Lords Sitting of 7 July 1971

Preamble
The House met at half past two of the clock (Prayers having been read earlier at the Judicial Sitting by the Lord Donovan):
The LORD CHANCELLOR on the Woolsack.

STERLING BALANCES AND THE BALANCE OF PAYMENTS
LORD BALOGH LORD BALOGH: My Lords, I beg leave to ask the first Question which stands in my name on the Order Paper.
[The Question was as follows:
To ask Her Majesty's Government how the statement of the Prime Minister (Commons Hansard, June 10, 1971, col. 1236) that the reduction of official sterling balances must be reconciled with "the avoidance of unacceptable burdens on our balance of payments" can be reconciled with his assurance "that it (the reduction of sterling balances) must not be done in a way which would at any time put a burden on the balance of payments" (col. 1243) and whether this means that the burden will be reduced at a stroke.]
THE LORD PRIVY SEAL (EARL JELLICOE): My Lords, the position of Her Majesty's Government is that, as the Prime Minister said in his original answer of June 10 in another place, any proposal to reduce the official sterling balances would have to avoid "unacceptable burdens" on our balance of payments. His latest supplementary answer was, as he made clear, intended to be read in the context of his original answer. How much, if any, burden would in fact prove to be "acceptable" to Her Majesty's Government would depend upon our external prospects at the time.
LORD BALOGH: My Lords, I thank the noble Earl for his courteous Answer. I should like to ask two further questions. The first is: what is "unacceptable" in this sense of the word? Secondly, does this include the movement of capital out
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side England which will be necessitated by the rule of the Common Market not to have exchange control between its members?
EARL JELLICOE: My Lords, I thank the noble Lord for his courteous supplementary question. In reply, I would merely say that I think that if he reads carefully—as I am sure he will—the terms of my original reply he will see that "unacceptable" must depend upon our external circumstances at any time, and that will be a matter of judgment. It would be quite wrong for me to anticipate the discussions which are due to take place, I think in Brussels on Monday, July 12, where these questions of exchange movements and movement across the exchanges are, I believe, due for discussion. It would be quite inappropriate for me to anticipate those discussions in an answer to a supplementary question.
LORD HUGHES: My Lords, I am not in any way dissenting from the form of the Question, but may I ask whether it means that Scotland will be exempted from these perils?
EARL JELLICOE: My Lords, at one stroke I do not think that I would chance my arm on this. I should like to assure the noble Lord that the "perils" are probably much more imaginary than real, whether for Scotland, or England and Wales, or Northern Ireland.
LORD HUGHES: My Lords, may I ask the noble Earl whether, in this connection, "at a stroke" is a quicker thing than we are presently led to believe that it is?
THE EARL OF DUNDEE: My Lords, has not Scotland, by itself, always had a formidable balance of payments?
EARL JELLICOE: My Lords, I think that is a slightly different question.
LORD SHINWELL: My Lords, may I ask the noble Earl whether, if it is to be a matter of judgment, the judgment will be exercised before we enter the Common Market, or after, when it becomes irrevocable? Is that the situation? Putting it very shortly, if there is a reduction in the sterling balances after we enter the Common Market and that should be found to be unacceptable, what is our remedy then?
EARL JELLICOE: My Lords, I do not wish to get into a substantive debate on this question. I suspect that we shall be debating the subject of the Common Market at some length in the coming months; but I think that the word "unacceptable" is perfectly fair in what it means. I think that the past Government would have been very content with the sort of arrangement which is now provisionally agreed on in this areas by the present Government, and that they would have been equally good judges of what was unacceptable in the national interest.
LORD SHINWELL: My Lords, the noble Marquess has not answered my supplementary question. I agree that we can discuss the matter in detail when we are dealing with the Common Market in general. I am merely asking the question: when do the Government exercise their judgment? Is it before we go in, or is it when we are in and when it becomes irrevocable and we have no remedy?
EARL JELLICOE: My Lords, I must thank the noble Lord, Lord Shinwell, for promoting me in the hierarchy and I gratefully accept the promotion. The point is—this is perfectly clear, as I suspect the noble Lord knows equally well—that the detailed arrangements regarding this subject have still to be worked out, and they will be worked out if and when, but not before, we become a full member of the Community. Thus we shall have our full say in the working out of the detailed arrangements.
LORD ALPORT: My Lords, may I ask my noble friend whether it is not true that in the event of this country becoming a member of the Common Market we shall have the same rights as existing members of the Common Market to ensure the maintenance of our essential interests—rights such as have been insisted on by France, Germany and all the other members, right from the start of the Treaty of Rome?
EARL JELLICOE: My Lords, my noble friend is quite right in this, as in most other matters.
LORD CHAMPION: My Lords, may I ask the noble Earl if, in his capacity as Leader of the House, he will tell the House whether it is normally acceptable
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for certain words in a Question to be italicised for the purpose of emphasis?
EARL JELLICOE: My Lords, I should like a lot of thought to consider the answer to the noble Lord's supplementary question. I think that he has put a very valid point and that it is one which, if need be, I am sure our very active Procedure Committee could well look at. Off the cuff I should not wish—in any event, it would not be possible—to venture a definite ruling.
LORD WYNNE-JONES: My Lords, would the noble Earl at the same time consider whether footnotes might be allowed?
EARL JELLICOE: My Lords, we are beginning to stray a little from the original Question.

BRITISH STEEL CORPORATION BOARD APPOINTMENTS
2.37 p.m.
LORD BALOGH LORD BALOGH: My Lords, I beg to ask the second Question which stands in my name on the Order Paper.
[The Question was as follows:
To ask Her Majesty's Government on the basis of what qualifications the new part-time members were appointed to the Board of the British Steel Corporation.]
THE MINISTER WITHOUT PORTFOLIO (LORD DRUMALBYN.): My Lords, if the noble Lord will read again the first section of the Iron and Steel Act 1967, he will see that it requires the Secretary of State to appoint the Corporation from among persons appearing to him to have had wide experience of, and shown capacity in, the production of iron ore or iron or steel; or industrial, commercial or financial matters; or applied science, or administration or the organisation of workers. Manifestly, the three part-time members recently appointed to the Board have had wide experience in, and shown capacity in, one or more of the fields specified, and my right honourable friend considers each of them in every way well fitted to serve as part time members of the Board.
LORD BALOGH: My Lords, I thank the noble Lord for his Answer. May I

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ask him three supplementary questions? Does he realise that Sir Matthew Stevenson was responsible, as Permanent Secretary, for the Continental Shelf Act, and also for the negotiations with B.P., that both things cost the country thousands of millions of pounds by not taking care of the country's interests, and that the two other gentlemen have made violently partisan statements against nationalised industry? Finally, may I assume that the present political persecution which has broken out in the Steel Board—
SEVERAL NOBLE LORDS: Oh!
LORD BALOGH:—is one of the first consequences of these gentlemen joining the Board?
LORD DRUMALBYN: My Lords, my right honourable friend is quite satisfied—as I think we all are—that Sir Matthew Stevenson is a man of great integrity, and that the advice he gave to the Government at the time when he was Permanent. Secretary at the Ministry of Power was entirely appropriate. With regard to the second supplementary question, the two other part-time members, as I have said, are men of great capacity and have the appropriate experience; and my right honourable friend is satisfied, in the light of their experience, that they will make a valuable contribution to the Steel Board. With regard to the third question of the noble Lord, the Chairman of the Board has made it quite clear that the appointment in question was solely in the hands of the Corporation. The Secretary of State appoints only members of the Board. Responsibility for the appointment and termination of appointments of all officials is entirely a matter for the Corporation.
LORD OAKSHOTT: My Lords, is not the indignation over this matter rather synthetic'? Are memories really so short? Is it not a fact that only very recently the present Conservative Government appointed as head of British Rail, Mr. Richard Marsh, a former Labour Member of another place, and there was no question of political prejudice in that?
LORD DRUMALBYN: My Lords, I am grateful to my noble friend. I entirely agree with what he has said.
LORD BALOGH: My Lords, while thanking the noble Lord for his answer to my supplementary questions, may I ask whether the word "appropriate" is appropriate in a case where one can show that the consequence of actions is disastrous'?
LORD DRUMALBYN: My Lords, the advice I have in this matter is that the advice extended at that time by Sir Matthew Stevenson was very far from disastrous, and that it enabled the industry in question to get on its feet.
LORD SLATER: My Lords, would not the noble Lord agree that it has become the policy of the Government to give notice to those whom they have appointed as Chairmen of these Boards (I am thinking particularly of the case of the Chairman of the Post Office) of the termination of their appointments after they have been only a short period of time in office?
LORD DRUMALBYN: My Lords, I do not understand how the noble Lord can relate that observation to the Question on the Order Paper.
LORD HYLTON: My Lords, can the Minister say that it is not the general policy of the Government to eliminate from the nationalised industries those who have Labour feelings and wish to protect the nationalised industries from hiving-off, and, further, whether this process has not been accelerated in the last twelve months?
LORD DRUMALBYN: My Lords, I have already said that the Government had nothing to do with the action which was taken and to which the noble Lord, Lord Balogh, referred in his third supplementary question—nothing whatever.
EARL JELLICOE: My Lords, I wonder whether I may make a slight intervention. I am not in any way quarrelling with the terms of the original Question or with the terms of most of the supplementary questions: they were perfectly in order. All I should like to suggest to your Lordships is that questioning which takes a particularly personal form about public appointments is unusual in your Lordships' House. I would not wish to go further than that.
LORD BLYTON: My Lords, if we suspect that people who are of Labour feeling are being sacked because they refuse to hive-off, surely we are entitled to protest?
LORD DRUMALBYN: My Lords, if the noble Lord suspects such a thing, he is quite entitled to explore the matter. I hope that I have laid his suspicions at rest.
LORD SLATER: My Lords, am I to assume from the intervention of the noble Earl the Leader of the House that when appointments to the Boards of nationalised industries have been made by Ministers and when a sacking takes place, we are not allowed to ask questions and seek to get answers from Ministers about such actions?
EARL JELLICOE: No, my Lords. I think that the noble Lord, Lord Slater, is misinterpreting what I said and perhaps he would like to look at it in Hansard tomorrow. I was confirming that there was nothing said in your Lordships' House, either by way of Answer to the original Question or answer to supplementaries, which was in any way out of order. I think that answers the noble Lord's question. All I was saying was that the personal tone which questioning had taken was unusual in your Lordships' House. I would not go further than that.
LORD SHACKLETON: My Lords, I apologise for inadvertently having missed the Question. I am advised that it is open to noble Lords, if they wish to pursue this matter, to do so by a substantive Motion. It may well be that the extent to which questions and answers on a subject of this kind can be pursued, though wholly in order in another place, is not in order here. I think that the noble Earl the Leader of the House has been moderate in his approach, in that he has suggested that this is entirely in order. It could be a matter of profound importance for noble Lords not to deny themselves the right to probe into these matters. It well may be that noble Lords may wish to put down an actual Motion, but that is a matter for fuller consideration.
LORD BLYTON: My Lords, it is possible to put a substantive Motion on this
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point, but it is left to the usual channels whether this subject is picked or not.
EARL JELLICOE: My Lords, if the noble Lord is putting a question, I should like him to put it by way of a question. I do wish us to keep within the rules of our procedure.
LORD SHACKLETON: My Lords, we seem to have moved slightly into a discussion on procedure. I think that my noble friend should be allowed to make his point; all the more so since I think that there is an answer to it.
EARL JELLICOE: My Lords, I was not objecting to the noble Lord, Lord Blyton, making his point. I was merely asking, since we are at Question Time, that he should phrase it by way of a question.

SCOTTISH CHILDREN'S FREE SCHOOL MEALS
2.46 p.m.
LORD GARNSWORTHY LORD GARNSWORTHY: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
[The Question was as follows:
To ask Her Majesty's Government the number of children in Scotland who are in receipt of free school meals.]
THE MINISTER OF STATE, SCOTTISH OFFICE (BARONESS TWEEDSMUIR OF BELFIELVIE): My Lords, on May 27 the number was 120,497.
LORD GARNSWORTHY: My Lords, while thanking the Minister for that reply, from which I understand that over 120,000 are taking up school meals, may I ask how that figure compares with the estimate of the number of those entitled to claim free school meals?
BARONESS TWEEDSMUIR OF BELHELVIE: My Lords, there was no exact estimate, because it was expected that there would be a fall-off, as there always is after examinations and in the height of the summer period, but there has been an increase in free meals from 11·1 per cent. to 13·4 per cent. and a decrease in the meals that are paid for from 30·2 per cent. to 20·4 per cent. I think it is easier to give it in percentages. Therefore, the net decrease over the whole field is from 41·3 to 33·8 per cent.
LORD GARNSWORTHY: My Lords, may I ask the Minister whether the figure she quoted of 120,000 does not represent an extraordinarily rapid increase in the number of those obtaining free school meals, in the light of the information given in another place on May 15 which indicated that the number was roughly about 50,000?
BARONESS TWEEDSMUIR OF BELHELVIE: My Lords, I think that this is a very satisfactory increase in the number of those taking free meals, but of course at the time when the price was raised from 9p to 12p we increased certain social benefits, as no doubt the noble Lord will recall.
BARONESS SUMMERSKILL: My Lords, could the noble Baroness clarify this point? Are we using the same terms? I should like to know whether the first number the noble Baroness gave represented the number of those eligible. I want to know the difference between those who are eligible and those who consume.
LORD GARNSWORTHY: My Lords, before the noble Baroness replies, may I draw attention to the terms of my Question, which specifically asks for the number in receipt'? If the estimate is 120,000, then I should certainly be obliged to know the number taking up free school meals.
BARONESS TWEEDSMUIR OF BELHELVIE: My Lords, I wonder if the noble Lord and the House will look at the terms of my reply and at the Question on the Order Paper. The Question was whether I would give
" the number of children in Scotland who are in receipt of free school meals."
I replied that the number on May 27, when the special survey was taken, was 120,497.
BARONESS SUMMERSKILL: My Lords, when the noble Baroness says "in receipt of", is that equivalent to "eligible"?
BARONESS TWEEDSMUIR OF BELHELVIE: No, my Lords, it is not, but that was not the Question on the Order Paper. I regret that I did not answer the noble Baroness at the beginning.
LORD GARNSWORTHY: My Lords, may I then, with great respect, ask the noble Baroness whether she will indicate the number of those entitled to free school meals who are in fact in receipt of free school meals?—because I understand that it is claimed that there are 129,000 entitled, but we are not aware of the number who are in receipt.
BARONESS TWEEDSMUIR OF BELHELVIE: My Lords, I would say once again that I have exactly answered the Question on the Order Paper.

IMMIGRANT LABOUR REQUIREMENTS
LORD O'HAGAN LORD O'HAGAN: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
[The Question was as follows:
To ask Her Majesty's Government when they will produce forecasts of the requirements by the United Kingdom of immigrant labour for the next few years.]
LORD DENHAM: My Lords, the Government will be able to make an announcement about the future intake of immigrant labour into Great Britain when they have completed their review of the relation between the current intake of overseas workers and our manpower needs.
LORD O'HAGAN: When, my Lords?
LORD DENHAM: My Lords, I am afraid that I cannot give the noble Lord that information.
LORD O'HAGAN: My Lords, is it not rather peculiar to be having to debate White Papers about the Common Market and an Immigration Bill without having these highly relevant figures? Could the noble Lord perhaps get some help from the noble Lord, Lord Rothschild?
LORD DENHAM: My Lords, my right honourable friend is quite right in having this review carried out to balance, on the one side, the unemployment problem in this country, and, on the other side, the wish of immigrants to come here. That is the sole purpose of the review that is being carried out. It is very much better that the review should be a

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thorough one to give my right honourable friend the information that he needs, rather than that he should set any time limit.
LORD O'HAGAN: My Lords, I accept that reply, of course, and I thank the noble Lord. But has it not been known for some time that the future manpower needs of this country would be being discussed, both when we were thinking about the Common Market and when we were thinking about the Immigration Bill? Would it not have been manageable to have got this forecast going and come to a conclusion by the time that your Lordships' House had to discuss these two important matters?
LORD DENHAM: No, my Lords. It is difficult to work out exactly what the manpower needs will be. Even this review will not produce a long-term forecast. It is most important that everything should be flexible on this matter.

EUROPEAN COMMUNITIES AND THE UNITED KINGDOM
LORD DENHAM: My Lords, with the permission of the House, my noble friend the Leader of the House will be making a Statement on the E.E.C. White Paper at a convenient moment after 3.30 p.m.

PROCEDURE
2.54 p.m.
LORD SHACKLETON: My Lords, before we leave Questions, may I ask the noble Earl the Leader of the House whether he will reconsider the—I hesitate to use the word "ruling" because, as I know, no Leader can give a ruling, but whether when the propriety or appropriateness of a question is under discussion, and the procedure that is to be followed is before the House, it is really necessary at that stage to frame one's remarks in the form of a question? I think the House will accept that I have always sought, and as Leader of the Opposition it is still my duty to uphold, the proprieties of your Lordships' House. But when my noble friend Lord Blyton raised a point just now, I do not think it was necessary to remind him of
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our custom, since his question related to procedure and not to the Question on the Order Paper. It may be that the noble Earl would wish to consider this point further, but if the House is to exercise its judgment in these matters without giving rise to a general debate, even if what is said does not relate to the particular Question on the Paper, I think noble Lords who are concerned should be able, however briefly, to express their opinion. It may be, as I have said, that the noble Earl, Lord Jellicoe, would wish to consider the matter further, but I think it rather important in the interests of the House to make this point.
EARL JELLICOE: My Lords, I am grateful to the noble Lord the Leader of the Opposition. I certainly should not wish—indeed as he said, I am not in a position to do so—to give a definitive ruling on this sort of matter; and I certainly was not wishing to give any definitive ruling on the question of substance. I made it absolutely clear that there was nothing out of order in the way we were proceeding. But I felt—and here I am just as anxious as any other noble Lord to safeguard our proprieties—that we were straying rather beyond our traditional areas. This may be right: I am not expressing an opinion; I am merely pointing it out. If I curtailed the debate unnecessarily and improperly by asking the noble Lord, Lord Blyton, to couch a further supplementary question by way of interrogation, I extend my apologies to the noble Lord. It is my impression that at Question Time we go by way of interrogation. If one interjects, as I did, then I am not certain what happens within the square brackets. This is perhaps something that we can look at. If I was unnecessarily terse towards the noble Lord, Lord Blyton, I extend to him my apologies, but I do not, if I may say so, resile at all from anything that I said on the point of substance.
LORD ALPORT: My Lords, may I ask my noble friend whether, when he is considering this matter, he will bear in mind that the House took 22 minutes this afternoon to dispose of four Questions, which in another place would probably have been sufficient for 20 questions or thereabouts?
SEVERAL NOBLE LORDS: Oh!
LORD ALPORT: May I also ask him whether he will not consider whether one of the reasons why we get into difficulties over Question Time is that we conduct ourselves so leisurely and give ourselves such latitude?
EARL JELLICOE: My Lords, I will certainly consider that point, but I will not add to the twenty-two minutes by considering it at length at this moment.
LORD SHINWELL: My Lords, is the noble Earl aware that it would not take long at all—it need not take twenty two minutes to answer the Questions—if we could be given satisfactory answers?
LORD BLYTON: My Lords, there was no need for the Leader of the House to apologise to me. All I was asking was this. I regarded the Question that was at issue as raising a serious problem, and I was told by my noble Leader that it could be dealt with by a substantive Motion. But can it? If one puts a Motion on the Order Paper, it is left to the decision of the Leaders on both sides as to whether it is taken or not, and one is in the lap of the gods.
EARL JELLICOE: My Lords, I am glad to hear the noble Lord, Lord Blyton, draw a close parallel between the Leaders of both sides and the gods.
LORD HUGHES: My Lords, is not the noble Earl doing very well this afternoon? First of all, he is given a Marquessate, and now he is given divinity.
LORD SLATER: My Lords, would the Leader of the House, in regard to the question asked by the noble Lord, Lord Alport, who, like many of us has had experience in another place, consider whether it is necessary to go into so much detail, because over the years such has been happening?
LORD GRENFELL: My Lords, is it not a fact that we have now moved away from Question Time and are having a debate on rules? Can we have a debate on rules, as we have been trying to do, during Question Time? We have Standing Orders in this House. I cannot believe it is right that we should have a debate on rules in Question Time, when
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Question Time for many years has been devoted to Questions.
LORD SHACKLETON: My Lords, perhaps I can close the discussion by saying that such is the nature of our affairs that now and again we get into slight difficulty; we throw it around for a minute or two, and then somebody says: "Refer it to the Committee on Procedure". I just wanted certain points to be on the record. I think that clearly, if propriety is under discussion, the House cannot ignore referring to it; but I think if it goes on for more than a couple of minutes, at that point we stop and perhaps think again.
EARL JELLICOE: My Lords, I think that this may be the moment at which to stop, because we have gone beyond the twenty-two minutes to which my noble friend quite rightly referred.

LONDON TRANSPORT BILL
Read 3a, with the Amendments, and passed, and returned to the Commons.

TRENT RIVER AUTHORITY (GENERAL POWERS) BILL
THE CHAIRMAN OF COMMITTEES (THE EARL OF LISTOWEL): My Lords, I beg to move that this Bill be now read a second time.
Moved, That the Bill be now read 2a.—(The Earl of Listowel.)
LORD DAVIES OF LEEK: My Lords, I do not want to detain the House unduly, but when it comes to river authorities (some of us are specially concerned with this subject) I would draw the attention of noble Lords—this is a bit of publicity—to the river authorities' magnificent exhibition upstairs, outside Committee Room 10. I have had contentions with river authorities who want to build reservoirs and ponds in the Manifold Valley and Dovedale, but I think we should all see the marvellous work that they are doing. I am sure many of your Lordships will find it worth while.
On Question, Bill read 2a, and committed to the Committee on Unopposed Bills.

PRESCRIPTION CHARGES AND MEANS-TESTED BENEFITS
3.1 p.m.
BARONESS PHILLIPS BARONESS PHILLIPS rose to draw attention to the proposed introduction of cost-related prescription charges and to the increasing dependence of Her Majesty's Government on means-tested benefits as the basis of social services which segregate those in hardship from the rest of society and produce consequent problems of disincentive and inadequate "take-up"; and to move for Papers. The noble Baroness said: My Lords, I should first like to apologise for the fact that I am introducing this Motion on behalf of my noble friend, Lady Serota. Indeed, I feel that if I am going to make a speech every Wednesday I may need to make a further apology, but I at least have the reputation for being brief and I will see that that reputation is in no way damaged on this occasion. The noble Baroness, Lady Serota, is unfortunately ill.
My Lords, we are discussing this Motion on a day when there will be a Statement on another very important matter, and I selected from the Library one of the fact sheets on Britain and Europe which describes how Britain is similar to or unlike the countries of the Six. Under the reference to health we find this statement:
" In Britain the National Health Service is largely paid for by taxes. The British Health Services are available to the whole population and the range of treatment is virtually unlimited."
That is a proud boast and one which we frequently make. When visiting other countries it is one we are only too proud to reiterate. But if your Lordships will look at the White Paper that was presented earlier in this Parliament, Policies of Public Spending, you will see that measures will be introduced as soon as possible to enable prescription charges to be related more closely than now to a proportion of the cost of individual prescriptions, and there will be a ceiling to the amount of the charge. Meanwhile, the existing flat-rate charge of 2s. 6d. per prescription item will be raised to 4s., the arrangements for exemption remaining unchanged. There will also be increased charges for plastic surgery and charges for certain appliances issued
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by hospitals; and charges for dental services and spectacles will be increased. These charges will produce a gross saving of public expenditure which is estimated at £71 million in the year 1971–72.
Let us see how this will work. First of all, let us take the flat increase in prescription charges from 12½p to 20p. I know we shall be told by the Government that there are exemptions. Indeed, in the previous Government I was responsible for introducing one of the Bills which dealt with those exemptions. One, of course, relates to age, and I am going to put in a plea at once to the Minister to ask whether he can put right an anomaly which I failed to put right in trying to present this matter before the House, namely, that a woman who retires at 60 cannot claim exemption from the prescription charge until she is 65. At various stages in different debates we have raised the question of the magic figure. There is the magic figure at which one must retire, the magic amount at which one has a ceiling in relation to a particular charge, and even, within your Lordships' House, the magic hour at which one can turn on the lights in the Royal Gallery. These figures are plucked out of the air and often do not stand investigation. I am sure that it is so in this case. There is also the question of exemption of children, which ends at the age of 15. I would again ask that exemption should be extended at least to children who are still at school, because they will still be, as it were, a charge on their parents. There will be the exemption of the chronic sick, and we know here the limitation of the categories. There is the exclusion of those who have chronic bronchitis, asthma and heart diseases. All of those are diseases for which you may need constantly to have prescriptions filled and for which you constantly need attention. I know about the "season ticket" arrangement and the fact that this can be taken up. I should be interested to hear what proportion of those who are eligible do take up this privilege.
Now let us look a little more closely at the proposed charges proportional to costing. This scheme introduces a frightening new concept into medicine. There are many people living to-day who can remember when women, in particular, did not have the services of a doctor, not

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because they were not ill but because they could not afford to call in a doctor to deal with their condition. If charges are related to any State services there is always a danger that they will be provided not for those who need them but for those who can afford them. Indeed, I understand that in America it is said that a doctor looks at a patient to see what is wrong with him and also to assess which drugs he can afford to make him better. We in this country have made remarkable strides in the treatment of certain diseases by drugs, and it seems to me nothing less than a tragedy if anything is allowed to interfere with the opportunity which is presented to a doctor to prescribe a new and possibly expensive treatment. My Lords, how can this scheme work, and what right have we to impose yet another duty upon a greatly overworked medical profession? I think this debate is particularly important now because the Government have not actually introduced this measure; and that is why my noble friend wanted the debate to-day. I implore the Government to think again. How much money will really be saved? Every time there is an introduction of cost-related benefits it means more people to operate the scheme.
I have some of the leaflets here which have been issued in connection with these cost-related prescriptions and with the family income supplement. One of them says very gaily—it is a splendid leaflet—"Which of these are yours as a right free?" There is a list given—welfare foods, prescriptions, school meals, and dental and optical treatment. Then one is advised to look at the incomes guide inside. There one is told what to do to get the benefits. If it is welfare milk and foods you must ask for leaflet W11 at your local post office or social security office. If you want National Health prescriptions you must get leaflet PC11 from your local post office or social security office, and for school meals you need to contact your local education office or the education welfare office. In connection with dental and optical charges you ask your dentist or optician for a claim form. You can also ask for a claim form in connection with Family Income supplement.
Now this is rather complicated, and I would say at once that I have been read
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ing a Study on people with low incomes and low pay. Here we see very clearly that those who receive low pay, receive it for the obvious reason that, first, they are not very well educated, and secondly, they are not very healthy. These will be the people who will be asked to go through this complicated ritual in order to reclaim these benefits. In addition we are beginning to see how the Departments are already overloaded. There was a letter in one paper the other day making this point. The more we ask these already overworked people to do, the more we shall have either to slow up the whole operation, or introduce more staff and make it colossally expensive. Quite a number of people have asked the dentists and opticians, and they do not understand the arrangement. But why should they understand it? They are there to deal with your eyes and teeth, not the complicated arrangements which the State asks them to undertake.
We now come to the question of means-tested benefits, which is the second part of our Motion to-day, and to the apparently increasing dependence of the Government on them. The Minister will probably tell me that it was not the present Government which first introduced means-tested benefits. This is so. We see an increasing leaning towards these benefits and an increasing use of them. A very interesting question was put in the other place on May 25 last when the Minister was asked what investigations he was making to establish the disincentive registered by low-income families from the accumulation of means-tested benefits restricted to such families. This was his reply:
" We are aware of consequences which the withdrawal of means-tested benefits can have for man's net income. This is a complex problem and we are considering how the more extreme effects can be mitigated."—[OFFICIAL REPORT, Commons, 25/5/71, col. 61.]
It is certainly a complex problem, and it is a human problem. These forms of means testing are divisive, wasteful and degrading.
I think we may also look at some of the other measures mentioned in Policies of Public Spending. Some of your Lordships will have read yesterday that there are nearly one million fewer children taking school dinners since the price of dinners was raised. The Minister in another place said that it should not be

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assumed that the drop in take-up was attributable only to the recent increase in price. Perhaps we may hear what is the reason for the drop in take-up. When I was concerned with school meals it was always noticeable that any increase in price was immediately followed by a decrease in the number of children taking them up. We have some further figures from the Department. Comparing the numbers with previous years, those taking school dinners are certainly far fewer than previously. This may or may not be a seasonal drop, but there is another factor which I should like your Lordships to consider. We see from an article in a newspaper to-day that about 60,000 people in low income families have lost their right to school meals because of the increase in child allowances in the Budget. Here is a piece of nonsense; you give with one hand and take away with the other. This is always with the expense of having more and more administration. Every fresh means-testing benefit needs more people to carry it out. I cannot repeat this too often.
We are going to have quite soon a Bill called—rather euphemistically—the Education (Milk) Bill. I do not propose to go into that Bill now because we shall have an opportunity to debate it. We understand that the purpose of the Bill is partly to enable us to switch our priorities to fill some of the gaps in educational provision, and particularly to improve and replace old primary schools. The Minister cannot be serious in this. Is the choice really between building more schools and allowing little children to have milk? I cannot believe that this is a choice that confronts us.
Here again we come to the magic figure of seven. It is presumed that from the age of seven a child does not need milk. Recent statistics show that many of these children do not have breakfasts. I know from my experience in school that the bottle of milk was often the first substantial intake of food of the child that day. We see the divisive factor: some children will receive free milk. We cannot imagine that this is not going to be known; children can be very cruel. This is where you divide those who have and those who have not.
It is not my intention to labour any of these points. There are speakers who
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will follow me who are very knowledgeable in all aspects of the Motion before your Lordships' House. I am making a genuine appeal to the Minister, whom I know to be a humane man, who likes and understands human beings and their problems. There is an old song, to the effect that:
" The rich get rich and the poor get poorer ".
My Lords, indeed this seems to be the case in the year of Our Lord 1971. I beg to move for Papers.
3.16 p.m.
LORD AMULREE: My Lords, when I first heard the words in the gracious Speech about the cost-related prescriptions I did not understand what this was going to be all about. I am not sure that I understand now because not a great deal has been published about it. I think that the amount of the prescription charge is going to be increased, or varied, according to the kind of drug which is prescribed. Quite apart from the drawbacks which the noble Baroness has referred to, there is this rather sinister drawback, that it looks as if the Minister, the Secretary of State, or whoever it may be, is trying to dictate to doctors what drugs they should prescribe for certain of their patients, in the sense that certain drugs that are expensive are going to carry a bigger prescription charge, and if a person has little money then he cannot afford to pay for the prescription. That seems a very peculiar and wrong point of view. This is something with which I do not think the National Health Service has tried to interfere before, except in the few cases where some doctors have been guilty of overprescribing; but that is not quite the same thing. If such a plan were put forward there would be a good deal of opposition to it.
I have never really liked prescription charges. There has been talk of quite a number of ways of modifying the National Health Service, lodging charges while in hospital and that sort of thing. They have all been dropped as being impracticable; but the prescription charge seems to have come to stay and it brings in about £30 million a year. I know that the National Health Service is a fairly expensive exercise. The disproportionate amount of money that is spent in this country upon the social services compared to the national income generally is

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not really as big as all that. Quite a number of countries in Europe spend a great deal more than we do in this respect, such as France, Italy, West Germany and Sweden.
It is also said that the tax burden is heavy and must be reduced. But again, quite a number of countries in Europe seem to have far heavier tax systems than we have, and yet they do not get into terrible trouble. France and West Germany are examples; they are fairly prosperous and well developed countries. It is the tax structure which is wrong; it bears too strongly on those with marginal incomes. Supposing you are really poor; you can obtain supplementary benefits which help you. But supposing you are in a category which I might call "marginal", and which includes a large number of people, then you can obtain no relief at all. And it seems to me that if you are going to get your prescription charges varied in this kind of way, the lot of the people I have referred to is going to become worse than it was before.
It is said that the change will stop a good number of people from wasting the resources of the National Health Service; that they go to their doctors and hospitals when they have nothing visibly wrong with them. But, my Lords, they are people who need some kind of support. They may not have any gross pathological lesions visible (if I may use rather technical language) but they are people who feel unwell, and they want comfort. The Service was intended to take care of such people as these. When it is said that many people who are hypochondriacal—one might call them neurotic or all sorts of unkind things—are using the Health Service, my reply is that that is really what the Health Service is for: to take care of people like that who need some kind of support. If that is put forward as a reason for these charges, I do not think it is a good one.
I want to say one word about the means test. "Means test" is a wrong term now: it shows the dominance that the Poor Law still has in our lives. It is a good old Poor Law term and goes back to the evil days in the 'twenties and 'thirties, when people had everything taken from them before they received any relief at all. I would much rather use the word "selectivity", nasty and unattractive
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word though that may be, because it seems to me to mean rather more than "means test" at the present time. The question of selectivity sounds rather attractive; but if one goes into the matter carefully, one sees that it is not as attractive as it appears at first sight. The numbers who would be protected by selectivity are not very large—I am talking now about elderly people. It has been worked out that about 83 per cent. of retirement pensioners have an income of under £15 a week, so they would not be in the wealthy class. It is more efficient administratively to pay everybody the same benefit and to recover it by income tax, because the percentage of the cost of administering the benefit from the Supplementary Benefits Commission is about twice that of running the benefits under the National Insurance Scheme. So I do not think there is a great deal to be said for selectivity, or the means test, or whatever it might be called. I have always been attracted by the system adopted in France. I am never sure whether we have gone into that system very much. Under it, the patient pays the full amount but can recover 85 per cent. or more from the Social Security Department. That seems a reasonable way of approaching matters and, on the whole, a fairer way of doing so.
My Lords, before I sit down I should like to join the noble Baroness in making a plea that women of 60 should be treated as retired, as men are at 65, and that there should not be a general age of 65 when they get some relief from prescription charges. If there is to be a difference in pensionable age, I cannot see why the principle cannot apply to all sorts of further benefits. I am very pleased to support the Motion moved by the noble Baroness.
3.25 p.m.
THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (LORD ABERDARE):
My Lords, I am grateful to the noble Baroness, Lady Scrota, for having put this Motion on the Order Paper today because it gives us an opportunity to discuss one of the most important aspects of our social provision. May I say how sorry I am to hear that she is unwell. I hope it is nothing that will take her more than a few days to recover

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from and be back in this House. And may I say that the noble Baroness, Lady Phillips, acted as her substitute in her usual eloquent, powerful and critical—rightly critical—way.
This is an immense subject and it is impossible to approach it without considering what our underlying objectives are, and I feel certain that our objectives are the same. In a comparatively rich country we wish to see that none of our citizens, of whatever age, is without the resources to lead a full life; that those who are sick receive the skilled care which they need to return to the community, and that those who are handicapped are provided with the facilities which will enable them to play their full part in the community. In other words, we are speaking about the transfer of resources from those who can afford it to those of our fellow citizens who require additional resources to enable them to attain such minimum standards. This transfer of resources can take place either by the provision of free benefits, or at least cheaper than cost benefits, or by the provision of cash which will enable the extra facilities to be bought. I am quite sure that these are objectives which we share on both sides of the House. But the Motion, and I think to some extent the noble Baroness's speech, seemed to imply that we on this side of the House had some special love for means-tested benefits, while her Party were opposed to them. This to my mind is an unfair comparison. When the facts are examined the picture of the Party opposite as one which regards means-testing with abhorrence is entirely unrecognisable.
As my right honourable friend the Prime Minister pointed out in another place a week ago, the system of means-tested benefits, found in many areas of social care to-day, is one which existed under the last Government. Not only did it exist under their Administration but, all credit to them, they significantly developed its scope. They introduced, as the noble Baroness opposite has told us, a system of relief from the payment of National Health Service charges, based on a means test. They instituted a scheme for means-tested rate rebates and recommended local authorities to grant means-tested rent rebates. Furthermore, they improved the old National Assistance scheme by substituting the supplementary
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benefits scheme—an excellent scheme, but again dependent on a means test.
What we have done is to go further in two directions. In the first place, we have introduced a new and, I suggest to your Lordships, a very good family income supplement which is not means tested in the old sense. It takes no account of capital, of the income of children or of income in kind. But it brings direct help to people in work with low incomes and dependent children; and, as was noted when the Bill passed through this House, it includes one-child families for the first time, and provides specially favourable treatment to one-parent families. The second thing we have done is to raise the exemption limits to ensure that more of those in need receive these benefits, at a cost estimated to be some £7 million a year.
Our view was summed up by my right honourable friend the Secretary of State for Social Services when he said, on May 5, that:
" there will continue to be scope for a healthy combination of the universal, the selective by category and the selective by means in the development of our social policies ".
The business of social security is to a great extent a question of helping those in misfortune, though this may not be its only sphere of activity. The Government believe that their social policies need to be a mix, as my right honourable friend's remarks made clear. From time to time the balance may change, both as regards the needs to be met and the resources available to meet them. We make no apology for regarding means testing (or selectivity, if the noble Lord prefers the word) as a valuable weapon in society's armoury, and we make no apology for doing our best to improve its efficiency.
We would, however, deprecate—and I am sure the noble Baroness would deprecate—anything that might suggest that there was any indignity involved in claiming the benefits available as of right. I would not deny for a moment that universal benefits have great advantages—they would avoid all need for discrimination, they are cheap to administer and easy to publicise. They are most useful when the object is to help everyone, or at least the majority, in a particular group—for example, retirement pen

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sioners. But there is no real possibility, and there never has been, of putting our whole social security system on a universal basis. For that we should need to enter not the European Economic Community but Utopia. The sensible view on which all Governments have acted is that the universal principle is useful for some purposes, while for others some form of selectivity is inescapable.
The first essential, in our view, in order to guarantee social advance is an expanding economy. If taxation is too high, this will lead to a lack of incentive, a lack of investment and a stagnant economy. To reduce taxation, as we believe is essential, again demands strict priorities. So not for any dogmatic reason, but in the interests of what is practical, we are driven to the conclusion that greater social justice will result from concentrating our limited resources where they are most required. And this inevitably lead, to the necessity of some test of means in order to determine where the greatest need lies.
All of us are used to an annual means test—all of us have to submit our annual income to the income tax inspector for his determination of our liability. All of us accept this as fair and that is the reason why the various concepts which are known as negative income tax, by which one annual means test would result in some paying income tax and others receiving income allowances, are so attractive. This was reflected in our Election Manifesto, and techniques of this character are among the matters being taken into account in the Government's study of family poverty. They are but one aspect of a complex set of issues to which we are determined to give the most thorough consideration.
So to start with, I cannot possibly agree with the words of the Motion that we are becoming increasingly dependent on means tests. In fact, our strategy for improving the system is likely to make it easier for the claimant. The noble Baroness mentioned this leaflet, to which I shall refer again later. It is true that there are a great number of benefits and a number of different places at which they have to be collected, but again this is no different from what it was under the last Government. What we are aim
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ing to do is to reduce the number of separate claims that have to be made by a person entitled to more than one benefit. We have arranged that the holder of a family income supplement book, like the holder of a supplementary benefit book, will be entitled to exemption or remission of charges for school meals, welfare milk, prescriptions, glasses and dental treatment. We have made it easier for people who supply information on one claim to obtain other benefits to which they are entitled, and we are continuing to examine such procedures so as to improve them where possible.
As a further step towards greater simplicity in making claims, we are exploring the possibilities of providing a single claim form for people applying for more than one benefit. My right honourable friend the Secretary of State for Social Services announced in reply to a Question on May 13 that an intensive study has been made in a preliminary way of a common form of inquiry for a wide range of means-tested benefits, administered both locally and centrally, and that the feasibility of such a procedure was being discussed with the local authority associations, whose co-operation would of course be essential, if the idea is to be taken further.
The Motion goes on to refer to the problems of disincentive and inadequate take-up. I would not for a moment deny that these are problems. But I would suggest that they are problems that have to be overcome, if we are to make the best use of our available resources. So far as incentives are concerned, not very much is known about the effect on the weekly wage-earner. It is true, however, that an increase in earnings in any given week is very unlikely to produce an immediate change in benefit entitlement, because assessment of benefits is based on income over a previous period of some length and different periods are used for different benefits. The problem is, of course, compounded by the income tax threshold, and in this respect at least we have improved on the situation which was left to us by the previous Government, by raising the tax threshold by means of increased child allowances.
On the question of take-up, we have made a real onslaught on this problem and we believe that we are succeeding.

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We have launched the largest ever campaign across the whole field of social services to seek out those who, for lack of knowledge, reluctance or for other reasons are not claiming benefits or exemptions to which they are entitled. This has cost over £340,000. It began in April and May with a campaign for take-up of free milk and welfare foods, prescriptions and dental and optical treatment for people in full-time work. So far we have received over 380,000 claims, and while many still remain to be processed we have already made over 175,000 awards. It was followed by a second campaign that is still in progress for the take-up of family income supplement. We have not only advertised in newspapers, on television and by posters, but we have also approached all local authorities and voluntary social workers to ask for their assistance.
I entirely reject, therefore, the latter part of this Motion and I am left with the first sentence on cost-related prescription charges. Once again we are concerned with a matter of priorities. We are continuing the wide exemptions for those people on whom prescription charges might otherwise bear heavily. But is it really right that all those who can afford to pay more towards the cost of their prescription should not do so, while there are so many other unmet demands in the National Health Service? The alternative is an escalating burden of taxation, and we have decided that this is wrong. We feel that those who can afford to do so without hardship should pay a charge more closely related to the cost of their prescription, and thereby enable scarce resources to be devoted to those aspects of the National Health Service, such as the care of the mentally ill, mentally handicapped and the old, where they are most desperately needed. We have, as your Lordships are well aware, already increased some charges. Without these increases and the further proposals for savings we have announced, we should not have been able to make available an additional £110 million over the next four years to assist those services in greatest need. But even so, with the wide exemptions well over half of all prescriptions are free of charge. If all prescription charges at the current rate of 20p per item were abolished, we should have to
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find some £40 million more in a full year.
There is an inevitable tendency for the drugs bill to rise and we must expect that with the development of modern medicines this will continue. The total gross cost of prescriptions in Great Britain in 1970 was of the order of £220 million, and the average cost of a National Health Service prescription is now about 75p, compared with a charge (where payable) of 20p. As the cost of the average prescription increases, the proportion of the drug bill which the charges save gradually falls and an increasing share has to be met from the limited resources available to the N.H.S. until the charges are next increased. In quite a number of other countries the share of the total pharmaceutical bill, contributed by patients, keeps pace quite smoothly with the total through a system of proportionate charges, which were mentioned by the noble Lord, Lord Amulree. We would not contemplate introducing proportionate charges without a ceiling to the charge, nor without the present very wide exemptions and the arrangements for season tickets which the last Government, if I may say so, so sensibly introduced. We have been in touch with the representatives of the professions concerned, and they have explained very fully the objections they see, including possible effects on treatment and the practical difficulties of operating such a scheme.
BARONESS SUMMERSKILL: My Lords, may I ask the noble Lord a question? He has, quite rightly, dwelt on the very important point that the doctors—when he talks about the professions concerned—oppose the scheme; the doctors who are going to be called upon to administer it are totally opposed to it. How can he therefore hope that this will be successful?
LORD ABERDARE: My Lords, the noble Baroness will be able to develop that point when she speaks. All I am saying is that we are well aware of the feelings of the medical profession; and we have been in touch with the pharmaceutical profession and we are well aware of their views, too. I was saying that we appreciate the genuine concern and

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we shall pay full attention to the representations that have been made.
The noble Baroness, Lady Phillips, asked me one or two more detailed questions. In view of the fact that an important Statement is expected, I will, if I may, speak at the end and answer her then. What I should like to suggest in ending is that we are all in the same difficulty. We all recognise the weak points in our social services. We know where additional resources are required. We are all of us aware from our own experience of the shortage of available finance and we have all therefore been driven, whether we be supporters of the Labour Party or the Conservative Party or the Liberal Party, into the necessity of using scarce resources where they are most required. Those are the hard facts which would be, I am sure, amply demonstrated in any Papers for which the noble Baroness has moved.

EUROPEAN COMMUNITIES AND THE UNITED KINGDOM
3.43 p.m.
EARL JELLICOE: My Lords, I apologise to the noble Lord, Lord Burin wood, for intervening at this point, but I should like, with permission, to repeat a Statement which my right honourable friend the Prime Minister has just made, I understand, in another place. The Statement is as follows:
" With permission, Mr. Speaker, I should like to make a Statement on the subject of the European Communities.
" The White Paper which I promised in my Statement on June 17 is being presented to Parliament and published this afternoon. Copies will be available in the Vote Office at the conclusion of this Statement. It is a comprehensive and detailed document, and inevitably long. The Government has therefore decided also to publish a short version next Monday.
" The White Paper records the Government's conclusions as follows:—

(1) The Government is convinced that our country will be more secure, our ability to maintain peace and promote development in the world greater, our economy stronger, and our industries and peoples more
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prosperous, if we join the European Communities than if we remain outside them;

(2) the Government is satisfied that the arrangements for our entry agreed in the negotiations will enable us to adjust satisfactorily to our new position as a member of the Communities and thus to reap the full benefits of membership;

(3) the Government will therefore seek the approval of Parliament in the autumn for a decision of principle to take up full membership of the Communities on the basis of the arrangements which have been negotiated with them."

My Lords, that concludes my right honourable friend's Statement.
LORD SHACKLETON: My Lords, we are grateful to the noble Earl for the short Statement, in contrast to the rather long Statement that had to be read on the last occasion. I do not think there is really anything to discuss now with regard to the Statement, beyond the matter of the arrangements. The Government have stated their views. We shall have full opportunity. I take it, to debate this White Paper, and it may well be that the noble Earl would care to say a word about what he sees with regard to arrangements. Your Lordships will need, I should have thought, three days, and quite clearly this is such an unusual occasion that, if I may, with respect, suggest it, it may be a good idea if noble Lords intending to take part in the debate give their names in rather early, so that the unfortunate managers of the House have some idea how much time to provide.
If I understand the situation correctly, we shall know in the next day or two the likely dates—this is a matter for discussion through the usual channels. Another place will be debating this matter before the end of July, and I take it that we shall be doing the same—not necessarily on the same days, though possibly we may have to overlap to fit in with other arrangements and matters that we have to discuss. I think that is probably all I need say now, beyond the fact that presumably we shall also have to consider when the final decisions are taken, when this will be, and whether it will be in the spill-over period or in the

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next Session. Here again, the Government may or may not be able, or wish, to give an indication.
LORD GLADWYN: My Lords, we on these Benches naturally welcome the first conclusion of the White Paper which was read out by the noble Earl, more especially since we have consistently maintained as a Party for the last twenty-three years that this is what should be done. Whether we can agree with the second conclusion, that,
" the Government is satisfied that the arrangements for our entry… will enable us to adjust ".
and so on, will naturally depend on our study of the White Paper. This we obviously cannot be expected to have undertaken in the few minutes that it has been at our disposal. But from what has already been announced by the Government it is extremely probable that we shall agree with it also, and, if so, it follows that as a Party we shall be behind the Government when it seeks the approval of Parliament in the autumn. For the rest, I would like to associate myself, as regards the arrangements, with what the noble Lord the Leader of the Opposition said.
EARL JELLICOE: My Lords, I am grateful to both the noble Lord the Leader of the Opposition and the noble Lord, Lord Gladwyn, for their reception of this Statement. I would tend to agree with what was implicit in what the noble Lord the Leader of the Opposition said and what was explicit in what the noble Lord, Lord Gladwyn, said: that it might be more sensible for us to reserve our substantive comments on the subject matter of the White Paper until your Lordships have had time to read, mark and inwardly digest this fairly weighty and not unimportant document.
I should like immediately to respond to what the noble Lord, Lord Shackleton, said about arrangements. As I see it, we have quite a massive timetable stretching ahead of us. There are the arrangements for the exploratory debate before the Summer Recess, and thereafter the debate on the matter of principle in the autumn. So far as our first debate is concerned, I would hazard a guess that a large number of noble Lords will wish to participate in a debate on what is a matter of cardinal importance, one way
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or the other, to the future of this country. It seems to me that the length of our debate, whether we need two or three days, for example, will depend upon the number of noble Lords who wish to take part. I would therefore echo what the noble Lord, Lord Shackleton, has said. It would be very helpful if we could have as soon as possible an indication of which noble Lords would feel inclined to participate.
As to the timing, I should like to keep our options open for a little while, and I imagine that this would suit the convenience of your Lordships. I think this is a matter to be handled through the usual channels, and I would wish to bear in mind also representations as to the convenience of individual Peers and the House. I think it would also be convenient to your Lordships' House if we were able to give an indication of the suggested timing as soon as may be. This I will have in mind. As regards the second debate, my assumption is that this would be—again it depends upon the future programme—some time in the early autumn; but at this stage I do not think I am in a position to go beyond that.
3.50 p.m.
LORD SHINWELL: My Lords, nobody can take exception to the noble Earl's suggestion that we should reserve our comments on the contents of the White Paper until the appropriate occasion emerges for a debate. I accept that it is quite proper that that should be so. However, I have just glanced at the White Paper, and I observe that there are two items which have a bearing on Questions that were asked earlier in our proceedings this afternoon. One was by my noble friend Lord Balogh, and the other by my noble friend Lord O'Hagan; one on the sterling balances, and the other on the subject of immigration. I observe that as regards the matter of sterling balances, what is contained in the White Paper is hardly consistent with the replies the noble Earl gave to my noble friend Lord Balogh and myself. What the noble Earl said was that the Government would exercise their judgment. It is quite obvious from paragraph 125 of the White Paper, that what the Government have agreed to, having had some discussion with the E.E.C., is to reserve the whole subject until after we have entered the

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Common Market. That is much like buying a pig in the poke, or pie in the sky. I could, of course, use more elegant language, but I have not had appropriate time to prepare myself. Anyway, that is how I regard it. It seems to me that when answers are given to the House—and I say this with the utmost respect to the noble Earl these answers should be consistent with what appears in the White Paper.
Then, on the subject of immigration and the free movement of labour. I observe that in paragraph 143 the Government has just dismissed this, leaving it entirely to the future. This is hardly consistent with the provision in the Treaty of Rome which makes it as implicit as it can possibly be that the matter of the free movement of labour is one for regulations to be devised by the Commission, and whatever regulations they decide upon, however adverse they may be so far as our immigration law and procedure are concerned, must be accepted by us.
I ask, with respect, that at least the Government might take note of the observations that I have just made, so that when the debate does arise we shall have more consistent and satisfactory replies; and in particular that it should be clearly understood that such vital subjects as sterling balances and the effect on our economic position, and the decisions taken by the E.E.C. on the subject of immigration, after we enter the Common Market, should receive further consideration. I think that in the circumstances, having observed what appears in the White Paper, I am justified in directing the attention of your Lordships' House to these matters.
LORD BALOGH: My Lords, before the noble Earl answers, may I put a supplemental question?
SEVERAL NOBLE LORDS: Order!
EARL JELLICOE: My Lords, I think it would be more helpful if I were to reply immediately to the noble Lord, Lord Shinwell. I believe that it would be sensible for all of us to reserve substantive comment until we have had time fully to digest the White Paper. All I should like to assure the noble Lord, Lord Shinwell—and I speak, as always,
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subject to correction—is that I do not believe that when he reads the White Paper carefully, and reads carefully what I said in answer to the first Question of the noble Lord, Lord Balogh, that he will find any inconsistency whatever between the two. I take note of what he has said on the point of immigration.
All I would say is that both matters are of considerable importance. On the question of the sterling balances, I should just like to say that what has happened is that at Luxembourg a broad agreement in principle was reached. The details have yet to be filled in. It seems to me that the line of the noble Lord's questions implies a lack of confidence in our ability, if and when we join the Community, to hold our own in the Community for our own national interests. I am sure that if the noble Lord has that lack of confidence, he is wrong in having it.
THE LORD BISHOP OF SOUTHWARK: My Lords, may I, as an individual member of the Episcopal Bench, say how much I welcome the Statement that has been read to us. As an enthusiastic European I supported the last Government in their efforts to go into the Common Market, and was disappointed when those efforts failed. I hope very much that the terms this time will be such as to commend themselves to people of all Parties, and that we shall soon find ourselves within Europe.
EARL JELLICOE: My Lords. I am grateful to the right reverend Prelate for his comments, of which I take due note. I hope he is speaking not only in his personal capacity but also in some of his other capacities as well.
LORD ST. HELENS: My Lords, is my noble friend aware that a great many of his noble friends behind him have entire confidence in Her Majesty's Government because of the way that they have conducted the negotiations so far, and indeed are heartily glad that they have achieved so much success? The fact that we do not propose to "jump the gun" by trying to debate a White Paper which we have not yet seen does not in any way imply that he has not got our overwhelming support.
EARL JELLICOE:My Lords, again I grateful to my noble friend. I will not

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attempt to "jump the gun". I happen to have read the White Paper, and perhaps have an unfair advantage. I am not wishing to debate the issue in any way, but however one views these negotiations, on whatever side of the fence one is on this issue, I would like, for my part, to pay a tribute—and I am not really thinking (although I include them) of my right honourable friends here to that determined team of British negotiators who have been engaged in Brussels and Luxembourg for the past many months, to whom we owe a very deep debt of gratitude, whichever way we feel about this particular issue.
LORD BALOGH: My Lords, may I ask the noble Earl how he considers that his statement to me that the full details of the problem of sterling balances, and of export of capital, can only be settled next week, can be reconciled with the Statement of the Prime Minister, which he so kindly repeated to us, that we have now all the details and conditions at our disposal in the White Paper? Are these two statements consistent?
EARL JELLICOE: My Lords, again I should like to clarify the position. When I said that there were negotiations still pending in Brussels—which I think are due to take place on this coming Monday, July 12, and I do not know what the outcome will be this will be on the question of capital movements. If I did not make that quite clear to the noble Lord, Lord Balogh, in answer to his supplementary question at Question Time, I should like to make it clear that this is what I was talking about on capital movements.
LORD BALOGH: My Lords, if that is so, does the noble Earl not think that if these negotiations are going to be conducted next week the Prime Minister is surely not quite entitled to say that all the conditions are at our disposal in the White Paper? Surely the capital movement is such a vital issue that a failure to fill in the details on that subject is not consistent with what the Prime Minister has said. While I congratulate everybody on their marathon attempt, I must confess that a little more candour would not be out of place.
EARL JELLICOE: My Lords, I am not at all clear to what paricular statement of my right honourable friend the
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noble Lord is referring. There is nothing in the Statement which I have just repeated which would bear on that matter. All I would say is that both my right honourable friend the Chancellor of the Duchy, and my right honourable friend the Prime Minister and this was very much the case when the Prime Minister was in charge of these negotiations some ten years ago—have been extremely forthcoming and have gone to great pains to keep Parliament informed of the conduct of the negotiations as they have proceeded. If I may say so, I resent what the noble Lord has said about lack of candour. I do not think that the testimony bears it out.
LORD BLYTON: My Lords, the noble Earl knows my opinion that it will be disastrous for England if we go in. But can he tell us whether there has been any secret diplomacy in the conditions which is not contained in the White Paper?
EARL JELLICOE: No, my Lords, there has been no secret diplomacy. There have obviously been, as is the case in any important negotiations, confidential discussions. But the agreement which has been reached up till now is set forth, and candidly set forth, in the White Paper which is now before Parliament and the country.
LORD BLYTON: My Lords, may we have an assurance from the noble Earl that everything that has been done is contained in the White Paper, and that there will be no repercussions afterwards from other happenings that we do not know about now?
EARL JELLICOE: My Lords, I can give the noble Lord an absolute assurance that the substantive agreements which have been reached between us and the Six are contained in the White Paper.
LORD AUCKLAND: My Lords, having, like many noble Lords and other people in this country, been apprehensive about the arrangements for New Zealand, may I ask my noble friend whether he is aware that what is contained in the White Paper, so far as I have read it, will give very much more relief to New Zealanders than was the case, say, a few months ago? Having said that, may I ask my noble friend whether there will

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be continuing discussions with the farming communities in New Zealand, through the New Zealand Government; and can there be a guarantee that if there is a need to make the transitional period for butter and cheese more flexible, that will be put in motion?
EARL JELLICOE: My Lords, I recognise my noble friend's connection with the Antipodes and with New Zealand, and it is a connection which I myself feel, having spent my earlier years in that country. I am grateful to him for what he has said about the outcome of the negotiations in Luxembourg as they have affected New Zealand. I share his impression about those negotiations. But I would remind my noble friend—I do not wish to go into the substance of this here—that, so far as butter is concerned, there is a three-year review provision. We shall remain, as always, in close touch with New Zealand—and I see no reason why our contact with New Zealand should be any less close in the future than it has been in the past. I am absolutely confident in giving my noble friend an assurance that if we receive any representations from New Zealand in the course of the coming years we shall pass on those representations and have them very much in mind if and when we become members of the Community, especially in relation to this review provision.
LORD HEYCOCK: My Lords, is there anything in the White Paper to allay the fears of the Australian Government?
EARL JELLICOE: My Lords, it is not for me to speak for the Australian Government, but the noble Lord might like to glance at paragraph 121 of the White Paper which deals with the Australian position. If I were an Australian, I should find very substantial reassurance in what is said there.
LORD SAINSBURY: My Lords, I should like to express from the Back-Benches on this side of the House the view of some of us that we shall give close consideration and sympathetic understanding to the White Paper, because we believe that
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it is in the long-term interest of the mass of people in this country, if their standard of living is to go ahead, that we should join the E.E.C. if the terms are reasonable.
EARL JELLICOE: My Lords, I am grateful to the noble Lord, Lord Sainsbury. Again without wishing to go into the substance of this matter, I cannot but say that I happen to share what I understand to be his point of view.
LORD GORE-BOOTH: My Lords, may I take up and generalise on a point already made by the noble Earl, and ask him whether he will agree that, whatever any of us may think, this whole discussion should be carried out on the basis that if we become members of the Community there should be no loose talk about British leadership, but that the British voice and British interests will be of great significance in the councils of the Community?
EARL JELLICOE: Yes, my Lords. I would entirely agree with the noble Lord, Lord Gore-Booth, speaking from his very great experience. If, as I hope, we join the Community, then I see us as partners in a continuing and great European enterprise.
BARONESS MACLEOD OF BORVE: My Lords, may I thank the noble Earl the Leader of the House for his momentous and historic Statement to-day? Also, may I assure him of the enormous welcome which I think this Statement will receive from practically everybody who has the future of this country at heart'?
EARL JELLICOE: Again, my Lords, I am grateful to the noble Baroness. In replying to her, I would say how much it means to me to be able to reply to the first supplementary, as it were, which I have received from that particular quarter. I have been a great admirer of her late husband and know the contribution which he made to the particular enterprise on which we are now embarking.
LORD SHACKLETON: My Lords, may I echo the noble Earl's personal remarks to the noble Baroness?

PRESCRIPTION CHARGES AND MEANS-TESTED BENEFITS
Debate resumed.
4.8 p.m.
LORD BURNTWOOD: My Lords, I now address myself to the matter of health, within the scope of the Motion before the House. I should have liked to mention various other matters in regard to the National Health Service and provision for health in this country. For instance, there is a need to bring before the attention of your Lordships the increasing anxiety by patients who feel that on being taken to hospital they lose contact with their general practitioners. I believe that the whole system of the somewhat unwieldy, though technically very efficient, district general hospitals may have to be modified sooner or later in favour of smaller hospitals under G.P. control. However, I now want to address myself to the first point in the Motion; namely, the question of cost-related charges for prescriptions.
I am second to nobody in admiring the courtesy and efficiency with which the noble Lord, Lord Aberdare, deals with these questions in the House, so I hope he will not take amiss what I am about to say. In any case, he has more than his fair share of charm. But I felt absolutely outraged by his speech this afternoon, for in essence his remarks about means testing in general, and more particularly about cost-related health charges, seemed to me to be so extreme and reactionary that I was as surprised about his remarks as I was about the original proposal on cost-related charges which was made some months ago by the Government. I do not want to spoil what I wish to do, which is to deploy what I think is a good case against the proposition, by exaggeration, but I am bound to say that if in one hundred years' time people read the noble Lord's speech they will react in much the same way as students of history now react when they read the Reports of Royal Commissions of 140 years ago on the employment of women and children in industry.
I feel that this proposition is outrageous; and I am most surprised at one particular omission in his speech. The noble Lord concentrated I think exclusively (though, of course, I should like
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to read his speech again) on the economic side of public finance in this matter. There was no enlargement that I detected in his speech on the question of the ethical considerations which should be given to this whole question. Indeed, when I first read about this proposal for cost-related prescription charges I thought it was a sort of sick political joke, and I do not think your Lordships can underestimate the sense of shock with which this idea was received by those of us who have had the Health Service much in our minds over the past 20 to 25 years. I speak with some feeling, because I think I am one of the only two Members in either House who were members of the Committee which in fact saw through the passing of the original, principal Act which established the National Health Service. Be that as it may, the only thing I do not find surprising about this is that the idea, the ethic of it, should be promulgated, if possible, or probably, by this Government. After all, the penalising of the weak and the sick has already been established on the justification that by reducing increased revenue in that way more money can be available for building what one might describe as the hardware in the provision of health facilities for this country.
But, my Lords, the Hinchcliffe Report of 1959 went into this question in very great detail. In point of fact, that Report was engendered by the Conservative Government of the day, and I am very surprised that the findings of that Report should even be questioned at this stage. If I may remind your Lordships, the arguments were deployed for instituting cost-related charges. It was said, for instance, that the patients would no longer want their doctors to prescribe extravagant quantities, since the larger the quantity the more they would have to pay. Nor would doctors be subjected to pressure from patients for necessarily expensive medicines. I do not want to go too far into the ethical question, because I see that there are distinguished members of the medical profession present to-day, and I hope that they will and I count on them to do so—object to the ethical concept of charges, which in point of fact will amount to paying for good health by the purse. But the Hinchcliffe Report threw out the idea of cost related charges, and cited the sort of results which would

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ensue were they so enforced. There were four main, principal objections, and I will mention the first two:
" A doctor might refrain from prescribing the more effective cure because it was expensive, or a patient might not present for dispensing an expensive prescription which a doctor might have given him. Those needing very expensive drugs would be hardest hit ".
The Report went on:
" The collection of a percentage charge by the pharmacists would impose an extra burden on them. They would have to work out the cost of every prescription. This would be much more onerous than collecting the shillings ",
as they were then,
" in respect of charges. Moreover, the amount of the charge would be liable to be challenged by patients ".
My Lords, prescription charges were bad enough, and I readily discard in the direction of Lord Aberdare the fact that it was the amending legislation of 1949, under the Labour Government, which ever permitted health charges to be made. I accept that. Many of us have been extremely upset and aggrieved that they were subsequently implemented by both Parties. But this is an entirely new concept. The administrative difficulties which have been submitted to the Minister by the chemists—the difficulties in administration not only in the actual dispensing, but the arguments which will follow with patients about the actual charges which are to be made—almost pale into insignificance against the picture that one can conjure up of patients not in the exempted classes, such as old people and young children, but the vast mass of the population, who are in fact in the very low income groups. Drugs nowadays tend to be much more expensive in the first few years after their introduction. Drugs which deal with high blood pressure and matters of that kind, which are extremely expensive, have to be used in large quantities by the lower income groups. They do not come under any provision for exemption; and I think that the whole idea that people should be penalised in this prescribing of medicines is, as I say, intolerable.
LORD ABERDARE: My Lords, I am sorry, but would the noble Lord allow me to interrupt him? He has not mentioned, of course, that there is a ceiling and there is a passport scheme, so that
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these vastly expensive drugs would not necessarily fall in their entire cost on anybody.
LORD BURNTWOOD: My Lords, it is more than probable that I have missed something announced in the Press. At the same time, when this matter was last raised in another place, in answer to a Question by Mrs. Shirley Williams, the Secretary of State said, in effect, that he had not really made up his mind but that he was engaged (it was some obscure language he used) in a dialogue on this matter with the interests concerned. If there is to be a ceiling, I am glad to hear it, although I comprehend from that intervention that these cost-related charges are now going to be enforced.
LORD ABERDARE: I am sorry to interrupt again, my Lords, but in my speech I said that we were still talking it over with the professions.
LORD BURNTWOOD: So we are now left with the position that, if they are to be introduced, there will be a ceiling?
LORD ABERDARE: Yes.
LORD BURNTWOOD: So we are making a little progress here. Nevertheless, the fact is that if these charges are to be introduced into our National Health Service procedures there will be a sense of public disquiet that a rich man can receive expensive and effective medication because he can afford to pay for these newly-developed drugs, while a postman, for instance, who does not normally come under the provisions for exemptions, will have to do with second best. Now this is a concept which is quite contrary to the original idea of the National Health Service, and I hope that the Government will have another think about it. Indeed, I had thought that, when the original, spontaneous objections were raised to this idea, the Government would gracefully withdraw, but I understand from the last statement which I have just quoted by the Secretary of State, and now the intervention by the noble Lord, Lord Aberdare, that it is still on. I can only say that there will be a great deal of trouble about this. We on this side of the House have struggled against any idea of exemptions per se. We believe that, according to the original concept of the National Health Service, health

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should not be a matter of any form of financial entitlement.
So, my Lords, I ask the Government to please reconsider this matter. The cost of drugs nowadays to some extent reflects the increasing cost in basic research. We all know the history of cortisone, the antibiotics and the new medicaments for possible conditions of cancer. I leave it to the members of the medical profession in the House now to deal with that. But the whole thing is so absolutely contrary to modern ideas that I ask the Government to reconsider the matter most urgently.
4.20 p.m.
LORD AUCKLAND: My Lords, owing to a long-standing engagement at New Zealand House this evening, I must apologise to the noble Baroness, Lady Phillips, to my noble friend and to the House for the fact that I may not be able to stay until the end of the debate. The noble Baroness need not apologise for having spoken on several Wednesdays, because I am sure I speak on behalf of the whole House when I say how much we enjoy her speeches, whether or not we agree with her, chapter and verse. I should like to associate myself with the sympathies conveyed to her noble friend Lady Scrota and to join in the hope that she will soon be back in fine fettle to contribute to our debates on this subject, about which she has had considerable experience.
The future of the National Health Service as a whole is of great concern to everybody in this country. Many noble Lords on all sides of the House—both those who practise in it and those who, like myself, serve on hospital committees and see what goes on—have a close interest in the National Health Service. My Lords, I must say that this Motion seems to show a curious lack of logic. Of course, prescription charges are something which could be described as anathema to anyone, for people do not become sick from choice, but there are one or two very basic if rather ingenuous facts that we have to face. The first is that the size of our population is greater than ever before. I do not wish to bring in any overtones of racialism, because as a nation we have always integrated people from all walks of life and have always been particularly anxious that they should
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get the best treatment in the social services, in health and elsewhere. But there comes a time when we must face the question of how we are doing to finance this Health Service, with the present shortage of doctors and of nurses, and with more and more people to look after.
I join with those who pay tribute to everyone who works under the egis of the National Health Service, be it on the medical side, on the nursing side or on the administrative side. I think that there is little in the problem of prescription charges other than that they are a necessary evil. I do not want to make the Party point that both Governments have had to impose prescription charges. In the circumstances, I think it was inevitable. But while it is arguable that cost-related charges set one side of the community against another, I make the contention that this method also ensures that there is some kind of watchdog on these charges. The exemptions from paying prescription charges are pretty considerable. I believe that something like 42 per cent. of the people in this country do not pay them.
There is just one point which I should like to put to my noble friend. It was brought out by the noble Baroness, Lady Phillips, and it is this question of the exemption age ceiling for the young. I understand from the White Paper, New Policies on Public Spending, that the age is 15. Leaving aside the contention of the noble Baroness that this affects school children, which it does, I think it is an accepted fact—and many of us who have teenage children will know this—that it is between the ages of 14 and 17 that children tend to pick up some quite distressing illnesses (and I am thinking of glandular fever and rheumatic fever) which need a fairly considerable amount of treatment. This may well mean the use of expensive but necessary drugs. I would ask my noble friend whether he will consult with his right honourable friend about the age ceiling. I think that 17 or even 16 would be a more practical limit.
My Lords, these services have to be paid for; and there is a crying need for new hospitals. Whether or not the saving of £71 million will contribute to building many of those new hospitals is a matter of conjecture, but those of us who have contact particularly with mental

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hospitals—as I know has the noble Lord, Lord Burntwood—will know how many very old, dilapidated buildings are now in use. An article in The Times the other day instanced two old hospitals where the staff were giving devoted treatment—and one must pay a tribute to the staffs of these hospitals—under extremely difficult conditions. We all want to see improvements made in these hospital buildings and in the amenities of the hospitals themselves, It seems to me that an increase in prescription charges must be looked at in the context of to-day's discoveries, when new drugs are being found: there is a chance now, so we read, of a possible breakthrough for some types of cancer, although one must not raise hopes too highly. If this is so, the question of Health Service charges must be seen in this context.
I would make just one observation about school meals. Of course it is right that children of families with low incomes should be provided with proper and, if necessary, free school meals; but I am not particularly convinced by some of these stories about children going to school without breakfast. This surely is a matter in which we cannot absolve the parents from responsibility. I know that it is argued that increased charges for school meals bring hardship to some families. They do. But there are, as I understand it, some quite considerable exemptions here.
So, my Lords, we must have some yardstick for the provision of these services. This document New Policies for Public Spending is at least a start towards trying to sort these out. One knows that the medical profession has objections to it. It is fair to say that there are medicines which can be obtained from the chemist, over the counter. If that were done it could save a considerable amount of time for the doctors. One hears a great deal about overworked doctors and nurses. Somehow that problem has to be solved. One appreciates the plight of the doctors and I am glad to hear that there is to be consultation. One hopes that it will be quick.
I should like, my Lords, finally, to reinforce the plea which I made earlier to my noble friend about the age limit for the imposition of prescription
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charges be they cost-related or any other kind of charges. It is important that before they start to earn wages the young should be afforded the best possible help and protection, and the elderly likewise. Having said that, I think that these plans of the Government are a step in the direction of trying to improve the Health Service facilities.
LORD GARNSWORTHY: My Lords, I hope that the noble Lord, Lord Auckland, will excuse me for intervening, but may I say, before he sits down, that he did indicate that he was leaving the debate early. That being so I should like now to address to him a question that I should normally have put later. As I understand it, the noble Lord is defending prescription charges, cost-related prescription charges, on the basis that they will help to meet the cost of the extension of the service. Is he really saying that a special form of taxation should be imposed on the sick to pay for this extension?
LORD AUCKLAND: My Lords, I do not accept that this is a special kind of tax. If we want proper services for the sick, and bearing in mind the number for which we must cater, unless we are to have large increases in direct taxation this seems to me a practical and less damaging way of providing them. But obviously, this is a contentious matter.
4.34 p.m.
LADY GAITSKELL: My Lords, I am grateful to my noble friend Lady Serota for bringing forward this very timely Motion and to my noble friend Lady Phillips for her valiant speech. No one would have guessed that she had to make it at such short notice. The Motion has been phrased in a very subtle way and goes right to the heart of the matter. Here I must disagree with the noble Lord, Lord Aberdare, who did not think that the Motion is phrased in the way I have indicated. The Motion shows that the Government have another peg on which to hang another series of means tests. I do not suggest that a means test is never justified, but I would say to the noble Lord, Lord Aberdare, that it is always a question of the amount, the degree and the trend. The recent series of charges, and increased charges, for various welfare benefits, and the way that

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it has been sought to justify them by an increase in the number of means tests, seems to me to be a hangover from the Poor Law mentality of the 19th century, and it puts the clock back in respect of our social welfare system in this country.
In the Economist this week there is one of those useful summaries of the different ways in which Britain and countries in the E.E.C. organise their social welfare services. There are differences both in philosophy and also in method. On the Continent the employers bear the major costs; in Britain it is the State. In France and Italy—I notice that the noble Lord, Lord Amulree, referred particularly to France and approved of the method adopted there—family allowances are higher and wages perhaps lower as a result of this system. In Germany, wage-related pensions leave pensioners better off than pensioners in this country, though widows come off rather badly. Because in this country the State bears the major burden the lower paid workers, when drawing benefits, tend to do better. This is a fair picture, despite lots of reservations that many of us might have had of the situation before the present Government took office; but it would not be so true today, despite Government protestations.
My Lords, the excuses are indeed lame and do not stand up to scrutiny. The proposed cost-related prescription charges are strongly opposed by the pharmaceutical and medical professions. The voice of the drug manufacturer is not heard, but perhaps this silence is a reproach to their favourite Government. With no support from those who deal with the prescriptions; with large categories of exemptions and the inevitable administrative costs which result, the economies hoped for by the Government appear to be very small. This will be another case where Tory doctrine does not work out, despite the good intentions.
After all, my Lords, four shillings (or 20p) is a pretty stiff charge for a large number of everyday prescriptions. Already this has increased the watch-dogs on over-prescribing by doctors and by regional medical officers; and to raise the charge even higher would make something of a mockery of a national health service. Various surveys by interested bodies show that the number of prescriptions
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per head of the population has been fairly constant since the beginning of the National Health Service. The percentage of the cost of pharmaceutical services in the National Health Service has remained stable for many years, although the total cost of prescriptions has risen. The increased costs are due not so much to price rises in the case of existing medicines but because new products have been prescribed. One analysis revealed that 58 per cent. of sales were for products launched since 1960.
It could be shown, my Lords, that prescription charges affect the number and cost of prescriptions. When charges were re-introduced in June, 1968, the number fell, but the average cost rose because doctors tended to prescribe larger quantities when patients had to pay. It appears that the per capita consumption of medicinal drugs is lower in Britain than in most Western countries. This was said by the noble Lord, Lord Amulree. If the Government remain obstinate about raising the charge for medicines still higher, I think that the health of the people might eventually suffer. The list of means-tested welfare measures seems to grow longer every day. Rent and rates have long been subjected to tests. Now, with the abolition of free milk and welfare foods for those under five years old, and the higher charges for prescriptions for dental and optical treatment, welfare measures are a headache for those who have to administer them. Also the variations in income limits for benefit, the different schemes by different authorities, complicate the whole of the new social security pattern and apparatus.
Perhaps the worst aspect of the Government's new style in welfare is the effect on those who have to apply for exemptions and benefits: the way they have to make themselves known. I think that this is where we on this side of the House differ from noble Lords opposite. This selectivity is really a throw-back to a primitive Poor Law attitude, and I am afraid that this is how Continental countries regard our selectivity system. No one can deny that all means testing can be something of an indignity. I feel that the noble Lord, Lord Aberdare, did not show understanding on this matter, when he said that it should not be an indignity. The

1011
fact is that people do feel it as an indignity, and that is what matters.
So far, the response, both from individuals and from local authorities, to some of the Government's measures has been something of a slap in the face, such as the revolt by various local authorities, both Labour and Tory councils, over free milk. It is really appalling to hear that in the short period of a year one million children have stopped taking school lunches because of the increased charge for them. The Minister of Education in another place must have found it somewhat difficult to sugar this particular pill.
When we come to the family income supplement for low-paid workers, the much publicised Tory policy to help families of lower paid workers, Conservative remedies have misfired lamentably. I remember the noble and learned Lord the Lord Chancellor (and I am sorry that he is not in the Chamber just now) replying for the Government, I believe at the end of the debate on the gracious Speech, with his usual brilliance and panache. He was indignant that we on the Labour side could accuse the Government of a lack of compassion. I am not setting a 100 per cent. store on Party labels—compassion for Labour and competition for the Tories. But the rigours and practice of Government in action often alters and erodes the credibility of both.
But let us look at what has happened to the proposed family income supplement for low-paid workers. According to the figures recently published by the Department of Health and Social Security, of the 160,000 families originally estimated in need of help who would benefit, 31,000 only have claimed, and of these under 10,000 have been awarded an allowance—that is, 6 per cent. of the original estimated number. Over 10,000 claims were rejected and the rest are being considered. This was the response after an expensive publicity campaign. Two offices had to be closed for lack of claimants. It was originally estimated that the family income supplement would cost £8·6 million. Up to date, spending has been £1·5 million, and I wonder how much of it has been spent on advertising. This is the response to the Labour Party's support for a more comprehensive
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range of social and welfare services. There is a feeling of indignity, amounting to humiliation, when the less fortunate in an affluent society have to apply and submit to a means test before they get help. This reaction to the family income supplement clearly demonstrates a revolt against the means test ideology. There is no incentive to apply for benefits. More damaging still is the damming up of incentive generally for low-paid workers. This is an indictment of any civilised affluent society.
The European countries can learn from one another, each copying the best of the welfare services in another country. The higher selectivity of the British system is not shared by other countries in the E.E.C., where there is a closer relationship between benefits and recipients' normal income level, according to the Economist again, which also states that the continental worker does better than the British worker on sickness, pensions and unemployment benefit. But apparently on health, the British national health system will tend to serve as an example for other countries to follow. If the Government continue in their means testing and in what I consider rather small, petty economies, I cannot see them setting an example to any European country. Increasing incentives for surtax payers is really no way to improve our welfare services.
4.47 p.m.
LORD PLATT: My Lords, I should like to join with other noble Lords who have expressed their thanks to the noble Baroness, Lady Serota, for initiating this debate, our sorrow that she could not be with us this afternoon and our hope for her rapid recovery. If I were speaking of anyone of less integrity, I might have wondered whether she had contrived the illness to build up a supply of expensive antibiotics while she could still afford them, but I do not think we could think that of the noble Baroness. I am also grateful to the noble Baroness, Lady Phillips, for opening the debate.
In an ideal world, I think most of us would agree, there should be no prescription charges. I think it is true to say that the medical profession was generally opposed to such charges from the beginning of the Health Service, but agreed to them on the ground that there was some truth in the statements that

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the public were demanding trivial benefits and domestic drugs from their practitioners, so wasting the doctor's time and a good deal of public money, and that a moderate charge might reduce this. I believe that there is still something to be said for that point of view, but I would hope that at this time, when the cost of everything goes up daily and when there is an enormous number of unemployed people, this Government will not still further increase the prescription charges, whether cost-related or otherwise.
I remember the days, to which the noble Baroness, Lady Phillips referred, in the 'twenties and 'thirties when there were really poor people in this country and a great many unemployed. There was the Lloyd George Health Scheme (so-called) for the workers, which did not include the womenfolk, who were also working, and the children. Many women did not go to their doctors or, if they went at all, did not go early enough and did not get treatment for themselves, because they felt that they could not afford it. Fortunately, nobody can say that we have got back to those times. But we are, I think, building up a new poor: not poor in the old sense, like the people I used to see in the out-patient departments, the children with no boots, and who really had not enough soap to keep themselves clean. We are not back to those days. But we are building up a new, large, under-privileged class of people, of low income, who are finding it more and more difficult to live at the standard of living which we nowadays, I think quite reasonably, expect, and who are appalled by the fear or the reality of unemployment, on the one hand, and by the high and mounting costs, on the other, to which they have already had added, as we know, certain charges, such as school meals, dental charges and so on, to be followed shortly by charges to museums. For all these reasons, I hope that we shall not have a higher prescription charge, which will deter people from going to the doctor and make it more likely that they will go and get some cheap, domestic remedy at the chemist's shop, thus putting off the day when they go to the doctor and get the treatment which they really require.
Before I come in detail to cost-related prescription charges, I should like to say that I realise that the Government have to take into account the enormous cost
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of the Health Service and of prescriptions. But this Government believe in private enterprise and collective bargaining, and presumably should be in a good position to get protection, through negotiation with the drug firms, against excessive charges on their part. As your Lordships know, a Committee was set up some years ago under the competent chairmanship of the noble Lord, Lord Sainsbury, which reported at length on the relationship of the National Health Service to the pharmaceutical industry. That Committee suggested certain measures, which I do not think have yet been fully carried out, as to how the Government might try to reduce the cost of prescriptions.
But let us not forget that a large number of the advances of medicine in my time have come from the drug companies. I have said this before in your Lordships' House, but it bears saying again. The eradication of pulmonary tuberculosis, which is the greatest advance of all in my time, depended originally on a drug produced by a pharmaceutical company. The whole range of antibiotics, after the initial penicillin, have depended on drug firms both for their discovery and for their development. Even penicillin did not become a practical possibility until the aid of the drug firms, or a drug firm, was called in. DDT was the discovery of a drug firm; and the eradication of malaria and other insect-borne diseases has become possible through discoveries by drug firms. The control, or the virtual elimination, of pneumonia, cerebrospinal meningitis and septicæemia—; killing diseases when I was a young man—has been brought about, first of all by the use of the sulphonamides discovered by a chemist working in a drug firm, and later by the antibiotics. New methods of X-ray investigation and anaesthetics have come from drug firms.
It is true that there are good drug firms and bad ones, but the good drug firms spend an enormous amount of money on research, and they run an enormous risk. Perhaps I should say, before going further, that I have no financial interest in any drug firm. But, as I say, they do run enormous risks. They may spend £1 million developing some drug which they think will sell in large quantities—it may be some antidepressant, or something like that, which a large number of people take. It may

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be that some other drug firm is also spending £1 million on its own drug, and if, for some reason, that drug turns out to be a little better or a little more free from side-effects, or, for reasons difficult to understand, more popular, the first firm may find that it has wasted an enormous amount of its money.
In any case, to control expenditure on prescribing by a cost-related device is, I think, both inappropriate and dangerous. It is bound to influence the doctor's prescribing; and although there are doctors who prescribe extravagantly—and perhaps a few who, one might say, prescribe irresponsibly—there are ways, as we have heard from other speakers, in which the cost of prescriptions by individual doctors is monitored. They can be warned if their average cost is much higher than that of the country in general, and they can be subjected to disciplinary proceedings. If you go to America and start discussing cases with medical colleagues over there, you find, to your utter surprise, because you are so unused to it in this country, that the conversation quite suddenly switches from what the patient needs in the way of investigation and treatment to whether the patient can afford it. I hope that nobody in your Lordships' House wants us to give up our principles and ideals, as embodied in the National Health Service, and go back—because it would be a backward step—to the jungle, as it were, of American medicine.
With a cost-related system there is bound to be a greater prescription and a greater taking of ineffective drugs from the chemists in order to save the patient the cost of the more expensive drugs, which are so often the specific ones which have a really potent antibacterial action or, in some instances, some other specific action. Occasionally you will thus lose the opportunity of avoiding chronic illness by prompt attention at the acute stage, and you will increase the length of quite a number of illnesses. When I was in North Africa during the last war, we had sulphonamide drugs, but there were no antibiotics. We had an enormous outbreak of bacilliary dysentry, and although we were overwhelmed with work we had not, luckily, as your Lordships will see, enough
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sulphonamides to go round. So I kept a careful note of the cases in which we gave the sulphonamides, and the cases in which we gave the old remedies, which were not so effective, but kept the patient going until nature cured him of his dysentry: and, amazingly, we had no deaths. The really big difference between the two cases was the speed with which we got the disease under control when using sulphonamide drugs and the speed with which we could discharge the patient from hospital and get him sent to a convalescent depot before he rejoined his unit. So I had personal experience of some hundreds of cases of an infective illness and I could see the number of man-days that were saved by the use of a specific drug—an experience which we rarely get on the same scale in civilian medicine.
I repeat, in winding up, that I understand the Government's concern with the cost of prescriptions, and I concede that some doctors are unnecessarily extravagant; but the introduction of a cost-related prescription charge is quite the wrong way to remedy the situation. In addition to the other objections, it cuts across the whole principles on which the Health Service was founded and the principle of the doctor's right to prescribe what he thinks to be right for his patient.
The noble Lord, Lord Aberdare, in his remarks, which he made with his usual patience and charm, referred to the transfer of resources from those who can afford them to those who are in need, and it all seems very reasonable, except that if you have any knowledge of history you remember, as the noble Lord, Lord Burntwood, has reminded us, that similar objections have been made to every single social advance in the last hundred years or more. Also it is an argument which, to my mind, may apply to a person with a fixed income who, whatever he does, is not going to get any more money, and therefore must budget within that amount of money, rather than to a nation like our own, in which no one can say what is the fixed amount that we must spend on health and above which we cannot go. I concede that a Government must watch and see that the amount does not rise too quickly. But, in any case, health is surely an area in which costs can be easily ascertained

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with some accuracy, whereas the savings and the gains are very difficult to estimate. Thus there is always a danger of false economy.
5.3 p.m.
LORD ILFORD: My Lords, I should like to begin, as other noble Lords have begun, by expressing to the noble Baroness, Lady Phillips, our appreciation of the very clear and lucid speech which she made this afternoon. I think we are coming to regard Lady Phillips as a very special exponent of the social services. This is not the first time that I have listened to her, and I hope that it will not be the last. May I also add a message of sympathy to the noble Baroness, Lady Scrota. Those of us who know the noble Baroness in other places know well what we have missed, and I hope that she will have an opportunity of moving another Motion concerning these circumstances a little later.
The noble Baroness, in framing her Motion, coupled the National Health Service with means-tested benefits. We have not heard very much about the means-tested benefits because this afternoon the debate, as these debates frequently do, has tended to creep into a discussion on the National Health Service. I regret that we have not heard a little more about the means-tested benefits. I hope that means that these benefits are not causing any great anxiety and that that view is merely being reflected in your Lordships' House.
I spent 10 years of my life administering various forms of means tests. I hope that what I did was right, but at any rate if my actions were wrong my critics were kind enough not to tell me so. None of us like means tests; but the fact is that the administration of social services, on a scale which is acceptable to-day, to the poorest section of the population is really not possible without a means test. It is not only that the burden of expenditure might otherwise unfairly rest upon other sections of the community, with benefits being paid to persons not requiring them, and it is not only that class of person who would benefit if such benefits were adminstered without a means test. Nothing annoys members of the public more—and I think one discovers this in administering these services—than to en counter some man who is said to be
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receiving benefits which he does not deserve. Indeed if that happens it brings the whole service into discredit. One has to frame the law so as to ensure that not only is unnecessary expenditure not incurred but also in order to be quite certain that the service is not exposing itself to the criticism that its administration is wasteful and extravagant.
The Labour Party at one time believed that it was possible to dispense with the means test altogether. When they found themselves in office they appeared to learn that certain benefits cannot be separated from a means test, and accordingly the Supplementary Benefits Commission was set up to undertake substantially the work which the National Assistance Board had been conducting. It is interesting to note that the Labour Party found that it is not possible, as they hoped before the Election, to dispense with the means-tested benefit altogether.
There are one or two matters of less importance which have arisen in this debate about which I should like to say something. First of all, there is the question of exemptions. I listened very carefully to the noble Baroness to see whether she could claim that in any one of these major social services there was no exemption, because it seems to me that so long as there are exemptions in a service it is really not possible or fair to claim that the benefit is not readily available to all sections of the population. It is. Although I listened to the noble Baroness carefully, I did not hear her indicate any service in which there was no exemption. Perhaps when the noble Baroness comes to reply she will let me know whether I have overlooked one of the services; otherwise we have to accept the position that the exemption is universal and that all these services are subject to exemption. If they are, it is not right to say that the social services are not extended to all sections of the population—they are. It may be that the exemption is sometimes inconvenient, and no doubt it frequently gives doctors and chemists more work. But when one looks behind those difficulties, the fact remains that the service is exempted in the case of those to whom it would be a hardship. That is one of the major principles to which we should cling in our approach to the social services. We should be sure that somewhere in some part of the service there is

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an adequate exemption for those who are not able to pay.
Now may I say a word about school meals. Yesterday, in another place, the Minister in reply to a Question gave a very long Answer dealing with the changes which have taken place in recent months in the consumption of school meals. The Minister's statement indicated a considerable drop in the number of meals taken in the schools. Everybody assumed that that drop was attributable solely to the fact that the parents were no longer able to pay the higher charges. Are we right in assuming that? Many of the children who ceased to have their dinners at school have done so because their parents thought that the higher charge was not worth it, and they would rather have the children at home. This is not because there was poverty in the home, but because the parents found it more convenient to have the children at home and did not want to pay the higher charge. Does not that explain why there was this drop in the number of school meals consumed? Of course there were other reasons. The Minister pointed out that it was not uncommon at this time of the year for a fall of that sort to take place, and there may be other reasons, too. But we must not ascribe the whole of that drop to the fact that parents were not able to pay the higher charge.
I should like to refer to the matter raised by the noble Lord, Lord Amulree. He suggested that there may be some form of universal benefit for all forms of social service available in all parts of the country, without the need for a means test. That is a most attractive proposition. It will not work for this reason. In the case of the applicant for supplementary benefits it includes practically the whole of his rent in most assessments. There is an enormous difference in rent levels in different parts of the country. Rents in the North are a great deal lower than rents in the South. The difference in the scale of rents in other parts of the country is even more marked. That fact alone prevents any universal form of benefit. It means that a benefit which may adequately meet the need in one part of the country will not meet the need in another part. In
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London, where rents are exceptionally high, the scale which would meet the need in other parts of the country would fall far short of what was required. Therefore these proposals, which always recur, about means tests are not practicable.
I wonder how many of your Lordships have realised the enormous size of the new Department which has been created. The Ministry of Pensions and National Insurance was created by the fusion of the old Ministry of Pensions and National Insurance and the National Assistance Board. The staff number something like 70,000 people. It is, indeed, a colossus. Yet this is a Department where success depends to a major extent upon sympathetic contact and cooperation between senior officers and the subordinate staff working in the field. Are we going to get sympathetic co-operation in a Department of this size? If the social services are to reach the poorest sections of the population they must be administered by a staff which has to have special training and special sympathy with the work which has to be done. What is most important of all is that there must be adequate contact between the senior members of the staff and the more subordinate members in the field. I have not the least doubt that the staff in the Ministry will work with the same devotion with which they worked for me when I was at the Board. But it will not be so easy to ensure those conditions in a department of this size. I am certain that the problems of decentralisation and staff handling will have to be studied. I do not suppose that this point will make a very strong appeal to my noble friend. Nevertheless, it is based on a long experience and I hope it will not be disregarded.
5.18 p.m.
BARONESS SUMMERSKILL: My Lords, I should like to join with noble Lords who have already congratulated my noble friend Lady Phillips. I am always charmed by the way that she manages to rise to the occasion when a colleague falls by the way. At very short notice she was asked to appear at the Despatch Box and expound on some complicated question, which she had learned about only the night before, and I congratulate her on her prowess. I am glad to follow the noble Lord, Lord Ilford, because he was Chairman of the

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National Assistance Board. He has heard the spokesman for the Government charge the former Government with having applied a means test in so many directions. The noble Lord will agree with me that there is a great difference between legislation and administration. You can have a measure on the Statute Book and two Governments can administer it in an entirely different way. Those of us who have served on local authorities well know that the administration of a certain group of councillors, who have a different political approach and who are there to administer the Statute, is entirely different from that of another group, although they have had to direct their attention to precisely the same matter.
First of all, I am going to deal with what I consider is a piece of harsh administration, something which I believe the social historians, when they review the effect of current social legislation on the lives of the people, will roundly condemn: I refer to the decision to abolish the supply of free school milk to children between seven to eleven, cheap welfare milk for expectant and nursing mothers, and for children under five. This was a reactionary decision. I cannot believe that the noble Lord who has just spoken, who administered the National Assistance Board, can possibly identify himself with this measure.
Nature has demonstrated that the most perfect food for a baby is milk. And to deny any expectant or nursing mother cheap milk at this most important time of her life, and that of her infant, indicates a callous disregard for the most helpless in the community. We are told that schoolchildren needing milk on grounds of ill health will receive it. How do the Government define "ill health"? The noble Lord opposite who answered my noble friend Lady Phillips glossed over this matter. If it is a pathological condition they are going to look for, presumably the child will be at home, and as poverty alone will not be a qualification for milk the Government can rely only upon a degree of malnutrition to attract attention. As malnutrition, unhappily, is not accompanied by a rash, it may well go undetected in a crowded school. We hear crowded schools described by teachers—forty or fifty in a classroom. Who is going to diagnose
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this condition, and when it is diagnosed, will gross malnutrition have developed, by which time the harm will have already been done? I was impressed by the Times Educational Supplement, which asked this question: How many medical officers can ever know enough about a child's background early enough to prescribe free milk?
I was glad to see that the Local Authorities' Association have indicated that if the school health service is not satisfactory they may appoint staff to improve its efficiency, in order if course to ensure that malnutrition will be detected in its early stages. This warning is in line with the Association's attitude to the Government's cheese-paring policy on school milk and school meals. Every local councillor brought up in a poor home is aware of the importance to children of adequate feeding. Therefore, it is not surprising that local authorities in touch with the realities of working-class life are protesting vigorously, and their protests occur all over the country. They are reported in all the papers, from what are considered Right-wing newspapers to Left-wing newspapers. They are protesting at the increase in the price of school dinners and the abolition of free milk for the over-sevens. It is significant that both Labour-controlled and Conservative-controlled councils—Newcastle is an example—want to pay for the milk from the rates. I was shocked to read in my newspaper to-day that in another place yesterday an attempt was made—and I hope it is only an attempt and that somehow it will be defeated—to stop these humane councils from raising a penny rate in order to provide milk and food for the children.
If I speak strongly on this subject it is because I spent four of the most satisfying years of my political life at the Ministry of Food, where I was concerned with prescribing food according to the biological needs of children, mothers, the aged and the sick, and not according to their capacity to pay. Curiously enough, in war time this was accepted. It was accepted that a Ministry should say that the nutritional needs of an individual are of paramount importance, particularly those of our children. We were given a free hand to ensure that the babies, the mothers, the schoolchildren, the sick and those with special diseases were given

1023
what they physiologically needed. If it was right then, why is it wrong now? This picture we have of children buying chips and cakes for their midday meal is of course familiar to those who years ago treated rickety children who were fed mainly on carbohydrates.
In the high street of every town in the country we see the lovely, straight legs of these girls in their mini-skirts—
A NOBLE LORD: Hear, hear!
BARONESS SUMMERSKILL: I am glad my noble friend realises it. They are proof of the success of the nutritional policy pursued in our schools during and since the war. In consequence, the hallmark of rickets, namely, bandy legs and knock knees, is found to-day only in the middle-aged and the elderly. That is not because the air has changed; that is not because housing has changed everywhere; it is because we in our great wisdom decided that the most helpless should be fed adequately.
It is suggested that a school means test should be disguised in order to avoid discrimination. It is difficult to believe that some, I suppose, highly intelligent civil servant devised this scheme. The scheme is that a child should take dinner money to school in a sealed envelope; the over-burdened teacher then returns it to the embarrassed child, who has already been informed by a harassed mother of every move in this cruel little game. This procedure is to be adopted in order that the most poverty-stricken—who are showing signs of malnutrition, of course—shall not be discriminated against. I should like those responsible for these variations on the means test theme to study some social statistics. The facts are that children in a small working-class family grow faster and gain more weight than those in large families. The average increase for London children was 2 in height and from 4 to 101b. in weight since the war. Before the war meals were given in schools to only 5 per cent. of children. In 1946, 42 per cent. received meals. It has been proved conclusively that we cannot separate education and child welfare if we are to produce the finest citizens, mentally and physically—and everybody here knows that so often the two go together.
The provision that certain categories—perhaps the noble Lord, Lord Aber
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dare, will tell me this—of very poor children can obtain free milk is an acknowledgment that children need free milk. But it is no guarantee that they will get it, because unfortunately children are sensitive little creatures and if they feel there is some discrimination in school, whether in the provision of milk or meals, it will be found that for one reason or another they will refuse; they will give some excuse in order not to be shown up in front of their friends. The poor, overworked mother, who I suppose is going to be asked to indicate why her children should have free milk or free food, is already told by the Government to "shop around" for cheap food. Surely, we should put no further difficulties in her way but should give free milk to these children without any further questions.
While the Government have demonstrated that they are out of touch with the needs of children, they have also revealed that they failed to understand the problems of the poor and the sick by the decision to increase charges for the National Health Service. On the subject of cost-related prescriptions, I was struck by the confidence shown by the Minister in another place in his reiterated statement that no charge would be introduced which would deter the patient from necessary treatment. How is the register of those who are deterred from securing advice and treatment to be compiled for his inspection? How is he to know? How can he go into the kitchen of a small home and know what a woman is considering when she says, "Shall I go to the doctor or not"?—because among those people will be the ordinary housewife who, with the rising cost of living, will be reluctant to pay a minimum of 20p and possibly much more, on the cost-related scheme. And when she finally visits the doctor, with a lump or a pain, and is quickly referred to the hospital for an operation, with a kindly reprimand (how well we know it!), "You should have come to see me sooner", it will be little comfort to her and to her family to be told that the Minister had said that no patient should be deterred from obtaining treatment. My Lords, these are just words! How can any Minister at Whitehall know what housewife in Durham has been deterred from getting treatment because of the cost?

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Again, how is it proposed to record the number of patients who will be deterred from taking to the chemist a prescription containing two or three expensive items? These people know. They look at the prescription, they know how many items are on it and they know that the crowded chemist at the corner may well contain some of their friends. They are faced with going to the chemist with this prescription which will cost them quite a considerable sum of money, and either paying money which they cannot afford or leaving the shop. They will look at the prescription and say, "I cannot afford this", and they will put it in the fire.
People who are ill cannot choose whether they have a cheap or an expensive illness, and a patient should not be punished for developing a disease which involves more expensive treatment. To be selective among those who are ill is illogical and unjust, and consequently the total cost of the treatment should be shared by the community. Surely it is not surprising that the General Medical Services Council of the British Medical Association has opposed this heartless scheme. And I find it difficult to know why, if all the doctors throughout the country feel that this really is unethical, a patient should either be denied a drug or be prescribed a drug which really is too expensive for him to pay for. How can the Government say that they will administer the scheme in such circumstances?
I believe that this scheme has been conceived because the widespread prescribing of expensive proprietary drugs has been permitted. I have heard the noble Lord, Lord Platt, say half a dozen times what he has just told your Lordships, and he has probably heard what I have said half a dozen times. But these things are written on our hearts. Successive Governments have allowed the prescribing of expensive drugs although a national formulary exists which sets out cheaper alternatives. When I spoke from the Dispatch Box in another place some years ago, I used to take with me what had been sent into my houshold of doctors on one day. I remember on one ocasion holding up at the Dispatch Box six boxes of sample pills and a pile of glossy advertisements. And still they come. Little is done about it. Why. I can never quite understand. I used then to appeal to the Treasury,
1026
and I cannot understand why the Treasury does not do something about it.
In 1967 the marketing and promotional practices of the pharmaceutical industry were examined by the Committee of Inquiry in conjunction with the industry and the National Health Service, and the conclusion was reached that the amount of advertising was excessive. Accordingly, it was recommended that a Medicines Commission should be set up to control advertising. The point is that the cost of advertising is met by the National Health Service. Although this Commission has been in existence for 18 months, expensive advertising continues unabated. I had four "glossies" this morning, and the glossy book that we have read about in The Times— the Book of Nobrium—is the illustration of the industry's contempt for the conclusions of the Commission's inquiry.
I listened carefully to what my noble friend told the House. He told us of everything that had been done by the various drug houses in the field of research. What are the facts'? In 1965—and these are the latest figures I have got advertising cost £15 million: a huge sum as compared with the £11 million spent on research. To-day we are asked to save £9 million through depriving children of their milk. Surely nobody can doubt that the milk is of infinitely more value to the welfare of the child than much of the output of the proprietary drug manufacturers that is peddled to the gullible. I want to sum up by saying that here is the striking contrast in the manner in which the Government retreat before the powerful pressure groups of the pharmaceutical industry and permit colossal profits to be made at the expense of the National Health Service, while the unfortunate children, powerless and inarticulate, are deprived of an essential food in the name of containing expenditure.
5.37 p.m.
LORD GARNSWORTHY: My Lords, I think that almost every speaker has expressed regret that the noble Baroness, Lady Serota, has been unable to be with us this afternoon because of illness, but I am quite sure we all feel indebted to her for having tabled this Motion. If I may, with humility and great respect, I would say that in my view the many tributes that have been paid to my noble

1027
friend Lady Phillips have indeed been well deserved. While she was speaking she touched on the position that used to obtain many years ago. She was going back certainly to the time when I was at home with my parents, and she said that in those days women could not afford the doctor. I recall that in our family the one person for whom the doctor was never called was my mother. My mother did not have the doctor because the cost would have meant that the amount spent on food or clothing would have had to be cut by the amount of the doctor's bill. Not for one moment do I think that the Government want to take us back to days like that, but certainly those of us who remember them feel fully justified in expressing concern at what appears to us to be the trend of this Government's policy.
The noble Lord, Lord Aberdare, speaking earlier in the debate, spoke in his usual model tones. He did his utmost to persuade us that there is little or no difference between the two sides in this House on this subject. I hope that this debate will make it clear that there is a difference, and that it will make clear that as far as some of us on this side are concerned we have learned a much needed lesson. It is that we ought to be careful before we introduce any policy for reasons of expediency which can be exploited by our opponents when they take office. I think no one will contend that when National Health charges were first introduced it was the intention of the Labour Government or the Labour Movement to maintain them. Indeed, at one point they were able to remove them, and many of us deeply regret that they were reintroduced, again, I think, at the time largely for reasons of expediency. As I say, there is a lesson that some of us have learned, and I hope it will be taken to heart by all those on the Benches behind me.
I should like to take up a point that I tried to get clear when we were dealing with Starred Questions this afternoon, and I hope your Lordships may excuse me for taking up your time. I should like right away to express my gratitude to the noble Baroness, Lady Tweedsmuir of Belhelvie, in that she has written me a note to confirm the figure she gave as to the number of
1028
children in Scotland receiving school meals. As I think the House understood at the time, I was after the shortfall as between those who it was estimated ought to be having school meals as compared with those who are in fact getting them; and if I am told that the 120,000 odd who are receiving school meals represent 100 per cent. of those entitled to claim, I shall indeed be surprised. I hope my point is clear. My experience as chairman of a board of governors that covers two secondary schools is that headmasters are concerned at the number of children who ought to be getting free school meals and whose parents, for one reason or another, will not apply.
If I may say so, while on the subject of school meals, both the noble Lord, Lord Auckland, and the noble Lord, Lord Ilford, touched on the 1 million drop in the number of children taking school meals. The drop that has taken place is indeed far beyond anybody's expectations; it goes way beyond the drop that took place in 1968 and 1970, when charges were raised on earlier occasions; and to assume that we are going to get, as it were, back into balance by September of this year is, I think, to express an optimism that is unjustified. May I say that I have been extremely interested in what has happened in my own county, and I find that there has been a tremendous drop, a record drop; and I am told that what has happened in Surrey is nothing like so bad as has happened in some other counties. If one refers to the details published in the Written Answer in another place the day before yesterday, to which the noble Lord, Lord Ilford, referred, it is pretty clear that there are pockets of the country where a very serious situation indeed has arisen in regard to the school meals service.
The noble Lord, Lord Auckland, made some reference to the responsibility of parents. I think we ought to take some note of the fact that a very substantial proportion of the work force in this country consists of married women, and they are not at home to feed their children at midday. They have many calls on their time, and I think it is a little unreasonable for the Secretary of State to suggest that we need have no concern on this; that their mothers know best. It

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is not so much a matter of their mothers knowing best; it is what their children do while mother is at work. I shall probably be returning to this subject presently. But I do want to make this point: that in so far as the drop in school meals in Surrey is concerned, alongside it there is a quite fantastic increase in the number of pupils bringing sandwich meals from home. May I give the figures that I have before me? In 1968, the number was 3,944; in September, 1969, 5,273; in September, 1970, 7.141 and in May, 1971, 24,014. I leave those figures to speak for themselves, because I think they are impressive, and provide the answer to what seemed to me to be a lack of concern on the part of the noble Lord, Lord Auckland, and the noble Lord, Lord Ilford.
Allowing for the need for some special benefits to ensure a minimum standard of living for all is one thing, but the introduction of means tests over what seems to me to be an ever-widening field is another matter; and the trend at present suggests that it is getting somewhat out of hand. Certainly the people who come just above the level of reduced cost services seem to catch an unfair burden, and I suspect that these include a great many people who struggle to maintain what are known as middle-class standards. I think it is time we showed some concern for those people whose incomes fall roughly between £1,000 and £2,500, because I have a suspicion that we are imposing upon those people who are struggling to maintain standards handicaps which they ought not to be called upon to bear. May I be quite clear about this? For my part, I should welcome a return to the concept of free treatment as of right in regard to all services vital to the maintenance of health, which includes optical and dental treatment, as well as medical, as indeed I would for free milk and welfare foods for expectant mothers and children under school age.
I have suggested that means testing is getting out of hand. It is also getting something of a maze. Two weeks ago I suggested that one needed to be almost a chartered accountant to understand how it all worked out, for each service has a different level of free benefit. My noble friend Lady Phillips referred to this leaflet, Which of these are yours as
1030
a right? Free, and, like my noble friend, I obtained a copy of that pamphlet from the Post Office. It shows four different levels. A married couple with one child can get free school meals at £17·25; for free prescriptions, the same family, the income level is £18·10; for free milk and welfare foods for expectant mothers and children under school age, it is £19·30; for free optical or dental treatment, £19·55. The disparities continue for families with children. I wonder how it is possible to justify these different levels? No one can be surprised that one should be asking the question, since they are all on the same leaflet which is handed out.
Whatever may be said in that respect, may I say that I am impressed by a paragraph that precedes those examples, which surely is a warning. It states that these are examples of income at which you "may" qualify. The significant word is "may". You have to till in a form; you have to wait to see what the answer is. You cannot be sure that you are going to qualify until it has been considered by somebody or other in some office. I am told that a quite large number of people think they are entitled and make application for benefit, only to be told that they do not qualify. Indeed, my noble friend Lady Gaitskell gave figures in one particular regard.
There is a different level of income again for a family income supplement. I take the point made by the noble Lord, Lord Aberdare, that if you are drawing that supplement you get all the other benefits, but it is again a different level. In regard to free milk for some children between the ages of 7 and 11, as my noble friend Lady Summerskill said, there is an entirely different standard, and I will come back to that a little later. The introduction of selectivity—as the noble Lord, Lord Amulree, said he preferred to call it—over a wide field, coupled with income tax reduction, has meant more for the childless and those in the higher income bracket (those over £4,000 or £5,000), and the crunch of these charges falls most heavily on those who just manage without entitlement to free benefits. I hope that we shall be inclined to show a little sympathy and understanding of their position.
Cost-related prescription charges have been pretty roundly condemned in this

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Chamber this afternoon. I have in my hand a copy of the Pharmaceutical Journal for May I. It reports widespread opposition to those charges, and in my contacts with those in the pharmaceutical profession—and I have no interest to declare—I find wholesale and deep felt opposition to them; opposition on grounds of imposed further hardship on the sick, and the burden of work it will impose, as they put it, even if it is workable.
The noble Lord, Lord Aberdare, said that the Government would pay full attention to what the doctors and pharmacists had to say. I hope that they will pay the closest possible attention to what the noble Lord, Lord Platt, has said. I think a fair question to put to the noble Lord is: what do the Government propose to do? Because the advice of the Association is clear. They have told the Government they do not like these charges, and have indicated in pretty clear terms—the pharmacists, at any rate, as I understand it—that they do not regard them as workable. In view of what I thought was a very powerful plea made by the noble Lord, Lord Platt, this afternoon, I think it is reasonable to ask, since the noble Lord, Lord Aberdare, said that the Government would pay full attention, what attention they propose to pay to what is the most serious criticism offered by the profession? As I see it, the extension of means-tested benefits means the further subsidence of inadequate earnings. In addition, it diminishes the incentive to earn more, because higher earnings result in loss of benefits. I really would like the noble Lord, Lord Aberdare, to reply to that point. Just what incentive does he think is afforded the wage earner living on family income supplements if any increase in earnings is lost as a result of loss of benefit? I think that question is very important and pertinent to this debate. It seems to me that, as a constructive and positive attitude, we ought to be encouraging those who seek earnings sufficient to support family needs. May I be excused for saying this in support of that proposition. It is high time that we had an incomes policy that dealt effectively with those at the bottom of the wages scales.
There is also the fact that many of those entitled to claim do not, or will
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not, claim. It may be that some of them just do not know of their entitlement. Certainly the Government have been spending a deal of money, as my noble friend Lady Gaitskell said, trying to inform people, with apparently not too good a return at the present time. Whatever the potential claimants may or may not know, we know that there are many in need who do not apply. It seems to me that when people get service as of right, there is far less risk of those in need suffering deprivation. By that, I mean that when we all get service as of right and there is no distinction as between one person and another, then those in need will run no risk of being left out.
I touched earlier on the subject of free milk for the seven to eleven-yearolds. Here incomes just do not count; it falls on the school medical officer to determine who gets free milk. As my noble friend Lady Summerskill again pointed out, it does not matter how poor you are: you do not get free milk because you are poor, only because the school medical officer has certified that you should have it. I wonder whether we shall have a school medical officer in some district who will have the temerity to say, "All children between the ages of seven and eleven in our schools ought to have free milk", and I wonder what the attitude of the Government would be if that was done, having regard to their declared intention of prohibiting I.L.E.A. from providing free milk because they think it is a wise and sound policy?
I hope that the Government will think again about this, and think again about it in the light of an article in the New Scientist for July 1 written by Dr. George Lynch and Dr. Sylvia De La Paz, members of the Social Nutrition Research Unit at Queen Elizabeth Hospital. They make the point that a significant proportion of children will be put at risk medically by the decision to withdraw free school milk from the seven to elevenyear-olds except those receiving "medical milk", which is the description given to it by the present Secretary of State for Education and Science. I hope that the warnings these two doctors give in this article will not be treated lightly, having regard particularly to the fact that in 1968 the Committee on the Medical Aspects of Food Policy advised that to

1033
withdraw milk from children below the age of eleven would result in nutritional detriment. I do not think that we can afford to ignore what Dr. Lynch and Dr. De La Paz have written, for they indicate that only 32 per cent. of children aged ten to twelve are satisfactorily fed. Some 18 per cent. of primary school children do not get enough calcium, and 28 per cent. lack riboflavin. Those statistics, again, are something of an answer to the noble Lords, Lord Auckland and Lord Ilford.
We are in danger of producing two nations; those who receive inadequate incomes and who are means-tested for essential services, and those whose incomes are above subsistence levels. But I think one ought to recognise that even among the latter there are many who just get by; on whom the burden of paying taxes, paying contributions and paying again when illness afflicts the home falls heavily. I believe that means-testing offends the sense of dignity of our people and, in addition, the varied pattern of scales now employed makes the whole business an off-putting puzzle to most people. If the Government persist, particularly in regard to cost-related prescription charges, I think that the necessity for a change of Government will be increasingly appreciated. I hope, however, that having regard to the risks involved the Government will not proceed with cost-related prescription charges and will not deprive the 7 to 11 year-olds of entitlement to free milk.
6.2 p.m.
LORD ABERDARE: My Lords, if I may have your Lordships' permission to speak again, I should like to refer to one or two of the speeches that have been made in what has indeed been an interesting debate. If I may go in the order of speaking, I said that I would try to take up one or two of the points made by the noble Baroness, Lady Phillips. One of her proposals was for free prescriptions for women, and she suggested that these should be given at 60, which is their retiring age. I think the noble Lord, Lord Amulree, agreed with that. The noble Baroness will undoubtedly be familiar with the answer: that 65 is the age at which it is considered people require more prescriptions, and it has no relation whatever to the age of retirement. I recognise that many people feel the same,
1034
but that is the distinction we make. One has to have regard to a magic figure in all these cases, and why one age is chosen rather than another is a matter for discussion. But the fact is that it is said' that people of 65 and over, whether they be men or women, should receive free prescriptions.
LORD AMULREE: My Lords, may I interrupt the Minister and ask him whether it is not really a question of capacity to pay? Presumably, a woman pensioner who has retired at 60 cannot pay as much as she could when she was in employment.
LORD ABERDARE: My Lords, as I said, the reason for the age which has been chosen is that they need more prescriptions at that time; not that they cannot afford it. But anybody who cannot afford to pay for prescriptions can apply to have free prescriptions, or for a refund of the charge.
The noble Baroness, Lady Phillips, also spoke about free meals, as did a great many others of your Lordships. To put one or two points right, so far as figures and the reasons for the fall-off in the take-up of school meals are concerned, my right honourable friend the Secretary of State for Education and Science made a very detailed Statement on July 5 in the other House, and gave a great number of reasons that are related to this question. Of course, she recognised at the same time that we naturally expected, as a result of increasing the charge, a fall-off in the take-up of school meals; and, indeed, this is exactly what happened when the last Government increased the charge for school meals.
I think the noble Baroness also referred to an article which appeared in the Guardian to-day, and that gives me an opportunity, which I welcome, to put right some of the facts. It was suggested in the article that the estimates had been wrongly made. This is not so. The fact is that the first estimate of 200,000 for the number of children who would benefit was made early this year, and took account of the reduction of sixpence in the standard rate of income tax which had already been announced by the Chancellor in October. But, of course, it could not be foreseen at that moment

1035
that the Chancellor would increase the child tax allowance in the Budget, and it is because the child tax allowance was increased in the Budget that certain families have been left with a higher net income than before. It is against that background that the estimate for those children who will benefit is now between 140,000 and 150,000.
But I should like to make this further point. There is no question, as the article implied, that 50,000 to 60,000 children already getting free meals will have them withdrawn. Free meals was a benefit in prospect for certain families which, on the basis of the April changes in remission scale and in child tax allowances, would not have materialised. However, the net income scale for remission of school meals charges will be raised again in September when the supplementary benefits scale is raised, and the 50,000 to 60,000 children referred to will then qualify for free school meals, plus many more.
BARONESS PHILLIPS: My Lords, I am not quite clear about that. Is the noble Lord saying that if you are lucky enough to be getting them already and you have a change in circumstances, you will continue to have the benefit?
LORD ABERDARE: No, my Lords. I am sorry, but it is very complicated and I was not saying that. What I was saying was that these predictions of the number of children who are going to benefit were made without taking into account the fact that there were to be increased child tax allowances. So the number who will benefit has fallen, because there will be that number of families who will be better off. The noble Lord, Lord Amulree, and I think the noble Baroness, Lady Gaitskell, made considerable and effective use of comparisons with European friends. I, too, read with great interest the article in the Economist. This is all very interesting, but it is very difficult to draw exact parallels in these cases. So many of the different benefits in other countries in Europe are covered by various types of insurance schemes, I think that any harmonisation which is going to take place will be a very long and complicated process, and one would hope that in the process of harmonisation it will be
1036
the best provisions made in the various countries that will become the harmony.
The noble Lord, Lord Amulree, alrm expressed the view that, in effect, it was better to pay allowances to everybody and recover some of them by means of tax. It is a nice thought, but it does not always work out quite so well as that, because tax does not take back all of the benefit, so that there are a number of people who benefit when they do not really need to. My noble friend Lord Ilford very effectively made the point that of course means-tested benefits of the supplementary benefit type take account of rents, which vary so widely and are such an important part of many people's budgets.
As to the noble Lord. Lord Burntwood, I had great sympathy, if I may say so, with his desire to raise all sorts of matters about the National Health Service. I, too, should have liked to have a debate on the Consultative Document on the National Health Service, but I recognise that this was not possible. I will merely say that I have every sympathy with him in his expressed hope that general practitioners will be more closely allied with the work in the hospitals. Perhaps it would be relevant to say that when we get a unified Health Service, with area health authorities that control the hospitals and the medical health administration, and organise the general practitioners' side, it may be that this will be easier of achievement. I thought he was a little hard in his comments on my speech. I did not think it was quite so reactionary as he seemed to think; and I felt that his speech was rather extraordinary, since he was a member, and a very distinguished member, of the previous Government, which did, after all, restore prescription charges and relied on many of these means-tested benefits that we are discussing this afternoon.
I hope that I have cleared up the matter of the cost-related prescription charge. The fact is that we have announced that we are to introduce a cost-related prescription charge, but we are now looking very carefully at this proposal, following the discussions that we have had with the professions. My right honourable friend has also said that any scheme which is introduced would retain exemptions, would have a ceiling on any single payment and would incorporate the passport

1037
scheme, which has worked very well hitherto.
LORD PLATT: My Lords, may I ask the noble Lord a question on that? I am sorry to see that the Government seem to have gone as far as this in their thinking, but when the noble Lord says that there is to be a ceiling, is this the total cost of the things prescribed or of each prescription? You see, to take the simple case of an eye condition, or something like that, it is very usual nowadays for the patient to be given something internally as well as something to be applied to the affected part, to say nothing of one or two accessories that may go with it. Extravagant though it seems, it is quite usual—and I am sure the noble Baroness, Lady Summerskill, will support me in this—to have three or four items on one prescription. So that if the total charge for one of them is (we will say) 30p, or something of that kind—an expensive one—the total cost of the whole lot might be approaching £1, or something of that kind.
BARONESS SUMMERSKILL: My Lords, may I put a supplementary to the noble Lord? We know that the minimum cost will be 20p. Now we are told that a ceiling is going to be fixed. May we know what the ceiling is; how much it will be?
LORD ABERDARE: My Lords, I purposely did not go into this scheme because, as I said, it is still under very deep consideration. We are still listening to the representations which are being made, and we do not wish to make a hasty decision in this matter because it is extremely important. So I do not wish to be drawn to-day into any further details of a scheme on which we have not yet decided.
LORD BURNTWOOD: My Lords, I am sorry to persevere in this matter, but do I understand now that the Government are going ahead with this scheme notwithstanding representations from all quarters, but with a ceiling on the charges to be made?
LORD ABERDARE: No, my Lords. I am awfully sorry; I do not seem able to make myself understood. We have announced that we wish, if we can, to find some means of relating what people pay for their prescriptions more closely
1038
to the cost of the prescription; but we have listened and are listening to representations made to us on this matter before we finally make any decision.
My Lords, I was very grateful for the speech of my noble friend Lord Auckland. I think he put very clearly what I had tried to make clear in my opening speech: the difficulty which we all face of making the provision that we should like to make for our social services within the limited resources available to us. The noble Baroness, Lady Gaitskell, as usual, I thought said some astonishing things in a very charming way. She began by taking us to task for the increase in the number of means tests. The increase is one: the family incomes supplement. All the rest were in operation under the previous Government. One other point I thought was not quite worthy of her, and that was when she implied that the reason why the drug manufacturers had not made any complaint was that in some way they were our friends and therefore they stood to benefit by cost-related prescriptions. But they do not. It is to their benefit that all the prescriptions should be free, so that everybody gets what they want however much it costs.
BARONESS GAITSKELL: They have not made their voice heard, my Lords.
LORD ABERDARE: They have not made their voice heard; but this is not for the reason that the noble Baroness thinks. What she never tackled, and what the noble Lord. Lord Garnsworthy, if I may say so, did not make clear to us, was how noble Lords on the other side would intend to pay for the rapidly increasing cost of these prescriptions. We have heard from all sides of the House, and from the noble Lord, Lord Platt, that more and more money is required to pay for more and more expensive medicines; and, somehow, these have to be paid for. Not only that, but the noble Lord, Lord Garnsworthy, went even further. He wanted all health benefits to be free, and a great many welfare ones, too. He must accept that this would increase taxation.
LORD GARNSWORTHY: My Lords, it is not a question of increasing taxation. The Government have chosen to reduce taxation, and in order to reduce taxation they are imposing additional charges on

1039
people, many of whom I suggest, can ill-afford them.
LORD ABERDARE: My Lords that is not putting it the right way at all. The reason for the charges is to find extra resources for the health and welfare services. But if the noble Lord is really considering having no prescription charges, no charges for health services and no welfare charges, I hesitate to think how much he is going to put on income tax when, if he ever does—and I hope he does not—he gets back into power.
My Lords, I took very careful note of the views of the noble Lord, Lord Platt, on prescription charges, and particularly on cost-related prescription charges, and I am grateful to him. I do not want to intervene between him and the noble Baroness, Lady Summerskill, on the question of the pharmaceutical industry, except perhaps to say that I find myself rather more in sympathy with the noble Lord, Lord Platt, on this matter than with the noble Baroness. Not only have these pharmaceutical firms done a great service in many ways, as the noble Lord, Lord Platt, described to us, in the development of new drugs but we ought not to forget that they have also been very considerable exporters, and have earned a lot of foreign currency for this country. But, having said that, of course, it is true that we still operate the voluntary price regulation scheme which was introduced under the last Government, and which keeps a check on the prices charged.
The noble Lord, Lord Ilford, from his long experience made his usual wise contribution to this debate. I was grateful for his assistance in pointing to the need for means tests provided that there are proper provisions for exemptions. He drew attention to the size of my Department, and rather thought that his remarks might not appeal to me. I must say that they rather did appeal to me. I am quite sure that there are very great advantages in Health and Social Security being amalgamated, because it means that the Secretary of State can take an overall view of cash arid care when dealing with this problem. I also take his point of the need for the human administration of
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social security benefits. I can assure him that this is very much in the mind of the Department. As he knows very well, it is very largely dealt with in local offices, and I have on many occasions paid tribute to the staff of those offices. I think that they deal with the claims on them in a most humane way.
The noble Baroness Lady Summerskill, made a powerful attack on what we did about school and welfare meals. She referred particularly to her experience when she was doing extremely good work at the Ministry of Food. She asked what was the difference. The difference was that in those days food was very desperately short. It had to be provided we had to see that those who needed it got it. Do we really now need to supply free milk to all children over the age of 7? We are a very well-fed community. Are there not other priorities? We can differ on this—
BARONESS SUM MERSKILL: My Lords, the noble Lord could argue as logically that in view of the fact that people are so very much better off to-day they should pay for their own education. Why do not the Government say that? The Government know that they cannot say that because education is of fundamental importance to the country. So are healthy workers. Welfare and education go together.
LORD ABERDARE: My Lords, as I said at the beginning, we believe in a mixture of benefits, some free where they apply to large classes of people—and everybody is in need of education. But I wonder whether all children over 7 really need milk? I do not know that all my children do. I wonder whether every child really does.
LORD RAGLAN: My Lords, I am sorry to interrupt and add to the number of questions which the noble Lord has to answer, but I think my noble friend Lady Summerskill has a point of substance here. I remember asking a question in your Lordships' House five or six years ago in relation to cases in Scotland, in Glasgow, which arose out of deficiency, cases of rickets—
SEVERAL NOBLE LORDS: Order, order!
LORD ABERDARE: My Lords, I am sorry, but the noble Lord has not made

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a speech in this debate and it is unfair of him now to do so. Would he like to ask a quick question?
LORD RAGLAN: My Lords, I was leading up to my question. How are the Department of Health going to ensure that deficiency diseases like rickets are not going to reappear with the abolition of free milk?
LORD ABERDARE: My Lords, I have made it clear that we are depending on the school health service in this. The Committee on the Medical Aspect of Food Policy has a watching brief on this.
The noble Baroness, Lady Summerskill, also challenged me on the fact that we had said we would ensure there was no deterrent on people going for their medicines on prescription. What my right honourable friend had in mind was a scheme under which there would be exemptions for those who could not afford it, or a maximum charge, so that certainly it would never be more than that maximum charge for that particular item. Furthermore, there is the season ticket system which is so effective at the moment, so that anybody can limit his prescription cost now to something in the region of 7p per week.
BARONESS SUMMER SKILL: My Lords, I am sorry to interrupt but this is a very important debate. Does the noble Lord realise that the season ticket system is attractive to individuals suffering from some chronic disease and to hypochondriacs? What we have to consider is the sort of person such as my noble friend Lord Garnsworthy referred to, his mother: the woman who every day will say, "I will not go to the doctor, for it will cost at least 20p, and perhaps 40p or 50p." How can the noble Lord opposite know whether they are deterred or not? They are the people who eventually become outpatients and wait to be seen by the doctor, only to be told that it is too late.
LORD ABERDARE: My Lords, the noble Baroness has made her point and I have made mine. I think that there are various safeguards by which we can continue to look at any new scheme. We shall provide for the noble Lord's mother.
LORD GARNSWORTHY: We do it ourselves.
LORD ABERDARE: My Lords, the noble Lord, Lord Garnsworthy, made various points. He went back to refer to the position in Scotland about which he had asked earlier. My figures for England and Wales show that something over 80 per cent. of those eligible for free meals are claiming them at the moment. He talked about National Health charges being introduced by his Party for reasons of expediency. I should not say that "expediency" is a very good word. I should say, "for practical reasons". But I would also say that nobody supports Health Service charges for their own sake. We do not believe in them as some sort of doctrine; that they are a good thing. But when looking at the priorities, when trying to provide health services and to make available the free services required, we are driven back partly on to taxation and partly on to charges—just as were the last Government. It is the balance between these that noble Lords are perfectly at liberty to criticise. I would suggest that we are always going to have a balance between how much one pays through tax and how much through charges.
The noble Lord made a great number of other interesting points. I have dealt with his desire for free treatment which I thought was a little Utopian. He mentioned the document that we both have and the different levels of income which ensure free provision. This again is what the Labour Party had: different levels of qualifications for different benefits. We have done better. We have increased the amounts. As I have tried to explain, we are bringing these benefits together so as to make the family incomes supplement the passport to the other benefits. We have tried to make simplification wherever possible. Finally, he mentioned some of the research by Dr. Lynch. We have not yet had all the details of his research; but my right honourable friend the Secretary of State said yesterday in the House of Commons that when this report is published it will be referred to the Committee on the Medical Aspects of Food Policy and fully and objectively assessed.
If I may end as I began, there are many demands on us. We need to use the resources we have to the best advantage. We have all had to rely partly on taxation, partly on charges and partly

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on the provision of free facilities to help those less fortunate. We can go on adjusting the balance between taxation and charges and free benefits as much as we like wherever we think the best balance lies. But in the end it comes down to a balance and we have to find the best one. My Lords, I very much welcome this debate.
6.30 p.m.
BARONESS PHILLIPS: My Lords, I should like to thank all noble Lords who have participated in the debate. There has been a great galaxy of that talent in which your Lordships' House is so rich. We have had speeches from ex-Ministers; people concerned with hospitals as governors, and people with knowledge in the medical profession. Each speech produced new ideas and confronted the Minister with questions to answer. I am sure that I speak for all noble Lords when I pay tribute to the noble Lord, Lord Aberdare, for his patience and the meticulous way in which he has answered everyone who put a point to him. We greatly appreciate it, and the fact that he spoke twice in the debate. I did not accept the explanation about the woman of 60 when it was given to me originally; I still do not accept it, and I shall come back to that later.
LORD ABERDARE: My Lords, perhaps the noble Baroness will accept it when she reaches the age of 60.
LADY PHILLIPS: My Lords, it seems more likely that it will be when I get to the age of 65, and I am sick.
I was heartened by the fact that the last debate which I had the privilege of introducing in your Lordships' House referred to retirement pensions, and shortly afterwards these were increased. I am now relying on my Patron Saint, who sees me in good stead in most things. Since the Government appear still not to have completely made up their mind about cost-related prescription charges, and are under heavy pressure, I hope that ultimately they will decide against such charges. I thank all noble Lords who have participated in this debate, and on behalf of my noble friend Lady Serota I ask leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.

RURAL WATER SUPPLIES AND SEWERAGE BILL
6.32 p.m.
THE PARLIAMENTARY UNDERSECRETARY OF STATE, DEPARTMENT OF THE ENVIRONMENT (LORD SANDFORD): My Lords, I beg to move that this Bill be now read a second time. This is quite a straightforward Bill; its purpose is to enable us to keep on making new awards of grant under the Rural Water Supplies and Sewerage Acts. Very soon we shall have given pledges up to the limit of our existing statutory authority. We must therefore have further provision. At present we have authority to pay up to a total of £105 million in capital terms as Government contributions towards the cost of rural water supply and sewerage schemes in England and Wales. Where the Government pay a grant, this entrains a county council contribution, usually of the same amount.
The post-war programme was launched by the Act of 1944 which authorised Government grants up to a limit of £15 million. As the programme developed, this was increased by three successive additions, each of £30 million, under the Acts of 1951, 1955 and 1965. The total value of grant awards to date is approaching £104 million, and new awards are running at the rate of £6 million a year or more. Since the war, a total of £415 million has been spent on these two rural services. A sum of £115 million has been spent on rural water supply, and the proportion of the rural population with piped water has been raised from 70 per cent. to an estimated 97 per cent. A total of £300 million has been spent on rural main drainage, and recent returns by rural district councils in England and Wales show that 75 per cent. of their populations are now connected, or could connect, to public sewers. Something like 40,000 existing properties are brought within reach of sewers every year by means of these grant-aided schemes.
Looking to the future, my Lords, returns from water undertakings show that not much is proposed by way of mains extensions because, of course, the water programme is in its final stage. Some 10,000 properties will be supplied for the first time during the next few years, and

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the signs are that the proportion of the rural population supplied will finally settle down at somewhere between 97 and 98 per cent. But sewerage authorities still have a long way to go. Rural district councils in England and Wales reckon to spend more than £160 million—at 1970 prices—during the next ten years, and bring the proportion of the rural population within reach of sewers up to 85 per cent.
Had the Government followed the precedent set by the previous Rural Water Supplies and Sewerage Acts, I should probably now be asking your Lordships' House to agree that the limit on grants should be raised by a further £30 million, which would provide for a further four or five years. But, instead, I am asking for agreement that the limit be removed altogether—an approach which, I may say, is entirely in accordance with the trend followed in other legislation in recent years. Perhaps I should say, by way of explanation, that the inclusion of a statutory limit in respect of expenditure provided wholly from Votes duplicates formal Parliamentary control exercised at annual intervals through the normal supply procedure for the approval of Estimates, and that the procedure provided for here is somewhat unusual.
The removal of the limit does not mean that there will be unlimited awards of grant. The intention is rather to maintain the maximum freedom of action in this field at this time, when Parliament has yet to take decisions about the future organisation of the water services, in particular, and the reform of local government, in general. The financial relations between central and local Government are also being generally reviewed, and within that the financial arrangements for the water services also fall to be considered. We cannot say now, therefore, exactly what the future holds for the rural water supply and sewerage grants, and we do not want to anticipate the decisions of Parliament about these matters by proposing some particular amount by which the grant limit should be increased. But in this period of change we are seeking authority which, by enabling us to continue to make further grant awards, will help to keep the programme of rural water supplies and sewerage schemes going forward without any check to its
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momentum. My Lords, with that explanation I beg to move.
Moved, that the Bill be now read 2a.—(Lord Sandford.)
6.37 p.m.
LORD GARNSWORTHY: My Lords, I should like to express the regret of my noble friend Lord Greenwood of Rossendale that he has been called away and has been unable to stay for this debate. Secondly, I should like to thank the noble Lord, Lord Sandford, for his very clear exposition of the content of the Bill. I understand that when this Bill was before another place, apart from the Ministerial statement, there was no discussion; but sometimes we do a little better in your Lordships' House. I say that as a prelude to putting one or two points to the Minister. First, my Lords, let me make clear that we give the Bill a wholehearted welcome because, as the noble Lord has said, it will permit the continuance of a policy to take sewerage schemes to rural areas which have hitherto lacked a system.
The position of rural areas is very fully reviewed in the Report of the Working Party on Sewage Disposal, so ably chaired by Mrs. Lena Jeger, entitled, Taken for Granted. I hope that some thought may be given to it, and I should like to draw attention to what the Working Party had to say in paragraphs 289 and 292 of its Report. The Working Party touched on the cost of connecting up. There is little point in having a sewerage system unless householders connect up. Attention is drawn in the paragraphs to which I have referred to the very high cost to householders in some rural areas of connecting to the main drain. One wonders whether the local authorities that may be involved should decide that they would carry a proportion, or indeed the whole, of the cost of linking up; and whether then the schemes might fall within what is regarded as a right and proper figure for grant.
Finally, my Lords, I should say that a number of rural district councils have had to postpone carrying out small sewerage schemes, costing under £100,000, because insufficient capital is available to be borrowed after the allocation of the county area pool under the new scheme for loan sanctions in Circular 2/70 from the Department of the Environment. It would be

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reassuring if the noble Lord could indicate that sufficient additional money will be made available, either from the pool or by other means, so that the money made available under the Bill will be fully used for the benefit of local areas which are still unsewered. If the noble Lord is able to indicate that such an assurance can be given, it will be very much welcomed. If not, perhaps I could have a word with him later and it could be passed on to those who have made representations. In the meantime, I give this Bill our whole hearted support.
6.42 p.m.
LORD SANDFORD: My Lords, I am grateful to the noble Lord for his reception of the Bill. I would confirm that the Jeger Report, with its many virtues and merits, is receiving close consideration, together with other reports which bear on this matter. In particular, the factors in the Report to which the noble Lord has drawn attention will be fully considered. The noble Lord also asked about the operation of the new scheme for loan sanctions. I do not think that I can give the assurance which he asked for in the precise terms in which he would like to have it, because he will recall that the object of the whole scheme is to give local authorities wider discretion and freedom to decide their own priorities within locally determined schemes. This means that central Government cannot say that funds made available are going to be used in this or that way in locally determined schemes. The noble Lord will know that this year is the first in which this system has operated. The experience gained is being taken fully into account and some changes have already been announced as a result of the consideration of this first year's experience. I can assure the noble Lord that the provision of water supplies and sewerage in the countryside is something which we and the local authorities would like to see going forward, so far as possible unchecked.
On Question, Bill read 2a: Committee negatived.

LUTON CORPORATION BILL [H.L.]
Returned from the Commons agreed to.
TORBAY CORPORATION BILL
Returned from the Commons with the Amendments agreed to.
MERSEY DOCKS AND HARBOUR BOARD (ORE BERTH) BILL [H.L.]
Returned from the Commons agreed to, with Amendments: the said Amendments considered and agreed to.