ADDRESS IN REPLY TO HER MAJESTY'S MOST GRACIOUS SPEECH (Hansard, 21 November 1963)

§ BARONESS SUMMERSKILL

My Lords, we are now moving towards the end of the debate on the gracious Speech, and no doubt many of us feel that this is the moment when we can comment on some aspects of the debate or the Amendments. I have only one comment to make. It is that I have noticed a curious change in the personalities of noble Lords who wind up our debates. There has been an aggressive spirit introduced. Indeed, if I were of a suspicious nature, I should almost feel that the Conservative Central Office had charged noble Lords to be perhaps a little more aggressive between now and next May. As I sat listening last night to the winder-up, I must confess that I began to think of Henry V and certain lines that I learned when I was much younger: … imitate the action of the tiger; Stiffen the sinews, summon up the blood, Disguise fair nature with hard favour'd rage. This seems to be now rather typical of the attitude of noble Lords, men who, as a newcomer to this House, I have always felt were mild, kindly and well-mannered. I must confess to feeling that last night the noble Lord who 455 wound up interpreted these instructions that I suggest have come from the Conservative Central Office in such a way, after a debate on education, that he used epithets which certainly did not reach Newsom standards. He deserved the gentle rebuke of my noble friend Lord Longford. But now I see the noble Lord, Lord Newton, sitting there and I am sure that nothing I have said will apply to him.

I am disturbed to find that the gracious Speech makes no mention of the immediate needs of the most hard-pressed in the country. There is some mention of social advance in relation to education, and we have had a useful debate on that. But surely it is axiomatic that the social progress of a country is measured, in the first place, by a Government's concern for the most helpless in the community. I always remember that a Government could be criticised, in the first place, on the ground that they did not treat their women fairly. But now I think we should criticise a Government if they fail, in the first place, to treat fairly the most helpless in the community.

Is my criticism valid? Why is there no mention of the widows? There are hundreds of thousands of widows in this country compelled to live on a pittance, and if they decide to add to their tiny income, they are subject to an earnings rule. Last night a noble Lord said to me in another room, "It is quite impossible to find women to work in our social services. "Throughout the country there are widows, with no dependants, free to do what they like, but unable to work because this Government, for some incredible reason, make their miserable little income which they earn subject to an earnings rule. What of the millions of aged people in our population? There are now at least 4 million who are struggling to survive on an inadequate retirement pension.

I know why so many of these hard-pressed people are not mentioned in this gracious Speech. It is not surprising that some of our most tragic social problems remain unsolved, because the frequent changes of Ministers in some Departments discourage a consistent policy. With the advent of our new Prime Minister comes a new Minister of Health, the seventh in twelve years. 456 The disappearance of Mr. Powell at this juncture is curious. He told the Press that he did not object to the Prime Minister and he did not object to the Conservative Party. But he hinted that there were other factors concerned with ministerial office which he could not divulge. Has he withdrawn from the Ministry of Health because the Treasury are threatening to withhold supplies? But surely this cannot be, because I would recall to your Lordships that it was Mr. Powell who on another occasion resigned from the Treasury because he opined that they were too generous.

Then, again, there is Mr. Macleod. After the squalid struggle for the Leadership, Mr. Macleod took umbrage and immediately went, first, to journalism, and then into business. I ask the House: why should Mr. Macleod aspire to high office? He was, I think, the third Minister of Health in this series, and his record was little better than Mr. Powell's. After twelve years of Tory rule patients are still housed in old and dilapidated buildings, overcrowded and understaffed. Do your Lordships recall the second item on the news this morning, when we were told of the publication of a report by the School of Hygiene? The Report said: The food supplied to patients in this country was of such a quality that only 55 per cent. was eaten and the rest went in swill. I anticipate that the noble Lord, Lord Newton, when he rises, is going to tell the House of the very large amount of money which the Conservative Party have spent on the health services. This morning we were told of gross wastage, not by a member of the Opposition, but by an impartial body who had investigated the conditions of 152 hospitals in this country. Only 55 per cent. of the food is eaten and the rest thrown to the pigs. What I want to know from the noble Lord, when he comes to speak, is how he assesses the wastage.

I should also like to know about the length of the waiting lists. In some areas the waiting lists of our hospitals in Mr. Powell's day were as long as, or even longer than, in Mr. Macleod's time. There is a widespread shortage of accommodation for the aged, and those who stay in their homes are often neglected for lack of adequate domiciliary service. In the two years that I have been in this House I have raised this matter time after time. 457 I have said that we cannot have a comprehensive Health Service unless those who have to remain in their homes can be helped by the local authority with a nurse or a home help. But these people are not there, although the Government for the last twelve years have been urged to provide them.

We know, of course, that these big Papers have been published. We had a debate last year on the ten-year Hospital Plan and the ten-year local authority plan. Why has Mr. Powell deserted these massive exercises without a qualm? I can only suggest that he is tired of straining his eyes to glimpse the Promised Land. For these documents which are put before you and which the noble Lord, Lord Newton, will mention—there are dozens of them—are rich only in promises. I would remind your Lordships of what was said in the Hospital Plan which we discussed last year. It was published in January, 1962, and said: The plan here put forward embraces work which might be started up to 1971, and adumbrates the pattern of hospital services to be produced in the middle of the next decade or later. It really seems that the six Ministers of Health have been adept only at building castles in the air.

Now we come to the general practitioners and other doctors who serve in the hospitals. The supply of doctors in this country is more limited now than it was some years ago, because a few years ago the Government cut down the number of medical students and have only recently increased it. It takes seven years now to qualify as a doctor. Last week a Paper was produced which said that in order to provide enough doctors in this country we should have five more medical schools. To think that we must now build medical schools for the student, and then it will take the student seven years to become a doctor! We are short of doctors now. Although it may be said that many general practitioners objected to the National Health Service at the outset, the concept of that Service is now accepted. But the doctor feels that his conditions have deteriorated. In every charge I make I feel fully supported by a publication of the Government. What did the Gillie Report on The Work of the Family Doctor say? It said: 458 Without exception, every principal we met has regretted the impossibility of achieving a satisfying standard of work with the present maximum under existing working conditions. I understand that the theme of our new Prime Minister is newness. But you cannot change the character of a Government by interchanging two noble Lords for two commoners. I think I am right in saying that after twelve years the electorate is more entitled to consider the Government's record over these twelve years than to be concerned with the next six months' promises. The fact is that in this country to-day, without doctors and nurses from the Commonwealth many hospitals could not be staffed. The noble Lord denied that last year. May I remind him of the Platt Report? That Report estimated that 51 per cent. of the junior staff in the hospitals of the North come from overseas. And this has all come about in the last twelve years. Recently a Report on the development of community care has been published. This has been examined in detail by the Medical Practitioners' Union, and they have listed services in each area which cannot be established until 1972, at this rate of progress. They say that all over Britain there are areas with no homes planned for the physically disabled and mentally subnormal, and no hostels or day centres for the mentally ill. They say that the numbers of health visitors, home helps and home nurses are well below the number needed. Yet these auxiliary workers are crucial to the establishment of a domiciliary service.

In order to cope with the growing number of elderly people in the country, the British Medical Association has urged that domiciliary physiotherapy should be provided to rehabilitate the chronic sick. This cannot be provided because there is a shortage of physiotherapists and, indeed, a shortage of all professions supplementary to medicine, particularly psychiatric social workers. These women are very grateful to this House, because your Lordships will recall that we had a debate on their conditions a years or two ago, and your Lordships were very sympathetic and supported them. But all these young women are grossly underpaid and, consequently, suitable girls are not offering their services.

It has been generally agreed that the right policy is to keep people out of 459 hospital in the interests of the patient, the hospital and the funds of the National Health Service. But one does not have to be a doctor to realise that in order to do that we must have a comprehensive domiciliary service. The noble Lord, Lord Newton—and I have come so many times to this Box and asked the same thing in the last two years—said this year that the development of a local authority service of trained social workers was in its earliest stages, and it would be premature to decide the most effective way of organising it". I would remind your Lordships that the Report of the Working Party on Social Workers, the Younghusband Report, was published in 1959; and yet the noble Lord comes to your Lordships this year and tells you that it is premature to make any decision upon it.

We have come to the position in this country now of prescribing pills to all and sundry because the service which should be available is not there. It is of little use prescribing pills for an old person who cannot look after herself without help, or sleeping capsules to an intelligent young woman who is bored because she is in a New Town. I believe that there are signs of social sickness everywhere, and manifestations of the most appalling ignorance. If a gas man calls on a lonely wife and she offers him a cup of tea and has a talk, she risks being called an amorous wife. But if she calls on the doctor and complains of loneliness and depression, the social conscience is satisfied if she is given pills either to pep her up or to soothe her. This is no exaggeration. The waiting rooms of the country are filled with people waiting for a prescription because the kind of domiciliary service which we should have staffed by the auxiliary workers, who could help these patients and potential patients, are not there. To-day our psychological cripples hobble along alone and provide a fortune for the drug industry. I believe that there is a great deal of untapped ability in the country, and there is no more certain way of inflicting unhappiness, and thereby inducing some degree of neurosis, than deliberately to ignore human capacity.

However, there seems little chance of securing the services of these auxiliary 460 workers to help with these problems because this Government under-values those already serving in the National Health Service. I think it is ironical that this Paper was published last week at a time when the nurses were making a protest and asking for more pay and shorter hours. The nurses' leaders argued that the claim should be approved, for only in this way could they reduce staff shortages which are crippling the work of many hospitals. The Ministry of Health officials and the hospital spokesmen refused to reduce the hours, and last week offered the nurses of the country a pound a week for night duty and Sunday work, an offer which had already been rejected.

In order to appreciate the enormity of the injustice, may I remind your Lordships again of the payment of these women? A State registered nurse who has also qualified as a midwife and is working part-time as a staff midwife in the National Health Service receives 5s. 0d. an hour—it actually works out at 5s. 0¼d. an hour. This is for a woman who has trained for at least four years and has had to pass written and practical examinations; who may be responsible for the care of women in labour and lying in, and who may be expected to teach pupil midwives: 5s. 0d.an hour, day or night. Is it any wonder that midwives give up practising and that the maternity units lack staff?

The exploitation of the nurses and midwives during the last twelve years has compelled them to ask for pay for night work and Sunday work, and this of course has created a crisis of conscience among the nurses, whose standards of medical ethics make them shrink from asking for extra nay for night work. Of course, the stupid handling of women's questions by this Government is not surprising when one realises that they have not one woman of Cabinet rank to advise them on even these questions. How can men understand these important problems which concern more than 50 per cent. of the population of the country?

This brings me to another Report published in 1959, the Cranbrook Report, which was concerned with the maternity services. It recommended that 461 hospital maternity beds should be provided for a national average of 70 per cent. of all confinements, and that antenatal beds should be provided for 20 per cent. to 25 per cent. of all confinements in the areas of hospital authorities. Furthermore, the Cranbrook Report said that experience in this country justifies adherence to a period of ten days as the normal length of stay in hospital after delivery. The position in this country is so serious that, during the course of discussion of the London Government Bill, it was revealed that in London last year there were 2,000 emergency cases of women in labour who had nowhere to go. The ambulances had to take them when they were actually in labour to find a hospital somewhere in London—despite the Cranbrook Report In some areas the shortage of accommodation is such that women are being discharged two or three days after the confinement.

In the Evening News last week there were the headlines: Mothers-to-be in Protest. Thousands of Mothers in North and West London are Protesting about Maternity Arrangements". It then added: New and larger maternity departments are to be provided at the North Middlesex Hospital". I served for seven years in the North Middlesex Hospital so I know it rather well. The hospital serves a large, congested area of North London and it still uses prefabricated huts of the First World War for its maternity work. Successive Ministers of Health have been told about this condition, but no action has been taken. I think that I have brought to the notice of your Lordships' House that over the last twelve years we have had a spate of White Papers and Blue Books—paper concepts only—but there has been no concrete, comprehensive service.

Finally, my Lords, I wish to say something about the cost and testing of drugs, something in which I believe every one of your Lordships has a special interest, for every one of your Lordships here is, after all, a potential patient. On February 19, 1953, I drew the attention of Mr. Macleod, the then Minister of Health, to the Report of the Auditor-General with regard to the heavy prescribing of expensive proprietary drugs, and I asked what action he proposed to 462 take in order to reduce this expenditure. That was in 1953. Mr. Macleod said: The doctors must refrain. For my part I am considering what further steps can be taken. In 1954 the average cost of a prescription—and I hope your Lordships realise that this does not mean just antibiotics; for the average costs of course include a few tablets of aspirin and of the minor things as well—was 5s. 1d.; in 1958, 7s. 4d.; in 1960, 8s. 5d.; in 1961, 9s. 3d.; and now I am told that it is over 10s. 0d. When it came up to 1959 the Government decided to set up a Committee, the Hinchliffe Committee, in order to consider the matter. The Committee recommended that an expert Committee should advise the Minister; but still the costs soared.

With regard to the testing of drugs, your Lordships will, I think, during the last few years have been alive to the dangers of the distribution of untested drugs in the country. Again this has been brought to the attention of successive Ministers of Health, and I think it was the thalidomide tragedy which focused public attention on the scandal. It was generally felt among doctors, and, I think, the public, that an impartial body should be responsible for testing, not the pharmaceutical industry which has a vested interest in the matter. This seems to me to be common sense. These views have been expressed time after time, but we have waited all these years. At last, when the House was in Recess, Mr. Powell announced in September that on January 1, 1964, a Committee will be convened to assess reports on toxicity tests and clinical trials of new drugs. Unhappily the toxicity tests are to be left to manufacturers and not to an impartial body, and therefore it will still be possible for an unscrupulous manufacturer to market medicines which have not been subject to a satisfactory test. When told of this, despite these Committees of eminent people, and despite his statement during the year, in which he said, "I want to show you all that these Committees will have teeth", he then said: If an unscrupulous manufacturer did distribute a drug which had not been tested, it could be brought to the notice of the Committee. I feel that is a little late. These drugs should be tested by an impartial body 463 before they are distributed. It is well known that there are many black sheep in the drug industry, which, with its American subsidiaries, has made a fortune out of the National Health Service, and I find it difficult to believe that Committees alone will induce a new, high standard of ethical behaviour among the black sheep. I think this highlights our indictment of the Government in the field of health. The test of a Government is not the aspirations they express, but the real worth of the men, the methods and the money they employ.