HL Deb 19 December 1972 vol 337 cc950-69

2.55 p.m.

THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (LORD ABERDARE)

My Lords, I beg to move that the House do again resolve itself into Committee on this Bill.

Moved, That the House do again resolve itself into Committee.—(Lord Aberdare.)

On Question, Motion agreed to.

House in Committee accordingly.

[The EARL OF LISTOWEL in the Chair]

Clause 4 [Family Planning Service]:

BARONESS LLEWELYN-DAVIES OF HASTOE moved Amendment No. 34: Page 3, line 27, leave out ("he considers") and insert ("is").

The noble Baroness said: I beg to move the Amendment standing in my name. The Committee listened with great interest yesterday to the reply by the noble Lord, Lord Aberdare, to a rather similar Amendment moved by my noble friend Lord Stow-Hill. Not being a lawyer, I do not pretend to have completely understood it. I think the noble Lord, Lord Aberdare, himself said that he was not wholly au fait with every phase of it. It was a fascinating explanation of why the Government could not accept the Amendment. So far as it goes one sees the point of it, but in the context of Clause 4 which deals with the family planning service there are particular reasons why the wording should be: It shall be the duty of the Secretary of State to make arrangements, to such extent as is necessary… rather than …to such extent as he considers necessary because as it stands at the moment this is purely discretionary; and we want to make it mandatory.

I think it is absolutely true that the right honourable gentleman who is the Secretary of State at the present moment is held on all sides of your Lordships' House in very great respect. He is humane, immensely devoted to his work and of great intellectual distinction. Such are precisely the highly-esteemed colleagues which any Prime Minister moves about on his chequer board in order to take advantage of their qualities. I will go further and predict that it is probably doubtful whether the present Secretary of State will be the Secretary of State when this reorganisation takes place in 1974.

Public opinion has been changing (and has, I think, now changed very much) on this whole subject of family planning from what it has been before. Ever since the Bill was drafted and we have had the Second Reading, we have had the welcome announcement of the expansion of at least some of the services for family planning—inadequate though we on this side think they are. Therefore, we feel that it could happen that what the Minister considers necessary may be different from what public opinion, from what social workers and even from what medical opinion consider would be necessary. That is why we want to make this not a purely discretionary matter but something quite different. We are really very anxious that there should not be established a kind of lowest common denominator in the family planning services. We want what is necessary; and not what is merely fitting at any particular time. That is why the Amendment is so worded. We have a great deal to do to-day; I do not want to labour this matter further; but that is the kernel of our point. For these reasons, despite the answer we had yesterday I would ask the noble Baroness to consider very earnestly accepting the Amendment.

LORD DAVIES OF LEEK

I should like to support my noble friend, not merely from the legal point of view but from the point of view of the Secretary of State. What he considers necessary may not sometimes suit the general religious opinion or the opinion of the country. I will be 100 per cent. frank. If the Secretary of State is of a certain religious opinion and he considers contraception to be against his religious prejudices (I use that word), he may not consider that supporting contraception is necessary.

I had even thought of putting down an Amendment myself. It could happen these days—and any doctor will support me on this—that there comes a sad part in the life of young people. When I was a Minister, it was my job to visit hospitals to see paraplegics and others. I do not want to be mealy-mouthed about this, but in the age of prophylactics and sexual appliances as well there may be a case for the use of appliances to ensure the happiness of individuals who want to live as near a full life as possible. The Secretary of State may think this unnecessary because of his own background or upbringing. I do not want to develop that point for any prurient reason whatsoever. Fortunately, I think I have passed that age long ago—

BARONESS SUMMERSKILL

Oh, no!

LORD DAVIES OF LEEK

—but I am tough enough to know what kind of a life we are living.

BARONESS SUMMERSKILL

One is never too old.

LORD DAVIES OF LEEK

This is a real point in modern life. There are many people, especially, for example, victims of road accidents and similar occurances, who are in the position that sometimes they need the aid of sexual appliances in order to live a rich and full life. This Committee, and indeed this generation, ought to face this issue. I could go into the matter in depth, but there is no need. Most people here have had vast experience at all levels of life, and before the Minister replies may I say that I hope we shall not have a similar answer to that we had to the first Amendment which was moved yesterday by my noble friend.

BARONESS YOUNG

I am glad that the noble Baroness, Lady Llewelyn-Davies of Hastoe, said that this Amendment is similar to Amendment No. 1 which was moved yesterday. Like the noble Baroness, I am not a lawyer and I do not feel that I am qualified to embark on a long legal argument, but I do understand that the point which is being made is that if this Amendment were accepted it would make the National Health Service a matter for potential litigation and ultimate decision by the courts. That, of course, is the answer which was given yesterday by my noble friend Lord Aberdare. But if I may expand it a bit further, the nature of the National Health Service is such that it is impracticable to lay down its precise extent in legislation. To attempt to do so would result in a most undesirable inflexibility.

The principle used in this Bill is one that was successfully followed in the 1946 Act. It describes the scope of the services in general terms and involves using such words as appropriate", "reasonable" and "necessary", and leaves it to Ministers answerable to Parliament to decide what is appropriate, reasonable or necessary according to the circumstances. If that interpretation is understood, I think it answers the point raised by the noble Lord, Lord Davies of Leek. He was suggesting that the Secretary of State would be swayed by his own prejudices or religious views. I think that is improbable, because, clearly, the advice he would be getting would be not only from Parliament but also from all the organs of public opinion which influence Government decisions. For that reason, I hope that the noble Baroness will feel able to withdraw her Amendment.

LORD STOW HILL

I do not wish to prolong the discussion, but I submit to the noble Baroness, Lady Young, that she has not met the point that is put in this Amendment. When I ventured to move a rather similar Amendment to Clause 2 I described it as a drafting Amendment which I did not wish to press. That is not quite the case here. What is said here is the following. When one speaks of family planning one is dealing with a subject on which people's personal opinions differ very widely; it is a subject upon which they hold very sincere differences of opinion. That being the subject of this particular clause, and in that respect it being a clause which deals with something different in genus from the other clauses in this Bill, what is submitted to the Committee is the following: an absolute standard, and not a relative standard, should be imposed by the clause. It should not depend upon the opinion of anybody.

I quite understand—if I may say so there is force in the point—that the Secretary of State, when he formulates his opinion and gives effect to it in actual proposals which he introduces, will be subject to Parliamentary criticism; that is certainly so. But at this stage in our legislation surely it is right, when one is dealing with a matter so distinctly personal and individual, that one should say that the clause should measure out what is the obligation, and in whatever terms it measures it out and formulates it that should constitute the absolute standard which must be achieved by the Secretary of State from time to time in charge.

That is the point we make by this change that we propose, and I hope that the noble Baroness will think, on reflection, that there is rather more in it than a question of testing this matter in the courts. The question is, should Parliament, in dealing with such a sensitive topic as this, set an absolute standard, or set a standard which is to depend upon the individual, perfectly sincere, opinion of the Secretary of State for the time being; albeit that his opinion, when voiced and given effect to, will be subject to Parliamentary criticism? I submit that it is right in this particular context to impose an absolute standard, and that is the case for this Amendment.

BARONESS YOUNG

I entirely agree with the noble and learned Lord, Lord Stow Hill, that this is a very sensitive matter, but it seems to me that he said in the first part of his argument that there are differences of opinion—a point on which I think we should all agree—about family planning and at the same time he said that we should write into the Bill something which would give us absolute standards, with defining how we should reach those absolute standards or indeed how we should find them. It seems to me that precisely because we would have this difficulty we should be involved in the kind of litigation about which I was speaking. The Bill is therefore drafted in this way to give this discretion. It is not setting up the Secretary of State as a kind of dictator who will say what will happen. He will, as always, be influenced by Parliament and by opinions as expressed.

BARONESS LLEWELYN-DAVIES OF HASTOE

I must confess that I am not convinced by the argument of the noble Baroness, Lady Young, and I was indeed convinced by the argument of my noble friend Lord Stow Hill, and not on any political basis. I can say this quite clearly because although the 1946 Act was a Labour Government Act, of course it was not perfect. Indeed, to use that as an argument shows how out of touch the Government must be with the way public opinion has moved since then. That is precisely the point that we are trying to put across in this—as my noble friend said—particularly delicate situation. Further, I cannot follow the argument about the Secretary of State doing something illegal. I cannot imagine that he does not have behind him a great battery of lawyers of every kind to prevent him from doing precisely that thing. In other words, we do not find the answer of the noble Baroness convincing. We do not blame her for that, because we know that it is a legal and a kind of—if I may say so—"identikit" reply to this type of question. We wish to say that we think the use of the words "appropriate" and "as he considers" were possibly a weakness in the last Act; that times have now changed and that therefore we do not accept her argument. We may well come back to this matter on Report, but for the present I beg leave to withdraw the Amendment.

LORD DAVIES OF LEEK

I will not delay the Committee but I want to come back again. I would suggest—I am in order, am I not?

BARONESS LLEWELYN-DAVIES OF HASTOE

The Amendment is being withdrawn.

LORD DAVIES OF LEEK

Oh! That is a pity.

Amendment, by leave, withdrawn.

3.10 p.m.

BARONESS LLEWELYN-DAVIES OF HASTOE moved Amendment No. 35: Page 3, line 29, after ("contraception") insert ("to all persons, whether married or unmarried, seeking such advice").

The noble Baroness said: I beg to move the Amendment—with apologies to my noble friend Lord Davies of Leek. I think that it would be for the convenience of the Committee if, with this Amendment, I spoke to Amendment No. 36. Since I think we are to have a much longer discussion on the next Amendment, I wish to be as brief as possible in moving this Amendment, and the more so since we had put it down before the noble Lord, Lord Aberdare, repeated in the House the other day the Statement by his right honourable friend about the expansion of family planning services. All noble Lords who take a special interest in family planning matters; indeed, noble Lords everywhere, are particularly concerned to prevent illegitimate babies from being born, with all the tragedy and suffering that this involves and all the social and economic deprivation for the child and, if one goes by statistics, even possible delinquency for the child. We were much encouraged by the Answer of the noble Lord, Lord Aberdare, to a Question by his noble friend Lady Ruthven of Freeland, when he said that there is to be no distinction made between the married and the unmarried. That assurance applied to the expansion of the services announced by the noble Lord. I move this Amendment now only because I should like the noble Baroness to confirm that the principle underlying what the noble Lord said applies to family services in general.

BARONESS YOUNG

I should like to begin by saying that the Government understand the concern of those who seek by this Amendment to clear up any possible misunderstanding that there might be in the interpretation of this clause; to repeat what my noble friend Lord Aberdare said last week, and make it quite clear that the advice on contraceptive services will be available both to the unmarried and the married. In fact, the present position is that most local authorities already provide contraceptive services for unmarried people; and the Department of Health and Social Security, in a circular last year, encouraged local authorities to provide contraceptive services for single people. In the new National Health Service we intend no discrimination against single people, and as proposed, supplies which will be available free of charge for the exempted groups will be available for single people as well.

We have some reservations about the wording of this particular Amendment. There are really two points involved. First, the Amendment places an emphasis on the duty to provide contraception for all who seek it. Generally, young people who ask for contraceptive services are those who need it because they are sexually active; but I am not sure that the Committee would happily contemplate giving to any thirteen or fourteen year old, whatever her personal circumstances might be, what amounted to a statutory right to contraception on demand. At the same time, the Amendments are slightly more restrictive than the Bill, because they limit the provision of contraceptive advice and appliances to people who seek them. We do not envisage any attempts to force contraception on people who do not want it, and we should be very careful not to urge people who have religious or other objections to use family planning. There will, however, still be occasions when it is necessary to draw the attention of people to the services that are available: for example, when professional social workers advise individuals of the undesirable effects of further pregnancies. This Amendment would prevent this kind of thing from happening.

I hope I have said enough to indicate that the Amendments do not add anything to the contraceptive services available under the National Health Service, but would import one or two effects which perhaps the noble Baroness has not quite appreciated. I hope therefore that she will feel able to withdraw this Amendment.

BARONESS SUMMERSKILL

The first Amendment concerns advice, whereas the second one concerns advice and the supply of the pessary or appliance, whatever it may be. I have a feeling that if the Bill is passed in its present form it will touch the fringe of the problem and do some good. But immediately you introduce qualifications—immediately, for instance, you introduce a means test—those women, married or single, whom you are anxious to draw in the kindly net, to teach, to help, to emancipate, to limit their families, will be reluctant to come along. They will say one week that they have to spend the extra money on something for the children. This was my experience at the Ministry of Food. It will be recalled that in 1946 we were still rationed, and children's rations were most important. We discovered that, for some reason or another, in congested parts of the country women were not getting their rations. I realised that when the woman had to come for her rations she was obliged to give her proper name. Many of these women were living in a stable relationship with a man to whom they were not married and did not want the neighbours to know about their situation. So we decided that a woman could call herself what she liked—she could call herself Mrs. Smith, Mrs. Jones, or whatever it might be, although she was Miss Brown. The point is that we opened the door widely. We said: "The only passport to your rations is the fact that you have a child".

This analogy does not apply here of course, so far as children are concerned, but the point I am making is that we had to remove every kind of restriction before we found that the women for whom we wanted to cater came to us. I cannot help relating the clause and the two Amendments to the Statement which was made by the Secretary of State and which was repeated in this House. That Statement implied that there would be differences between married and single women, so far as their financial circumstances were concerned; there would be differences between those who had aborted and those who had not—the woman who had aborted would be given free an appliance; and there would be differences particularly between those who were better off and those less well off. These are the things that must be swept away if we are to make a success of this scheme.

I feel strongly about this. Of course we shall achieve some success, but we will not get hold of the feckless, the poor, the downtrodden, the slum-ridden women, many of whom will not go to a clinic because they have not a decent frock to wear. I feel that it must have been men who were responsible for devising this scheme, because they have only an academic knowledge of women.

LORD DAVIES OF LEEK

Edith, you don't know all men!

BARONESS SUMMERSKILL

I know a good many. We must recognise that a young woman—and we are talking about young women, because obviously we are trying to cater for women who are in the age groups where reproduction is highest—is having to overcome an innate modesty, because she is having to go to strangers to discuss the most intimate relationship in her life. Let us get rid of this question of means-testing, inquiries and arguing. This reeks of form-filling. If she knows there is form-filling to be done and means-testing, the sensitive young woman is not going to come forward.

I would ask the noble Lord to recognise that this is a matter of profound importance. There is this difference between advice and appliances. When she has come forward, she does not want to have an exposition of her anatomy and physiology. An elementary explanation must be necessary. What she wants is a proper fitting and then to be given the appliance to take away with her. According to this method, if there is to be a means test and you have got your woman there, she will go away with instructions to get something, and she will not get it. These are the facts of life; and unless the Government recognise this situation and see that the necessary provisions are embodied in the Bill, although some success will be achieved the Bill will not achieve the tremendous success that we all want. What we have to learn is that ignorance, fear and timidity in an individual will respond only to kindness, understanding and the removal of all those obstacles which stand between those who seek help and those who are there to give it.

I want to say one thing more. I am sure the House will not agree with me completely, but I hope I shall be able to plant at least a few seeds. Whereas I approve of practically all the appliances that are mentioned—and I have fitted thousands of women in my time—I profoundly disapprove, and have done so from its inception, of the pill, because I still believe that it has not been proved safe. I am a feminist and I believe in birth control—but not at the expense of the health of the woman. Really all we know about the pill is that it bombards the pituitary, which is a gland situated at the base of the brain. Even the most expert find it difficult to explain just how it works. I have been saying for a long time that there is evidence to show that the pill is still not safe. For instance, we all know that it is responsible for depression in about 25 per cent. of cases.

We all read in the papers of cases of thrombosis and liver disease, but I was particularly struck—and I was especially glad that the noble Lord, Lord Aberdare, had the courtesy to read this when I drew his attention to it—by the first article in the British Medical Journal of October 14. I mention this because it is a recent issue and every noble Lord here can go into the Library and read it for himself. This article took up the whole of the first page of that British Medical Journal and I should like to put part of it on record, because I am perfectly certain that social historians will record these things and I am pretty certain that in a comparatively short time the pill will be prohibited. The heading of this article was "Infertility after the Pill", in large letters. The article said: A disquieting feature of treatment with oral contraceptives is receiving increasing attention among gynæcologists. This is that some women, on discontinuing the use of oral contraceptives, do not experience a normal return to menses, but may remain amenorrhœie for years. This state of post-pill amenorrhœa was first noted in 1966 by three separate groups of workers. Since then the number of reports have mounted rapidly. R. P. Shearman, who has followed up this condition most assiduously among his patients in Sydney, first reported nine cases in 1966. Two years later he reported 22 cases. In 1970 he noted 26 women with amenorrhœa and galactorrhœa mainly following withdrawal of oral contraceptives. In 1971 his series had risen to 69 and in 1972 he presented data on 96 patients with secondary amenorrhœa after the discontinuance of oral contraceptives. The last series, by much the largest published so far, when taken in conjunction with other publications on the subject, clearly establishes some of the facts about the condition. Then it gives a scientific explanation, which I leave your Lordships to read. Later on it says: Shearman found that in a group of 230 women with secondary amenorrhœa 42 per cent. had it after withdrawal of oral contraceptives. I would say this to the House: I quite understand that, when challenged, the noble Lord, Lord Aberdare, should say that he was guided by his specialists. Of course he is. He must be: he is a lay Minister and they are the experts who are there for the purpose of guiding him. But surely the noble Lord will agree with me—it has been said so often—that science has no frontiers. In all these other countries there are experts who know as much as, and perhaps even more than, the experts who are advising him. Therefore I ask the Committee to consider very seriously whether we should continue to give the pill. Talking of experts, surely nobody here could say that the Soviet Union has not first-class scientists. I have been to the Soviet Union and they have there a first-class birth control service; but the pill is prohibited. The scientists say, "Our women must not have this". Is that not evidence that there are specialists throughout the world who have some doubts? And if we have some doubts then we should not prescribe it.

My final word is this—and I ask the Minister to consider it: could we not have a compromise? When pills are distributed to women, could there not be a Government health warning put on the packets? We have a Government health warning on cigarettes. We now have evidence which makes us think that perhaps it is unwise to prescribe this pill, so why not put a health warning on the packets? I hope that consideration will be given to this; but apart from that reservation I heartily support the Bill and these Amendments.

BARONESS GAITSKELL

I hope the Committee will understand that, though I support this Amendment, I do not follow my noble friend in everything she has said about the pill, because there is much evidence to refute everything she has said. In fact, originally it was known that after taking the pill a woman was particularly fertile, and not infertile. However, I do not wish to proceed with this aspect except to comment on the Soviet Union's wonderful birth control service. Of course, they do not have the pill, and they probably do not have the coil either. They have abortions. Perhaps the noble Baroness would prefer abortions to the pill: I do not know. Certainly in Japan, for instance, they do not have the pill: it is illegal. The coil also is illegal, and there are as many abortions as there are births. In fact in all countries where contraceptives are not liberal, as they are in Britain and Scandinavia, there are a great number of abortions. I shall mention the number when we come to the next Amendment.

To return to this particular Amendment, I must confess that when the statement on family planning was made in both Houses I felt that I should like to give it three cheers. I thought the proposals embodied in the Statement were exceedingly good when I first heard them, but on closer examination these three cheers have been reduced to a rather reluctant two cheers. Sir Keith Joseph, the Secretary of State, clearly saw the problem as the need to reduce the numbers of unwanted pregnancies, and I endorse the three areas of improvement which he mentioned: improvement in advice; in education, and in free supplies. Let us consider the area we are speaking about now.

Free advice really comes out on top. We can all welcome this. But by 1972 nearly half the local health authorities were providing free contraceptive advice, as I think the noble Baroness, Lady Young, has just said, thus forestalling the Secretary of State. Nearly two-thirds of the Family Planning Association's patients have advice paid for by public authorities. In the case of the Brook Advisory Centres, which deal with the problems of young people, 20 of the 33 London boroughs pay for some or all of their residents to attend. In Birmingham the city is using a proportion of a grant under urban aid to give residents free consultation and counselling, as well as, I may say, free supplies. Sex education has taken a giant step forward under the care of the Brook Advisory Centres for the young with an increase of 10,000 new young people seeking advice every year. Sir Keith Joseph, the Secretary of State, for whom I have considerable respect, also said that improvement was necessary in free supplies; but we shall come to that in the next Amendment.

LORD PLATT

It would help me a great deal (I am very interested in this discussion) if I knew whether we were discussing Amendment No. 35, No. 36 or No. 37.

BARONESS LLEWELYN-DAVIES OF HASTOE

Nos. 35 and 36.

BARONESS SUMMERSKILL

Both.

BARONESS LLEWELYN-DAVIES OF HASTOE

I moved No. 35 and said that I would take No. 36 with it.

BARONESS YOUNG

I am glad the noble Lord, Lord Platt, asked his question because many of the contributions that have just been made really apply to Amendment No. 37, and I think it would be more useful if we moved on to that now.

BARONESS LLEWELYN-DAVIES OF HASTOE

I am bound to say, in reply to that, that because the noble Baroness said that the principle applied to advice and supplies—and I underline the word "supplies"—I feel the sort of confidence that I began to feel when the noble Lord, Lord Aberdare, spoke on the Statement. I think it is quite proper, as the noble Lord, Lord Platt, has asked, that we should leave any discussion about the safety of the pill until we come to the next Amendment. All I would say for myself is that I have enormous confidence in what used to be called the Dunlop Committee on the Safety of Drugs; and the Committee know that I differ from my noble friend Lady Summerskill on this point. But on this particular Amendment, because of the assurances we have had about the principles the Government are applying. I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

3.33 p.m.

BARONESS LLEWELYN-DAVIES OF HASTOE moved Amendment No. 37: Page 3, line 31, leave out from ("appliances") to end of line 35 and insert ("and such arrangements shall provide that no charge shall be made for any such medical examination or treatment or for the supply of any such substances or appliances.").

The noble Baroness said: I beg to move Amendment No. 37, and in doing so I want to make quite clear that many Members of your Lordships' Committee consider that only a full, free, comprehensive and integrated family planning service can make family planning really effective and can serve the country in a way which will use properly a reorganised Health Service. I am anxious not to make another Second Reading speech and I will not repeat the arguments so cogently made by my noble friend Lady Gaitskell and the noble Lady, Lady Ruthven of Freeland, on Second Reading. All those who are concerned with family welfare, and especially those who spoke in the debate, will I am sure agree that only if it is free of all charges can there be an adequate and sufficient service in this most complicated and most delicate part of our national and social health.

It seems to many of us wrong that for some time now one could have had free on the National Health Service abortion and vasectomy (not sterilisation) but not contraception. This has seemed to us a misconception of the way in which these problems ought to be tackled. I know how very difficult it is to reply in detail to every argument in a long debate, but when Clause 4 was raised in Second Reading the noble Lord, Lord Aberdare, was only able to say that Clause 4 in the Bill provides charging powers equivalent to those which the present health authorities and local authorities have, and that the charging side of it would be subject to regulations. We know that he probably had in mind that his right honourable friend was going to make a Statement about the expansion of the services later on. Nevertheless, welcome though that Statement was on some extension of services, it does not go nearly far enough for those of us who want an entirely different approach to this whole question.

Of course, we on these Benches and many others welcome the fact that every new mother can have birth control for a year after a birth—and it is even longer for those who have special social and financial needs. But we have several specific worries about this matter. For instance, when my noble friend Lady Serota asked the noble Lord to define special social and financial needs, his reply was that it will be linked with one or other of the entitlements which exist at the moment under the social services. But we know that with a limited service only a certain percentage—indeed, I believe only about 50 per cent.—of those qualified actually take up the benefits to which they are entitled. Surely, to allow free contraception after an abortion cannot be sustained, either in logic or in humane terms. I feel deeply shocked that any woman should be allowed to undergo the traumatic experience of an abortion if it can possibly by any means be prevented. This is one of our basic differences and controls our approach to this temporary expansion of the service.

We very much welcome the fact that general practitioners are to be encouraged to take the initiative in this field. This is especially a good thing, because in the past if public-spirited general practitioners did this it proved actually a financial liability for them—that is, if they took time off to initiate giving family planning advice, let alone providing supplies. I should like to ask the noble Baroness who is to reply whether the Department are considering any training of general practitioners in this regard. We know that medical students have all too scanty a training in family planning techniques. Indeed many medical noble Lords (if I may call them that) have spoken about this before. And, leaving aside the medical students, we should like to know whether the Department is considering refresher courses for general practitioners, because this, I am quite sure, they will undoubtedly need. As I have said before, I do not share the almost total apprehension about the pill of my noble friend Lady Summerskill, but there is no doubt that there is a skill and a knowledge in prescribing the various forms of it in which general practitioners ought to have training; and they should have training in the other, different kinds of appliances. We should like to have something from the noble Baroness on those lines.

We should of course like to think, as my noble friend Lady Serota said, that the doctor must be completely free to prescribe and to give the treatment the patient requires, regardless of its cost. No doctor wants to think twice about whether he can prescribe something, about whether his patient qualifies for benefit or not; and we should like to have this concern removed completely from the approach towards family planning services. Again, we do not know whether the new Area Health Authorities will be allowed sufficient decentralised power to develop and initiate real family planning services. I am a little apprehensive that Scottish legislation apparently limits its powers on contraception. I am worried that this may be an indication of the Government's thinking, and we should like to have an answer about that. We also greatly welcome the domiciliary visits which were mentioned in this regard, but the chief people who look after domiciliary visits are the health visitors. Only about one-third of all health visitors at the present time routinely give contraceptive advice post-natally. I should like to know whether the Government are considering also a form of training for health visitors, giving them some kind of new approach to this matter, because I am afraid that otherwise even their limited expansion of family planning services will fall to the ground.

I do not want to be considered churlish in my response to what was, after all, a welcome expansion and I should particularly like to welcome the grant to the Health Education Council. I believe that this is a body which is a little unhonoured and unsung but which does a magnificent job of work on a very small budget and under great difficulties. We feel that education and communication (quite apart from finance of course) are the keys to the whole business of proper family planning. So we welcome that.

Our major worry about this whole approach is what will happen to those local authorities which are already giving free services. Here again if I may quote him—and again we know how difficult it is to say everything in a Statement—when the noble Lord. Lord Aberdare, was asked about the local authorities which are already giving free supplies, he said: 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."—[OFFICIAL REPORT, 12/12/72, col. 490.] That sounded a little ominous to us. In the first place, we think that at the very least it will discourage other local authorities from embarking on these free services in which we believe so strongly; and secondly, we really must ask the noble Baroness to tell us what it really meant for the future of these free services. This is absolutely vital and we are not at all clear about what it really meant. We must press this, because it is the basis of our whole approach to a free, comprehensive service. We know there is absolutely no shadow of a doubt that where all services, supplies as well as advice, are offered free this increases most dramatically the numbers of people using the service. My noble friend Lady Gaitskell has described the London borough situation and your Lordships are familiar with that.

To illustrate what our Amendment really will mean if we can get it passed and carried out, I should like to refer to a fascinating report of the Aberdeen Family Planning Services. It is not yet published, but I am quite sure that the noble Lord has it in his Department—indeed I know that he has. It is based on reports from the medical officer of health, from the professor of obstetrics and gynaecology and from the health and welfare departments. The first thing that the report does is to point to this dramatic increase in the use of the services when all charges were dropped in 1967. In Aberdeen, nearly half of all women of child-bearing age have been to the family planning clinics. The report describes the benefits in quite dry medical language, and the benefits of this kind of comprehensive gynaecological service, which is what we are aiming at, are: major reductions in the illegitimate birth rate; major reductions in higher risk maternities and in unwanted pregnancies in large families. In Aberdeen, illegal abortions are practically unknown, with everything that we know about the horrors, the link with crime, the suffering and so on that that implies.

Perhaps most important, and in order to show your Lordships' Committee the kind of service at which we are aiming, the Aberdeen experiment has resulted in the lowest infant mortality rate, almost in the world, and this in spite of the fact that Aberdeen has a very high proportion of what we call "socio-economic group 5". That, in sociology language—and I do not much care for sociology language—means the groups of people who are most difficult to reach; it means people who are not used to preventive medicine; it means people who do not do much reading; people who do not keep up with the latest medical advances; and it means, above all, the poorest, the people who are most in need. I am quite sure that the Health Education Council in its educative work will aim at precisely these groups because these are the people it knows about and these are precisely the people whom our Amendment will largely benefit. One quite incidental benefit, in which I think your Lordships will be interested, from the tremendous experimental and pioneering work done in Aberdeen, was that: …the Pupil/Teacher ratio for infant and primary schools in Aberdeen gradually but steadily improved over the last five years, without the expense of additional staff. So there is really no end to the benefits one gets if one grasps the nettle and treats the subject properly and comprehensively.

I will not go on about the Aberdeen experiment for too long, but apart from anything else, they work in very close harmony with the hospitals, whereas nationally less than a quarter of national hospitals actually give contraceptive advice, let alone supplies after birth. What we really want, and what the Aberdeen experiment does, is that as well as all this it is a focus of preventive medicine. They deal at the same time with heart and kidney complaints, with cervical cancer smears, breast examinations—all the things which save lives, which prevent suffering and which prevent people getting into hospital when it is too late. I have to declare an interest here because I am the Chairman of the Women's National Cancer Control Campaign. The people in these lower groups are precisely the people we want to get at and if we can reach them through this kind of service we shall cover the whole welfare of a family.

I have gone into this matter in perhaps too great detail, but I wanted to get across to the Committee that with this Amendment we are not dealing with the question of promiscuity, we are not dealing with some exotic and Bohemian and perhaps immoral form of practice. What we are dealing with, and what we want to do is to improve the physical, social and psychological health of the whole family—the children, the mothers and indeed the fathers.

On Second Reading the noble Lord, Lord Hayter, said …our National Health Service is not, or should not be, a matter of Party politics and we should all be voting according to our conscience."—[OFFICIAL REPORT, 4/12/72, c. 111.] That is absolutely true, and I believe that your Lordships will agree. Nevertheless, all Governments want to please the electorate, and perhaps at this precise moment of time Her Majesty's Government want to please the electorate more than they may have done previously. There is no doubt that enormous strides have been made in public opinion about family planning services. The latest poll which was taken for the Daily Mail has shown that 84 per cent. of the electorate feel that population growth is a problem; two-thirds of them feel that the Government should take action about it; and 65 per cent. want a national family planning service. If Her Majesty's Government accept our Amendment, as I profoundly hope they will, they will not only be doing what is right but will also be doing what I believe the country wants.

Her Majesty's Government, in their latest statement, have already trebled their expenditure by £12 million. Why not do the job properly? It has been estimated that it will take only £30 million to provide a proper free family planning service, and there is no doubt that this is what we need. I have always believed that one of the main reasons why contraception fails, or is used inefficiently, is that basically, women want babies. What we need is a family planning service which gives counselling, which also makes supplies available and gives free practical help and supplies. If we get this it will save lives, it will prevent suffering and will provide a positive advance towards social health and a real family welfare service. This is what our Amendment means. I believe that the country wants it, and it certainly needs it. The noble Baroness probably knows that we shall press it to the very end. I beg to move.

LORD ABERDARE

My Lords, I hesitate to interrupt this very interesting debate but we have two Statements to be repeated, and I suggest that this is an appropriate time for me to beg to move that the House do now resume.

Moved accordingly, and, on Question, Motion agreed to.

House resumed.