her Majesty's Government that the great bulk of the population are in a position to provide their children with a proper diet, and to pay for any necessary vitamin supplements. At this point the continuance of an indiscriminate subsidy is surely no longer required.

The charge for amenity beds is in a wholly different category because it is not a compulsory charge. Ordinary beds are available free of charge on medical needs. No one, therefore, need pay this charge and it will not, in any circumstances, exceed the same proportion of the cost of the accommodation as was envisaged when the present charges were fixed. The change is simply an adjustment to take account of rising costs.

I should now like to say something about the proposal to increase the National Health Service contribution by 1s. to 3s. 4d. per week. This is the new rate for the man in employment. There are to be other, lower, rates for women and boys and girls, and for the self-employed. The benefits of the Service are, of course, open to everyone, and that is the most important fact about them. They are not conditional on any qualification such as having had to pay a certain number of insurance contributions. But, from the beginning, there has been a sense in which the people as a whole have been insuring themselves against the costs of medical treatment of all sorts by agreeing that a part of the weekly contribution which they make should be used for the Health Service.

The major part of the cost has always been met from general taxation and will continue to be so met. I will not risk boring your Lordships or confusing you on a subject on which I find it very easy myself to run into mathematical confusion, by talking about the percentages of the cost of the Service which have been met in the past in this way or the other, but I wish to emphasise that we have to think in terms of the 1960s. This country, in the 1960s, is a very different place from what we had any right to expect, or to hope for, at the time, during the war, when the noble Lord, Lord Beveridge, was preparing his famous Plan. There is no high unemployment to-day—thank God! Average earnings have risen and so has the standard of living of the people of the country.

In this situation it is not unreasonable to ask people to pay a little more when they are well for the benefits of the Service which will take care of them when they are sick. But having said that, and having claimed that it is reasonable to ask people in the present circumstances to pay a little more than the Government asked them to pay immediately after the war, I agree that the obligation remains strong on the Government to ensure that in absolute terms this is not too heavy a burden on the people. I think it is not unreasonable to suggest that the burden is still just about all right in the sense that although the percentage which the total weekly contribution bears to total earnings has fluctuated a bit, it does not show any serious increase.

I think the truest guide to your Lordships in this matter comes from a consideration of the relationship of the total weekly contribution to the earnings of a group who are, on the whole, among the lower-paid sections of the community. I am thinking of agricultural workers. The wage rates for these workers were increased recently and we have not yet got any figure for the average earnings in the industry later than April of last year, but even taking that figure and making the quite unrealistic assumption that earnings will not rise between then and next July—when the new rates of contribution are to be introduced, if Parliament approves —the ratio has risen by only 1 per cent. comparing October, 1948, with the situation after next July—from 4.7 per cent. to about 5½ per cent.

In the light of what I have said this afternoon I believe that the changes which Her Majesty's Government propose are generally fair and reasonable; and I believe, too, that they will be accepted as reasonable by the public which has, after all, accepted for some years now a system of charges and contributions. All the necessary arrangements for meeting hardship will be continued and applied to the new charges. War pensioners will continue to be entitled without charge to all medicines needed for their accepted disabilities. All those in receipt of National Assistance are entitled to refunds on charges for medicines, dentures and spectacles. The National Assistance Board also make refunds to people who are above the Board's normal standards of need, including those who are actually working. The Board's scheme for pro- viding welfare foods free of charge relieves, and will continue to relieve, those in need. In cases where medicines are regularly required by the chronically sick, doctors are able and encouraged to prescribe for periods up to three months.

I believe these arrangements will ensure that the proposed changes will not result in hardship. Moreover, my right honourable friend the Minister has pledged himself to examine any case of potential hardship due to prescription charges which may be brought to his notice. The Government proposals which we are debating to-day form part of their plans for promoting the continued progress and development of the National Health Service. I ask your Lordships to decide that they call not for condemnation but for approval.

4.7 p.m.

BARONESS SUMMERSKILL

My Lords, I rise to-day to speak on a subject in which I have a profound interest, and therefore I find that the conventional handicaps attaching to a maiden speech are weighing rather heavily upon me today. I propose to exercise great self-restraint, but if I do err I cannot be justly charged with introducing a partisan note, because the British Medical Association, which cannot claim to be an ally of my Party, have themselves opposed these health charges. In the first place, I should like to stress the point made by the noble Lord. Lord Beveridge, in his poignant speech, and to emphasise the iniquity of taxing a section of society which demands the maximum degree of indulgence from us—the aged, the chronic sick and the children. And have your Lordships realised that this same measure will leave completely untouched the well-to-do hypochondriac who cares to press his doctor to prescribe expensive proprietary drugs?

I believe that everyone on both sides of this House will agree that, to the aged, easy access to the doctor should be regarded as a necessity and not a luxury. No financial barrier, not even what the noble Lord has just described as a small one, this increase of 100 per cent. on the charge for medicines, should come between the aged and medical help. And let us think of the details. May I remind the noble Lord who has just spoken that these figures which he dismisses in such an easy way mean, in fact, that in the winter months an old person will be called to pay for a bottle of cough mixture and a bottle of liniment—not luxuries, surely—the sum of 4s. The noble Lord has told us to-day that it is proposed to refund this sum. Has he thought of the mechanics of that? Has he realised what it means to an old person, sick and lonely, as described by the noble Lord, Lord Beveridge, to be told he has to fill in the appropriate document and deliver it, or arrange for it to be delivered, and that he will then be able to have a refund of his money? My Lords, to put aged people who are on a small pension to the positive task of retrieving their money when they are already ill is to place an extra burden upon them just when they are in extra need of our help.

We have heard to-day about hospital building. We have been told what it is proposed to do in the future in respect of mental hospitals and general hospitals. But I would remind noble Lords that it has been argued time after time in another place that, while the revenue accruing from these sums is to be used for the hospital programmes, nevertheless the only way to reduce the pressure upon the hospitals is to improve the domiciliary service. To put any barrier between the patient and the general practitioner is to diminish the therapeutic and preventive value of service of the domiciliary service and will undoubtedly increase the demand for hospital treatment. Indeed, I foresee that all these new beds we have heard about this afternoon will already be mortgaged as soon as they are provided if it is intended to diminish the value of the domiciliary treatment in this way.

Everybody knows that the aged patient who fails to obtain advice immediately may well need hospital treatment when finally a doctor is called. Again I refer to the speech of the noble Lord, Lord Beveridge, who said, quite rightly, "Unfortunately, the aged, when sick, cannot be bothered to call in a doctor". Precisely! There is the picture, the picture from which perhaps we are a little remote in this House at times. And when, finally, a relation calls a doctor the doctor says, "This patient must go into hospital". I have therefore tried to emphasise to your Lordships that the hospital schemes of which we have heard, which have been described by the Minister of Health in another place, can be satisfactory only if at the same time we improve the domiciliary service.

Now I come to the chronic sufferers —that is, those suffering from diabetes; the bronchitics, or those suffering from tuberculosis and nervous disorders—who need a continual supply of drugs. I would remind your Lordships that these are not people who are enjoying an average wage of £14 a week. These are people who are trying to live on the National Insurance benefit; and these are people who will feel this imposition very keenly. We have just heard that it is proposed to tell the doctors—indeed, the doctors have been advised before—to prescribe for these people for a long period. I am surprised to learn from the noble Lord that he suggests two or three months. But does he not know that similar advice has been given to the doctors on other occasions, and it has been learnt that reducing the total number of prescriptions does not solve the problem? May I recall to him the Civil Report of the Comptroller and Auditor General? What did he say on this subject? He said: Although the total number of prescriptions dispensed fell from 228 million in 1957 to 227 million in 1958, their total cost rose from £68 million to £73 and the average cost per prescription rose by some 10 per cent. from 5s. 11½d. to 6s. 6½d. Within this total the cost to the Health Service of proprietary preparations had risen by 1958–59 to some £34½ million and represented over 70 per cent. of the cost of ingredients of all prescriptions. I might remind noble Lords, too, that this figure for the average cost of prescriptions is completely out of date. To-day, a prescription in this country costs over 7s.

I come next to the children. I do not think that anybody here is unaware that there has been a spectacular improvement in the physical condition of the children in the last twenty years. Nutritional disease, particularly rickets, is almost non-existent; and the infantile mortality rate and morbidity rate of children's diseases have dropped in a dramatic manner. All this has taken time, and has involved the education of the mother in the necessity to use medical facilities and welfare foods. And I say that to reverse this policy now, to make a visit to the doctor an added expense and the welfare foods a luxury, is bound slowly to undermine the fine achievements in the field of preventive medicine. We cannot possibly see the results immediately. It will be an insidious process, and only the social historians will be able to point to the folly of this action.

People who have the greatest knowledge of the subject, who have lived with it, not just surveyed it briefly for a few weeks, namely, the medical profession, as organised in the British Medical Association, recognise the profound un-wisdom of this step. I realise that the new Minister of Health has not, and cannot have after a few months of office, an intimate awareness of the problems involved. I am afraid that I have to say—I say this very gently—that he has not viewed it as a compassionate Minister of Health but as a fugitive from the Treasury. Indeed, he views his primary function solely as a close ally of the Chancellor of the Exchequer. Indeed, he is virtually undertaking the same task of which he found himself baulked at the Treasury a few years ago.

On the question of drugs, I feel that I have not to appeal to the noble Lords opposite me in vain. There have been repeated appeals (I have made them myself time after time, to successive Ministers of Health) to curtail the huge profits of certain drug houses. Nothing effective has been done, then or now. The Minister (I think it has been repeated from the opposite Bench) said that he proposed to take action. I can only quote to the noble Lord what was said in theBritish Medical Journal of December 24, 1960, under "The Minister and the Drug Firms".They said: The recent rumours in the press that the Minister of Health was taking a much tougher line with the pharmaceutical industry than his predecessors when negotiating renewal of the voluntary scheme for the regulation of drug prices seem to have been exaggerated. The modifications which he announced in Parliament last week, though important, are not likely to reduce the drug bill substantially. My Lords, in the interests of the country, I would esteem it of great importance if you would concern yourselves with the drug traffic ("drug" is a generic term) in this country. An outrageous exploitation of the sick by the drug firms has been exposed by a Senate Committee of the United States of America, under the chairmanship of Senator Kefauver. The special significance to us and to this country is that most of the drug companies which Senator Kefauver castigated for extracting colossal profits in the United States from the sick have now established subsidiaries in this country and are conducting their business in precisely the same way, with high-powered salesmen, in order to take the maximum profit from the National Health Service. Because of this, I believe that this action which is proposed to-day will fail to have the desired effect, in view of the powerful interests which encourage the "bottle of medicine" habit.

Finally, my Lords, I should like to make a few constructive suggestions. I think we need a bold and imaginative campaign designed to re-educate the people. There should be more research, in order that doctors should be given only authoritative information about the most effective drugs; and successful clinical trials of drugs should be the sole criterion of their worth. There are still those—knowledgeable people—who think that the new, expensive antibiotics are infallible. People should be told that already, in consequence of using these antibiotics for trivial complaints, we are left with resistant organisms which to-day defy antibiotics. Furthermore—and I agree with the noble Lord when he talks about the importance of mental disease in this country—statistics reveal that one-third of the drugs prescribed are for some form of nervous disorder, including, of course, the psycho-sematic complaints. Here is a challenge, not only to the Ministry of Health but to the Ministry of Education and to the Home Office. I believe that action along these lines is long overdue. Meanwhile, we fiddle with a measure which is calculated only to penalise the poor. Surely, my Lords, the criterion of a civilised society is that the strong should succour the weak, and I therefore ask you to oppose these proposals, on moral and practical grounds.

4.23 p.m.

VISCOUNT AMORY

My Lords, it has fallen very agreeably to me to congratulate the noble Baroness, Lady Summer-skill, on her first intervention in our debates in this House. My regret is that this task has devolved on such a junior Member of your Lordships' House. The noble Baroness has experience of high office in two Departments of Government; and, furthermore, she is a member of a profession for which I personally have always had a very high regard indeed. She has therefore been speaking from first-hand knowledge of her subject. I remember, too, that when I was Minister of Food, the noble Baroness and I, at Question Time, almost bi-weekly, indulged in verbal sparring, if the noble Lady will forgive that expression borrowed from what I know she regards as an ignoble art. But, whatever may he her views on pugilism, she is known as a stern critic and an exacting taskmaster, or taskmistress, and certainly in her instruction she does not spare the rod. She is always practical; she speaks often from first-hand knowledge, and I am sure that noble Lords will feel that our characters are likely to benefit and be strengthened by advice from the noble Baroness on many future occasions.

My Lords, the broad subject which we are discussing to-day—the treatment of ill-health—is not one that we should consider purely in the dry terms of finance because it clearly has to deal with suffering misfortune, hardship and sacrifice, and it is excusable that each of us, in his or her own way, should feel a little emotionally about these subjects. I am not going to take on the noble Lady on her technical ground, because I also, of course, am a fugitive from the Treasury, and I know that there are those who feel that my heart, if I ever had one, was atrophied by two and a half years' service in that Department. But because of that temptation or incentive that I have mentioned, to think emotionally, I am sure that we must be on our guard and must try to keep a sense of perspective and remember just what are these proposals that have caused this Vote of Censure.

There are, first of all, no new principles compared with the practice of the past ten years. The principles which have been followed, and which are to continue to be followed, as I understand it, for allocating the cost of the Service, are principles that were officially approved by the Government of the Party opposite. As the proportion of the gross national product or national income, the National Health Service has about kept, I believe, its percentage, though we must remember that no one service has any prescriptive right to do so. In fact, if room is to be found for educational progress, for instance, it is perfectly clear that some other services will have to contract in the proportionate demands they make. To date, I think there can be little doubt that people, as recipients of social service benefits and as against their position as taxpayers, have actually improved their position over the past ten years. They have improved their position and their claims, not merely in real terms but relatively to other demands. Nor again, as I understand it is, there any intention that there should be a substantially different ratio between the direct contribution from the individual, whether in stamp or in stamp and charges combined, and the contribution from the general Exchequer revenue. Therefore, one wonders at first sight what all the indignation is about.

I think that the main trouble is that many members of the Labour Party have never really accepted the decisions of their Government, or the strong insistencies of two of their Chancellors of the Exchequer, that a strict upper limit must be set to the cost of the Service falling on general public funds. Speaking from memory I believe that in the days of the Labour Government that limit was fixed at £400 million. Many members of the Opposition seem to feel that, because treatment of ill-health is a good thing, it must be morally wrong to question the amount spent on it, quite regardless of other commitments, and that it must be right that the whole of that expenditure, whatever it is, must fall on general public funds. Incidentally, I noticed during my time at the Treasury a fairly widespread inclination to feel that, if only one could shift something from a specific heading of account to the general account that was almost as good as saving the expenditure concerned. I think that some of us, in our private transactions, perhaps do the same. Payment seems to cause much more heart-burning when it is a question of producing cash from one's wallet than it does when it is a matter of meeting it by banker's order and having it added to one's overdraft.

It may be, of course, that some time in the future changes in our social economy may cause the whole concept of the financial principles on which the National Health Service has been based to be called into question; I do not know. But the point I want to make is that that is not being done here in the proposals that are being put before us. The Government's proposals, as I understand them, are in fact of an extremely limited nature. They are designed to ensure that the Service will continue to develop, with the cost shared in approximately the same proportions as hitherto between the individual's direct contributions and general funds respectively. The Minister of Health, in what I thought was a very able speech in another place, made it clear beyond doubt, I thought to anyone, that there could be no question whatever of the Service being either attacked or undermined. The figures he quoted of the record of the past decade, both as regards expenditure and achievement, I think spoke for themselves. So far from the Service having been undermined in these ten years, in real terms it has been substantially developed; and for the future, the Government plans we have heard of provide for further development on a broad front. So there is really no proposal before us that could amount to any cut in the Service in any way.

The noble Lord, Lord Silkin, made, as is his habit, a reasoned and temperate criticism, but it seems, from proceedings in another place, that once again the Opposition have planned to destroy the Government by an explosion of moral indignation of nuclear proportions. I doubt whether that will be successful, because, really, the facts are against them. Noble Lords opposite are no doubt doing their best, with the strong sense of duty which characterises them to work themselves up to desirable temperatures and pressures, but their fuel supply is lacking. It might be said of them, as I think was said of one great statesman of the present century, that if the facts were against him, so much the worse for the facts.

It seems to me that there is really only one point that is directly relevant to our discussions to-day, and that is whether the proposed proportions between the sources of financial contributions are reasonable ones or whether there should be no direct contribution from the individual at all. If I may, at this stage I should like, in parenthesis, to mention my own attitude to the National Health Service. It is this. I favour the scheme because I believe the financing of the treatment of ill-health is something which it is sensible and advantageous to us, as individuals, to tackle on a comprehensive pooling basis—the insurance principle—even though this scheme itself is not strictly and literally an insurance scheme.

I did not vote for the particular National Health Service Bill at the time it was started, because, as I think I made clear in a speech at that time, I thought the scheme as brought forward then was too big a one to digest in one bite without serious loss of quality. But I was all in favour of a National Health Service scheme of a fairly comprehensive kind. Secondly, I personally most strongly favour the principle of meeting the main part of the cost of treatment while people are in sound health—the insurance principle. Thirdly, and because this is a direct service to the individual, it seems right that each beneficiary should, during his working life, while in good health make some direct contribution as an insurance premium to the cost of the scheme.

Now, what precisely the figure should be is of course, an arbitrary decision. When both costs and incomes are changing from year to year it would obviously be wrong to think permanently of just a monetary figure. The relevant considerations, surely, are: what relation should the direct contribution bear to the total cost of the Service, on the one hand—or, to the cost of specific items of the Service, if that is what it is dealing with; and, on the other hand, its relation to the level of personal incomes.

I think the Minister told us in another place that the direct contributions—the stamp and the charges together—have recently been substantially lower than the proportion at the inception of the scheme. I understood that, allowing for these new increases, they would not be much higher. In terms of cash per week, the stamp will be, I think, 2s. 8½d. for the employed man; and in relation to current levels of incomes and the fact that it is not paid by the old, the young, or certain other categories, I cannot myself think that that is an excessive Percentage, or other than a very moderate insurance premium for such very comprehensive cover. I believe that a failure to adjust this direct contribution in any way in the light of the rapidly rising cost of the Service, and so to allow the present decreased percentage which is now substantially less than it was originally, to be further eroded away, would be a cause for which no case, I think, has been made out.

The Party opposite are strong, even fanatical, believers in the principle of progressive taxation; and, indeed, it is a principle that is firmly established in our taxation system and which, to a greater or less extent, all of us accept. But even a sound principle of taxation, like an improved method of medical treatment or an educational idea, must not be pushed without any regard or consideration for the need of a sound balance. If it is, then the beneficial effects of it will be destroyed.

My Lords, I have heard it said that there are three things not worth running after—a woman, a bus, or a taxation principle, because if you wait a little while, another will come along. I think there is a good deal of evidence that, in the light of experience, the present levels of direct personal taxation linked to earnings are still too high and must be further reduced if the incentive to earning is going to be safeguarded. It is true that a still greater part of the cost of the National Health Service scheme could be met by further increases in indirect general taxation; but I believe, there again, that the present percentage of the gross national product taken, in the aggregate, by the central Government through general taxation, though substantially less than ten years ago, is quite high enough. Indeed, every effort must be continued to be made to reduce it further. So, in all the circumstances, I believe the maintenance of a proportion of round about a fifth or a quarter of the cost of the scheme, to be covered by direct contributions of stamp and charges together from the individual, cannot be regarded as anything but moderate and reasonable. So I entirely support the proposal to increase the weekly stamp.

The proposals to put up the charges merit, I think, a still closer look, because here there is an expense falling directly on those who need treatment. If that were carried too far, then it would conflict with the principle I have referred to earlier, that the main cost should be paid by those in sound health. The real justification, to my mind, for imposing a charge on the individual to cover part of the cost of prescriptions is if it discourages waste and abuse. One would expect a charge to have some effect, on balance, in that direction; how much I do not prefess to know. But clearly the charges must not be so heavy as to conflict with the principle I have mentioned.

I know that when I was at the Treasury the aspect of National Health Service expenditure which afforded me the most concern was the rapid and continuous rise in the drugs bill, from £31 million to start with to something over £80 million foreshadowed for next year. This was also the item over which there was least control. I know the medical arguments for the uninhibited use of the latest drugs, which are also often the most expensive. Looking back, I am hound to say that I do not think that the Ministries concerned have been very successful to date in tackling this matter. I am not sure whether the independent Committee appointed helped them very much. But, having said;that, I agree that it;is an immensely difficult field of action for the Government to limit or interfere with the clinical judgment of the doctors. But the evidence of waste is, I think, pretty compelling. I am glad to hear that the Ministers concerned are going to make still greater efforts to see whether they can find ways to ensure greater efficiency and economy in the use of drugs and in getting best value for money.

If the object of increasing the prescription charges were simply to find some revenue as a means of helping meet this greatly increasing bill, then personally I should have preferred a still bigger increase, if necessary, in the stamp: but if it is considered—and I understand that it is, and personally I think that there are good grounds for this—that the maintenance of a charge representing a proper proportion of the cost (not too big) does help to reduce waste and abuse without involving hardships to those of small means, then I think that the course is justified. I understand that the Minister in another place has said that though the charge of 2s. a prescription would be double, the cost per prescription has more than doubled in the time that has intervened.

LORD SILKIN

My Lords, may I ask the noble Viscount whether he has read the justification for these increases made by the Minister in another place? It was exactly the one which the noble Viscount has just said he would oppose, if that were the reason—namely, in order to meet the extra cost of the Service. The Minister did not say that the justification was to deal with waste and abuse.

VISCOUNT AMORY

My Lords, the noble Lord, Lord Silkin, will know that I am expressing my personal view and saying where my own preferences would lie, because I believe so strongly in this principle of paying while your are in sound health. I think that the proposed increases in charges, on balance, at the moderate level to which they are being raised, should help to effect economy without damage and prevent abuse. But I am expressing purely my personal view.

I was about to refer to the speech of the noble Lord, Lord Beveridge, to which I am sure we all listened with respectful interest, because he is speaking on a subject on which he knows so much, He mentioned inflation as being a deadly enemy which must be combated with all possible resolution. I could not agree with him more. The noble Lord spoke of the difficulties that confront the elderly, who are always the first victims of inflation. That is why I am sure that the finance of a Service like this must be looked at very carefully. After all, the prevention of inflation is the first and best service of all that we can render to the elderly who have to live on small incomes.

This is one of the occasions, of which there have been a number in the past few years, where some members of the Opposition a living a little in a world of fantasy unrelated to what is going on in the real world around them. My noble friend Lord Newton mentioned this. All the time they seek to find wicked dragons for slaughter. Tory Ministers who confront them seldom measure up quite to the dragon-like specifications (if I may put it like that), so they invent a caricature of Tory political attitude, then shut their eyes, raise the battle-cry and charge. The charge is exhilarating but less than decisive, because the enemy are not there.

I remember once teaching a young chap to shoot and having to reprimand him for inaccurate marksmanship. He said, "I am not inaccurate. I shoot absolutely straight, but when I fire, the rabbit is no longer there". Substitute "the Tory dragon" for a rabbit and I think that there is some truth in this.

VISCOUNT ALEXANDER OF HILLSBOROUGH

My Lords, has it not been said constantly of the Tories over the last fifty years that they have always been condemned for stealing other people's clothes while they were bathing?

VISCOUNT AMORY

My Lords, so long as the clothes are the right clothes their source does not matter so much. There was a General in ancient history whose prepared attacks were models of military art and whose aggressive spirit was superb, but he never won his battles because, when the time came, the enemy were never there.

If I may respectfully say so, the Opposition have once again invented an issue out of their imagination, an issue of the alleged destruction of the Health Service, which simply bears no relation whatever to the actual proposals which are before us. I suggest that we ought to confine our attention, though it may be less exciting to do so, to the actual proposals being made to us by the Government. I am convinced that if we do so, then we shall find them reasonable and justified and likely to contribute to the further development of the Service, to the benefit of the nation at large

4.48 p.m.

LORD TAYLOR

My Lords, it is a great pleasure to follow the noble Viscount, Lord Amory, in congratulating my noble friend Lady Summerskill on her delightful maiden speech—her non-controversial maiden speech, because those noble Lords who have seen her and heard her in controversy will know that to-day was but a small taste of things to come and of things past. She is a redoubtable and formidable fighter. When I was a new Member of another place, I viewed her with the greatest respect and a little alarm and apprehension; but she was so helpful to those of us who were new that our fears soon disappeared.

I remember that on one early occasion I was supporting the Government on a measure. My noble friend was sitting on the Front Bench, obviously not agreeing with the Government at all, and she was indicating her disagreement in no uncertain way. Finally, she turned round co me and said. "Don't try to teach your grandmother to suck eggs." I was sure that I was right and I am sure that she was equally sure that she was right. My noble friend is an expert not only on medicine but also on that kind of feminine logic which we all know in the home and know the effect of—that: is: how to save money by buying a new hat. I am delighted by the addition not only to our medical strength but also to our strength on the ladies' side in future and we look forward to many interesting speeches from her.

I was delighted to listen to the very reasonable speech of the noble Viscount. Lord Amory. At least half of it could have been delivered from these Benches and the other half was the most reasoned arid reasonable presentation of the case that I have heard. It really is the only substantial statement that has been made in attempted justification of the increases in charges. It was notable at once that the noble Viscount had great doubts about the increase in charges on prescriptions, even though he was quite ready to defend the increase in charges on contributions. And if one is going to defend anything, he was correct in his choice of strategy, because the increase in the charge on prescriptions is the difficult, dangerous, unpleasant and thoroughly bad one. The noble Viscount said, very honestly, that when the National Health Service was debated he voted against it, because he said it was too big a thing to tackle at one bite. Of course, he was wrong, and I am sure he will be the first to admit it; just as, if I may say so, the Labour Party were wrong when, eleven or twelve years ago, they introduced a charge for health services. I have no doubt that we were wrong to do that and I see no virtue in continuing to pretend that one must support what one has done eleven or twelve years ago even when it is obviously erroneous.

A few days ago the Lord President of the Council announced what the British Medical Journal described as "Hailsham's Law" (I do not know if he saw it), which is that a Party is absolved from its proposals by defeat at a General Election. The noble Viscount may recollect that he was replying to a question by the noble Lord, Lord Airedale, about doctors' free prescriptions for private patients. He quite rightly said that a Government are not bound by their proposals made at an Election when they are defeated. Of course, what is sauce for the goose is sauce for the gander, and I have no doubt that we were wrong to put these charges on. They have been tested and re-tested for ten years and have been found wanting, even by the Government's own Hinchliffe Committee. Therefore, say the Government, they must be increased.

The Government's argument, as I see it, is that the increase in cost in the National Health Service is such that either the Service must be cut or the charges and flat-rate contributions must be increased. This is a wholly false dilemma, and it is an argument which could have been applied every year since the National Health Service has been in existence, because every year the cost of the National Health Service has gone up. In a society where national economy and national wealth are increasing, it is right that the amount devoted to the health of the people should also increase, so, that health gets at least the same share. Indeed, the attempt by Sir Stafford Cripps to put a ceiling on the cost of the National Health Service was not only mistaken but quite impossible. He tried to do it, but could not do so, for the simple reason that where wages and prices are increasing, inevitably the costs of the wages and prices of those inside the Health Service must also increase. In fact, it was never done. Over the years ahead it is certain that the cost of the National Health Service will continue to increase, as it has done every year under the present Government. So each year there has been, and each year there will be, an excuse, if one is wanted, for increasing the charges to the patients. It has happened every year.

Why then have the Government picked on this year? We know that the real reason is the particular philosophy of the present Minister of Health. But he has a little better case this year than he might have had last year, or will have next year, because, for technical reasons, the increase will not be the same each year: some years it will be a little bigger than other years. This year we have had to absorb not only the effect of the Royal Commission on Doctors' Pay—and doctors' pay has not gone up steadily, but in a series of jerks at three or four yearly intervals, because of the machinery for adjusting their pay—but we have also to face their back-pay award, all pushed into the one year. That is the main reason for the increase in the Health Service Estimates. It has nothing to do with hospitals, and although it may have a little to do with drugs it has little to do with anything else: the real reason is the absorption of this increase in doctors' pay, which we should consider as a continuous curve as part of the cost of the National Health Service over the years.

If we look at the increase in hospital costs, we find that it is microscopic. It is only £5 million over previous Estimates, as compared with the £75 million which these increased charges in contributions are going to yield. The hospital building programme is very desirable, but in this context is quite a political red herring. Incidentally, we finance our hospital building in a peculiar way. We pay the total capital cost (the noble Viscount, Lord Amory, will correct me if I am wrong) out of current revenue; we do not fund it and spread it over the life of the hospital, as we do with, say, a factory, a house or any other building. This is a peculiarity of the National Health Service and I should have thought that a financially-minded Minister of Health would be much better looking at the way hospital building is financed than doing this particular kind of squeezing that has been going on.

The third item to which the noble Viscount. Lord Amory, quite rightly referred is the increase in the cost of drugs. This is not due to public profligacy. Admittedly there has been, and there always will be, some small wastage of medicine; you cannot avoid that. The increase is partly due to bad prescribing. But the main reason for the increase in the cost of drugs is the enormous volume of rubbish which descends every morning on every general practitioner in this country. I took the chair at a conference of general practitioners a couple of months ago, and one of them asked when we were discussing the drug industry, if he could bring in exhibit A. It turned out to be two boxes, each four times the size of the Dispatch Boxes in this Chamber, crammed full with circulars, booklets and what-not. They represented fourteen months' deliveries by the drug firms at that doctor's house. Imagine the chaotic state of mind if the doctor tries to read but one-tenth of this!

I am not on their mailing list, but I get three or four every morning; and once or twice a week, I usually get a parcel of drugs, beautifully packaged and some of them looking like "hundreds and thousands". But the effect on the doctor's prescribing habits must be substantial, or the firms would not go on doing it. We beg them not to do it, but they take no notice and go on pushing out this stuff. It is partly due to the pharmaceutical industry, its highly competitive methods and its non-coordinated research activities, and partly to the real improvements in medicines. Drugs are better and are still getting better. It is true. as my noble friend Lady Summerskill said, that we must have better information services for doctors, and that we must also, somehow, get the pharmaceutical industry to serve the public interest. One does not say more than that it should do that. One does not say that it should be nationalised or socialised. If only it will serve the public interest, we shall have it working as a part of this great public service.

The pharmaceutical industry is a most interesting one. It is highly competitive, and that should make it highly efficient. But it does not. It is highly profitable, and also highly secretive. As those of your Lordships who served on the Public Accounts Committee in 1937–38 will know, the Ministry of Health find it difficult to drag information out of the pharmaceutical industry. There are two divisions of the pharmaceutical industry. There are the genuine manufacturing firms, and there are the packaging firms, who simply buy from other people, wrap the stuff up and advertise it—and occasionally they compound it a little. They are purely parasitic. They need very little capital to get going, and they contribute nothing beyond the wrapping and the, advertising. I think we could do, without these parasitic pharmaceutical firms. The genuine manufacturers have done much good work and produced many excellent things. However, they still waste an immense amount of public money, first, on competitive research, and secondly, on competitive advertising.

In research, there is the most extraordinary overlapping. If we have, say, ten firms, each having a small research team looking for either an antibiotic or a tranquilliser, then each team is treading exactly the same ground. In medicine, we combine and pool the knowledge, but here it is impossible because these firms are in acute financial competition and must not give away their secrets to each other. There was, in fact, one attempt to make such a combination, and four of the big firms got together to build a thing called the Therapeutic Research Corporation. I am not absolutely certain but I think they were B.D.H., Boot's, Burroughs and Well-come, and I.C.I. There I stand open to correction. It was a complete failure; they could not do it. It has disappeared, and any attempts at combined pharmaceutical research have, so far as I know, met with complete failure.

So what happens? A firm expends, say, £50,000 to £100,000 in looking for a new antibiotic. They find one which looks promising. Tests are started, and the results are a little equivocal. In medicine, at this point we write off that line of research and return to our laboratory benches. Not so in industry. The investment in research must be made to yield a return, so the product is marketed and boosted, hoping that it will recover its costs in a short run of popularity—for they only get a short run of a couple of years and then they disappear; that is the usual sequence. There are a few which go on, but most die a pretty early death before they have got properly costed and any control starts to operate.

All this has happened in the case of a drug which claims to be the first antibiotic to act against the viruses. A factory was opened by this firm in the North of England, in an area of substantial unem- ployment, thus giving the Government a reasonable and real interest in its success. As a matter of fact, it was opened by my noble friend Lord Boothby. I told him that I was going to mention him to-day, so I am not taking an unfair advantage of the fact that he is not here. He opened it with a very merry speech, in which he said that he was a confirmed taker of pills. This firm is marketing this so-called antibiotic. I am not going to name it, but it is marketing it with tough publicity. I was invited, with the local doctors in my area, to see a film strip show and to partake of an excellent buffet lunch. The film strip was shown, arid then our local doctors, who are very intelligent, cross-questioned the representatives. First, they learnt that it was no good against any big viruses; then they learnt it was no good against any small viruses, and then they learnt it was no good against any fatal or severe viruses. It was claimed to be any good only against those from which one recovers spontaneously, mainly influenza and upper respiratory infections. It was claimed to be good not only therapeutically but prophylactically. What a wonderful opening for this drug!—everybody needing it, and everybody able to take it with a clear conscience to prevent these things.

To prove this requires very careful control therapeutic trials. We were offered therapeutic trials with about 70 persons, conducted by some Swedish gentleman, which were completely and utterly inadequate to show that this stuff did anything. Unless I am thought to be exaggerating. I will quote to your Lordships what the British Medical Journal had to say about this drug in its columns: Thus it is quite impossible, on the basis of work published on this drug so far, to form a clear estimate of its therapeutic value, if indeed it has any. The basic National Health Service price is 48 tablets for 15s. Up and down the country these sales representatives are pushing this drug as hard as they can, no doubt with the aid of other good buffet lunches, and certainly with the aid of the film strip. I reckon that of least £1 million of National Health Service money will be wasted on this product, in the absence of any evidence that it does any good at all, before it goes out of fashion. I have not named the firm or the drug, but I would say that this is a fairly typical story, and I am certain that the only proper answer is not to rely upon internal departmental investigation but to have a proper Royal Commission on the pharmaceutical industry as soon as we possibly can.

THE LORD PRESIDENT OF THE COUNCIL AND MINISTER FOR SCIENCE (VISCOUNT HAILSHAM)

My Lords, I quite agree with the noble Lord in not naming either the firm or the product; I think it would be most unsuitable to do so. But as he has said this about it, I hope he will give it to me in confidence at a later stage.

LORD TAYLOR

With the greatest pleasure. I shall be delighted to furnish the noble Viscount with full particulars. Indeed, I am sure his own Department will be only too familiar with these extraordinary claims.

LORD FERRIER

My Lords, might I inquire whether the drug in question is in fact on the list of those prescribed under the National Health Service?

LORD TAYLOR

I understand that that is so.

VISCOUNT HAILSHAM

We will soon find out.

LORD TAYLOR

When we take the overall picture of the cost of the National Health Service, the real measure of whether we can afford it is, as has been said, the proportion of the national product devoted to it. Here the figures are quite simple: 3.8 per cent. of the national product in 1949–50; 3.7 per cent. in 1950–51; 3.2 per cent. in 1954–55—notice that it is going down—3.4 per cent. in 1956–57 and 3.6 per cent. in 1959–60. Compare that with the proportion of the national product which we spend on defence, which I understand is about 8 per cent. I understand that it is the custom for honourable and right honourable gentlemen in another place habitually to defend the Defence Estimates on the grounds that they amount to about 8 per cent. of the national product. That is a fair defence, but, surely, it is equally a fair defence to say that we should have our National Health Services financed in the same way as Defence. We do not finance that by contribution charges or charges for Home Guard uniform or what you will on the users at the time of service.

Moreover, if we are to have defence forces, surely we must have something worth defending, and one of those things is the National Health Service. Manifestly, we can, and are, affording the National Health Service quite well. The present charges are a matter of budgetary convenience only. I think we could, and should, afford up to about 4 per cent. of the national product, and I am not claiming any completely extensible ceiling. The noble Viscount said that we must have a ceiling on essential services. That is fair enough; but let us express it as a percentage of the national product, as that is the only fair ceiling to take.

I should have thought that if we take it at 4 per cent. of the national product it would be about right, bearing in mind that we have to finance an increased capital expenditure in the years ahead, because we have let the thing run down. We have had virtually no capital expenditure in the last ten years except on maintenance of existing buildings, and that pretty poor. Secondly, we have defeated the easy diseases. We are now running into a very difficult situation, because more and more people are living on into old age. They are not dying of quick pneumonias, but from chronic illnesses which take prolonged treatment over weeks, months or years and very often end in death. But they are going to provide us with an increasing volume of work; and that volume will increase.

Behind the National Health Service, as my noble friend Lord Silkin said, there are two great conceptions. The first is that we should relieve those who are sick of the unnecessary financial burdens of ill-health. The second is that we should all pay for our National Health Service when we are well, according to our capacity to pay. The effect of the new charges is to shift the method of payment: an increase in the poll tax —the flat per capita tax—to avoid putting the cost on the graded tax; that is, income tax according to capacity to pay. Increased contributions hit everybody equally, regardless of income, and they hit the poorest hardest and the richest least. Increase in the payments at the time of illness are much more serious. These hit at the time when the payments are hardest to make.

We have heard from the noble Lord, Lord Beveridge, about old people and poverty. He is going to inquire into their position in an affluent society he were to look at poverty in an affluent society he would find that most of the sick are poor, and the reason they are poor is perfectly simple; it is because most of the sick do not get their wages continued when they are sick; they go on to sickness benefit. They are the people we are now penalising by these increased cash contributions on medicines. It is not so bad, perhaps, if you are a wife—though it may be bad in other ways—if you are sick and in bed. But if you are a wage-earner, and you are sick and in bed, you are not only ill, not only losing wages, but now you will pay two, four, six or eight shillings a week for your medicines as well. I think it is a shame. It is a negation of what the National Health Service stood for.

Here we have the extraordinary discrimination between hospital medicines and extra hospital medicines. If you are sick in hospital, as the noble Lord, Lord Beveridge, was in St. Thomas', and as I was later on, you get your drugs free. But if you are sick outside you have to pay 2s. a bottle or packet. If the Government charge for drugs outside hospitals and not for in-patients, the logic is that one is more necessary than the other. And this, my Lords, at a time when the Government are urging doctors to treat patients at home and save money on hospital beds!

Many people have the idea that general practitioners do not look after the seriously ill: that what goes on in doctors' surgeries is a lot of nonsense. But it is not so. I have sat in many doctors' surgeries and we have produced statistics of the amount of serious illness the general practitioner sees. One in five of the visitors to the surgery are suffering from serious illness, illness so serious as to carry the danger of risk of death or so severe that the person has got to alter his manner of life very substantially. One in five of the people in doctors' surgeries are in that category. Among those the doctor visits at home the proportion is one in two—except, of course, in time of epidemic, when the minor complaint group shoots up. Most of the people the doctor visits at home are seriously sick. They are the people who will have to pay two, four, six or eight shillings for every prescription they have taken to the chemist.

Doctors have always opposed the charges for medicines, because it puts back the cash barrier between the doctor and patient. It is particularly hard on the chronic sick. About 20 per cent. of all patients in this country suffer from bronchitis and other respiratory infections. Chronic bronchitis is a terrible thing, particularly in the North and Midlands. People get bronchitis and then slowly develop heart failure. As a result, they are kept going by drugs, digitalis for the heart, the anti-cough medicines, sedative cough medicines, and usually sleeping medicine as well, because they cannot sleep. This goes on not for six months but five or ten years. It is the basis of their life. They cannot get by without it. Those are the people we are taxing six or eight shillings a week for their medicines. Of course they cannot take them en bloc, because if you keep cough medicine it gets a mould on it after a week or two.

We have heard about the mentally sick. The noble Lord, Lord Newton, referred very seriously and graphically to it. But we are being urged under the Mental Health Acts to treat more and more at home, and this is possible only if we can prescribe quite elaborate sedatives— largactil and the other tranquillisers, as well as sleeping tablets. Those people are not fit to work. We are being asked to keep them out of hospital beds; yet we are being asked to prescribe costly drugs at home for which the patient has to pay. Time and again the doctor will find himself in the extraordinary dilemma that the 2s. charge will be more than the cost of the drug he is prescribing. The only thing lie can do is to write another prescription on an ordinary piece of paper and say "Take that along and pay 1s. 6d. for that one", which is fantastic. As the noble Baroness, Lady Summerskill, was saying, it is quite unrealistic to expect the chronic sick, or their relatives, to go traipsing along to the National Assistance Board. They cannot do it. There is nobody available. It is hard enough to get anybody to cook a meal, let alone to go for long bus journeys to gel this money back. It is all nonsense. My only conclusion is that those who framed this legislation have no idea whatever how poor people live or how sick people live. They just do not know.

The increases in charges for welfare food are in a different category. This is quite a small item, because most of these welfare foods are being taken up only by a small group. Only a few people are using these welfare foods free, but they are the people who need them most. They are the feckless, rather stupid, mothers, who cannot be got to do what they ought to do. They are the people who are getting these free welfare foods from the clinics, and it is a jolly good thing, because this is preventive. They are the people who will develop rheumatic carditis when they get older, and will be a burden on the community for twenty years because they have not had prophylactic foods. It seems to me absolutely dotty". I sincerely hope that, whatever else the Government do, they will drop that particular bit of nonsense.

The right answer is, surely, a graded National Health Service and National Insurance tax, a graded one as a proportion of income tax. How simple it would be! You would get over this business of industries all over the country having to do the whole job twice, first with P.A.Y.E. and then with stamps. Really the stamps are not fair; they are a poll tax. As national income rises so would contributions to such a scheme rise.

The Government have, up to now, enjoyed, I think, a remarkable measure of electoral success, and the reason is mainly, as the noble Viscount, Lord Alexander of Hillsborough, said, that they have been up to the old game of "dishing the Whigs by pinching their policies." If the Government's Commonwealth and Colonial policies had come from Labour Ministers, the roars which would have come from the other side of the House would have made one sick. I am all for their "pinching" our policies; I think it is the most sensible thing they can do. I am interested in this new programme of hospital expenditure of £50 million a year. It is identical with what we had in our pre-Election booklet, Members One of Another, setting out our Health Service policy. It is very intelligent of them; they have it exactly right. This is the first misjudgment of the people they have made. They have gone absolutely off-beam here, and they base it on pure ignorance. They do not know how ordinary people live or get ill or die, and because of this I hope that those of your Lordships who do care about the sick and the needy will join us in the Division Lobby, or at least will abstain and show what you feel about this wrong.

5.20 p.m.

LORD FERRIER

My Lords, in thanking the noble Lord who introduced this Motion for bringing about this debate I have one personal regret, and that is the shortness of the notice which came our way—though I appreciate that it was not entirely his fault. It also is a pleasure to join in the congratulations to the noble Lady opposite on her first contribution in this House. I only wish that her stern self-control in regard to controversial matters had been exercised with more thoroughness, shall we say; and I shall use all my firmness to control my temptation to be controversial on the matter in return. Let us hope that it will not be long before we shall have an opportunity of again crossing swords on this or some other subject.

I am concerned on this matter of National Health Service charges not only as a member of the public, but also (and this noble Lords may not know) as chairman of a group of pharmaceutical companies who manufacture distribute, wholesale and export, pharmaceutical chemicals and supplies. I am not a chemist; I am not a pharmacist. In fact, any skill I possess, if I possess any at all, is that of an industrial administrator and a student of man management.

My connection with the pharmaceutical industry is entirely fortuitous. It happens that this is an important industry in my native city, to which I returned after a number of years in the Tropics, where I had been at the receiving end of many thousands of grains of quinine. But, further than that, I have a childhood background of connection with the medical profession. I was brought up by an uncle who was an eminent professor of physiology, and all my life I have been connected with the talk or the jargon of medicine and the knowledge of frequent contact with laboratory work and research. It is therefore fasci- nating to me to find myself concerned, as I am to-day, with the (intricacies of this highly competitive business—highly competitive, remember, in an international sense.

It is an extremely complex industry. Would it were as simple as the noble Lord, Lord Taylor, seemed to indicate in some of his remarks! It is a highly speculative and a highly rewarding industry. I say that deliberately, because I do not mean "rewarding" in a remunerative sense, but in the sense of ethical reward for services rendered. I am a member of an industry which, in spite of what all the noble Lords opposite have said, has made, and is making, a real contribution to the welfare of the nation. In passing, I would remind your Lordships of the important part played in the community by the pharmacist, the ordinary chemist, and sometimes by his wife as well. They are qualified and skilled people. They are respected. They render a 24-hour service. They have considerable responsibilities, not only to the customer and to the public, but to the doctor and also to the law. In the village the chemist's shop is the first-aid post. Not only is the chemist a professional man, but he has the added burden of making a business pay. Often, indeed generally, it is his own business. At the research and manufacturing end his colleagues are deeply engrossed at the highest level of scientific expertise, striving to improve the service which renders what it does to medicine, and which contributes what it does to the exports on which we live. It is a matter of pride to me to be associated with this business.

With that disclaimer, I would turn to the charges which are the subject of the Motion, and accept what my right honourable friend the Minister in another place, and the noble Lord, Lord Newton, here, have said in regard to the necessity for more finance in order to pay for the necessary development in the hospital services. When I have the task of moving the Motion in regard to road construction later this week, I shall be referring (and I hope that I shall get support from him) to Lord Taylor's point about the need for financing capital work from capital. But more money is needed. I do not think that anybody in any part of the House will doubt that, whatever may be his ideas as to where it should come from.

On the subject of the hospitals I have but little to say, except to join in the remarks which have been made in all parts of the House about the wonderful attention obtainable in British hospitals from the staff —from the doctors, the nurses, and everybody. There is one point here which I have come across and which I would mention that in dealing with the cost of the hospital service I feel that my right honourable friend will sooner or later have to face some increased differentiation between the wages and salaries paid to trained and senior nursing staff as compared with the wages of junior nurses and domestic staff. Though much has been done and is being done, more has still to be done, about the conditions under which nurses live. I had occasion to talk the other day with a colleague whose daughter has within the last couple of years nursed in both the United States of America and this country: and whereas she was in no doubt as to the comparison and standard of nursing qua nursing, it meant a great deal to her that the conditions under which nurses live on the other side of the Atlantic were infinitely more conducive to their fitness for their duties.

I will not go further in reference to the charges until I come to this problem of the prescription charge. Other noble Lords are better able than I am to develop the hospital side of it. But on this problem of the prescription charge I find myself, a little to my surprise perhaps, but no more than to the surprise of the noble Lord, Lord Taylor, in entire agreement with him. Some have maintained that the application of the increased charge will reduce the off-take of drugs and their consumption. I personally doubt it. The effect was slight when the 1s. charge was first put on, but it soon swung back again. I do not think their consumption will be reduced more than temporarily; nor do I believe that the increase will reduce waste. Nor do I believe that it will have the effect of improving prescribing: it will only encourage over-prescribing.

Another side-effect will be the encouragement of self-medication. Perhaps the noble Lord will have found the reference in the Hinchliffe Report that we were discussing just now. That Committee were not only against the 1s. charge, but were against an increase and in favour of complete abolition of a prescription charge. As the noble Lord has pointed out, the problem as it now arises is that with 2s. per item you get a prescription charge on a number of items which exceeds the cost of the item itself. From the pharmacist's point of view, that is going to lead to a strain in chemist-customer relations. It will lead to the customer not putting in a prescription and going in for self-medication; or even, perhaps (and this is particularly so in the case of those in need), going in for no medication at all. This point has been made before. Although the noble Viscount, Lord Amory, made it in a gentle sort of way, I should like to reinforce what he said with almost the same force as the noble Lord. Lord Taylor. Doctors are opposed to it, and I therefore hope that the Government will agree to have another look at it.

In the debate in another place one honourable Member indicated figures with which I have no reason to quarrel showing that this charge will go unnoticed by 80 per cent. of the people; that 10 per cent. will be borne by National Assistance anyway but that for the other 10 per cent. it will represent real hardship. If finance has got to be found for this, surely it should and must be found somewhere else. In the light of what has been said, I was going to read only a portion of a letter I have here from a colleague, who is a doctor of medicine; but I will read more because it sets out very clearly the position of people in need who would now be subjected to this increased prescription charge. The letter says: Anyone who is on National Assistance, but not employed, can get a receipt for the prescription charges from their chemist and have the money refunded at a post office on displaying the National Assistance book. An unemployed person receiving a disability pension can proceed in the same way, using his disability pension book as proof. An unemployed person receiving unemployment benefit can obtain a refund at the employment exchange. Old age pensioners do not automatically qualify for a refund; if they are not on National Assistance they have to make a special claim to their local National Assistance office. Anyone who feels that the prescription charge causes him undue hardship can make a claim on the National Assistance Board for a refund, and this is likely to be allowed if his income is at, or only slightly above, the level at which National Assistance would normally be granted. Your Lordships will appreciate the trouble this will bring to some poor, ill, tired old person. My colleague, who is a doctor of medicine, goes on in his letter to say: These rules do nothing to help the proud old age pensioner who normally just manages, but whose economy may be completely upset by the necessity of paying perhaps four to six shillings a week in prescription charges. I can remember patients for whom even the old charge was too much, but who were too proud, or unable, to go to the Assistance office, and one often had to produce the odd shilling oneself. I am sure that this must be the experience of most general practitioners. I cannot suggest a solution, for manifestly the old age pensioner who is paying surtax should not be let off his subscription charges! Equally, it seems rather an imposition to ask the G.P. to decide which of his patients should have to pay and which should not. If I do not refer further to the question of charges it is not because I have no views, but because they are views which have already been stated or are points which are to be made by other speakers. But I do press that Her Majesty's Government should think again on this matter, and either alter their proposal or take steps, very urgent and earnest steps, to see that the means for making recoveries for poor people should be facilitated, and, indeed, that it should be possible for them to get the cost of prescription charges in advance.

My Lords, I now turn again to the pharmaceutical industry. This has been described in another place as a "dragon". I have a feeling that my noble friend Lord Taylor and the noble Lady who has just made her maiden speech feel rather the same way as their friends in the other place. I believe that they have made a mistake. They have mistaken for a dragon what is, in fact, a serpent; and a very prudent serpent. I refer to the serpent of Aesculapius which, if memory serves me right, was very cunning in finding healing herbs. I have already said I am associated with this "serpent", but I would say that I am not in any way a mouthpiece of the industry. I have no place in their hierarchy. It is just that I come into day-to-day contact with the problems of the industry; therefore I feel that I have a contribution to make to your Lordships' deliberations.

I gather that several noble Lords opposite, and their friends in the other place, feel that there is something wrong with the industry. Or is that putting it too mildly? Be that as it may, I propose to show that there is something right with it. Admittedly the National Health Service is the industry's largest customer; of course it is, in a country with such a Service. But, broadly speaking, only one-third of the product of the industry goes to the State. One-third is sold over the counter and the remaining one-third goes for export. That is a very important point, and I feel that it is important to have those proportions clear in our minds in turning to the accusation of over-extravagant advertising.

Noble Lords will, of course, know that the advertising to the public, and on television, if you like, do not affect drugs which are prescribable under the National Health Service. Those are over-the-counter drugs, and that form of advertising, therefore, does not come into our calculations. The "glossy" type of material, to which the noble Lord. Lord Taylor referred, which is posted and distributed to doctors, may be, and in some cases is, extravagant. I think that can be definitely accepted. The industry as a whole does not like that kind of feeling and I know that they are keeping an eye on it.

Nevertheless, my Lords—and this is why I mention this matter immediately following my reference to the fact that one-third of the drugs produced are exported—it is not that other places are so different from this country but that we in this country are rather different from other places; and this particular type of sales promotion applies elsewhere throuhgout the world. Actually, the industry has a difficult task in promoting sales abroad, and on that I feel I should read a cutting from the City Press of October 28 last, in which the reporter says: From daily contact with customers all over the world, the industry is painfully aware of the harm which has been and is being done in overseas markets by the campaign carried on at home against proprietary preparations. By the constant battering of uninformed critics, the term proprietary preparations' has come to have almost a derogatory connotation. This attitude does not pass unnoticed abroad, and it is perhaps not altogether coincidence that a fall in the average rate of increase in exports of pharmaceutical products in the early 1950s coincided with the adoption of this short-sighted policy. I should like to make that point and to press home the fact that, where we have to live by exports—and as the noble Earl the Foreign Secretary made so plain to us last week, exports are our very life-blood—it is a pity that any member of the nation should be injudicious in attacking an industry which provides a great deal, and will provide more, to the export trade of the country.

LORD TAYLOR

My Lords, will the noble Lord permit me to intervene for one moment? Surely it is equally important that the quality of what we export as pharmaceutical products should be maintained.

LORD FERRIER

Does the noble Lord suggest that the quality of our pharmaceutical exports is inferior?

LORD TAYLOR

I suggest that on some occasions they are the type of remedy of which I was speaking; that as a result of this multiplicity, by very slight modifications in drug structure, alleged new drugs are produced which are not, in fact, new drugs at all; and that there is, on occasion, an accidental as it were, misleading of the receiving public at the exporting end.

LORD FERRIER

My Lords, I think that "on occasion is the operative phrase there. Knowing the largest single exporter in our industrial community in this country, I cannot believe that the largest exporter could have such an imputation made on any of his products. I do not want to weary your Lordships, but I could turn to an American paper which says that there are wails in America at the low costs of drugs which are obtainable from this country.

While on this subject, I would say that there has been criticism of the industry's force of representatives, of travellers really bitter criticism and. in my view. quite unfair criticism. This staff of excellent men are employed calling upon doctors. The noble Lord, Lord Taylor, himself made the point—and do we not all in business know it, as in every other walk of life?—that you cannot read everything you get nowadays. The fact is this—and correct me if I am wrong. In my view, the fact is that the great majority of doctors rely on a visit from the representatives of reputable firms to keep them in touch or to draw their attention to developments as they come along. I have personal knowledge of a large number of occasions in which this has happened. In my own locality I was pleased the other day to be talking to a doctor who indicated the same thing.

The traffic is two-way traffic, because not only does the doctor keep in contact with the industry through the representative, but the industry keeps in contact with the doctor through the representative. At the teaching hospitals and the like they have the main medicaments, and problems in regard to packaging, storing and the like are always accessible to the manufacturer through this force of representatives. They are, as I said. an important link in the chain of service that strives to relieve sickness; and the traffic is two-way traffic.

I made some notes while the noble Lord, Lord Taylor, was speaking, and I feel it would be only fair if I referred to one or two of them. I have dealt with the problem of the suggestion that the industry does not operate in the public interest. I would refute that with every ounce of my energy. That is just not so. If there are black sheep in the family, well, that occurs in every walk of life. But to brand the whole industry in that way is quite out of reason.

LORD TAYLOR

My Lords, I was very careful not to brand the industry in that way.

LORD FERRIER

Good!

LORD TAYLOR

I certainly did not intend so to do. I said that there are many firms doing excellent work, and then I went on to explain why they were not doing better work.

LORD FERRIER

I thank the noble Lord. I am glad I made that point. Frankly, that was not the impression I got when the noble Lord was speaking. There was another point he made regarding competitive research. Again, I said in my opening remarks how I wish it were as easy as the noble Lord thought it could be. On pooled research he mentioned The Therapeutic Research Corporations which, he admitted, broke down. The problem is one which, to my simple mind, is this. The only way to pool research is to nationalise the whole industry, and if you do that you get a muddle and your research becomes a whole lot of—

LORD TAYLOR

My Lords, that is precisely what we have done with medical research as a whole, nationalised it, and we have had the Medical Research Council. It has not proved a muddle but an absolute example to the world.

LORD FERRIER

I said, first a nationalised industry. That is where we come up against it. The problem is this. If we centre or concentrate research in one place, then who is to make the product that is invented? That does not apply to the problem of medical research. It is a question of trading which, as I pointed out, applies only as to one-third of the requirements of the country. One other point I should like to make is that the noble Lord referred to a drug which he criticised very adversely. I should like to know whether it is in fact on the list. I rather doubt it myself. If it is, he would not be criticising the drug industry; he would be criticising the medical authority which permitted a drug which is apparently of no practical use to appear on the Government list.

LORD TAYLOR

My Lords, surely many drugs appear on the official recognised list of prescribable substances which are of very doubtful therapeutic value, with a note that they are of doubtful drug therapeutic value.

LORD FERRIER

My Lords, judging by the activities of the noble Viscount who is to reply, I feel certain that we shall get something from him on the subject, and we need not go on with it at the moment. They are classified clearly by the medical profession. This rapid development in new drugs is one of the imponderables of this very complex trade. These new drugs are almost invariably more costly than the old. I am sorry that the noble Baroness, Lady Summerskill, is not in her seat, because I think it is fair to say that it is "pie in the sky" to believe that the more complex drugs become the cheaper they are going, to get. It is going to be the other way. It seems to me inevitable that that should be so. For instance, it is possible to put down a plant for the manufacture of a new drug—I know that this occurred in one instance—where not one thing is produced by the plant because by the time the drug is ready a new drug has been invented which supersedes the original one.

There is another point to be made while we are talking of the cost of drugs. I feel that it is fair to consider—it is often not considered—the credit entry opposite the debit entry for the cost of drugs. It is quite incalculable. I think noble Lords will agree that, with improved drugs, the pattern of hospital admissions has changed altogether as the years have gone by. The duration of stay in hospital has varied and fallen and fallen. Of course, that can be calculated in terms of pounds, shillings and pence, but it is not possible to calculate the savings to the nation which result from prevention or early cure by modern therapy before patients are hospitalised.

VISCOUNT ALEXANDER OF HILLSBOROUGH

My Lords, on the question of these costs—I am very interested in the argument—could the noble Lord, during the course of his speech, give sore indication how it is that the costs of drugs have gone up so enormously, by giving us the basic cost of units of drugs leaving the factory and what they cost when they come to the consumer? Could he say what margins there are to the wholesaler and retail chemist? I wish we could get it.

LORD FERRIER

My Lords, I really was trying to make that point in an oblique way in pointing out that there are costs in connection not only with research but with obsolescence of plant and the like, which it is quite impossible to apply to any single drug. No rule can he applied to any single drug. That is what I said to the noble Lord, Lord Taylor. If I may make a rather simple comparison, it is this. I remember well when I was a young man that I got a boil on the back of my neck, and it was pretty painful. I should say that the total cost of the drugs required in those days was 1s. 10d., for a little mag. sulph., a little glycerine and a little plaster and cotton wool. It meant ten days' agony and three days off work. To-day it would mean three shots of penicillin at 7s. 6d. a shot—22s. 6d.— and no boil at all, and not a day, not an hour, off work.

LORD TAYLOR

Is it not down on 7s. 6d. a shot? It is 4s. 3d., is it not?

LORD FERRIER

A shot?

LORD TAYLOR

Yes.

LORD FERRIER

Plus prescription charge. There are three of those. That is the point, perhaps, which the noble Viscount was making. And it is the same to-day. You go on from your penicillins to aureomycin, and the like. As they increase in effectiveness, so they increase in cost. But the credit entry in terms of pain saved, lives saved and grief saved, quite apart from patient hours in hospital, is out of all proportion to this figure about which—and here I join with the noble Viscount, Lord Amory—such a fuss is being made. Because, quite frankly, we realise—do we not?—that we are talking of trying to reduce a cost of something under £50 million. When you take off the cost of appliances and the distributing costs of that share of the National Health budget which goes to drugs and appliances, it conies to just less than £50 million.

VISCOUNT ALEXANDER OF HILLSBOROUGH

My Lords, could the noble Lord explain to us some of these costs? When you walk into certain chemists' shops, some of them under the chain principle, you can buy quite a quantity of say, aspirin for 4d. When you go into another shop and maybe take a prescription, it costs you 1s. for what you pay 4d. for, perhaps, somewhere else. Is it not time we had art inquiry into the different margins of profit on these drugs which—and I concede this at once to the noble Lord—because of their necessity in treatment, are costing far too much to the scheme?

LORD FERRIER

I have not quite got that point. The aspirin in one shop is sold across the counter at 4d.?

VISCOUNT ALEXANDER OF HILLSBOROUGH

Yes.

LORD FERRIER

And the other at 1s.?

VISCOUNT ALEXANDER OF HILLSBOROUGH

Yes.

LORD FERRIER

But that is not aplicable to the National Health Service. Correct me if I am wrong. An aspirin would be a charge at so much aspirin B.P. Is that not right?

LORD TAYLOR

I think the noble Lord is right. It is a standard rate when is comes on a prescription.

LORD FERRIER

That is why I emphasised that we were talking of three equal shares—National Health, over the counter and export. What you like to pay over the counter does not affect this debate. It is perfectly possible—and personally I prefer it—to buy a certain proprietary article over the counter rather than to buy the same tablets B.P. I prefer it. It is put up neatly in a little tube that will slip in the pocket, and I prefer to do that; but it is not obtainable under the National Health Service by prescription.

My Lords, I have talked about research, and I have switched to this problem of the credit side and have made the point that new drugs are naturally more expensive than the ancient and the simple remedies; but, remember, there is other than ordinary chemical research. The research department is not just a bunch of boffins chasing molecules. There is a great deal more to do. There is clinical research, and there is biological research before that. Then comes the chemical engineer and the problem of how this drug can be produced commercially. Then there is the cost of raw materials, market research and the like. All these things have a bearing on the cost of drugs, and I feel they have got to be borne in mind by noble Lords opposite who criticise what is being done.

However, my Lords, here we have a factor on which your Lordships may wish to ponder. I read the cutting which I have here about the export trade earlier in my speech, so I will turn to the question of profits and meet the point that the noble Viscount, Lord Alexander of Hillsborough, made. On the subject of profits, it is necessary to remember that only one-third of the industry's production is sold to the State, and all of it at very reasonable prices. The overall profits which noble Lords have criticised so adversely refer to overall business, of which one-third is over the counter and one-third is for export—and that is worth pondering. Remember, also, that the actual receipts for drugs by the industry from the State is less than £50 million. It is not the gross figure which appears as a proportion of the £850 million.

I have, I hope, added to your Lordships' proceedings with some contributions which will be useful. In conclusion, I should like to return to the points which I have principally made. First of all, I hope that the noble Viscount who is going to reply will give us some cheer about the question of the 2s. prescription charge; and I trust that, as it is opposed by the medical authorities, by the Hinchliffe Committee and by so many parts of the House, that will be given careful consideration. If it cannot be adjusted, then action might be taken to make it easy for the poor and sick person to make a recovery against it. Further, I trust that noble Lords will be as balanced as they can in their meditations on the matter of the pharmaceutical industry, which is a very valuable and, indeed, vital part of the industrial set-up of this country to-day.

5.57 p.m.

LORD AIREDALE

My Lords, one of the things that impressed me most about the delightful maiden speech we heard this afternoon was where the noble Baroness said how unfortunate it was that any prescription charge at all should stand in the way of the aged, sick person; and when it comes to the question of doubling prescription charges one wonders whether part of the object of the exercise here may not be defeated when one considers the possible temptation that may be placed before doctors to tend to over-prescribe in quantity in order to absolve some of their patients from having to pay the double prescription charge twice, or over and over again. I had intended to say a few words about drug prices, but, having heard the noble Lord, Lord Taylor on this topic just now. I shall not attempt to add any words of my own, except to say simply that, notwithstanding what has been said upon the other side of this question by the noble Lord, Lord Ferrier, for my part—and I think I can say this on behalf of other noble Lords who sit on these Benches—I wholeheartedly join with the noble Lord, Lord Taylor, in his demand for a Royal Commission on the pharmaceutical industry.

The topic that I was going to touch upon mainly this afternoon, and that not for many moments, was the question of the proposed charges as they are likely to affect private patients. Private patients, as I think is well known, are a class who, although they pay their compulsory contributions towards the Health Service, do not receive the drugs and medicines that the Health Service provides. Now so far as Cam aware, Her Majesty's Government do not frown upon private patients as a class, and their policy towards private patients has, in my submission, always been both amicable and perfectly dear. It is, I think, enshrined in the following words—and I do not apologise tor quoting these words for the second time in your Lordships' House. The words are these: We shall allow private patients to obtain free of charge drugs prescribed by their doctor on a parity with the people in the State Scheme Those words did not first appear, as some have since thought, in a possibly hastily prepared election manifesto. They appeared in July, 1949, in the Conservative Party's publication The Right Road for Britain, which, as its sub-title made quite clear, was a calm statement of Conservative policy at that time. It is also worth remembering that the final paragraph of that booklet, under the heading "Final Words", said: We have sought in the foregoing pages to set forth the constructive theme of Conservatives during the next five years. The Party opposite came into power in October, 1951, at a time when there were nearly three years to run of the five-year period which had been planned for when The Right Road for Britain was published. Neither in October, 1951, nor at any time since, so far as I am aware, has there been any ministerial denial of any kind that this pledge in the booklet, given to private patients, was not to be kept. I suggest, my Lords, that at this distance of time there can be no question whatever of going back on that 1949 pledge. The only question that can now possibly arise is: when is this undertaking to private patients going to be implemented? For my part, I suggest that the time to implement that undertaking is now, because if it is not implemented now private patients are going to pay by way of compulsory contribution, in the very near future, still more toward drugs and medicine; which they will not, in fact, receive under the National Health Service.

6.2 p.m.

LORD GIFFORD

My Lords, I should like to give full support to the increased charges proposed by Her Majesty's Government. I do so particularly because these charges have bean raised only in proportion to the increased cost of the Health Service, and it is unthinkable that the standards of the Service should be lowered, which is the only alternative. With regard to drugs, I had understood that the cost had risen twice as fast as that of any other section of the Health Service, and therefore I do not think that the new charge of 2s. per prescription is excessive. But I should like to ask the noble Viscount the Leader of the House, who is to reply, what happens if a drug is prescribed which costs less than 2s. Does the patient have to pay the full cost, even though it may only be 6d. or 9d. over the counter?

I was going to say something about drug prices, but this subject has been exhaustively discussed by two noble Lords much better informed than myself, so I will refrain from saying anything except that I feel quite sure that the Minister will watch the situation and where he thinks it necessary will make representations to the industry. I thought the noble Lord, Lord Airedale, made a very good case for private patients to receive their drugs on a National Health basis in accordance with what was foreshadowed, as he has said, in the Conservative programme in 1949. My Lords, there is another point with which I should like to deal, and it is this. I think that only in a minority of cases is there a tendency for members of the medical profession to 'be extravagant in their prescriptions concerning the more expensive drugs, but I think it would be right for the Minister at this time to draw their attention to the necessity for economy.

The most expensive part of the Health Service is the cost of running hospitals, which is. I believe, about two-thirds of the total budget. The time has now come when a considerable number of new hospitals will have to be built and very large sums will be needed to modernise and replace old buildings, many of them dating back well into the last century. I think it is fair to say that, in the provision of new hospital buildings, this country is very much behindhand compared with some Continental countries, and certainly compared with other parts of the Commonwealth. I hope that when these buildings are being planned, study will be made of the latest trends in hospital architecture, not only in this country but all over the world.

I should like to say a few words about the amenity bed, a feature of the Health Service which causes me some concern. I regret to say that in certain cases the amenity bed has become a gentlemanly racket. It is used largely on an "old-school-tie" basis for sick members of the medical profession, the nursing staff and their friends. I am not saying that this is universal, but it occurs quite often. I am therefore glad that the Minister has doubled the cost of these beds. Personally, I should have gone further and abolished amenity beds altogether. And, having done this, I should have replaced them with something else. I should have replaced them with the type of bed which has been used in Australia for many years with great success. This type of bed is known as the intermediate bed. It is rather different from the amenity bed and brings considerable revenue to the hospitals. These beds are open to anyone, subject to certain upper income limits, and the charges made far them are exactly half the full bed costs of the hospital. Doctors who attend patients in these beds are allowed to charge one half their normal fees, and these beds fill a considerable gap between the private bed and the ordinary public ward bed. There are a considerable number of people in these days who, when they get ill, can afford and do like a certain amount of privacy when they go to hospital. This is made easier for them by the number of excellent voluntary schemes—hospital provident schemes—such as the Hospital Services Plan and the British United Provident Association.

LORD STONHAM

My Lords, I wonder whether the noble Lord would allow me to interrupt? I am very interested in his remarks and his suggestion that we should abolish amenity beds, but is not his alternative proposal that, having abolished them, we should recreate them and charge a lot less for them?

LORD GIFFORD

No, it is not that. I think the charges would be slightly more, in addition to which there would be a saving on the total hospital bill. Because I am going to suggest that, when building new hospitals, a great many of these beds should be provided. In a big general hospital, there should be, say, 50 to 100 of these intermediate beds, in small wards. I think they would be very popular and would bring considerable revenue to the hospital and a saving in the cost of hospital services. I particularly ask my noble friend whether he will look into this Australian scheme, because, to my knowledge, it has run now for not less than 30 years, with great success; and believe that it is something that we should adopt here. Having made what I hope is a constructive suggestion, I will conclude by saying once again that I strongly approve of these charges which the Government have proposed.

6.10 p.m.

LORD AUCKLAND

My Lords, first and foremost, I should like to congratulate the noble Baroness, Lady Summerskill, on her hard-hitting and always interesting maiden speech. For some time, while the noble Lady was Member for Fulham in another place, I was an officer of 'the local young Conservatives and we had a number of bouts. Although our side never secured victory, sometimes we suffered a defeat, which could be called a defeat "on points only". I am sure that we all welcome her to your Lordships' House. She will be a useful addition, particularly to our controversial debates, and certainly she acquitted herself well to-day.

I am on the board of a children's hospital, and therefore hospitals and the Health Service are one of my main interests. I should like to say, first of all, a word about welfare foods. I am the father of a daughter who is not yet two and have had a little experience of the welfare centres, which do a fine job. I aim convinced that there is a certain amount of wastage in these foods. At the time the scheme for distributing cod live oil and natural orange juice was started, there was a lack of proteins in our national diet and the children badly needed these foods. I am not suggesting that the scheme should be abolished but I think that the organisation of the supply needs looking into. As has been said, the number of parents who bother to collect these amenities is very small. Let me quote from an article in last week's Economist, which is not a pro-Government paper in any great form. It said this: Only between one-tenth and two-fifths of those who qualify seem to bother to collect the various welfare foods anyway and they are not necessarily the poorest people either. I think that it can be said that it is not necessarily the neediest who benefit from the supply of these foods. In outlying districts, where chemists' shops and doctors are in short supply, there is a case for this service; but I feel that in the cities and towns there is reason for looking into the scheme, bearing in mind the present-day diets of this country.

Reference has been made to the position of diabetics. I would urge Her Majesty's Government to give a great deal of thought to the matter of insulin, which I believe should not be included in the increased charges. I support the charges applying to cough mixtures, and items of that sort, but not to insulin, which is something that diabetics need all their lives. The noble Lord, Lord Taylor, will correct me if I am wrong.

I would also urge my noble friend to consider the possibility of exempting from these increases children under five years of age. If there should be an outbreak of measles, or even of pneumonia, in a family of three or four young children, several of them may go down and a great many drugs might be needed. That would impose great hardship. I would go so far as to suggest that, if necessary, the prescription charge could be increased for, say, those between 15 and 50 to meet the extra financial commitments of this proposal. I know that this is not a Second Reading debate, so not press this point too hard now. However, it seems to me to be a point that could be considered, and I would ask the noble and learned Viscount the Leader of the House if the could perhaps consult his right honourable friend about the justification or otherwise of this suggestion.

The Party opposite has said on a number of occasions that we have tried to kill the National Health Service. I have read carefully the Second Reading and Third Reading debates on the National Health Service Bill in 1946, and honestly I can find little support for these allegations. Admittedly, the House divided, but we gave one very good reason for dividing; that was, that the whole Bill then was far too centralised and far too little freedom was given to the medical profession. I have always supported the idea of a National Health Service.

When we consider countries such as America, where it costs a fortune, literally, to be ill—although President Kennedy is now seeking measures to obviate this—we can say that we are fortunate in possessing this wonderful Service. I would ask Her Majesty's Government to consider whether more reciprocal arrangements could be made with countries overseas. I was talking to a doctor friend the other day. There are countries, such as Portugal, where I believe if one has treatment for a serious illness one has to pay a great deal of money. I am not entirely opposed to foreigners' getting National Health Service treatment when they come here, but I feel that the Government might look into this matter a little more carefully and see whether, through diplomatic channels, more reciprocal arrangements could be made.

I will make but one reference to drugs. There has been a great deal of building of new factories for pharmaceutical products which obviously costs a lot of money. I do not know whether the Government make any grants towards factories for this purpose, but, if not, it seems to me that the proprietors of these drug firms have a case for making reasonable profits. I do not think that the idea of a Royal Commission to look into the industry is necessarily a sound one, but perhaps a Select Committee could look into it. It is obviously something that needs looking into quickly. I support the Government on these increased charges, hut there are certain matters, such as a probe of some kind into the pharmaceutical industry, which I think are necessary. Having said that, I would add that I believe that the Minister, who is a very humane man, has done the right thing in bringing in these charges. We shall have more opportunity to debate the matter in full at a later stage, but I, for one, will support the Government on this occasion.

6.23 p.m.

LORD AMULREE

My Lords, before I come to the main matters on which I wish to speak in this debate, there are two points that I should like to mention quite briefly. The first is the increase in the weekly contributions. These have gone up by 1s., of which 10d. is to be paid by the employee and 2d. by the employer. That does not seem to me to be a fair balance. If we must have an increased contribution, I wonder whether the employer's share should not be somewhat bigger and the employee's share not quite so great. The second point is on the question of amenity beds. No one, I think, will grumble that the price of these beds has been put up, but I trust that it will not lead to an abandonment of the principle, which I think is a good one, that supposing a patient needs a single room for medical or even social reasons, that room should not be denied to him because he cannot pay the increased charge for an amenity bed. I know that at the present time quite frequently amenity beds are filled by people who need a single room for medical reasons, and I trust that this practice will continue and that the increased charges will not make any difference to it.

The next point I wish to touch on is the question of whether charges for welfare foods should be increased or not. Personally I have no objection to the fact that they are now to be sold at cost prices, because I never believed in a subsidy for important things like that. People should be paid a sufficient wage or should get sufficiency in allowances to make it possible for them to buy these goods and not to have them as part of a general subsidy. What I think we can say now is that the majority of people do get a reasonable wage, and mothers of families receive a certain amount for the children: I know that they get nothing for the first child, but they do receive a children's allowance for the second and any subsequent children. Therefore, I have no particular objection to these charges being made.

As several noble Lords have pointed out, when this provision of welfare foods was first instituted the nation was living on very short commons; and it was important that the children should be given extra food, both during the war and for a long time after the war. But now that food is plentiful again, and most children are given a normal, good, mixed diet, I am doubtful whether it is necessary to supplement it with this large amount of extra vitamins and other substances. I do not think a great deal of danger is caused by giving them to children who do not require them but it has been shown that there can be danger from taking too much cod liver oil, which is why, I believe, the standard dose has been drastically reduced in the past few months. Therefore I am not going to cry a great deal about the fact that the welfare foods are now going to be sold at cost prices.

There will be a few unfortunate people and a few improvident people, and I think it may be necessary for them to apply to the National Assistance Board for money to get these foods, supposing the doctors and nurses in the clinics feel that they are really necessary. If it is said that parents will not willingly pay this sum, then I think it is the function of the doctors and nurses at the clinics to instruct and guide them and bring them on properly.

But when it comes to the question of increased charges on subscriptions, I think that the Government are on far shakier ground. It is true that to a number of people, probably the majority, who are not likely to be taken very ill often, and who are getting good money, the increase will not make a great deal of difference. But there are a number to whom it will make a substantial difference, and I have particularly in mind those with longstanding illness. Reference has been made to diabetics, who need insulin for a long time and may require it when they are quite young. For the most part they will be able to work, but they will certainly have this burden with them for the rest of their lives. I am not referring particularly to these people, however. Nor am I necessarily referring to the elderly people, because there is a way (I do not say it is a very satisfactory way) of assisting them. Those to whom I refer particularly are the people for whom more than one drug is needed, who are able to do a full day's work or part of a day's work, provided that they can get these drugs. I have in mind the large number of patients suffering from chronic bronchitis and the various complications of that illness. These may need to take four or five drugs regularly, and particularly during the winter months, to kep them fit and well.

It may be said that a doctor can give a prescription to cover several months and, therefore, the cost is not very great. But that is not a good practice, because the drugs these people take are rather strong and potent, although they are not dangerous drugs under the terms of the Dangerous Drugs Act. I should be extremely reluctant to allow a patient of mire to go away with several months' supply of some of these drugs. Then again, people in this state of health probably need to be seen by their doctor from time to time, so that it will not be possible to make out these prescriptions to cover a long period. This means that they may be subjected to what may often be an extra weekly, fortnightly or, maybe, monthly charge of 8s. or 10s., which, to my way of thinking, is a large sum and one of which I do not approve at all.

One can say that the elderly persons can claim a refund from, I think, a post office or the National Assistance Board. But that again, I think, shows a lack of appreciation of what elderly people can do. It. is true that they can, but they find great trouble writing the necessary letter, and they find even more trouble in going round to the post office or National Assistance Board office to claim their refund. It is quite true that the Assistance Board officers are very good: they will call if asked to do so. But here again it is a question of writing a letter, finding a stamp and posting it, all of which sounds comparatively simple to young folk, but I assure your Lordships that it is not at all easy for old people living by themselves.

If the Government want to economise, would it not be better to focus attention on the prescriber of the drugs, and upon the manufacturers of the drugs? When I say "the prescriber", I mean the doctor, because there are quite a large number of drugs which can be supplied in various forms and types. I have a list in my hand. There is a drug which we all know by the name of cortisone, which is used for various diseases. There are various forms of cortisone, and the price varies from 6s. 9d. to 25s. 2d. I am not going to say that the cheap ones can be used for everybody. I think many people get rather carried away in prescribing something new because it is new, without thinking of the cost. There are quite a number of things of a similar nature among the other new drugs. For example, there are various kinds of tranquillisers, popularly given as sedatives, and antibiotics. They can all be obtained in various kinds at different prices. Some people do not find that the cheaper ones do them any good, not because they are cheap but because they do not contain the right drug. But I am sure that a great deal of money could be saved if that point were really put across.

The cost of drugs has certainly increased, and it will, I think, go on increasing as more and more potent drugs are discovered and prescribed. But one has to take into consideration the converse, because the probable result of these useful but expensive drugs is that illness has been shortened, a good deal of ill-health has been prevented, and the call on hospital services has probably diminished. Many of your Lordships will remember that in our young days young people got pneumonia in their twenties and thirties. It was an extremely serious illness, and a large number died. That sort of thing does not occur now because of these expensive drugs. So one has to be rather careful, when one condemns the increase in the drug bill, to make sure that one is not unintentionally cutting out a thing which may be reducing the costs of the Service in general a great deal.

I have never from the start been entirely happy about the prescription charges, both when they first came in and about the present increase. That, I think, is an opinion shared, certainly by noble Lords who sit with me on these Benches and, indeed, by other noble Lords and Ladies in the House. I am sure that what the Government wish to do, and what I should not mind doing, if there is to be an increase in the price of drugs or in the charge, is to have some check on the valetudinarian. But he rather enjoys it the more he has to pay, and the more prescriptions he is given, because he would rather be given prescriptions than food. That kind of person will not be shocked or checked at all by this increase in the charges.

I should like to support what my noble friend Lord Airedale has said; that there should be some inquiry into the drug industry. Because although there may be absolutely nothing which is not entirely correct—the profits may not be excessive, and an excessive amount may not be spent on advertising—there is a certain popular feeling that this is the case; and the best way to stop that, once and for all, is to have some kind of inquiry on the lines suggested by several noble Lords this afternoon.

6.36 p.m.

VISCOUNT WAVERLEY

My Lords, speaking from these Benches, I do not wish to add to the political controversy. There is, however, one aspect of the drug question which has not, in my view, received due emphasis. I should like to suggest to your Lordships that the public are too pre-occupied with medical treatment. They are curiously unalive to the fact that treatment is subordinate to diagnosis. Diagnosis depends primarily on a careful case history and meticulous physical examination, with or without additional help from radiologists and clinical pathologists. This is a time-consuming and exhausting occupation, which is not well fostered by overcrowded surgeries. The pressures on the doctor to prescribe, without adequate diagnosis, are tremendous. Many of the public are positively hostile to the medical disciplines of interrogation and examination. They discern in them, or suppose they do, a lack of diagnostic flair, an absence of magic and a peculiar reliance on a rather plodding, pedestrian approach to the medical art. These people wish their doctors to prescribe with or without a scientific rationale. This attitude is a carry-over from the time, not so long ago, when medicine was largely inexact and most or much of the treatment empirical and directed to the relief of symptoms, not causes.

The position of medicine to-day is transformed, and the frontiers of knowledge and understanding are extending from moment to moment. Scientific diagnosis is a reality over much of the medical field, but many of the public still adhere to outmoded beliefs and clamour for treatment regardless of causes. It is only necessary to stand for a short time in any chemist's shop to test this hypothesis: "My cough is no better; my pain is worse. The doctor's medicine has not helped. Now, what can you suggest?" I believe that somehow the public's image of the modern doctor must be changed, so that he is seen, not as a potential cornucopia of drugs, often very expensive and quite frequently having undesirable side effects, but a thoughtful, humane scientist whose primary consideration is, or should be, accurate diagnosis. The best way to attain this desirable end is, I think, conjectural. Having at first been sceptical about the value of such television programmes as, "Your Life in their Hands", I now believe them to be of the utmost educational value. They eschew morbid dramatisation, they on the whole present the art and science of medicine as it is to-day, and they afford an opportunity for the public to see and, I should hope, understand that they and the medical profession are partners in a joint endeavour—the scientific alleviation of pain and distress, an endeavour in which basic causes are paramount and treatment subordinate to these.

6.40 p.m.

LORD LATHAM

My Lords, I confess that I participate in this debate this evening with a feeling of shame that in the year 1961, after two great wars and all the sacrifices that they entailed, we should be discussing such shabby and shoddy proposals as were embodied in the statement made by the Minister of Health some few days ago, proposals for the transfer of £50 million of expenditure in 1961 and £69 million in a full year from the Exchequer to the backs of those unable to bear the burden. It is the case, of course, that whenever this question is raised the old spirit of the Poor Law emerges and expresses itself by suggestions that application should be made to the National Assistance Board, which of course is the descendant of the Poor Law and the Guardians and of the relieving officer which any self-respecting nation would exclude from its social institutions.

But it is not only we who object to this interposition of the National Assistance Board, for, whatever his views may now be, I find that on March 27, 1952, the present Secretary of State for the Colonies, who at that time was much concerned with health and local government problems, said [OFFICIAL REPORT, Commons, Vol. 498, col. 964]: The last conclusion I wish to leave in the mind of my right hon. Friend is that I think I am right in believing that, particularly with the poorer people, health expenditure is a marginal expenditure and one of the first things which goes by the board if anything has to be paid for. That is precisely what the noble Baroness, Lady Summerskill, said in her brilliant and impressive speech. He went on to say: Surely, then, it follows that, if there is a much greater deterrent charge—and I hope that the Ministers will look at this—it may be that they will be able to come to the House and, by an Order in Council, achieve what we are trying to achieve in this Bill with a much smaller charge. I was surprised to hear the noble Lord, Lord Beveridge, state in his otherwise impressive speech that inflation was due to the action of the workers because, as he said, they did less work for more pay There is nothing in history to justify a statement of that kind, which I feel sure the noble Lord would like to revise when he considers its implications.

VISCOUNT HAILSHAM

My Lords, I do not think I really ought to answer for the noble Lord, Lord Beveridge, who no doubt will be very well capable of looking after himself, but I think, in fairness to him, as he is out of the Chamber, I should remind the noble Lord that that is not what he said. He said inflation was due to both employers and workers, and he did not say that they did less work for more money but that they did the same work for more money. I think it is only fair I should say that.

LORD LATHAM

We must look at the OFFICIAL REPORT. I was not expecting the noble Viscount to reply for Lord Beveridge.

VISCOUNT HAILSHAM

No, but I like to be accurate.

LORD LATHAM

I should like to point out this fact: that the noble Lord, Lord Newton, said in connection with the agricultural workers that the increase in. the percentage of contributions in relation to wages was no more than 1 percent. from October 1, 1948. That goes to show that the wages go up with the increase in the contributions except to the extent of 1 per cent.; which means of course, as is the case, that if the contributions to National Insurance or any other imposed obligation is increased, then, in so far as those people are organised in trade unions or otherwise, they recover it through an increase of wages. That would seem to have disproved in some measure, what the noble Lord, Lord Beveridge, said.

I was interested to hear that the very admirable suggestion made by my noble friend, Lord Taylor, that there should be some inquiry into the cost of drugs—whether by way of a Royal Commission or a Select Committee or in some other appropriate and convenient way— has been received with support by the noble Lord, Lord Auckland, and the noble Lord, Lord Amulree; and I gather that the noble Viscount, Lord Waverley, was not indisposed to support that proposal. I am sorry that the noble Lord, Lord Ferrier, is not in his seat. He entertained us to a pretty lengthy defence of the pharmaceutical industry, but there are a number of aspects of that industry, knit, as it is, inescapably into the framework of the National Health Service, on which the National Health Service and health generally very largely depend, although perhaps not so much as the advertisments would at times have us believe. There are the questions of cost and overheads. The noble Lord said, I gather, that one-third of the output was sold to one customer, namely the State, to meet the requirements of the National Health Service. The question of adjustment of overheads on marginal costings and all sorts of things arise, which I think justify some inquiry on behalf of the State, and I hope that the noble and learned Viscount may be able to indicate that this proposal will receive consideration at the hands of the Government.

I view this decision to increase contributions and to increase charges as being another step towards dismantling the Welfare State. It is, in my submission, a part of the policy of the Conservative Government, ever since it assumed power in 1951. It is to make the affluent society affluent for the rich and for those well circumstanced. These proposals to save £65 million a year are really an expression of a mean and wretched philosophy. They take one back to the atmosphere and the mood of 1910, when the first Health scheme was introduced and when we had processions of well-attired ladies, marching to the Albert Hall to protest that they would never lick stamps.

The Conservative Party have got back to the attitude of mind which was quite different from the attitude of mind in this House during the war. If. I may be a little personal, may I say that I have been in your Lordships' House about nineteen years. I have been in the House longer, I think, than any one of the occupants of the Government Front Bench, and longer than any occupant of the Opposition Front Bench except my noble friend Lord Listowel. I remember in 1942, when this country had been in dire peril, there was almost an orgy of contrition from all sides on the part of Members of this House. In those days, nothing appeared to be too good for the people of this country who at that time were risking their lives, as we all did, in order to save not only this country but the world for freedom.

I was here, and I remember the appointment of Committees galore. There was the Uthwatt Committee, then the Scott Committee and the Beveridge Committee. There was a kind of conscience of guilt throughout the whole of 'the nation, especially among those who had been responsible for the affairs of the nation, at the wretched condition, in between the two wars, in many cases, of the working classes and the people, with unemployment reaching a figure of 3 million; the figure was nearly 1½ million when the war broke out in 1939. Notwithstanding that the people of this country had been—shall I say—cheated after the First World War, when they were told that they would have "homes fit for heroes", we know now that in the year 1961 there are several million houses in this country without a separate bathroom. We had Reports from the Uthwatt and the Scott Committees recommending that the benefits arising from community activity and action in connection with land should be the property of the nation and should belong to the people who had defended the land. We have seen each of those Reports torn up, including the Act which gave effect to Uthwatt and to Scott—the Act of 1947. They were torn up, and the bits have been thrown in the faces of those who defended this country during those dark and dangerous days from 1939 to 1945.

Among the other Committees there was the Beveridge Committee, in respect of whose Report the Coalition Government issued a White Paper in 1944, stating, as regards the National Health Service, that it was to divorce cares of health from the question of personal means or other factors irrelevant to it, and to see that all relevant medical facilities were available to all people. Those words have already been quoted by my noble friend Lord Silkin this afternoon. These promises to the people who had borne the heat and burden of the day have been largely betrayed. We had the Land Report; we had the Act of 1946 on the National Health Service, and one in 1947 for Scotland. There was to be a free service of full facilities, as the Guillebaud Report at paragraph 718 clearly and unmistakably set out. It became the admiration and the envy of other nations.

Now the Government are engaged in dismantling this great Service, which I once heard described as the Magna Carta of the people's health. The Government are eroding its foundations bit by bit; they are burrowing. The National Insurance Act was primarily an Act not to provide for retirement pensions, but to recoup the Exchequer in regard to a large measure of its contributions to the finances of the pensions scheme. As the Economist said, it would save the Government £99 million in the first year, and that saving would rise to £420 million in 1981. At the time The Times said that it was none other than a crude form of income tax."

I ask, what right have the Government to destroy this public service, bit by bit, piece by piece, as the present Minister wishes to do? His philosophy is: transfer as much of the cost to the shoulders of those who are least able to bear it. There have been five increases of contributions, including one which comes into operation next July, in respect of National Health Insurance. There have been seven reductions in tax, mostly for the benefit of those who pay considerable sums either in income tax or in tax and surtax. As I have indicated, the new proposals will save the Exchequer £50 million in the year 1961, and £69 million in a full year. Of that, £49 million is in respect of the increased contributions.

A good deal has been said this afternoon, especially from these Benches, as to the percentage of the national product which the cost of the National Health Service represents. My noble friend Lord Taylor said it has moved up from 3.2 per cent. to 3.8 per cent. in five years—those are the figures of the Minister. But it has moved down from 4.5 per cent. to 4.2 per cent. over the last ten years. I suppose it is interesting to comment, en passant, that the interest on the National Debt went up by £269 million between 1952 and 1958—nearly 50 per cent. Surely that small percentage of the national product devoted to the Health Service is one of the best investments that this nation can make. After all, it is not by a disease-ridden, sickness-ridden, working population that we can expand the productivity of this country or its output. It is by having active, healthy, lively, physically fit men and women—and children—that we can expand the economy of the nation and move forward into a greater degree of comfort and prosperity.

And this increase from 3.2 to 3.8 per cent. as a proportion of the national product would not have been the case had Her Majesty's Government pursued an active and vigorous policy to expand the economy, instead of imposing credit squeezes here and boom facilities there front time to time. Moreover, the increase in the percentage of the national product takes account, of course, as it must, of the effect of the increase in the population of this country and the change in the age structure. According to figures given to the Guillebaud Committee it was estimated that the change in age structure would represent an increase of expenditure of some 3½ per cent between now and 1971–72; and as regards the increase of population. would represent 4½ per cent. That must be taken into account when it is suggested that the expenditure on the National Health Service at the present time is getting out of hand.

Then it has:been said by those supporting; this change that the people's earnings at the present time average some £15 a week. That, of course, included overtime and the very high earnings of those engaged in the motor and aircraft industries. They are not earning £20 per week now. Many of them are on shoot time, and a large and increasing number are unemployed. There certainly is not much overtime available; and that figure of £15 per week was swollen (because I do not think they exist now) by the inclusion of the high earnings in those particular industries. But the right honourable gentleman the Minister of National Insurance himself said, when he introduced the 'proposals for the National Insurance Bill, that in 1959 there were 7¾ million persons earning £9 or less per 'week. To say, therefore, that those who will have to pay this increased contribution and these increased charges can well afford to do so, because they are earning £15 per week, is not true at the present time; and generally speaking it was never true.

Then, what about maintaining stable prices if we are to have these increased contributions and increased charges? Surely they will have to be recovered, as other increases in prices are, by increases in wages, which of course moves away from the alleged settled policy of the Government to maintain a stability of prices? And what about the disincentive upon the workers? We are told a great deal about those who are subject to surtax: that it discourages them from marginal activity; that they sit back and say, "I have to pay so much in tax, what is the good of working hard or concerning myself with other activities?" That never was true. It is not true now. The Committee, presided over by the noble Lord, Lord Radcliffe, on Taxation of Income and Profits came to the conclusion that there was no foundation for the allegation.

But in any case, the total of the surtax which relates:to income from employment, not from investment, is no more than about £52 million a year out of the total of £163 million, which I believe is the figure of tax collected from surtax payers. It is sometimes assumed that the increased cost of the social services is borne wholly by income lax and surtax payers. That, of course, is not the case. There is a contribution amounting to some £2,400 million a year arising from the taxation of consumer expenditure, principally (but not wholly) Customs and Excise, and purchase tax. There is indirect taxation of £2,400 million and direct taxation of £2,758 million; that is leaving aside the contribution under the National Insurance Act.

And so, my Lords, we have put down this Motion, a Motion of censure, because we take the view that the present Government are resolved to destroy the Welfare State. They have done so, as regards land. Land now costs local authorities more per acre—and very much more on the present basis of ascertainment—than it did before the last war. Transport has been torn asunder, torn apart. The provision for old age and retirement pensions, as I have indicated, casts an additional burden upon the people and will save the Exchequer huge sums of money in the coming year. Now we have this attack upon the National Health Service. It is an affluent society for the few.

The present Minister of Health now conceives himself, as it were, as the saint of public economy and he is putting a hair shirt on the rest of the people of this country in testimony of his sanctity. We say these proposals are unworthy of this nation. They are shabby, shoddy and unfair. In my submission, no one can get up feeling a sense of self-respect and defend them. They are the measure of how much the Conservative Party care—notwithstanding the posters. This, we were told sometime ago by the present Prime Minister, is an "Opportunity State." An opportunity State for whom? For the speculators; for the wealthy (and I am using this word, which was also used, some years ago it is true, by the present Prime Minister), a State where in many cases the ethics of the casino prevail and not the ethics and morality of decent: men and women. This is another betrayal, in our submission, by the Tory Party. One is entitled, I think one is induced, to say almost: "May God forgive them, for they do know what they do!".

7.10 p.m.

VISCOUNT HAILSHAM

My Lords, my work has been done so largely for me, particularly by the noble Lord, Lord Beveridge, with almost every word of whose speech I entirely agreed, by my noble friend Lord Amory, and by several noble Lords behind me, including Lord Auckland, that it is rendered very much more easy than it would otherwise have been. The noble Lord, Lord Silkin, said, in introducing this Motion, that it was not common in this House to have a Motion of censure. It is a well-established right of an Opposition to put down a Motion of censure, and a well-established duty of the Government to answer a Motion of censure. The trouble about a Motion of censure in this House is not so much that it is wrong as that common sense will keep breaking in. I am afraid that a good deal of common sense has broken into this debate, which renders it more difficult to retain the atmosphere of drama and heat than one would otherwise like in a Motion of censure. In his wilder flights of fancy—with the old spirit of the Poor Law and the entire people, except the affluent few, in a hair shirt; the sickness-ridden population and old age pensioners never worse off; and a long talk about the fate of the Uthwatt Report, and especially in his rather inapposite, I thought, perversion of the words from the Cross at the end, the noble Lord who wound up for the Opposition did his best, but I do not think he achieved very much.

The fact is, of course, as my noble friend Lord Amory pointed out, that this Motion of censure is very largely an air-shot. The dragon is not there. The noble Lord, Lord Latham, sought to put his case not so much upon the details of the proposals as upon the belief, which has been sedulously asserted by members of the Opposition in the country and elsewhere, that (as the noble Viscount who leads the Opposition put to me when we made our original statement) this is part of a combined attack on the Welfare State. It is impossible, I think, to attribute this fantasy which is sought to be created by noble Lords opposite to any insincerity on their part. We know that they are wholly sincere, and therefore I am bound to say that I attribute in part the public heat which has been expressed against my right honourable friend the Minister of Health and his proposals to wishful thinking. The fact is that the Party opposite have snatched at the belief that my right honourable friend has mounted a deliberate assault on the Health Service which it is his duty to defend, and the Welfare State, as a sort of lifebelt for their own Party in the stormy waters of internecine strife, enabling them, they hope, to unite against the common enemy.

They may be right. It may be easier for them to unite in a negative opposition against a policy at the present juncture than to unite in support of a constructive policy of their own. It may, for all I know, be easier for them to unite against the Minister of Health than to unite behind the Leader of the Labour Party. It may be easier to look back to the palmy days of 1946, or even, in the case of the noble Lord who has just resumed his seat, to the palmy days of 1910 and pictures of Tory ladies refusing to lick stamps. It may be easier to do that than to look forward to the world of the 1960s and its present needs and the future, and to the realities of a society of both full wages and full employment, which they are perpetually sneering at as an affluent society.

But before noble Lords rejoice too soon and entirely take leave of reality, it is my duty to tell them that they are proceeding on a false assumption. Whatever may be the merits or demerits of my right honourable friend's proposals which are under discussion, it is incorrect to say that we intend or regard them as an attack either on the Health Service or on the Welfare State. Our case, which it is as well to put, or at least to try to understand—and it is certainly not one which has been seriously met from the Opposition—is that, so far from being an attack on the National Health Service, these proposals are in fact necessary to its healthy growth; and we think that its healthy growth can no longer be delayed.

My noble friend Lord Newton, in speaking earlier this evening, referred to three fields in which we consider it is necessary for the Health Service to be developed in the near future: the fields of mental health, hospital building and the development of the community services, which (if I may say this in parenthesis) I think is exactly what the noble Lord, Lord Beveridge, had in mind when he asked from the Government an assurance that we were really going to do something to try to stop people missing the advantage of the Service from ignorance or carelessness. There, I would suggest to him, is a positive field in which we are already taking steps. These are, in fact, the new and expensive developments which my right honourable friend is determined to foster.

We shall, in due course, be coming to Parliament and shall be approaching the taxpayer for money to pay for these developments. But our case is that we do not think we shall be able to secure the sympathy of Parliament or the support of the taxpayer, who has to provide the money, unless we are prepared to show ourselves seriously inclined to cut away a little of the dead wood which accumulates from time to time; to exercise a small degree—I am afraid I can only say a limited and small degree—of financial responsibility and discipline, and a willingness to ensure that this Service—upon which we are spending currently something like £800 million a year—is simply not going to be allowed to run away with unlimited quantities of the taxpayers' money in directions where, as I shall show, the philosophy of the 'forties needs correction after 20 years, in the light of the experience of the 'fifties and the realities of the 'sixties, to which noble Lords opposite seem really quite unable to accustom themselves. The dispute, therefore, is not between those who believe in the Health Service and those who do not: the dispute is whether the Service is to be allowed to stand still or, if not, how best it can be developed.

My Lords, I would say that, in a way, it is not unlike the dispute between the fundamentalists and modernists in the matter of religion. Both sides are, of course, sincere. Both sides desire to keep alive the true flame of religion. But the fundamentalists—the noble Lords opposite—regard the legislation of the 'forties as the Ark of the Covenant containing tables of stone, verbally inspired, engraven on Sinai, and incapable of serious improvement.

Now, my Lords, the modernists, on this side of the House, think of the Welfare State as an excellent but essentially human institution, sired, as he reminded us, by Sir William Beveridge (as he then was) out of the Coalition White Papers; and, though excellent. capable of improvement and needful of adjustment if it is to grow, or even survive, in decent health. In matters of social service, as in matters of morals, it is perhaps worth remembering, since we are to quote Scripture (I hope this time properly), the maxim: The letter killeth. The Spirit giveth Life. The question is: what is the spirit of the Welfare State?

VISCOUNT ALEXANDER OF HILLSBOROUGH

That, apparently, is going to be very aptly used, so far as I can see, to justify why the Tories run away from the promises which they made in the 1940's.

VISCOUNT HAILSHAM

I do not think that remark is either relevant or worthy. I am not at all ashamed of the suggestion that we perhaps develop occasionally in 20 years, and I do not think it can be shown that we have broken a single promise that we have made.

VISCOUNT ALEXANDER OF HILLSBOROUGH

It was quoted against you.

VISCOUNT HAILSHAM

Perhaps, in this connection, I might be forgiven for asking: what is the spirit of the Welfare State? What are the principles that underlay it which we are supposed to be dismantling? Perhaps here, too, as other noble Lords have done, I might indulge for a moment in a little personal reminiscence. Like millions of other people, during the war I found myself in the Army. My Lords, war having been defined as long periods of boredom interspersed with moments of acute fear, I spent my long periods of boredom largely reflecting upon the shortcomings of our society and the means of improving them after the war. By the end of 1942, when I was down-graded medically and could no longer hope to play a fully active part, I reached the conclusion that the two pillars of British society after the war ought to be a publicly-organised social service and privately-owned industry. It was to further these aims that I returned to the House of Commons at the beginning, of 1943, when, my Lords, at almost the same time, by a dramatic coincidence, the proposals of the Beveridge Report became public. I thought the proposals contained in that Report, and the assumptions which were made in it, exactly corresponded to the kind of thing which I then wanted to support.

My Lords, to-day we are discussing the meaning of the first of these objectives—a publicly-organised social service. I would define it in terms almost exactly identical to those which the noble Lord, Lord Beveridge, used to-day and which he quoted if I do not mistake, from the document of 1943. I would say that there are two broad principles: in the first place, the principle of public organisation; and, in the second place, the principle of accessibility irrespective of means. Of course, the first of the two principles is fundamental, and I think it is worth saying, so because it is this which one finds oneself arguing in discussions with Americans and others who either have no experience of, or do not desire, what they call socialised medicine. It is worth saying, if only to limit discussion, that the fact is that all Parties in this country are fully committed to the principle, not merely in regard to the National Health Service but to all the social services generally. In nine years of Conservative Government, all the social services have grown —and, for what it is worth, they have grown much more rapidly than in the previous six.

Whatever may be the merits or demerits of the present proposal, the first principle, therefore, remains unaffected. The argument which we are having to-day concerns only the second. But, my Lords, it is worth establishing at the outset that here again the principle itself is not in dispute. It is that publicly-organised social services should be accessible to all irrespective of means. But, my Lords, I must point out that this is not at all the same thing as to say that they should be universally free, or universally paid for as to 100 per cent. by the taxpayer, or in every case available on absolutely identical terms. They should be universally accessible, and nobody should be deprived of them simply because he has not the money to pay.

My Lords, from the very first, as my noble friend reminded us, it has been accepted that different sources of finance are necessary in a fully developed Welfare State. Some of the services are financed solely at the charge of the Exchequer. I was very glad to hear the noble Lord, Lord Beveridge, remind us that the family allowances, which were one of his assumptions, are an example of this. This is because, even under a system of full employment, there is an element in family raising of which wages in the nature of things, cannot take full account; and, therefore, even under full employment, lack of means tends to concentrate with sinister discrimination where there are children, and an adjustment out of the taxes is necessary to counter an inbuilt injustice in any wage system. Other services, like education, are partly financed out of taxes and partly out of local funds. I need not repeat the arguments regarding children in relation to education, but I should have thought that they were clearly adequate to make a complete answer to the argument which was, I think, a little fantastically presented by the noble Lord, Lord Silkin, who suggested that the education services were going to be treated in the same way as the health services. My Lords, they never have been. Other services—and the insurance scheme is the main example—are partly, at any rate, financed out of contributions. This is because we think it right that though part—and it may be the largest part—is borne by the State, some should be borne out of wages as a condition for benefiting from the service.

The noble Lord, Lord Silkin, seemed to me, by his speech, to prove too much. At one passage I thought he was arguing that the whole of the Health Service ought to be borne out of taxation. That is what he appeared to be saying; and if his argument had any validity, that is where it would lead. But the fact is that it never has been so borne. The noble Lord, Lord Beveridge, reminded us that from the very start, in the purest form of the tables of stone brought down from Sinai by Mr. Aneurin Bevan, there was an element in which people were asked to pay a proportion of the Health Service out of the stamp, and I agree with my noble friend Lord Amory: there can be no injustice in asking people to pay when they are well for a small proportion of what they need when they are sick. The question is not whether, but "How much?" This is a question of degree, not of principle. The present proposal is to put up that element because the service is worth more, because it is costing more and because, in conditions of full employment which were not envisaged at the present levels either in 1942 or in 1944, or in 1946, people are earning more—and the level of their wages is not affected as it would have been, even under Lord Beveridge's assumptions in 1942, by a level of unemployment as high as 8 or 10 per cent.

Now no one has really produced evidence that this burden is intolerable. No one can expect us to take from the noble Lord, Lord Latham, in view of, his wilder talk, the broad proposition that another is on the stamp (2d. from the employer and 10d. from the employee) is putting a burden on the backs that are unable to bear it. On the contrary, if the whole value of the stamp is taken into account, the National Insurance and the National Health Ser- vice element combined, the relationship of the stamp to average earnings has remained, I believe, almost constant over the years. That being so, in regard to the increases in stamp, it becomes a question of whether, by themselves, these sources of finance are adequate for a healthy and efficient Service. I am bound to say that I should not have thought so. Almost from the start it was contemplated, as we have been reminded more than once, that some charge should be made for the use of the Service; not, indeed, for treatment or diagnosis, which is not under consideration now, but for objects like teeth and spectacles, and even bottles of medicine.

Of course, it is true that such a charge can bear hardly, if it is not humanely administered, when it is incurred by the sick—when it necessarily is, as my noble friend Lord Amory reminded us—and not by the healthy. Therefore, it is not in the same position as the stamp. That I fully agree. It is also true that it is unpopular. As has emerged from the debate to-day, it is unpopular with the doctors and the chemists, who do not like collecting it; it is unpopular with the patients, who do not like paying it; and I may add, if it will give noble Lords any satisfaction, it is unpopular with the Government, who do not like imposing it.

But the question is not whether it is popular, but whether it is right; whether, indeed, it is not our duty to impose such a charge—our duty, that is, if we are to achieve social justice and display a proper sense of responsibility in the administration of a public service. I cannot write off as easily as noble Lords opposite have done the fact that each successive Government has, in turn, felt such a duty. The Labour Government imposed charges for spectacles and teeth. They also passed in 1949 the enabling legislation for the prescription charge. The alibi of the Korean war will not do. The Act was passed a year before the Korean war. The ceiling of £400 million, which proved to be impracticable when Sir Stafford Cripps was faced with a similar crisis to the present, was imposed in April, 1950; and that is when the statement was made— months before the Korean war. The noble Lord, Lord Silkin, really must not assume that memories are so short.

It is difficult to see, in view of these facts, how noble Lords opposite can claim that a prescription charge in a period of soaring costs is, in principle, either something which ought not to be levied at all or something which ought never on any account to be increased above 1s. The real trouble, as my noble friend Lord Amory pointed out, and as the noble Lord, Lord Taylor, himself has candidly admitted, is that the Labour Party have never really accepted the Labour Government's decision in 1949 and 1950. My Lords, I am proposing to justify noble Lords opposite to their own supporters, and, if I may say so, it is an example of what I might, I hope not too facetiously, call "Hailsham's Second Law": "The responsibility of a political Party is in inverse proportion to its chances of getting office."

The justification for a prescription charge is twofold. It is equitable, and it is administrative. It is equitable because, in the kind of society which we now have, there is an essential social justice in asking people to pay a small sum—in this case a very small part of the cost of what they get—when they get it. It is not a good thing in principle to allow people to believe that, having a good job for good wages, they should then look to other people to supply them with everything except luxury. There is an administrative justification, too. I do not suggest (I do not think anyone suggests, although some people, not in this debate, have done so) that there has been, or ever was, a conscious abuse of the Health Service, either by patient or practitioner, on a scale sufficient to justify a general indictment. But if one is responsible for the use of public money, one must seek to put in some balancing factor to counteract the inbuilt defects of the system—the result not of conscious abuse, but of inherent tendency.

The noble Lord, Lord Taylor, interrupted my noble friend Lord Newton to raise the question whether we thought the dentists did not sometimes put in dentures which were not entirely necessary. My Lords, do not claim to be an expert in dentistry, but I do know that that is exactly what has been suggested at times: that the in-built ten- dency of the Service was to cause people to have dentures which were not really necessary. That is why there grew a new doctrine in dentistry—the better sort of dentistry, called "conservative dentistry," the object of which is not to make dentures but to save teeth.

LORD TAYLOR

My Lords, the noble Viscount says that the prescription charges are administratively justified. Has he read his own Government Committee's Report, The Cost of Prescribing, made by the Hinchliffe Committee, where they say: The present prescription charge is a tax which, besides stimulating the wrong incentives, has proved disappointing financially. Consideration should he given to the desirability of abolishing the prescription charge altogether. That is a most serious Report which, so far as I can see, has been completely ignored by Her Majesty's Government.

VISCOUNT HAILSHAM

My Lords, the arguments were put very powerfully by the noble Lord in his speech, but I am now seeking to answer the arguments which, although they could hardly have greater authority than the noble Lord himself, would, of course, have a very much added authority from the fact that they were supported by the Hinchliffe Committee.

But, my Lords, however conscientiously the system may be used, the fact remains that the tap of public expenditure is turned on by the combined action of the patient, whose natural tendency when he visits the consulting room is to expect, and in circumstances perhaps even to press for, a bottle of something, and the doctor, whose legitimate anxiety is to do something positive to give reasonable satisfaction to his patient. It is not unreasonable, only responsible, to put into the machinery some factor: an expense not small enough, we believe, to deter the proper use of the Service, but large enough to ensure the proper use of the Service. Obviously such a charge must be generously and humanely administered. It is also obvious that the cost has to be recoverable in suitable cases. But that is what is being done.

It is obvious that the chronically sick must be made a special case, and must be prescribed for in adequate quantities; and that also is being done. If there are any other ways in which experiences shows it can be done better, I feel quite certain that my right honourable friend will do it. As experience grows, the harder cases would be identified and dealt with, at first individually, and later probably generically, by rule. With a total of 220 million prescriptions a year, there is bound to be room for improvement. But that is what the Government propose to do. In the meantime, I would submit that it really is too much to pretend that 2s. is in general, an excessive burden in a society where average wages for men still run, as at present, so I am told, to £14 10s. a week, and where social security payments are at an all-time high.

My Lords, as the noble Lord, Lord Beveridge, discovered, and as I think the noble Baroness, Lady Summerskill, also found (and may I, in passing, both congratulate her on a highly successful debut in this place, and also tell her what a great recruitment of strength she will prove to the Labour Party in debate, which, after all, was part of the object of the exercise; and for her own sake we are all very glad to welcome her), £14 10s. is only an average figure. But the question at issue has a good deal of bearing on that. The question at issue is whether, in order to make more easy the path of those to whom the payment of 2s. may be difficult, we have to give the service to all, every time they are ill, without any form of charge at all. That is the question. You really do riot assist that argument simply by pointing out that there are hard cases, which everybody is as anxious to deal with as, I think, the Party opposite.

There is no evidence, so far as I know, that the original charge of Is. inflicted any real hardship. It is, of course, true that the recovery in hard cases of the sum presents certain difficulties of what the noble Lady called "mechanics." But I must press on the House and on the noble Lady that the mechanics are just as difficult if what is recovered is 1s. as they are if what is recovered is 2s. That is an argument not against the Government's present proposals, which is what is under discussion this afternoon, but against the principle of a charge at all.

BARONESS SUMMERSKILL

My Lords, I think that the argument that the noble Viscount has just adduced is a little faulty in logic. There is a difference between parting with 1s. in the first place and parting with 2s.

VISCOUNT HAILSHAM

My Lords, obviously there is a difference between parting with 2s. and parting with 1s., but the point which I was venturing to put and which I do not think is faulty in logic is that the difficulty in the mechanics of form-filling—which is what the noble Lady was referring to, as she will find if she will refer to her excellent speech in the OFFICIAL REPORT—is just as great when filling in a form for 1s. as when filling in a form for 2s.

To my mind, the weakest part of the case made against us is that relating to welfare foods—orange juice, for which at present 40 per cent. of those entitled put in; vitamin tablets, for which at the moment 30 per cent. entitled to it put in, and cod liver oil, for which 9 per cent, of those entitled put in. Here I think we can all agree about the necessity of a balanced diet and on the fact that, on the whole, mothers and young children have probably the largest vitamin requirement. No one denies the need for the availability of these supplements, or that, in suitable cases, they should be issued free. What is in question in the present proposals is a continuance of an indiscriminate subsidy long after the circumstances which gave rise to the need for it have radically altered.

The welfare food subsidy was essentially an emergency measure for war and its aftermath. Our general diet was then restricted. Bread and potatoes, neither of them usually rich sources of vitamins, were a substantial part of the general diet. Butter, a source, I believe, of vitamin D, blackcurrent juice, fresh fruit and vegetables were either difficult to obtain or obtainable only at high prices and in insufficient quantities. Moreover, a great proportion of the young adult male population—the breadwinners, as it were—were in the Services, earning rather less than their economic wage. The case then for a generally subsidised supplement to the diet of mothers and children was surely overwhelming. But none of these circumstances applies now, in 1961. As my right honourable friend said in another place, people must really be living in an unreal world if they suppose that in 1961 a mother has neither the wit nor the money to choose how the vitamin uptake of the family should he regulated, and requires a subsidy either to make good her income or her absence of understanding. The smallness of the current uptake, to which I have referred, seems to indicate that, in the opinion of the mothers of the nation, an adequately balanced diet for their families can be had, in numberless cases, without recourse to these special supplements, and no evidence has been brought before the House of any cases where they ought to be made available for a general subsidy.

I am sorry to prolong this matter at some length, but I have had several points to answer. Several noble Lords have invited us to look to the drug manufacturers for part of the economies to be sought by the scheme. This was mentioned by the noble Lord, Lord Silkin, by the noble Lord, Lord Beveridge, by the noble Baroness, Lady Summerskill, and by other noble Lords. Of course, if and in so far as it is proper to do so, my right honourable friend will make full use of this suggestion, not instead of, but in addition to, his proposals in the present case. It is our duty to see that the National Health Service is not exploited in any way. But, without going the whole way with the noble Lord, Lord Ferrier, I think I should urge one or two cautionary notes.

In the first place, our objective ought to be to achieve a just price in every case between the manufacturer and the Service. In so far as profits could be thought to be excessive, this must be recognised as a failure on our part which must be put right, irrespective of our general policy on these proposals In so far as profits are not excessive, then I think it would be wrong to look to the manufacturers, whose legitimate profits are, of course, subject to income tax, to recoup the Service by reducing prices to levels which may not be just. I must warn the House against too facile an acceptance of some of the figures which have been used. I must insist that the profits which are sometimes quoted relate, as the noble Lord, Lord Ferrier, pointed out, to veterinary products, products for export and products sold otherwise than through the Health Service, and are not simply Health Service figures.

Secondly, I would say that in approaching the reasonableness of profits, it is reasonable and just to measure profits in relation to turnover rather than in relation to share capital. At this stage, I think that perhaps I should say to the noble Lady, who quoted American figures, that I have some figures relating to American profits which indicate that, under the administration of a succession of Governments of different complexions, in this country, profits are less than one-third of what they are in America, which indicates that we have met with a good deal of success.

Thirdly, I would say in this connection that, if we are to pursue a policy, advocated I think on all sides, of industrial expansion, it is important to encourage industry in every way to expand its research, much of which, in the nature of things, is almost always abortive in the first instance. It is reasonable that an industry which devotes its money to the risk and expense of new discovery should be rewarded more richly than the business which pursues a legitimate but humdrum course of ordinary manufacture. When these higher rewards result in higher profits, I think we can trust the tax-gatherer to make the necessary social adjustment. What is wrong is to discriminate against the man who uses science 'by treating him less favourably than his less adventurous competitors.

I do not want to pursue, because it is not within the terms of the Motion, the interesting dispute which began to develop between the noble Lords, Lord Ferrier and Lord Taylor, about the position of research in the practice of manufacturing medicine, but I cannot resist putting forward my own point of view as Minister for Science in this connection. It is true that basic medical research is and ought to be financed by foundations and to increasing degrees by the State, through the 'Medical Research Council, but this is only parallel and analogous to the business of research in industry generally. There is a place in research for publicly financed research, usually that of a more refined and pure character; but between that and the application of research in actual commercial practice a great deal more science ought to be used than is being used and a great deal more science ought to be used than can be used simply by the national institutions or by teams working under national finance. Indeed, part of the trouble we have, not only in medicine but over the whole range of industry, is to induce the commercial firm first to employ a scientist and then to use him so that the results of his science can be known. Of course, in a rapidly developing industry this will involve very often individual firms running in parallel lines of research. All the advice which I have received is that this is not necessarily a bad thing.

I would fully accept that we must be careful of the public interest in this matter, and I know that my right honourable friend will be greatly fortified in his dealings with the industry by the expressions of opinion which have been made, I think from all sides of the House, in regard to it. We must also consider the aspect of the matter which I felt it my duty to put forward. In a sentence, I may say that since the war we have succeeded in building up the medicine industry into one of the important exporting industries of this country. I think I can say that our prices are very competitive with those of the United States of America, and I hope that they will remain so.

I do not propose to spend time dealing with the extra charges for teeth, spectacles or amenity beds, although I have taken note of what my noble friend Lord Gifford and other noble Lords have said. I am sure we are all glad of the remissions for children, which we have been wanting to make for some time. It is difficult to see how any serious claim can be made that the increases for adults are not adequately accounted for by increases in costs.

I therefore conclude by a short reference to the general financial argument. Of course the need for any increase in charges must he justified in context. But the context in which we justify it is supplied by three groups of facts: first, the constantly rising cost of the National Health Service expenditure in relation to other needs; secondly, the desperate need for further expenditure by increasing the scope and value of this Service and other social services; and thirdly, the general needs of the nation for a policy of public action which will support the foreign policy we were talking about the other day. I do not now question, and I never have questioned, the sincerity of noble Lords opposite. I do not now grudge them, nor have I ever grudged them, the privilege—for it was a privilege—of having been the British Government first to he able to carry out the measures of social security that we all planned in the last years of the war. Like my noble friend Lord Amory, however, I do twit them rather for not having moved since then; for being now nearly 20 years out of date. The people of to-day are fully employed, enjoying wages the consequences of half a generation of full employment. The mentality of this Motion of censure is ultimately a mentality which would condemn them to the financial corollary of pauperdom. The Welfare State, which noble Lords opposite largely created, will continue to grow and develop in Conservative hands and on the lines I have tried to indicate. But it will slough off the dead skin and characteristics appropriate only to a period of under-employment.

7.54 p.m.

LORD SILKIN

My Lords. I rise for a few moments to conclude this debate. I am sure we have all listened with great enjoyment, and certainly with interest, to the statement: of the noble and learned Viscount; he has given us an interesting and lofty example of debate and dialectics which we have very much appreciated. But I am bound to say that little of what he has said has been directed to the Motion which we have put down. We take the view that the real issue before us to-day is not that there is a danger of the cost running away with the Service, or that this Service will be in any way interfered with. We accept the fact that the Service is going to cost more in the coming years. The question and the issue before us is: who is to bear that cost? Is it to be placed upon the shoulders of the poorer section of the community, or is it to be placed upon the public as a whole?

Although the noble Viscount suggested that it was where my argument intended to lead, I am not necessarily saying that the whole of the cost should be borne out of taxation. That was not my case, because I was not dealing with the philosophy of the thing at all, but simply with the additional charges—the:£60 million in a full year—which are to be borne. Nor was I suggesting that the Government are going to do the same thing with education. My point on education was that exactly the same argument as they are putting forward for putting the burden of the additional cost on the people who are going to suffer sickness can be made as regards increased costs of education. I am not suggesting that the Government have yet arrived at that conclusion, although it is possible that in the future, if there were heavy additional cost on the Educational Estimates, they might come to the conclusion, on the same line of argument, that it was right that that should be borne by the people who benefit by the education. What I did say was that I thought if there were any further budgetary difficulties on the Health Service, this would form a further precedent for increasing the charges.

I am not suggesting that large sections of the community are unable to bear this increased cost, but I say that a considerable number will be. I thought I gave some figures showing that it was going to affect a substantial number of people; that it was going to be a hardship on them, and that it was going to be a deterrent to their accepting treatment. It was for those reasons that I felt, and we on this side feel, that this ought to be resisted. I have a feeling that quite a number of noble Lords opposite have the same view about the additional charges for spectacles, teeth and prescriptions; I thought that at least three noble Lords opposite in their speeches expressed apprehension on that

subject. Certainly the same view was expressed by the Medical Association and by the Medical Practitioners' Union, two bodies that ought to know something about it; and, as I said, a good deal of apprehension has been expressed in the Sunday Times.

I do not think it is possible to develop the case any further at this time of night. I have made my own position quite clear. I thought I had made a pretty conclusive case for condemning the Government for seeking this method of providing the moneys for the increased health costs. I thought that there was a much more satisfactory alternative, and to some extent the noble Viscount has accepted the case—to a small extent, I admit—by recognising that there was the possibility of making savings, which is a concession we have not received up to now so far as the cost of drugs is concerned. If that will lead to an inquiry into the matter, it will be welcomed generally. I do not propose to add anything further to what has been said. We are fundamentally in disagreement on this question. We feel that the Government approach is quite wrong and unjust, and we propose to divide the House on this question.

On Question, Whether the said Motion shall be agreed to?

Their Lordships divided: Contents, 27; Not-Contents 79.

CONTENTS
Addison, V.	Douglas of Kirtleside, L.	Pethick-Lawrence, L.
Alexander of Hillsborough, V.	Granville-West, L.	Shepherd, L.
Amwell, L.	Henderson, L.	Silkin, L.
Attlee, E.	Latham, L.	Stonham, L.
Burden, L. [Teller.]	Lawson, L.	Summerskill, B.
Chorley, L.	Listowel, E.	Taylor, L.
Crook, L.	Lucan, E. [Teller.]	Williams, L.
Dalton, L.	Macpherson of Drumochter, L.	Wise, L.
Darwen, L.	Pakenham, L.	Wootton of Abinger, B.
NOT-CONTENTS
Amory, V.	Carrington, L.	Dundonald, E.
Ampthill, L.	Chesham, L.	Falmouth, V.
Ashton of Hyde, L.	Cholmondeley, M.	Fortescue, E.
Atholl, D.	Colville of Culross, V.	Freyberg, L.
Auckland, L.	Conesford, L.	Furness, V.
Balfour of Inchrye, L.	Craigmyle, L.	Gage, V.
Bathurst, E.	Crathorne, L.	Gifford, L.
Birdwood, L.	Croft, L.	Goschen, V.
Boston, L.	Cullen of Ashbourne, L.	Gosford, E.
Brand, L.	Davidson, V.	Hailsham, V. (L. President.)
Brecon, L.	Denham, L.	Hastings, L.
Buchan, E.	Derwent, L.	Horsbrugh, B.
Buckinghamshire, E.	Drogheda, E.	Howard of Glossop, L.
Carrick, E.	Dundee. E.	Howe, E.
Hylton, L.	Newton, L. [Teller.]	Soulbury, V.
Jellicoe, E.	Onslow, E.	Spens, L.
Jessel, L.	Perth, E.	Strathcarron, L.
Kilmuir. V. (L. Chancellor.)	Radnor, E.	Stuart of Findhorn, V.
Lambert, V.	Rathcavan, L.	Swinton, E.
Lansdowne, M.	Rochdale, V.	Teviot, L.
Lothian, M.	St. Aldwyn, E. [Teller.]	Torrington, V.
McCorquodale of Newton, L.	St. Oswald, L.	Tweedsmuir, L.
Malmesbury, E.	Salisbury, M.	Waldegrave, E.
Massereene and Ferrard, V.	Savile, L.	Waleran, L,
Merrivale, L.	Sinclair, L.	Ward of Witley, V.
Milverton, L.	Somers, L.	Wolverton, L.
Newall, L.

Resolved in the negative, and Motion disagreed to accordingly.

House adjourned at ten minutes past eight o'clock.