§ 3.35 p.m.
§ THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (LORD ABERDARE)My Lords, with your Lordships' permission, it might be convenient if I were now to repeat a Statement being made in another place by my right honourable friend the Secretary of State for Social Services about family planning. It is as follows:
"My right honourable friends, the Secretaries of State for Wales and Scotland, and I have carried out a comprehensive review of the provision for family planning services within the 487s National Health Service. We have concluded that a substantial expansion is needed if the numbers of unwanted pregnancies are to be reduced. With modern contraceptive methods available there should be fewer abortions and much less of the unhappiness and ill-health which results from unplanned pregnancies.
"There are three areas in which we need to improve our family planning services—advice, education, and free supplies for those who need them. First, my right honourable friends and I propose to expand the family planning advice services, which from April, 1974, will all be the responsibility of the new National Health Service authorities, so that a comprehensive service of advice is readily available free of charge to all who wish to have it. There will be more clinics, more easily accessible, giving free advice on contraceptive methods, and the domiciliary services will be further expanded to enable all who wish and need advice in their home to receive it. More emphasis will be placed on the offering of advice and where appropriate treatment, to patients in hospital, particularly maternity and abortion patients.
"Many people will prefer to consult their general practitioners. At present they receive full advice and services under the National Health Service only where there is a medical need for contraception. I therefore propose to enter into discussions with the medical and pharmaceutical professions to see whether satisfactory arrangements can be agreed with them under which the fees which general practitioners may at present charge National Health Service patients who have no health reasons for avoiding pregnancy, for the work of prescribing the pill or the fitting of an appliance, can be replaced by appropriate remuneration from official sources.
"Secondly, it is clear that we still need to do more to inform the public about the services available and to encourage them to use them. I intend to make extra funds available to the Health Education Council for this purpose and am providing money for special training courses for professional workers. Finally, my right honourable friends 488 and I have concluded that there should be free contraceptive supplies for those who have a special social need and who would otherwise be unlikely to undertake effective contraception and also for those with a financial need. We also propose a new category for automatic exemption from charges for family planning supplies; that is, women who have had a baby or an abortion within the previous twelve months. Apart from these, people with a medical need will pay no more than the standard prescription charge. Others will pay the full cost of their supplies.
"I believe these new arrangements will be generally welcomed. They will be implemented as soon as possible. Their cost will depend on the use which the public makes of the new services. We expect that in response to this demand the total cost for England, Wales and Scotland will build up to about £12 million per year over the next four years compared with current annual expenditure of about £4 million. This represents total additional expenditure of £20 million over the four year period."
My Lords, that ends the Statement.
§ 3.39 p.m.
§ BARONESS SEROTAMy Lords, may I first thank the noble Lord for repeating that long and important Statement which has been promised for some time. We on this side are in full agreement with the outcome of the Government's review: that a substantial expansion is clearly needed, and that we should develop a comprehensive family planning service. The difference between us, if I understood the Statement aright, is that the Government are proposing to provide a free family planning advice service, but payment will still need to be made by certain categories. The vast majority of women will continue to have to buy such supplies and appliances as are prescribed. We are particularly concerned about these distinctions between the different categories. In particular, I should like to ask the noble Lord how he would define a medical need for contraception. I understand from the Statement that even where a need is accepted the woman concerned will still have to pay flat rate prescription charges for their supplies, rather than the full cost.
489 We are also concerned at the definitions of "special social need" and "special financial need", and I ask the noble Lord what criteria will be applied to the categories that were mentioned in the Statement. Does this mean another kind of means test? What kind of social tests will be applied? We are particularly concerned that women will need to have had a baby within the previous twelve months, or an abortion, before they are entitled to full free supplies. This comes at a time when many local authorities are already providing a free service. This point was made in our Second Reading debate on the National Health Service Bill, and I have no doubt that we shall be coming back to it when we go into Committee, particularly on Clause 4 of the Bill, early next week.
May I ask the noble Lord, finally, whether this Statement means that in future those local authorities already providing a free and comprehensive service will be prevented from so doing until such time as their service is transferred to the new integrated National Health Service?
§ 3.41 p.m.
§ LORD BEAUMONT OF WHITLEYMy Lords, may I, on behalf of noble Lords on these Benches, greatly welcome this Statement? It is very quick and good of the Government to implement 60 per cent, of the Liberal Party policy on this matter passed last September. Perhaps after another two by-elections they will implement the other 40 per cent. There are four questions I want to ask. First, part of this Statement refers to telling people about the service, and letting them know by as wide a means as possible. Will this include a programme of advertising on the mass media as to the availability of these services? I certainly think it should. Secondly, will it also include a pressure on those public or quasi-public bodies which do not accept advertising at the moment on family planning, that they should review the situation? Thirdly, will any finance be put into the research that is needed for more and better ways of family planning? Fourthly, we have now a situation where it will be possible for anyone who is poor to get family planning free. We have a situation now where it is possible to get a male vasectomy on the National Health. Will it 490 be possible to have voluntary female sterilisation on the National Health? That seems to be one thing which is left out at the moment. Finally, I hope that when talking about this the Ministry will not just talk about the expense, as they have in this Statement, but about the immense saving there will be in regard to ill-health, abortion, human misery, et cetera.
§ LORD ABERDAREMy Lords, I am very grateful to the noble Baroness and to the noble Lord, Lord Beaumont, at least for their 60 per cent, welcome of this Statement. The noble Baroness asked me one or two questions. First, as regards medical cases, there will be no change so far as they are concerned. At the present moment a person having a medical ailment gets a prescription from his general practitioner and has to pay the subscription charge for that prescription. If our conversations with the general practitioners and the pharmacists reach a successful conclusion, we shall be providing a means whereby a person who goes for advice to a general practitioner will not have to pay the general practitioner; that will be included in his fee. So to that extent we are providing an additional service.
So far as those who have a social need are concerned it is not possible to lay down detailed criteria; but the important thing is that the family should have a special social need, and whether there is a need and whether the person concerned would be unlikely to go for supplies if he had to pay for them is left to the judgment of a professional worker. As to the financial need, it certainly is not intended to introduce any other form of means test. It will be linked with one or other of the entitlements which exist at the moment under the social services. So far as concerns the present situation with the boroughs which provide free supplies, they will be perfectly at liberty to continue to do so; but, of course, in 1974 the whole service will become part of the National Health Service.
The noble Lord, Lord Beaumont, asked me four questions. I think the answer to his first two questions is that this must be a matter for the Health Education Council, to whom we are making extra funds available. I understand that it is in their minds to do something along the lines of at least trying some sort of 491 advertising on the mass media. So far as research is concerned: Yes, we do both support the Family Planning Association and make grants to the Brook Advisory Centres, which are responsible for quite an amount of research. So far as female sterilisation services are concerned we have yet to issue guidance as to what sort of policy will be effective after April 1, 1974. This has not yet been decided.
§ LADY RUTHVEN OF FREELANDMy Lords, is there some question of the unmarried woman being allowed to have these extra services? I think this matter is very important. It is no good saying, after a girl has had a baby or an abortion, that she can then have free family planning. We really want to prevent her from having an illegitimate baby. I should very much like to know whether this aspect is covered.
§ LORD ABERDAREYes, my Lords; there is no distinction to be made between the married and the unmarried. As I said in the Statement, there will be more clinics, more easily accessible, giving free advice on contraceptive methods. I have no doubt that this will be of help.
§ BARONESS SUMMERSKILLMy Lords, while I am in full agreement with this decision to disseminate birth control information, am I to understand—I hope I am—that this is to apply only to appliances and not to the pill, which I believe has not had sufficient time to be adequately tested?
§ LORD ABERDARENo, my Lords; this will certainly apply to the pill as well as to appliances. I have noticed that the noble Baroness has a Question down on this subject, which I shall have pleasure in answering.
§ BARONESS SUMMERSKILLMy Lords, may I ask the noble Lord—because I think this should be decided before this information is given to the public—whether he is aware that, for instance, on October 14 the first long article in the British Medical Journal was warning the doctors of the country of the danger that these young women taking the pill may be infertile for years afterwards? I quote that to the House as one reason. Further, is the noble Lord aware that in America (and it was in America that thalidomide was never 492 given, because the doctors said that it was dangerous) there are most eminent people who still say that the pill has not been adequately tested? Is it fair on the innocent young women in this country for the Government to distribute pills indiscriminately in this way?
§ LORD ABERDAREMy Lords, I think the noble Baroness is anticipating her Question. Her question now is exactly what she has down on the Order Paper.
§ LORD ABERDAREI can only say to the noble Baroness that we are content to take the advice of our own very highly professional expert committee, the Committee on the Safety of Medicines, which has advised us that there is no reason to fear ill-effects from the pill.
§ BARONESS SUMMERSKILLMy Lords, but is it not the fact that the same advisers were wrong on thalidomide?
§ LORD ABERDAREMy Lords, the Committee on the Safety of Medicines did not exist in the days of thalidomide.
§ LORD ROBBINSMy Lords, could the noble Lord be persuaded to elucidate a little further what he means by "social need"? To me, it covers such a variety of cases that I am still completely in the dark as to the intentions of the Government in this respect.
§ LORD ABERDAREIt is, I would hope, my Lords, a fairly imaginative concept. We intend to leave it to the professional worker—it may be the health visitor, it may be the social worker—to advise where there is a suitable case. I can only suggest, as one possibility, a married couple where in fact the husband's income is above the limit at which he would qualify for free supplies but where, because he is a thoroughly selfish and ill-mannered husband, he is not making things sufficiently easy for the wife to afford the supplies. This is the kind of situation we have in mind.
§ LORD WELLS-PESTELLMy Lords, the noble Lord was good enough to mention that this information would be available to all who need it. Would the noble Lord say from what age it will be available? I have in mind the increasing 493 number of schoolgirls of 11, and 11-plus, who are being aborted and who are having illegitimate children. I should be interested to know at what age this information will be available.
§ LORD ABERDAREMy Lords, what education is given in the schools is a matter for the education authorities, but it is one point on which there is a great deal of concern. I know that the Department of Education and Science are well aware of the problem.
§ LORD WELLS-PESTELLMy Lords, I am obliged to the Minister. But, having regard to what is happening in our schools, is it really only a matter for the education authorities? Is it not a matter for the education authorities to lay down that something must be done? We have a very effective Health Education Council and I was going to ask the noble Lord whether his Department intend to ask them to embark on a series of talks in the schools; and that any aid or additional grant which the Government give them should be conditional on such talks.
§ LORD ABERDAREMy Lords, I know that the Health Education Council are well aware of this matter and that they are in close contact with those responsible for the content of the schools programme.