Sitting of 23 May 1969

Preamble
The House met at Eleven o'clock
PRAYERS
[Mr. SPEAKER in the Chair]

WHITSUN ADJOURNMENT DEBATES
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Ernest G. Perry.]
Mr. Speaker: Order. May I remind the House that I have timed the debates today, and we must stick to these times, for otherwise hon. Members who were late on the list might find their debate a little cramped.

SCOTLAND (HOSPITAL BUILDING PROGRAMME)
11.5 a.m.
Mr. William Hamilton: I sought this opportunity to raise the question of the Scottish hospital building programme because the building of new hospitals or improving older ones seldom hits the headlines. We all agree that there is a great need for a steadily improving hospital service and for the modernisation not only of hospital buildings but medical and nursing techniques and so on.
It is clearly becoming more and more costly to provide the kind of service that our people rightly demand. It is interesting to see what has happened since the beginning of the National Health Service back in 1948. Between July 1948 and December, 1967, the amount of hospital building in Scotland totalled £65·61 million-worth. Over a third of that, at any rate in value, was completed in the three years 1965, 1966 and 1967. By the end of 1967 work to the value of about £47½ million was in progress. That is the enormous acceleration of hospital building that has taken place in recent years. It compares very favourably with the figure of £32 million-worth of building in progress at the end of 1964.
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I shall not go into all the projects that are under way or nearing completion, but since the beginning of 1968 two very big projects have been started—the rebuilding of the Royal Hospital for Sick Children in Glasgow and the Gartnavel District General Hospital, also in Glasgow.
We can all play the numbers game, whether with house-building, murder rates, unemployment statistics or anything else. If one makes one's selection of statistics sufficiently carefully, one can prove whatever prejudices one holds at the time. But the Government's case in this, as in so many other matters, is so good that there is no need to be selective in that obnoxious and futile way. For example, in the 1950s hospital capital expenditure in Scotland was increased from about £2 million in 1952–53 to less than £3½ million in 1959–60. Even in 1962, after about 11 years in office, the then Government planned an expenditure of £70 million spread over 10 years—an annual average of £7 million. In 1964—significantly, on the eve of an election—the carrot was increased in size to £105 million over ten years, an annual average of £10·5 million.
The present Government, in their 1966 review, planned a programme of £60 million over five years—a £12 million annual average—and this has been more than maintained in real terms, not purely in money terms. In 1962–65 the total expenditure was £19·5 million and between 1965 and 1968 it was £35·5 million—an 80 per cent. increase in money terms and over 50 per cent. in real terms.
I have mentioned one or two of the major schemes under way, but in addition the regional hospital boards and the hospital management committees have been getting on with their regional and local programmes of relatively minor capital works. In that context, I should say in fairness how much we appreciate the fact that much has been done to improve the standards of accommodation in the West Fife hospitals and that the South-East Regional Hospital Board has just completed a new mental deficiency hospital at Lynebank near Dunfermline at a cost of £2¼ million. I was at the official opening a week or two ago.
We are proud of the honour bestowed upon us in that the area was chosen for

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the site of the first entirely new hospital for the mentally deficient or mentally ill for 30 years. The facilities are quite remarkable. There are a children's ward and school, facilities for industrial training and occupational therapy, a nurses' training school, a patients' shop and tea room, an X-ray and diagnostic department and an out-patients department. This is a remarkable achievement by any standards. I see that the hon. Member for Moray and Nairn (Mr. Gordon Campbell) is smiling and I think I know why. This project was initiated by the Conservative Government, but the money was provided by the Labour Government. There is no party point in it.
When one thinks of the kind of mental hospital that still exists and which my right hon. Friend the Secretary of State for Social Services has talked about—that horrible institution somewhere else in the country—and when one thinks of the grim, gloomy spectres of Victorian asylums, one cannot but be grateful for the revolution which has taken place not only in medical care and treatment of the mentally sick and disabled but as important, if not more so, the great change in the community's attitude to these problems.
It is interesting to note that when the hospital was originally announced and when it was building, I did not receive a single complaint from anyone in the locality objecting to the location of a mental hospital in the area. One of the pleasing aspects of the Lynebank project is the strong evidence that the local community are co-operating with the hospital authorities in order to take the hospital within the community and help the patients in every way possible.
Other schemes have been completed in Fife since 1965. There has been the second extension at the Victoria Hospital in Kirkcaldy at a cost of £2,336,000. This will be the first full district hospital in Scotland. It provides full medical and surgical services for the whole of East Fife, except for certain specialists services which are provided in Edinburgh.
Incidentally, I have previously raised the question of the difficulty of Fife patients who have to go to Edinburgh for the regular use of kidney machines. I hope that this facility will be provided somewhere in Fife, either in a unit in
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the Victoria or by the provision of home units for patients, since considerable expense and inconvenience are caused when patients have to travel to Edinburgh regularly for their treatment.
I return now to the list of some of the achievements. At Milesmark Hospital, Dunfermline, there were provided in 1967 a 60-bed unit, X-ray diagnostic facilities and an out-patients department and physiotherapy facilities at a cost of more than £250,000. This was in addition to other facilities, like a new boiler house, which cost nearly an extra £200,000.
In West Fife Hospital, again in Dunfermline, there was the provision in 1966 of new twin-operating theatres, a new record office and other accommodation costing about £88,000. At the Cameron Hospital, Windygates, in 1967, a 60-bed medium-stay geriatric unit plus an attached rehabilitation unit costing over £200,000 was provided.
So one could go on. There are many relatively minor but still costly projects. At Stratheden Hospital in Cofar, improvements carried out in 1966 and subsequently have cost £158,000. At the Victoria Hospital, Kirkcaldy, a central laundry for the whole of Fife hospitals was provided last year at a cost of over £300,000, together with residential accommodation for married medical staff costing £67,000 and residential accommodation for nurses costing £109,000. Finally, there was the provision at Fath Park Maternity Hospital. Kirkcaldy, of a general practitioner unit costing over £300,000.
This is a record about which no one need be apologetic, and I hope that when the Opposition talk about cutting public expenditure, as they frequently do, in vague general terms, they will make it abundantly clear that they do not have the hospital building programme in mind. We have a right to know what they have in mind and they should either spell it out or shut up.
In the light of all these achievements and many more which I have not time to mention, it might seem churlish to ask for more, especially for my own area of West Fife. But then I am a churlish kind of character. It is my privilege to be difficult to satisfy in this and other regards. I recognise not only that the National Health Service has to compete

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for financial and physical resources with other desirable objectives such as housing, education and roads, but also that even within the total allocated to the National Health Service there are conflicting and competing claims as between one part of the country and another and between one speciality and another—for example, whether one should provide more geriatric units or more maternity beds.
All this involves extremely difficult and complex political decisions by politicians of a geographical, economic and medical nature. In the south-east region of Scotland, we in West Fife recognise that there are competing claims on the resources available. For example, we know that there is a good case for a new district general hospital in the Borders. It may well be that that case is stronger than the case for the provision of a similar hospital in West Fife. That is not for me to decide but for the regional hospital board. One of my purposes today is to put the case for a new West Fife district general hospital.
I understand that the regional hospital board, in putting in its building plans for 1971–76 to the Scottish Home and Health Department, will be including as a priority the provision of a new district general hospital for West Fife. I need not labour the point. I simply recall the letter dated 9th February, 1966, which was sent to the Secretary of State for Scotland by my hon. Friend the Member for Dunfermline Burghs (Mr. Adam Hunter) and myself. The Secretary of State sent us a reply, dated 14th March. 1966, justifying the allocation of resources as between regional boards, and pointing out that the South East Regional Hospital Board did not propose to him at that time that a general hospital in West Fife should take precedence over the projects which were included in the programme up to 1970–71.
Since then there have been improvements, some of them quite substantial, in the West Fife hospitals, but the fact remains that the Dunfermline and West Fife Hospital, which is the main surgical hospital, is outmoded and out-of-date. The medical and nursing staff are first class; no patient need be worried on that account. The dedication of the staff in the West Fife Hospital, and in others, is beyond praise. The principal concern
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is that the present arrangement, whereby surgical beds are concentrated at the Dunfermline and West Fife Hospital and the medical beds at Milesmark, leads to duplication of certain ancillary services, with associated staffing difficulties. It also affects adversely the liaison between medical and surgical elements of the service. Furthermore, the provision of beds for general surgery, geriatrics and orthopaedic surgery, though better than it was, is still inadequate in the view of the hospital management committee. It is unsatisfactory to have the second line beds at Milesmark where there are no operating facilities. It means that the beds at Milesmark are little more than accommodation for convalescents.
I know what a difficult task the regional hospital boards must always have in determining priorities between conflicting demands on the resources available to them. In general, the regional hospital boards do a valuable job, and nothing that I say is in criticism, implied or otherwise, of the job they perform.
The National Health Service as a whole needs far greater injections of resources than it now gets. That is true of other services. One could put up an equal, or perhaps more powerful, claim for housing, roads and so on. Nevertheless, there is no room for complacency or smug self-satisfaction about the imaginative programme of house building in Scotland.
In preparing for this debate, I read some of the speeches that were made in 1946 and 1947 during the passage through the House of the National Health Service Act. They make astonishing reading; one does not know whether to be angry or to burst with laughter when reading some of them. For instance, on Second Reading, Sir Thomas Moore condemned the service as
"… this lifeless control by the State …"—[OFFICIAL REPORT, 10th December 1946; Vol. 431, c. 1078.]
Even more extravagant language was used on Third Reading on 21st April, 1947, when Lieut.-Colonel Walter Elliot, whom most of us remember, referred to the National Health Service Act as Fascism, and Lady Grant, now Lady Tweedsmuir, said that there were defects in the Bill:
"… which destroy much that is good of the past, limit the possibilities for the future, and

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give us instead, a rigidity of administration which is quite unsuited to the living human art of caring for the sick."—[OFFICIAL REPORT, 21st April, 1947: Vol. 436, c. 739.]
She is no longer with us, being otherwise engaged outside. Mr. Niall Macpherson, who is now being punished for what he said by serving in the House of Lords, said:
"But this will not be a health service; it will be a vast bureaucracy of red tape."—[OFFICIAL REPORT, 21st April, 1947; Vol. 436, c. 759.]
He forecast that it would bring chaos into the health services of Scotland.
Finally, Commander Galbraith spoke of it being a Measure which was highly repugnant to the people of Scotland.
Nobody dreams now of disbanding the National Health Service. We realise that it is here to stay and that we have to improve it, which means the injection of more and more capital and resources of all kinds.
I would, if I may, like to raise one or two general points arising from the section of the 1967 Annual Report, Cmnd. 3608, which deals with hospital planning. My first point concerns the research and development project at Falkirk to discover the optimum design for a hospital ward. That project was a pioneering effort for the whole of the United Kingdom and it deserves far more publicity than that which is given to the more squalid aspects of life and society in this country today. It involved the co-operation of medical, nursing, architectural and engineering staff, as well as patients. I hope that the Under-Secretary of State will be able to tell us more about it and how the results will be translated into practice in future hospital design.
There is reference in that section of the Report to progress made in standardisation of certain hospital departments, for example, the possibility of a standard design for hospital wards, which I have already mentioned, and standardised operating theatres. The more progress we can make in those areas the better value we shall obtain for money spent, and the more money we spend the more essential it is to ensure that it is spent wisely. Will the Under-Secretary of State give us some idea of the progress which is being made in that direction?
What has been the progress during the last year or so in the use of industrialised building and the standardisation of building
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components? Examples are given in paragraph 255 of that Report of the reduction in prices produced by the use of these methods. What progress has been made in the use of industrialised building methods for the provision of residential accommodation for junior medical staff in the hospitals? I know that in many areas this is a sore point. What progress has been made in linking up with hospital boards in England and Wales to build such accommodation by industrialised methods? Hospitals are one of the most expensive capital assets in the country, and it is vital that we should get value for money.
May I end by referring to what I regard as an extremely important point? The principle that prevention is better than cure makes it obvious that serious consideration should be given to whether it is worth while concentrating more investment in preventive measures rather than in building highly expensive curative institutions, which is what hospitals are.
In that respect it is good to notice a steady acceleration in the provision of health centres. Aneurin Bevan, when he was introducing the Health Service, made it abundantly clear time and again that the health centre where provision for services to the community a comprehensive provision with all the ophthalmic, dental, medical and minor surgery means were concentrated in one building, with means of doctors and teams of nurses, dentists and opticians working there, is the ideal corner-stone. Nye Bevan always used to say that this was the corner-stone of a real health service and that the service would never be what it ought to be until we got a nationwide distribution of such centres.
It is well known that at the outset of the National Health Service there was considerable opposition to this principle by the medical profession, which is an extremely personal profession. They were extremely suspicious of being either State or local authority servants. I believe there is much evidence that that opposition is breaking down. This probably is one of the reasons why there has been a substantial extension and growth in the number of health centres.
There were only three in Scotland before 1964. Since 1964, according to the latest figures I have, five more have been

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completed and one is building or completed at Livingston. I hope that my hon. Friend the Under-Secretary will give the most up-to-date figures. Plans have been approved for another 10—I am speaking of last year—and 50 other proposals were being considered. This probably is where the emphasis will be placed increasingly, on the provision of health institutions rather than haspital building.
I hope that I have said enough to enable my hon. Friend to give an up-to-date picture of what is happening in the hospital building programme. I am grateful for the opportunity of having this debate.
11.32 a.m.
Mr. Gordon Campbell: I am very glad that the hon. Member for Fife. West (Mr. William Hamilton) applied for this debate and was successful. I know he has a particular interest in hospitals and the Health Service in Scotland and has pursued this subject from time to time.
While I congratulate the hon. Member on raising this subject today, I do not propose to filibuster the rest of the time for this debate and prevent the Under-Secretary replying. Some might think that there was a certain temptation to do so in view of the hon. Member's treatment of the private Members' precious time won in a Ballot the other day by my hon. Friend the Member for South Angus (Mr. Bruce-Gardyne) when he also chose a Scottish subject.
I am specially interested in hospitals and hospital building, if only because I spent a year as a patient, at the end of the war, in one of the large teaching hospitals. I have continued my great interest, as a "customer" one might say, in hospitals and the hospital services. The hon. Member for Fife, West has spoken about the numbers game, the fact that it is possible to consider, over 20 years or more, selected statistics to show that one party or the other has done better during the time it was in office. I believe he knows I agree that there is little point in competing in the game of producing selective statistics. None the less, I noted that he indulged in it to some extent.
In reply I will simply say this. In early 1964 the present Home Secretary,
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who was then shadow Chancellor of the Exchequer, referred to the Conservative programme of hospital building and for roads and schools. He acknowledged that those programmes
"could not be exceeded by any party with any degree of responsibility".—[OFFICIAL RFPORT, 11th March 1964, Vol. 961, c. 477.]
I remind the hon. Member for Fife, West of that before passing from this subject of competition in selective statistics.
I wish to raise a point of great concern on which the hon. Member hardly touched. That is the way in which costs have escalated. Money itself is no longer a realistic measure of the quantity of building being carried out or completed, or of results in general, because the rise in costs of building hospitals have soared to such a degree in recent years. On 30th January, 1968, nearly a year and a half ago, the Secretary of State for Scotland made a very important announcement. It was on the postponement of 12 major hospital schemes within the five-year programme and postponement of three others beyond the current five-year programme. That was shortly after devaluation. The Prime Minister, in his famous broadcast to the nation, stated that the hospital building programme would be safeguarded and not reduced as part of the measures accompanying devaluation.
The Secretary of State for Scotland made perfectly clear that he had had these proposed cuts under consideration before devaluation and stated clearly that they were not connected with devaluation. I have to accept his word because at that time he ascribed the cuts to the enormous increases in the costs of building. He said that costs had risen to such an extent that he had to reduce the programme. This was disappointing to hon. Members in all parts of the House, and also to the Press and the public. The Press reported it very widely in Scotland at the time.
My reckoning is that the increasing costs were such that the amount required to carry out the same hospital building increased by about 50 per cent. over a period of five years. This is illustrated in particular by the Ninewells Hospital at Dundee. The estimated costs are recorded in the Civil Estimates and the increase between the Estimates for 1963 and those for 1968 was 50 per cent. The Under-Secretary may say that there

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are some additional points to be taken into account, but I point out that the Civil Estimates also show a comparison with other projects between the Estimates of 1967 and recent Estimates and the increase is in the same proportion. It is a very large increase. Although it is two years or less ago, the increase is in the same proportion of 50 per cent. over five years.
The Under-Secretary of State for Scotland (Mr. Bruce Millan): The difference in respect of Ninewells is at least half accounted for by additions to the programme and the inclusion of equipment which was not in the original figure which at Ninewells amounts to £2½ million. Increases in the other cases can be accounted for in the same way.
Mr. Campbell: I wish that this could be made clear in the Civil Estimates. On 30th January, 1968, the Secretary of State announced that there had to be these 15 postponements of major hospital schemes and stated that it was because of soaring costs.
We then see the civil estimates, with schemes put forward and precise estimates put against them in different years. Whether some of it, as the hon. Gentleman suggests, is in all cases attributable to extra equipment, the effect is that the costs of identifiable schemes are increasing at the rate of about 50 per cent. over a period of five years. We shall be interested to hear the hon. Gentleman's explanation, because the purpose of the debate is to enable him to explain these matters at greater length.
The Secretary of State ascribed the postponements to rapidly increasing costs. Clearly the building industry is having to face very steep increases. On 18th April, only a month ago, the Minister of Public Building and Works, in reply to a Question, stated that the increased costs to the building industry in Scotland in a full year arising only from the increase in selective employment tax proposed in the Finance Bill would amount to about £5 million.
Mr. Speaker: Order. The hon. Gentleman may refer to that matter, but he knows that he cannot propose on the Adjournment a reduction in or abolition of selective employment tax.
Mr. Campbell: I made that reference to the Bill, Mr. Speaker, only in order
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to identify the increase. I do not propose to go into the question of changes. I merely wish to remind the Minister that there have been two increases in the tax and that these fall very severely on the Scottish building industry. The Minister of Public Building and Works has given an estimate of the latest increase in costs to the building industry in Scotland. I therefore hope that the Under-Secretary of State will be able to give us a forecast of the likely increase in the cost of hospital building arising from the increase in S.E.T. and other increases which can be foreseen, such as in transport costs. It is the prospect of the estimates increasing even further which is worrying me and, I am sure, the hon. Member for Fife, West.
The hon. Gentleman raised another matter of considerable importance to which I hope the Minister will reply, namely, the design of hospitals. While new hospitals are being built, it is important that the suggestions and ideas of medical and nursing staffs should be sought, collated and crystallised and then put into effect as well as the techniques and expertise of architects and others concerned with building. The life of a ward in a hospital is unlike the routine in most other buildings. With a bit of imagination and thought, hospitals can be so designed as to make life in them as efficient as possible and as comfortable as possible for the patients.
I turn to a point which particularly affects my area in the North of Scotland, and that is regionalisation and where hospitals are to be built. I am not entirely happy with some of the proposals about where regional hospitals should be sited. For example, it may mean that some of my constituents would have to travel 70 miles to hospital, which is not easy in severe winter conditions, for certain operations or treatment. I should like the Under-Secretary of State to tell us whether this matter is still under consideration or whether it has been frozen into definite proposals. The Government should take into consideration the difficulties of travelling long distances which arise in the North of Scotland.
The Minister has plenty of time to make a statement about the latest position. I hope that he will make use of it and will tell us as much as he can

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about the present hospital building programme and future prospects in Scotland.
11.45 a.m.
The Under-Secretary of State for Scotland (Mr. Bruce Millan): I very much welcome this opportunity of saying something about the hospital building programme in Scotland. I am glad that my hon. Friend the Member for Fife, West (Mr. William Hamilton), with his usual initiative, managed to obtain this debate and to make the very well informed speech that he made in introducing it. I hope to take up most of the points which he and the hon. Member for Moray and Nairn (Mr. Gordon Campbell) put to me.
I start by saying something about the present hospital building programme as a whole. I follow the very accurate account which my hon. Friend gave of the expansion in hospital building expenditure which has occurred over the last few years and will make some additions to it to bring it even further up to date. In the last two or three years there has been a very considerable expansion in the hospital building programme in Scotland. The hon. Member for Moray and Nairn said that we must not just compare expenditure because it costs more money these days to provide a hospital bed than it did a few years ago. However, even allowing for that, the progress has been remarkable.
May I give the figures in terms of hospital beds provided. Between 1948 and 1962, the building programme in Scotland produced an average of about 230 beds a year. In the next three years, from 1962 to 1965, the rate rose to about 570 beds a year. But in the four-year period from the beginning of 1965 to the end of 1968, 3,900 beds were produced and the rate rose to almost 1,000 beds a year. In fact, the 1968 figure was considerably greater than that. These figures are based on comparable terms and they show the tremendous increase which has taken place over the last two or three years.
I turn to the question of expenditure. In 1968–69, the amount spent on hospital capital works was approximately £14·5 million. The exactly comparable figure for five years ago—1963–1964, which was the last full year when hon. Members Opposite were in office—was only £6·25
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million. Even after allowing for the effect of increased wages and prices, this represents a rate of growth in real terms of about 15 per cent. compound per year over the years that I have mentioned. Although I should like us to do even better, this figure demonstrates the priority which the Government are giving to the hospital building programme.
On the question of costs, the programme which was announced in the 1966 review of the Hospital Plan has been maintained in real terms. Therefore, increases in costs have been taken into account. The programme of £60 million as it was then over the five-year period at 1965 prices is considerably more than that at current prices. In other words, we have maintained in real terms the programme which we set out in 1966.
Mr. Gordon Campbell: How does the hon. Gentleman tie that up with the postponements which were announced by the Secretary of State in early 1968?
Mr. Millan: I intended to deal with that point. First, I wish to say something about the figures as they appear in the estimates, particularly for Nine-wells, which the hon. Gentleman quoted. Ninewells is a major teaching hospital, the first to be built for a very long time, and it must not be taken as typical of hospital developments in Scotland.
Even there, a large part of the difference in cost arises because the original costs did not include, and were not meant to include, the equipment for the hospital. It is difficult to estimate well in advance what the equipment costs will be, because equipment more than anything else is changing rapidly as medical technology improves and the equipment costs come in later than the original estimate.
In the case of Ninewells, no less than £2½ million is accounted for by the equipment cost alone which was not in the original estimate. Much of the other expenditure is also accounted for by reasons other than changes in costs—for example, by the addition of a radiotherapy department. Many of the other increases which appear in the estimate also relate to additions to the original project. As it develops, it is seen that additional departments or facilities have to be added.

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I do not consider it desirable that as a project continues we should always be faced with adding additional bits to it, but in some cases this is inevitable. This explains some of the additional costs. An even more important factor is the equipment factor which I have mentioned in the context of Ninewells. This also applies elsewhere.
I take the hon. Gentleman's point that the Civil Estimates do not bring this out clearly. I could not agree more. When I read the Civil Estimates, published a couple of months ago—I do not have them with me—I was horrified at the interpretation placed on some of the figures in at least one Scottish newspaper because it had been misled by the footnotes in the Civil Estimates. I am taking steps to see that in future years we make the footnotes in the Civil Estimates rather more intelligible than they are at present and in particular, if possible, to bring out the equipment factor, because so much of the apparent increase in cost is accounted for by the items of equipment which do not appear in the original estimates.
It is also true that in January, 1968, my right hon. Friend the Secretary of State announced that there were to be certain deferments in particular hospital projects. Some of those deferments arose because of increased costs and additions to projects which were already in the programme. Some of them also arose because of the larger programme that we are dealing with in Scotland and because of the additional expertise that the regional hospital boards have been able, therefore, to build up in the handling of their programme.
We are now building hospitals more quickly than in the past. The planning and design is going ahead more rapidly than it used to do. When the building of a hospital commences, we are now improving on building times. All this brings expenditure forward and, unfortunately, means that some projects have to be dislodged from the programme and put a little further back.
Another factor of special importance in the deferments announced just over a year ago was that the rebuilding of the Royal Hospital for Sick Children in Glasgow, which could not be anticipated but had to be put into the programme as a matter of urgency because of the literal collapse of the previous building. This
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was a very expensive project which resulted in the deferment of certain other projects beyond the period in which we originally intended to see them built.
Those were the basic reasons for the announcement that was made just over a year ago. I repeat, however, and I cannot emphasise too strongly, that there was no question then, and there is no question now, of any cut in the hospital building programme. That was the word used by the hon. Member for Moray and Nairn. It is a completely inaccurate description of what happened. The amount of money made available to the hospital building programme has been maintained in real terms and has, indeed been slightly increased.
When we were preparing the review of the Hospital Plan in 1966, tremendous questions of priority had to be determined. I was glad to hear my hon. Friend the Member for Fife, West make the point a number of times during his speech that in the hospital building programme we are constantly involved in determining priorities between demands which, if the resources were available, we would like to settle simultaneously. In an ideal world, we would all like to see all parts of the hospital building programme going ahead as rapidly as possible, whether we are talking about priorities in different specialties or in different geographical areas. We do not, however, have the resources to allow that to happen and, therefore, these difficult questions of priority are involved.
When we published the review in 1966, we laid great stress on the need to repair serious deficiencies in the provision of beds for the care of elderly people. Anyone who knows anything about the appalling problem of dealing, whether at hospital or at residential level, with the increasing number of old people would support the priority that we gave to the increase in geriatric provision, particularly in the South Eastern and the Western Regional Board areas, in the 1966 Review.
Since 1965, almost 1,100 beds have been provided in new or substantially converted buildings for geriatric patients. We are talking here of a total stock of about 8,000. Schemes in present in progress will provide another 85, with further schemes to start shortly, including the important Langside cottage scheme,

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in Glasgow, of 256 beds, which will help considerably in the Glasgow situation.
Another important sector of development is maternity provision. Taking Scotland as a whole, although there are still little patches where we would like to see improvements made, we now have, with the existing beds and the beds in prospect, improved maternity provision out of all recognition; so that in most parts of Scotland, in terms of total beds at least, it is now very satisfactory. There are now many areas where more than 90 per cent. of babies are born in materity hospitals. There are 516 maternity beds under construction and 400 of these will be completed by the end of this year.
The third priority which we gave was to mental and mental deficiency patients. Again, those of us who spend time looking at different hospitals in different parts of Scotland will be very much aware of the need to improve our provision of mental and mental deficiency beds. Since the review of the programme was announced, we have completed nearly 1,300 new beds for mental and mental deficiency patients and a further 276 should be ready this year. The bed numbers in these three categories are substantial achievements within the overall priorities that we laid down for the hospital programme.
In all these fields of geriatric provision, materity provision and mental and mental deficiency provision, we can look back on progress over the last year or two as being, while obviously not as great as we would like in an ideal situation, nevertheless very substantial indeed.
On the question of hospital beds, there are schemes at present in progress valued at about £55 million. That must easily be a record figure for hospital building in progress. It is greater than the figure mentioned by my hon. Friend for the end of 1967. These schemes will provide about another 2,750 beds, and schemes are being planned to start in the period to 1972 providing over 4,500 more beds, so that the impetus we have in the hospital programme is being maintained.
There are many major schemes in progress. I do not wish simply to provide a catalogue of them, but the hospital at Ninewells is a very important development.
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There is a new general hospital at Inverness, of which the first phase is well advanced in construction, and there is the new mental deficiency hospital there. There are under construction four large maternity units in the western region. My hon. Friend mentioned the new Gartnavel Hospital and the Royal Hospital for Sick Children. In Edinburgh, there are major developments at the Western General Hospital and new geriatric and eye units are being built.
Mr. Gordon Campbell: The hon. Gentleman mentioned Gartnavel Hospital, which is one of those where there has been a tremendous escalation in costs, according to the official estimates, since 1967. If I put down Questions to the hon. Gentleman, would he be able to answer on the various projects mentioned in the Civil Estimates, where explanations are not given?
Mr. Millan: If Questions are put down on individual projects, I shall be very glad to show the difference between one year and another. The hon. Gentleman will see that the explanation I gave off the cuff is accurate.
I was about to mention a number of individual completions we have had in recent years, and I am particularly glad to refer to the Falkirk ward mentioned by my hon. Friend. To the best of our knowledge, it is a unique example, certainly in Europe, of a fully worked through research project in ward design. It has an importance well beyond the area it serves in Falkirk and district. The 260-bed ward floors in the block are to a design prepared after a systematic study in detail of the functional needs of wards by a special study team of the Scottish Home and Health Department, which took in the various disciplines involved in the running of a hospital. It has been looked at particularly from the point of view of the medical and nursing staff involved in the operation of the ward. The results of the study were published in a Planning Note on Ward Design and related publications. The ward was designed down to the last detail to embody the operational policies devised as a result of the study. Even more important, it was the intention from the very beginning that the ward should be evaluated in use thoroughly, consistently and coherently.

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Therefore, its use has been very carefully recorded and detailed studies have been made of the way in which the concepts on which the ward was built have operated in practice.
The results have recently been published in a Design In Use Report, and I shall be very happy to send a copy to my hon. Friend. He will see in the Report evaluations of the ward not only from the technical point of view, but from the point of view of the medical and nursing staff who have had to operate it. He will see that, for example, it has proved to be more economical in nursing use than we had planned at the beginning, and that the financial aspects, in terms of current building costs, are also very favourable.
The Falkirk design is being used, with certain modifications, as a basis for planning ward design for many of the new district hospitals which are beginning to be planned. I shall say something later about hospital planning as a whole, but I thought that I might mention the Falkirk Ward here because, although there has been a good deal of interest in it, the interest has not been adequate in view of the importance of what has happened in the design that we have now put into operation.
Many other projects have recently been completed, and I would particularly mention the new Lynebank Mental Deficiency Hospital in Dunfermline, about which my hon. Friend talked. It is an important development in our mental deficiency services. It has very good educational, training and occupational facilities for children and adults and, as a modern mental deficiency hospital should be, it is very much designed to prepare its patients to the fullest possible extent to return to community life.
I am very happy to have confirmation direct from my hon. Friend of my information that, far from there being any resentment in the local community at a hospital of this sort having been built. the local community has welcomed it. That augers well for the success of the hospital.
My hon. Friend also mentioned developments and hospital provision in West Fife. I was glad that he was generous enough to outline some of the projects, admittedly comparatively minor
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ones, which have been carried out at the Dunfermline Hospital in the past few years. It would be unfortunate if the impression got about, as it sometimes has, that Fife as an area has been neglected in terms of hospital development since the inauguration of the National Health Service. In the first 20 years of the Health Service, the capital expenditure per head of population in Fife has been £25 10s., whereas in Scotland as a whole it has been £17 8s. That is a very crude figure. I am not suggesting that it represents an adequate answer to my hon. Friend, and I accept that there is a pressing need in West Fife for a new district general hospital. There is no dispute about that, and I would in no way question his point about the inadequacy of the present hospital situation in that part of Scotland. I am glad to add my tribute to the staff who are working sometimes in inadequate conditions to provide a service in West Fife.
I agree with my hon. Friend that it is necessary to have a new district general hospital to replace the series of hospitals and the divided service available in West Fife. But my hon. Friend knows that this is very much a matter of priorities, and that the original determination of priorities here is a matter for the South-Eastern Regional Hospital Board. We recently asked all five regional hospital boards in Scotland to give us their projects in order of priority for the mid-1970s, which is the period to which we are now looking. We have yet to receive details from the South-Eastern Regional Hospital Board, but I know that it is considering the West Fife General Hospital among a number of other very pressing priorities that it has to consider in looking at the next stage of the hospital building programme. I am not able to say clearly on this point just at what part of the programme West Fife District General Hospital will find its place, but I do know that the regional hospital board is looking at this at the minute, and, as I have said to my hon. Friend, there is no question that we for our part accept that there is a need for a district general hospital in West Fife.
There are, however, in the South-Eastern region as a whole a very large number of important projects which have to be fitted into this exercise in priorities. There is, for example, the rebuilding of

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the Royal Infirmary in Edinburgh, which will eventually be a very costly project indeed. There are important developments at the Western General Hospital in Edinburgh, and the Royal Hospital for Sick Children in Edinburgh which will be built in the grounds of the Western General Hospital. There is need for a district general hospital in West Lothian to be built at the new town of Livingston. There is need for a district general hospital in the Borders. There is need for more geriatric accommodation, including geriatric accommodation in Edinburgh and Fife and there is need also for a regional plastic surgery and burns unit to be considered.
One has only to state very briefly the outline of the projects involved to demonstrate that there is a very considerable problem of priorities indeed in the South-Eastern Hospital Region, and that, of course, is one region out of five for which priorities have to be settled, but I repeat that a hospital in West Fife is certainly one of the projects which the South-East Regional Board has very much in mind in determining its programme for the next few years after the mid-1970s.
My hon. Friend also mentioned the question of health centres and perhaps I could just say something about them now, because as he said—
Mr. James Dempsey: Before he leaves the question of hospitals, could my hon. Friend give us some information as to the new hospitals to be started in 1970? Will he recall, for example, that Airdrie Hospital, which serves Coatbridge and an area including the town of Cumbernauld, has been postponed twice, but a statement was made that it would be started in 1970? Could my hon. Friend give us some information about that?
Mr. Millan: I think my hon. Friend has a Question down about that today. Unfortunately I have not seen the Answer yet, but I think I can give him the assurance he has asked for. However, he will get the Answer a little later today about Airdrie. If I had known my hon. Friend would be here I would have made sure that I knew the answer, but, unfortunately, I do not, but I think he will be reassured when he gets it.
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I was going on to mention the health centre programme because, as my hon. Friend the Member for Fife, West said, there has been a very considerable improvement in the acceleration in that programme over the last few years. It has taken a very long time indeed to get it generally accepted by the medical profession as well as by others that the health centre is the way in which general practice should be expanded and developed in Scotland. As my hon. Friend said, this is the way for getting the new service which will provide in one group not just general practice but also a range of local authority and a range of hospital services as well, providing both a better service to the patient and a more adequate and stimulating environment to the general practitioner to work in. It has, as I say, taken a long time to get this generally accepted, and I am glad to say that there is now a general acceptance of this in Scotland.
Before 1964 there were only three health centres in Scotland. That is, from 1948 until 1964 only three had been built. Since 1964 eight more have been opened, four of them by local health authorities under delegated powers. There are five more under construction at the present time. Plans have been approved for another 15, and there are proposals for about 60 more centres under consideration. I may say that of that figure eight of them are in Fife, one of them for Glenrothes, which will be of particular interest to my hon. Friend.
Again, one has only to state the bare facts about the health centre programme to see that there has been a considerable acceleration, an acceleration which will continue over the next few years.
In this programme, of course, and particularly in the hospital programme as a whole, it is important to get value for money, and I was very glad that my hon. Friend made a particular point of this, because, again, I think that there are quite important developments happening at the present time. I have already mentioned the Falkirk ward. That is not intended simply, even primarily, as an exercise in economy. It is an exercise in getting the best design, the best facilities, the most efficient use of space, and so on, from the point of view of nursing staff, as well as providing, as it does, enhanced amenity

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for patients. It has also very important economic considerations, and is an illustration of the way in which we are trying to develop our planning from the point of view of getting services which will both improve amenities for the patients, be more efficient from the medical point of view, and also at the same time be economic in building terms.
It is true that the advantages of standardisation and particularly hospital development would be increased if it proved possible to adopt a standardised system of building that would permit the use of common structural and other components in all such development. The work which is being done upon the functional layout of wards is being studied to ascertain whether it would be advantageous to adopt a client-based system of construction of new hospitals. Any system which may eventually be adopted would need to be related to the Compendium of Hospital Assemblies which continues to be revised as necessary, and work is going on on that at the present time.
Another development which I may mention relates to the need for residential accommodation in hospitals. We set up a small study group last summer to report on the possibility that the entire programme for building staff residential accommodation in hospitals over the next 10 years or so might be tackled as a whole rather than that we should treat each hospital scheme separately. The study group's report demonstrates that a programme approach of this sort is likely to be feasible, and also that there are available local authority house plans which could be fairly easily adapted to provide residential accommodation to meet the requirements of different grades of staff. So we are considering this important aspect of development with the regional hospital boards.
As for industrialised methods of construction generally in hospital building, we are looking at the minute at the possibility of using the CLASP system of construction, of which, of course, my hon. Friend will already be aware.
I may also mention the work which is being done at the Scottish Hospital Centre. I do not know whether my hon. Friend has ever visited it in Edinburgh, but it is very well worth visiting. It is now providing an information centre for ideas and developments in building and
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equipment and all the rest of it, and it is providing a focal point for exhibitions and so on, and it allows people in the hospital services as a whole to see what is going on in design, what is available, and to see it on the spot in a well laid out way which otherwise would not be possible. The Scottish Hospital Centre, for example, has recently published information on the layout and equipment of domestic service rooms.
We have been looking at the accommodation needs of new nurse training schools, in this case in consultation with the Scottish Education Department. We have been carrying out an interesting study, which is producing interesting results, about the extent to which we could relieve acute hospital beds by providing pre-discharge units to which patients could go at an appropriate point in their recovery from, say, a surgical operation to an atmosphere which would be both less expensive in nursing and medical terms, and also more congenial from the point of view of the patient who has gone from the acute stage of illness and wants to spend the rest of his time in hospital in a more relaxed atmosphere. That is the position in the acute surgical wards in general hospitals. Work is going on and it looks as if development of pre-discharge units will provide an economical way of relieving some of the burden of the acute hospitals.
Mr. Gordon Campbell: I am most interested in what the hon. Gentleman is saying. I know that we are coming to the end our allotted time, so could he reply to my general inquiry about the state of regionalisation in Scotland?
Mr. Millan: I am just coming to that, but at the moment I am dealing with the question raised by my hon. Friend about giving value for money, hospital planning, and so on.
We are at present faced with tremendous demands on the hospital building programme. Unfortunately, we are not able to meet all these demands as quickly as we should like to meet them. We have therefore to determine priorities, which we are doing. We have also to see that we use as economically as possible the resources which we have.
My general point is that there is far more thought, study and consistency of

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approach being given to that problem than has even been the case at any time in the past. In fact, the tremendous increase in the hospital building programme over the last few years enabled us to carry out all the work to which I have referred. We now have a sufficiently large hospital programme, it is coherently organised and the regional hospitals boards are now staffed to do the planning which is required so as to enable us now to go on to the rather more sophisticated developments which have taken place over the last few years.
The hon. Member for Moray and Nairn mentioned regionalisation. I am not quite clear what he means by it. If he means the concept of the district general hospital, he knows that it is not economical to build district general hospitals except when there is an adequate population to use the hospital so that it can be built on the basis that, except for certain specialities or super specialties as they are sometimes called, the normal range of medical and surgical services can be provided in the district general hospital.
Unfortunately, it is not possible in the area represented by the hon. Member to provide the complete range of services. Therefore, patients will have to look to Aberdeen, as they do at the moment—and they will continue to have to look—for a number of the services which from their point of view it would, of course, be far more convenient for them to have in Elgin. The hon. Member would also know that there has been a considerable advance in hospital building in Elgin. I have seen some of it for myself in the last 12 months. But I could not hold out any promise that Elgin would ever be anything like self-sufficient in hospital services.
Mr. Gordon Campbell: I was not inquiring so much about the particular as about the general. I agree with the hon. Gentleman in principle, but there is argument about what is an adequate population, particularly when long distances are involved. I asked whether these matters had been settled or whether the situation is still flexible and open to discussion with the medical authorities concerned.
Mr. Millan: The board of management at Elgin manages quite successfully
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to keep a number of matters flexible and open as between it and the regional hospital board. No absolutely rigid limits are laid down, but the general principle is as I have described it.
May I say in conclusion that I am grateful to my hon. Friend for raising this subject this morning, for the way in which he did so, and for the compliments which he paid to the Government for what they have done over the last few years. A tremendous amount of progress has been made. There is still need for a good deal more progress.
It is a tribute to the medical and nursing staff in our hospital services that the quality of the service provided for the patient is not always dependent just upon the adequacy of the buildings. In many cases it is considerably greater than the adequacy of the buildings would in fairness lead one to expect.
Many members of the medical and nursing staff are still working in difficult conditions and are still providing excellent service to patients. But as the hospital building programmes steps up, as it has done over the last few years and as it develops over the next few years and into the future, we hope that in Scotland we shall see more and more hospitals of the quality which we see, for example, in mental deficiency at Lynebank in Fife. With that increasing quality in building there also comes an increasing quality in the service provided for the patients. This is the end to which all our efforts in the hospital services are devoted.

TINKERS (WEST MIDLANDS)
Mr. Speaker: I remind the House that this debate will finish at 1.15.
12.27 p.m.
Sir Henry d'Avigdor-Goldsmid: I should like to begin by thanking you, Mr. Speaker, most genuinely and sincerely for having selected for discussion the subject of gipsies in the West Midlands, which is a burning question in the area. It has a special topicality for discussion at the moment.
I have not heard such a long speech from the hon. Gentleman the Member for Glasgow, Craigton (Mr. Millan) since he used to speak on the Finance

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Bill. I am pleased to see his hon. Friend the Joint Parliamentary Secretary to the Ministry of Housing and Local Government, because we know how conscientious he is and we know his devotion to these matters. He will not be surprised if I tell him that, unlike the hon. Member for Fife, West (Mr. William Hamilton), I shall not be paying compliments to the Government.
In raising this matter I have the moral and physical support of my right hon. Friend the Member for Birmingham, Handsworth (Sir E. Boyle) and my hon. Friend the Member for Dudley (Mr. Donald Williams).
I am in a curiously unique position on this topic. In my constituency is the urban district council of Aldridge, which has provided a caravan site, and the county council of Walsall, is coming under pressure from the Minister to do the same. Therefore, I can see both sides of the question.
I will hark back, for the sake of the record, to the Caravan Sites Act, 1968, which the hon. Gentleman the Member for Orpington (Mr. Lubbock) introduced to this House and on which, I believe, he received Government support. Part II of the Act dealt with the provision of sites by the local authority, and further provisions dealt with the control of unauthorised encampments. In other words, the philosophy was that a local authority, provided that it produced a number of sites for itinerants, would have control of unauthorised encampments. The Government have not thought fit to implement Part II of the Act, and it is rather a statement of intention than a statement of reality.
When I had the honour to introduce the Walsall Corporation Bill to this House for Second Reading on 23rd April, great exception was taken by the hon. Member for Orpington to the fact that the Walsall Corporation sought control of unauthorised encampments but made no provision for sites. It did not include in its Measure two Clauses, Nos. 116 and 117. I do not think that I need detail them now, but they made it unlawful to place a movable dwelling on land without the consent of the owner of the land, and that such movable dwellings should not be used for human habitation and kept on land in the borough without the approval of the corporation.
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To a large extent, the Bill was a consolidation Measure, and it ran into what can only be described as very heavy weather. When the Joint Parliamentary Secretary intervened in the debate, he said, referring to his Minister:
"My right hon. Friend has it in mind to suggest to the appropriate Committee in his reports that the caravan provisions should not be allowed or, if the Committee decided to the contrary, that the provision should be limited by the requirement that the provisions should be allowed in the Bill only on the understanding that sites are first prepared and that the provisions would lapse when Part II of the Caravan Sites Act comes into operation."—[OFFICIAL REPORT, 23rd April, 1969; Vol. 781, c. 602.]
Mr. Speaker: Order. The hon. Gentleman knows that we cannot debate the Walsall Corporation Bill in this debate. We are on the Adjournment.
Sir H. d'Avigdor-Goldsmid: I am sorry, Mr. Speaker. I do not want to take up the time of the House, but this is essential background to this Adjournment Motion.
I believe that if the Joint Parliamentary Secretary had not intervened in this sense, there was a good chance that the Bill might not have been given a Second Reading. There was important Government business following it, and in my view that caused the Government to allow the Bill to get a Second Reading.
When the Bill was considered by the Select Committee, the Chairman said:
"The Committee has been impressed with the difficulties and indeed with the wish to maintain high standards in the Borough of Walsall and, I think I can say on behalf of all my colleagues, has been dismayed at the evidence of what seems almost guerilla warfare which goes on … and the Committee has decided that both Clauses 116 and 117 may be permitted to continue only under the conditions that have been mentioned … i.e., only up to the time that Part II of the relevant Act comes into force and subject to the provision by Walsall of 15 pitches for the caravans of these people."
Therefore, it seems to be doctrine that the provision of pitches is the solution to the problem, and it is to that that I direct my attention.
I turn to the urban district of Aldridge. Perhaps I should explain that part of it separates the county borough of Walsall from the county borough of Birmingham. The history is as follows. In November, 1967, a temporary site was provided for six families. Water was laid on. There

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was even hot water. There was a boiler. There was lighting and, in order to help the inhabitants who did not have their own lighting arrangements, the site was floodlit. There were sanitary facilities, and I understand that the Catholic authorities produced a mobile school for the children. It was an innovation. I went to see the site myself, and one could not help wishing it well.
The Clerk to the Council reported in December:
"The turning point came earlier this month when the Council agreed to let six families have a temporary site. This was set up on condition that all other tinkers left the district."
Not surprisingly, nothing of the sort happened. I learned that earlier in December there was an affray, gun shots were fired, a caravan was wrecked and one of the inhabitants was hurt. On 28th December there was an invasion of the site by three further families. The provision of this attractive site caused jealousy, and those who had not been included in the six hand-picked families on the site took it amiss. There was a further shooting affray in March and, after that, all attempts to control the site were abandoned. No warden could be found to look after it, and the site deteriorated.
We now get a situation where the site has been abandoned. At the same time, caravans are coming in almost daily from Birmingham. In the words of the Deputy Town Clerk of Birmingham, they are towed to the border, where the bailiff sees the last of them.
In January of this year on a weekend there were 15 caravans on the site, but only one family was there with the council's consent. The position at the moment is that the temporary site has been closed. The council is still looking for a permanent site. In its wisdom, Birmingham Corporation has offered a grant of £3,200 towards the capital cost of such a site, to which Staffordshire County Council has added £1,000. In other words, every authority wants to pay Aldridge to look after the gipsies for them. The estimated capital expenditure involved in the provision of such a site is only £6,200, so that it can be seen that in the provision of a site the expense is not a problem to the ratepayers.
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What is a problem is the attitude of the ratepayers. I was there 10 days ago, and I thought that I was almost within the confines of a beleagured city. On all sides, the road verges were lined with earth tippings to prevent caravans gaining access to them. In the area of Pheasey, which is really a dormitory suburb of Birmingham, no fewer than 2,509 residents have signed a petition to the urban district council. That is a striking figure when one realises that the normal turnout at a local government election is about half that number. In other words, twice as many as the number who are prepared to vote in a local election were prepared to sign a petition asking for protection from the visitations of tinkers.
In the words of the Clerk to the Aldridge Urban District Council,
"The problem is being handled as far as practicable in the manner recommended in the Caravan Sites Act, the Ministry's Circulars, and the publication 'Gipsies and other travellers'.".
In his letter, he says:
"Many of the residents of the Rushall ward suffer from great nuisance, great annoyance and some danger."
That is not the language of an irate ratepayer. Those are the words of the Clerk to the Urban District Council.
Mr. Eric Lubbock: Can the hon. Gentleman give figures of the amounts which have been spent on earthworks and the various other steps taken to move on gipsies by the Aldridge Council? Is he aware that the Government have refused to implement the Caravan Sites Act because of the alleged expense, which they say is far more than local authorities are having to spend on these purposes?
Sir H. d'Avigdor-Goldsmid: The figure that has been given by the Clerk to the Aldridge Council in connection with the earth works is £600. That is not negligible figure.
The clerk says that these inhabitants had genuine cause for vehement complaint.
So much for Aldridge. Now I turn to the Borough of Walsall. I am glad to see the hon. and learned Member for Walsall, North (Mr. William Wells) in his place. I want to avoid any emotive language on a subject which has aroused

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considerable feeling. Therefore, I will confine my remarks mainly to a report which I have had from the Chief Superintendent of Police in Walsall. He has sent this report to me for my guidance and I should like to draw to the attention of the Joint Parliamentary Secretary some extracts, because he may not be familiar with all of it.
The Chief Superintendent begins with a brief note on the history:
"Although Walsall has not been immune to the attentions of caravan dwellers of the Irish tinker class since the early and mid-1950s, the present position has fomented since a considerable militant influx in late 1967. Prior to that the comparatively casual visits of itinerants in small numbers were dealt with by local authority removals from Corporation land … such action kept the position in manageable proportions."
He then lists a number of incidents which took place beginning in November, 1967, when an encampment of 27 caravans was removed. On 5th December a further four were removed and on 11th December a further nine were removed. There were then court proceedings, which were appealed to Quarter Sessions. During this time there were between 25 and 45 caravans parked on various bits of waste ground in the town.
A significant sentence in the Chief Superintendent's report is:
"There is little doubt that caravan dwellers, through the auspices of the Gipsy Council and the National Council for Civil Liberties, were making a concerted effort to force Walsall town Council to provide a camping site, as had been successfully done a week or two earlier in Staffordshire."
As a result of the court proceedings being brought to a conclusion, there was a further removal of caravans on 27th March, but they came back almost immediately to other areas. In this connection the Chief Constable observed:
"To sum up, the situation is that the caravan dwellers are determined to stay in Walsall until Walsall County Borough Council provide a site, and the Council adamantly refuse to do so, athough in my opinion there is space for such a project. Between the parties stands the police force and experience with these caravan dwellers has shown that no accusation against a member of the Force is too vile to be made, and of course the object of Mr. Puxon's allegations is to attempt to discredit the force."
He adds, and to this I should like to give some publicity:
"This has been realised from the beginning by me, and every incident in which police are in conflict with these people has been carefully reported on by the officers concerned. I have
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no doubt whatsoever that the officers at Walsall are fully aware of the situation and carry out their duties in a most correct manner."
I saw him a month or so later and he commented:
"The pattern which seems to emerge when dealing with these people is that the local police summon them if they are on the highway for such things are obstruction, no lights, depositing litter, etc. They eventually appear at court, are found guilty, and fined. They then move off to another area to avoid the fines."
I should like to give the House some statistical information about offences. The Chief Superintendent wrote to me saying that since December, 1967, no fewer than 1,183 offences were reported to the police. Of these 271 were dealt with, 286 were not dealt with by the courts and in 626 cases summonses were not served. That was obviously owing to the very difficulties which the Chief Superintendent mentions in his report.
In addition, 23 were dealt with for cases of crime. I will return to that subject later, because to my mind it is one of the most serious aspects of the whole problem.
There is a growing feeling in Walsall that the powers of law and order are not able to protect the citizens from the assaults—there is no weaker word—of the so-called tinkers. A highly respected local solicitor advised some clients not to pay their rates so that the matter could be ventilated. As the police have sent me this letter I imagine it is no longer confidential. This gentleman wrote:
"Thank you for your letter of 28th March. I have indeed been watching this matter. I am quite certain that the only way in which effectively pressure can be exerted will be for all of you to refuse to pay your rates so that the matter can be fully ventilated in court."
This letter comes from someone I know and whom the hon. and learned Member for Walsall, North knows well as a man of the highest responsibility. Yet he is going so far as to advise ratepayers in Walsall not to pay their rates so that the matter can be ventilated.
Sir Edward Boyle: My hon. Friend knows that I have a constituency almost adjoining his. We have the same problem in parts of Birmingham. Does he find, in addition to the crime of assault, that the anxiety of parents who have children going to school is another feature of the situation?
Sir H. d'Avigdor-Goldsmid: I have sought throughout to keep emotion out of this because this is an important statement of fact. I do not want to be accused of emotionalism or anything else. I am sure that many parents of children do have those feelings, but these are not open to statistical evidence.
I want now to return to the subject of crime, because this is important. The hon. and learned Member for Walsall, North and myself share a constituency interest in the important copper refineries of Messrs. Elkingtons, where, since 1st January, 1968, there have been eight cases of robbery. Three of these cases are undetected, four do not relate to caravan dwellers, and the remaining case concerns two caravan dwellers who have been remanded, so I will not comment on that further.
Mr. William Wells: Is the hon. Gentleman using the word "robbery" in its technical sense of stealing from the person, or in the general sense of stealing from premises?
Sir H. d'Avigdor-Goldsmid: The hon. and learned Gentleman must forgive my ignorance of the law. I have here the Chief Superintendent's letter describing them. I am sure the intention is that it is basically stealing from premises, because two were offences of office breaking. I do not think that these are cases of violence. The hon. and learned Gentleman knows that industrial towns are not free from local crime. It is obviously, for the criminal element in a population, a matter of satisfaction that there are easy scapegoats for their own illegal activities which they wish to practice. The same is true of Church and Bramhall (Stockholders) Ltd. where two thefts are undetected.
This is the position that we have to face now. The tinker-gipsy population is for the moment relatively small and under control. I did an extensive tour of the area about a fortnight ago and I have certain comments to make about it. The numbers are few. The answer is that this is the season of the year when fruit picking and other agricultural activities can be carried on by the itinerants, and they appear to be taking advantage of it.
The conditions of the sites occupied, however, are fearsome. I refer particularly
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to the temporary site in Aldridge where, if there were a wind on the heath, as referred to by George Borrow some years ago, it would blow very foul indeed. All the facilities that I mentioned earlier, including the hot water boiler and the lavatories, have been destroyed. A large field next door, where animals are kept, has had its wire fence systematically broken down. A cattle shed has been used as a latrine, and this misuse of outbuildings is not confined to cattle sheds. Many complaints have been made by local inhabitants because of the wholly unsanitary and barbaric habits of some of these people, who defaecate in the road.
We are not dealing with people who are desperately poor. I have seen luxurious caravans, such as one sees in holiday resorts, and lorries pulling them which would clearly have a market value running into four figures. These are not the poorest people in the world. Neither are they entirely Irish. Some of my constituents have suggested that if there were some check on Irish immigration this problem would come to an end. I doubt that. In fact one gentleman, in reply to my polite inquiries, cast grave doubts on my sexual habits and the legitimacy of my ancestry. He did not do this in an Irish brogue. I do not believe that he was born anywhere but within the shores of this country.
The fact is that a growing number of our people take advantage of this semi-lawlessness to create local Alsatias—Alsatia being an area of London where outlaws lived 300 years ago. They are making local Alsatias of certain areas of the West Midlands, where they live largely beyond the law because of the inability of the police to serve summonses.
One real danger arises; in this recrimination there is obviously a tendency for the local people to take the law into their own hands and, equally, considerations of normal humanity sometimes seem to be lost. In this connection I have had communications with the borough engineer of Walsall, who cites half a dozen cases in which, because of illness and other reasons, long-extended stays have been granted to caravan dwellers in various parts of the borough. This refutes the suggestion which is sometimes made

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that inhumanity is being displayed in dealing with this problem.
I have characterised the situation as a nuisance which may become a disaster. I do not think that that is too strong a word, because although, at the moment, the itinerants are widely distributed, when fruit picking and other agricultural work is over they will return to the areas which they formerly occupied, where they obtain a living by dealing in scrap metal. They acquire old cars, or wrecks, pull them to pieces on the side of the road, making an indescribable mess, and sell the resultant scrap to the scrap metal merchants. This problem is likely to be with us next winter in an acute form. The danger is that if the Government do not show their interest in this matter, other than by twisting the arms of those authorities who are subject to having their arms twisted—because, like Walsall, Wednesbury and West Bromwich, they have Bills coming up in the House, causing them to leave Part II of the Caravan Sites Act unenforced, the situation will become very nasty, because disrespect for law and order is something that no hon. Member can contemplate with equanimity.
Time is running short. There will be a big move back in the early autumn to the area of the conurbations, and it is essential that action should be taken to reassure the local population that their interests are not being entirely ignored. That is why I am grateful to you, Mr. Speaker, for being allowed to raise this matter today. I await with interest the views of the Joint Parliamentary Secretary.
Mr. Speaker: There are 19 minutes left for this debate, which must finish at a quarter past one. I must protect other hon. Members who have subjects to raise. Any intervention must be brief.
12.56 p.m.
Mr. William Wells: The hon. Member for Walsall, South (Sir H. d'Avigdor-Goldsmid) has drawn attention to an urgent and important problem. He has done so in words of studied moderation which, however, do not conceal the gravity of the problem for the local residents. It is natural for the hon. Member and myself—we are both members for the borough of Walsall, and both members for the urban district of Aldridge Brownhills—to look at this problem
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rather through Walsall-Aldridge-Brown-hills glasses.
This is a problem for the whole of the West Midlands, and in the few minutes during which I propose to address the House I want to call for some kind of regional approach to the problem, and some kind of regional settlement. This is not a problem that defies human wisdom. I live in Hertfordshire. That county has had just this problem to deal with. Perhaps there has not been the aggravation of a great conurbation such as that of Birmingham, but the county has dealt with the matter quite successfully by putting its hand not too deeply into its pocket, providing an extensive area where these people can be housed, providing minimum but adequate sanitary facilities and minimum but adequate sanitary and police inspection, making life tolerable for these people so long as they stay in the extensive and adequate compound provided but intolerable if they move out of it.
They can carry on their normal trades within reasonable reach of the various towns or farms in the district. The county borough of Walsall has very limited space. The problem there has been an acute one. Nevertheless, I urge the Joint Parliamentary Secretary to see that his Department, in collaboration with the local authorities of the area, evolves a solution to the problem, probably on the lines of the solution arrived at in Hertfordshire, if necessary giving by Statute adequate powers to enforce the decisions that are reached.
1.0 p.m.
The Joint Parliamentary Secretary to the Ministry of Housing and Local Government (Mr. Arthur Skeffington): May I begin by saying that I understand why the hon. Member for Walsall, South (Sir H. d'Avigdor-Goldsmid) my hon. and learned Friend the Member for Walsall, North (Mr. William Wells) and the right hon. Member for Birmingham, Handsworth (Sir E. Boyle) have sought this opportunity to ventilate the genuine grievances of many of their constituents as the result of the matters which both have described so graphically. Anyone who has not seen or experienced the nuisance which arises from unauthorised, uncontrolled camping by itinerant travellers has no appreciation of the smell, the litter, the dirt, the squalor

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and the inconvenience, which are not confined to the site, but which spread out and affect the community, sometimes over a wide area.
It would be futile to pretend that there are not some people, where these distressing congregations have been created, who have had to put up with a great deal. Although I hope to take a balanced view, I want to begin by saying that those who have had this unfortunate experience have my sympathy, and I understand their indignation.
What we have to do in the circumstances—and I was grateful for the constructive suggestions—is to see how quickly, both now and in the long term, we can solve what is undoubtedly a social problem of some magnitude, and of growing magnitude, so that it does not reach the kind of explosion point to which the hon. Member referred.
I have had this experience myself, not only in the county where I live, but in my constituency which, being near London Airport, attracts many of those whom I would prefer to call "gipsies", which was the title used in the Preamble to the Caravan Sites Act, 1968 where it says:
"… use of gipsies and other persons of nomadic habit.…"
The expression covers all these types of travellers, and if one uses other words, one may be accused of prejudice. When one has seen as I have, not only where I live, but, as I say, in my constituency, the kind of difficulties which arise, one appreciates that action must be taken.
I am delighted that, even though Part II of the Caravan Sites Act has not been put into operation, some authorities, with considerable vision and imagination, have proceeded already to create proper sites, controlled sites with the amenities and facilities which are the long-term solution to the problem. In Kent, there are five such sites and the hon. Member for Walsall, North knows some of them, and although they have not solved all the problems, they have eased conditions for at least a considerable part of the county. In my constituency, where we have the same sort of problems, the very energetic town clerk, Mr. Hooper, with his council, has provided not only a temporary site, but a rehabilitation site.
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Although it is not free from difficulty, at least something has been done.
I hope that the hon. Members have studied the considerable and authoritative research document which my Ministry produced, "Gipsies and other Travellers", which was the first complete analysis. It showed the background to the problem and gave us the key to the solution of which we must never lose sight. It points out that in recent years the gipsy population has had to face a complete revolution, as it were, in its way of life. Gipsies normally earned their living by horse trading and casual labouring in agriculture and so on. Conditions of life have altered and they are now faced with different problems.
It is true that most of them find that they earn the best sort of living for most of the year in connection with scrap metal dealing and, of course, they have tended to move close to where the motor car industry is, in the Midlands, or to areas with similar kinds of trade. But a considerable proportion of them are to be found in the South-East of England too. It is wrong to think of this as a West Midlands problem it is a problem which affects other areas of the country.
It is right even now to realise that the only solution for people, most of whom were born into this way of life and who have never lived in a house, or had that kind of experience which ordinary people have had, is to provide a permanent improvement with sites under control where they can live and where their children can go to school so that they may learn a different way of life and probably leave the attractions, if there are any attractions, of being on the road.
The hon. Gentleman said that there had been trouble on the sites and I know that last year there was trouble and one site was closed. I gather that the other small site is now proceeding more satisfactorily. I pay tribute to local authorities which have attempted and are still attempting to make provision in the area. I am sure that this is the right approach. The Borough of Walsall has had this continuing problem for some time and its expenditure on dealing with the matter on the only basis on which it can be handled, other than providing permanent sites, has been more than £4,800. The

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hon. Gentleman said, the provision of a full site would cost about £6,000.
The more one looks at the problem, the more one sees that there is no solution in moving these people along and fencing them off. I agree that once we get permanent sites, the police will be able to have new powers, which have been carefully worked out with the Home Office, to be able to deal with what is sometimes an elusive population, but it would be futile to provide measures in private legislation, or in any other way, in advance of the provision of sites.
We know from the document which I have mentioned that there are about 15,000 gipsies. Some 3,000 families, for whom provision must be made around the country. We have estimated that about 200 sites would meet the requirement; that is permanent sites which could be controlled and where there would be some hard surfacing for caravans, water and toilets and so on. The total cost over a number of years would be about £3 million to £4 million. That would be a cheap price to get the problem solved and I reiterate that my right hon. Friend wants to implement Part II of the Caravan Sites Act at the earliest possible moment.
In the meantime, he wishes to encourage authorities to make preliminary plans. Loan sanction for expenditure will be most sympathetically considered, as we have said for a long time. We hope that this will encourage authorities to go ahead and make provision even now. When we have further figures, they may well show that many authorities are spending large sums on merely putting up earthworks and moving gipsies around and perhaps the implementation of Part II will come more quickly than might otherwise be the case. I think that there is a strong reason for believing that where, as in the case of Walsall, there has been expenditure on preventive rather than on creative work, the argument I am adducing becomes even stronger.
It may be asked why, if that is the solution, and only 3,000 families are involved and the cost spread out would be only £3 million to £4 million, the Government do not bring Part II of the
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Act into operation. My right hon. Friend would like to do so but it cannot be done at that time when we are emphasising to local authorities the need to control public expenditure so strictly. It would be unfair and anomalous to impose immediately this extra burden on them but that is the only reason why Part II of that excellent Act has not been brought in. It will be brought in at the earliest possible moment and it is along these lines that we shall see a permanent solution not only to deal with the grievance outlined vividly in this debate but which will provide, we believe, a permanent solution in that, once the families are settled, they can become absorbed in the community, their children can get proper education and they themselves will be able to find jobs and have social contact which they cannot get when they are continually on the move.
These people are not legally entitled to be anywhere—apart from the few sites provided—except when they are on the move, and we cannot be satisfied with that state of affairs. I congratulate those local authorities which have made provision. I cast no blame on anyone but unfortunately only one site has been provided of any significance in the West Midlands as opposed to five in my county. I hope that this matter will be looked at, bearing in mind what I have said about loan sanction. My hon. and learned Friend referred to a regional approach. The West Midlands Planning Conference has a sensible plan whereby a number of sites could be selected so that no one authority would carry the whole burden or responsibility. It would enable the problem to be spread, diminishing the kind of difficulties to which hon. Members referred.
By strategically siting the places, we would get a spread which would provide a solution of the character he referred to as being achieved in Hertfordshire. We shall give the authorities all the encouragement we can because this is the only way the problem can be solved. The Government will do everything possible in the interim period to help through loan sanction and advice, and will implement Part II of the Act as soon as possible.

AUTISTIC CHILDREN
1.14 p.m.
Mr. Albert Murray: I offer no apologies for raising the subject of the problems associated with the autistic child. There was an Adjournment debate about a particular child last December, but autism is a continuing and increasing problem, and the House should devote more of its time not only to discussing it but finding ways whereby we can help those helping autistic children.
Being neither a psychologist nor a medical man, I shall not deal with the symptoms and pyschological and medical problems associated with autism, because there are many categories. But the best description I have heard of the condition is that it is a glass wall, that the children who suffer from it are imprisoned behind a glass wall unable to communicate with the outside world.
At least 3,000 children of school age in Britain suffer from autism. The number is increasing possibly by 400 or 500 each year. There are 1,400 blind children and 3,400 deaf children in the country, so the number of autistic children is almost the total of these two figures. There are also about 12,000 adults now in institutions of one sort or another who were autistic children.
I have a particular association with this problem. I want here to pay public tribute to certain people, because I have in my constituency the Helen Allison School for Autistic Children. It was set up by the National Society for Autistic Children and named after Mrs. Helen Allison as a tribute to a lady who has done so much work for autistic children. I am fortunate because also serving at the school is Mrs. Sheila Skeffington, who is known to so many of us as the wife of our hon. Friend the Joint Parliamentary Secretary to the Ministry of Housing and Local Government, and we are also very ably served by the principal of the school, Mrs. Landman. I now pay public tribute to them and to the many others who do work not only in my constituency but elsewhere.
Being a member of the board of governors of the school has made me ever more aware week by week of the problems which the parents of autistic
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children face. Recently the board was discussing applications for children to become pupils at the school. Out of over 20 applications received, at least 17 had to be turned away. Yet the alternatives listed were predominantly none. There was no alternative educational establishment in most of the areas concerned which could cater for these children. The applications came from places as far apart as Bexley, Haringey and Hertfordshire.
In the light of all this, perhaps one begins to understand the size of the problem, not only in terms of the difficulties for parents and the cost to them, but the cost to society. It has been estimated in the United States, where a great deal more work has been done on this matter than here, that the direct cost of keeping people in mental institutions of one sort or another is about £60,000 over a person's lifetime. It has been estimated that the indirect cost can be reached by multiplying that figure by seven.
I do not suggest that those figures apply to Britain, because we have to take into account the difference in costs in both countries. But even if we halved the first of the figures we would still get a cost of about £30,000 in keeping a person in an institution for life, and then we must multiply that figure by the indirect costs inasmuch as the person concerned cannot earn a living or pay taxes or contribute to the gross national product. That is why the Government must spend more money on this sort of problem.
We have various estimates of how much it costs in this country to keep a person in a mental institution. Depending upon the institution, the direct costs are between £500 and £1,000 per year; the direct cost of keeping a person in an institution for a life span are £65,000 per person.
We have been dealing with what we know as autism only for 20 years. The Minister last year said that a great deal of research was being encouraged by the Department of Education and Science. Research is now being undertaken by Dr. Michael Rutter at the Maudsley Institute of Psychiatry which will take five years. Will the Under-Secretary say whether there will be an interim report on this research, and whether any action will be taken before the five years are up?

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During that five years a newly-born autistic child will have grown to the age of five, and a 5 year old austitic child will have become ten years old. Five years in a child's life is a long time, but to the parents of autistic children it is a lifetime. I hope that we shall see early action as a result of that research.
In the South-East there are about 20 schools and units, whereas in the rest of the country there are only three. It is sometimes argued that a person's education depends on where he lives, but the chance of an autistic child who lives outside the South-East getting a place at a special unit or school is extremely limited.
This problem is associated not only with children but with teenagers. It is estimated that there are about 4,000 adolescents or young adults suffering from autism of whom about 2,000 are in institutions.
A recent survey of 42 adolescents and young adults of 17 and over showed that half were in mental hospitals or hospitals for the sub-normal. The results achieved by the other 21 showed what could be done by really tackling autism. Of the 21 who are not in hospital, one is at university, one is at the Royal College of Organists, one is an apprentice bricklayer, having studied at a technical college, and two are working in offices. So out of the 42 who were surveyed half have been enabled to return, although sometimes in a limited way, to normal life, and are able to play their part in and to contribute in every possible way to society. Will the Under-Secretary consider the creation of more facilities, particularly for youngsters around the age of 17?
Dr. Lorna Wing has suggested various ways of setting up such units. She suggests that the initial average capital cost would be about £30,000 and the cost of keeping a person in the unit would be about £1,000 per annum. This is a reasonable price compared with what it costs to keep such a person in a mental institution, even ignoring all the other costs to society.
Will the Under-Secretary consider also the listing in regulations of autistic children as a category needing special education? I know that the Government intend to introduce a new Education Bill and such a provision might be included in it. Because autistic children are
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outside all the categories, people think that they are ineducable, which is an awful word and an awful thought. The inclusion of such children in a special category would encourage local authorities to pay more attention to them and to think about setting up schools or units. Even if an education authority could not set up a unit on its own it might co-operate for that purpose with other local education authorities.
Will the Under-Secretary also consider issuing a direction or an encouragement to local education authorities to support autistic children at school beyond the statutory school leaving age? At present this is a permissive power which is not used by all education authorities. The issue of such a direction or encouragement would be a positive move towards encouraging local authorities.
I do not want to ask the Minister too detailed questions, but will he tell the House the amount of money which is being spent on the education of autistic children? My hon. Friend the Member for Eccles (Mr. Carter-Jones) and I visited this week an organisation which deals with machines which help to educate, amongst other groups, austistic children. We saw the talking typewriter and the talking page. I will not go into detail, but the talking typewriter appears to be a very useful adjunct in the teaching of autistic children. It is an expensive piece of machinery, and it cannot be said to solve every problem. It costs between £15,000 and £16,000. If talking typewriters could be supplied to units which catered for 15 or 20 children, and if, as a result two or three children were brought back to play a useful part in society, on the basis of the arithmetic which I have already given to the House this would be a great saving.
We shall continue to press the Government to do more for autistic children. I hope that before long we shall have another debate on this matter, and that the Government will examine every possible method of giving help to autistic children, to their parents and to those who teach them, and show that the Government really care and are doing something about it.
1.28 p.m.
Mr. Paul Dean: I am sure the whole House is grateful to

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the hon. Member for Gravesend (Mr. Murray) for putting the Parliamentary spotlight on this small group of our fellow countrymen who suffer from autism. One of the chief marks of a compassionate society is that it cares and wants to know about people who are handicapped, particularly, as in this case, comparatively small groups of people about whom not very much is known. Another mark of a compassionate society is the extent to which it is itself prepared to do something about this type of problem and not pass on the buck entirely to the Government.
I join with the hon. Member for Gravesend in paying tribute to the National Society for Autistic Children for the school which it set up and for the tremendous amount of work it has done in researching into this problem, in drawing it to the public attention and in itself doing something about it. That is of tremendous value in our community today.
Two things strike me about this problem. The first is the shattering effect which an autistic child can and often does have on the parents of the child. So often one finds an apparently normal child looking physically a very good specimen, who is unable to respond to its parents. This is a shattering experience to them and deeply disturbing for the child. It leads to the disturbed behaviour one so often finds in autism because of the inability of the child to understand and make itself understood.
The other feature is that research now shows that a great deal can be done for these children provided the problem is diagnosed in time and treated in time. So often for want of the right help at the right time these children are permanently resident in mental deficiency hospitals, whereas if they were trained from the earliest years many of them would be able to live a useful life, maybe with supporting services, and be able to earn their own living and have the dignity and independence of normal human beings. One can say this about a great many handicaps, and I do not want to exaggerate it at the expense of others, but I hope that the Under-Secretary will respond to the points which have been made by the hon. Member for Gravesend.
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It is interesting and encouraging—and I mean no disrespect to the Ministry of Social Services—that we are to have a reply today from the Department of Education and Science, which is shortly to take on responsibility for education and training of the handicapped. I hope that the hon. Gentleman will be able to assure us that in taking on this responsibility—I welcome the transfer—his Department will keep in very close touch with the Department of Health and Social Security. I am sure the hon. Gentleman would be the first to concede that there are aspects of this disability, as of others, in which the experience the Ministry of Health has built up, will be of great value to his Department in the work it is to do, particularly in education.
Diagnosis is one of the difficult problems with children who look physically normal in their early years. So often the problem develops to the extent where it is very much more difficult to deal with because the diagnostic facilities are not available and the disability is not recognised sufficiently early. Although I realise that this is not quite the province of his Department, I hope the hon. Gentleman will tell us about what is being done to try to improve diagnostic facilities.
Another point mentioned by the hon. Member for Gravesend with which I entirely agree is that here we have a group of children who are not legally entitled to specialist education. As a result, understandably in the circumstances, education authorities do not necessarily pay the attention to this group of children which they pay to other groups that are entitled to specialist education. There is now very strong evidence that it is possible to train and teach these children, but a specialist approach is needed. I hope the hon. Gentleman will be able to assure the House that it is the intention of the Government to include autism as one of the categories which required and deserves specialist education.
There is need for more special schools or units in which this education can be given. The hon. Member mentioned the pioneering work which the National Society is doing in the school in his constituency, but there is a great shortage of specialist units. I understand there

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are only 18 in the south-east of England and three in the rest of the country. Although the numbers of these children are small, there is a case for encouraging local education authorities to co-operate together and with the voluntary bodies interested in this development.
My final point concerns the follow-up from education. The hon. Member said that to cut off education of these autistic children at 16 or 18 is very unsatisfactory. In relation to normal children they are at a very much lower stage of development. It is necessary not only to carry on their education beyond that age, but to ensure that when their education and training is complete there is work available for them, in sheltered workshops where required and in hostels when it is not possible for them to live at home. There is a problem here which one finds in other types of disability. However good the work of education and training may be, unless employment is available after training so much of the money spent on training can be wasted. The psychological effect on the person concerned is then extremely serious. If these children come out from training full of hope that they can lead an independent existence and then they cannot find employment, the psychological effect is worse than if they had had no education or training. This is an important aspect if we are to improve the services available for these people.
It is not only the human aspect which is involved but the economic aspect. Here is a possibility for these children, when they grow up and are trained, of earning their own living. The economic effects of this can be considerable. From that point of view, as well as from the human point of view, it is highly desirable that they should be equipped to do this rather than to be incarcerated in mental deficiency hospitals of which the cost to the State is very considerable.
I appreciate that the hon. Gentleman who is to reply to the debate has tremendous demands on the resources of his Department at present. None of us can hope for a miracle overnight, but we can fairly ask that he and his Department will recognise the pioneering work which has been done by the National Society and that they will be able to give further help and encouragement to ensure that there is at least some
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extension in co-operation with voluntary bodies of the facilities and services available for these children.
1.39 p.m.
Mr. Lewis Carter-Jones: I should like to associate myself with the remarks of my hon. Friend the Member for Gravesend (Mr. Murray) and the hon. Member for Somerset, North (Mr. Dean) on the problems facing autistic children and their parents. This matter is frequently overlooked. I suppose that all of us who are parents of normal healthy children have had the great joy and pleasure of having them looking and smiling at us and sometimes cuddling close to us and laughing with us. These are some of the joys of parenthood.
I have in my hand a pamphlet written by the headmistress of an autistic unit in my constituency. I join in the tributes which have been paid to the National Society and the schools which have been established. I represent Eccles which has one of the three schools in the North. It is disgraceful that outside London and the South-East there are only three of these schools. The title of the pamphlet is "She Now Cries with Tears". The moment that one gets this response one has broken through the barrier to which my hon. Friend the Member for Gravesend referred; one gets an emotional response.
The final paragraph of the pamphlet states:
"How far we shall be successful in restoring these children to normalcy only time will tell. So far they have done better than I expected and the burden on their families and parents has been lessened. Enough has been accomplished to make it quite clear that all autistic children should have their educational chance"—
that should be repeated—
"Enough has been accomplished to make it quite clear that all autistic children should have their educational chance and the setting up of suitable classes should not depend on the good-will of individual education officers or organisers.".
It is the uneven spread of provision for this type of child which is so worrying. I pay tribute to the work which has been done at the Moat Hall School in Eccles since 1966 and the pioneering spirit of the education authority and its officers in establishing this unit. But all the work has to be done in a youth club. There is all the paraphernalia of setting up the

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autistic school facilities, dismantling them, setting up the youth club facilities and then dismantling them, and so on. The way in which this lady works is incredible, and the results which she has achieved are incredible.
I should like to quote from the publication entitled "World Medicine" in which there is an article about an autistic child at a Surrey County Council school. It reads:
"Before she was accepted by The Lindens, her worried parents",
who were trying to get a response from her, a smile, a tear, a flicker of recognition, no more than that—
"had taken her from doctor to doctor to psychiatrist with little improvement. Life-long incarceration in a mental institution seemed the only solution. This is the grim fate of many of these aloof and often strikingly beautiful children for whom human warmth appears to mean nothing at the height of the disorder. Yet statistics from Britain and America show that many can attend school and college. One is now a mathematician, another a noted nuclear physicist."
The "noted nuclear physicist" is making his contribution to society.
I very much agreed with my hon. Friend the Member for Gravesend when he referred to the direct cost and the indirect cost to society of not taking care of these children. I suppose that it is difficult for a Welshman, brought up in a religious environment, not to be emotional. But we know that it is morally right to help these people, and we know that we should do it. But some extremely sound economic arguments can be advanced as to why we should do it. If we put them into institutions, we shall have to face a ghastly bill over the years. In a paradoxical way, we have to face a ghastly bill for being compassionate and prepared to look after them.
It seems that whenever I speak in the House I ask some Minister to try to deal with both sides of the balance sheet. It is rather unfair that I should ask my hon. Friend the Under-Secretary of State to do that today, but he is concerned with the expenditure side. Somebody from the Treasury should be on the Front Bench to account for the cost to society, both directly and indirectly, if my hon. Friend is not given the money to carry out the necessary task. The Treasury should be
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answerable. As we are now talking about cutting public expenditure, there should be a spokesman on Treasury matters on both Front Benches. I should have liked to see my right hon. Friend the Chancellor of the Exchequer and the Opposition Shadow Chancellor of the Exchequer nodding approval of the value analysis argument that it is economically sound to provide as much money as possible to achieve a breakthrough for these children. They could then also have the glow in their cheeks of knowing that it was morally right.
1.46 p.m.
The Under-Secretary of State for Education and Science (Mr. Denis Howell): I entirely agree with the hon. Member for Somerset, North (Mr. Dean) that the House owes a debt of gratitude to my hon. Friend the Member for Gravesend (Mr. Murray) for initiating this debate. It is the second debate on the problems of autistic children which we have had in recent months. I do not complain about that. Indeed, I welcome the fact that attention is given to the subject. Those of us who are blessed with normal, healthy, wholesome children should never cease to give thanks for that fact and have an added responsibility when we consider the plight of these children and the families who shower such dedication and devotion on them. The more time I spend as Minister responsible for the education of handicapped children, the more this point is borne in on me.
One advantage of having had these responsibilities for a number of years is that I see initiatives taken four years ago beginning to pay off. When I joined the Department four years ago, the terrible word "ineducable" was prevalent. These children were solely the responsibility of health authorities, not education authorities. I like to think that perhaps one of the most compassionate things which this Government have done is to say that no child should be written off as being beyond the help of education. The Prime Minister's announcement, with the fact that it was welcomed on both sides of the House, that responsibility for these children should be transferred from the Health Department to the Education Department gave great personal satisfaction to me. I can say the same for the officials in the Department, the medical officers and civil

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servants in the special services branch, who have responsibility for these matters.
I agree with my hon. Friend the Member for Eccles (Mr. Carter-Jones) that when we get involved in passionate arguments about where the money is to come from and we talk about cutting public expenditure it is worth while stopping to think that this is the end product of the exercise. It sounds very nice to cut back in large global terms, but the end product is the quality of life of ordinary people; and to make it possible for these children to have an education which they did not have before means that we must take compassionate decisions, not only about personal social services, but about global questions of Treasury finance.
I am happy to associate myself with the tribute which my hon. Friend the Member for Gravesend paid to the teachers and head teachers. He mentioned those in his constituency. He will not mind if I widen the point. It is most touching and moving to go round the special schools and to see the work which has to be done by teachers and the hours of dedicated work which they spend with two or three children or sometimes only one child, in order to get a response or, as my hon. Friend the Member for Eccles said, a flicker. Society certainly owes a debt of gratitude to these teachers.
The great problem is that of early diagnosis. This is recognised today on all sides of the House. Autism is a relatively new category of handicap in our knowledge. It has existed for many years but was not defined until recently. This largely explains why the special provision for these children is, possibly, so inadequate compared with other handicaps.
On the previous occasion I listed the nine symptoms by which one could generally recognise autistic children. Suffice it to say that, on the whole, they are children who have considerable difficulty in establishing personal relationships with most other people. This expresses itself in different ways—severe head-knocking/rocking and banging, apparent deafness and/or tremendous reaction to noise in other children. The great difficulty, which we are now beginning to understand, is that very often these children do not have only one handicap. They suffer from multiple
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handicaps. They can be not only autistic, but deaf or partially deaf, too. Therefore, the problem of diagnosis in children with multiple handicaps is of tremendous difficulty. I will mention presently some of the things that we are doing in this respect.
I think that we are all agreed in welcoming the formation of the National Society. The fact that it has managed to get two Adjournment debates in one Session in this House is a great tribute to it. It is marvellous that we have people who are prepared to focus attention on these matters. There is no difference of opinion, based upon the surveys which have been done, between the National Society and ourselves, that the size of the problem is thought to be about 3,000 children in the country as a whole. We are continuing to do work on that question.
Indeed, the House will be glad to know that during the last 18 months Her Majesty's inspectors in the Department of Education, in association with the old Ministry of Health, now the Department of Health and Social Security, have done a survey, in conjunction with local education authorities and regional hospital boards, to try to assess what diagnostic facilities are available in homes for mentally handicapped children and in other places so that we can assess the need for the Government officially to give further guidance to the appropriate bodies on diagnostic facilities and procedures in order that the autistic children who can be found shall be found and have their special handicap looked at. My hon. Friend will be glad to know that this field work and activity, led by Her Majesty's inspectors of education, is going on.
Since the emergence and diagnosis of this handicap is relatively new, we need much more research. Doctor Rutter's research project, the cost of which the Department is paying 75 per cent., is proceeding apace. I am told that it is proceeding a little more slowly than when I last spoke to the House. We hoped to have the results this year but I am sorry to say that it is a year behind time. The reason is that the children in the units with which Dr. Rutter is working are showing very different degrees of retardation and emotional disturbance. It has, therefore, been necessary initially to

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assess the stage of the development, intellectual and emotional, in the use of language and social behaviour which these children have reached, in many cases having to devise special test procedures, since all this is new.
I am glad to say that special techniques have been developed to describe and record in quantitative terms the differences between the units in the methods of dealing with children's behaviour and to get a degree of consistency about all this. It is hoped to re-test the children after one complete year, which is why there is a year's delay, in order then to draw reasonable interim conclusions, which, I believe, is what my hon. Friend wanted, rather than wait until the whole project is completed before we can hope to benefit by at least part of it.
On the subject of provision, it is entirely for the local authorities, plus the voluntary bodies, to provide these facilities. I am advised that it is possible in certain circumstances for the Government to give financial assistance to the voluntary bodies for capital equipment. I am not certain of the extent of that. My hon. Friend took me by surprise in mentioning it. I will, however, have inquiries made into that aspect and will write to the three hon. Members who have taken part in this debate. Obviously, the provision of capital equipment and other things is an expensive business.
I have been asked questions about categorisation. It is true that in the existing categories autism, for the reasons I have mentioned, does not appear. I am not quite sure that it should appear, although I have been asked three times to have it written in as a category. I think that everybody knows that we are drafting legislation to bring before the House for the transfer of responsibility, and there is also the possibility of another Education Act.
Our thinking at the moment—it is open to influence; we shall be glad to hear what people say—is that autism has emerged as a new handicap since all the known handicaps were last defined in Regulations, and it might be better not to include any categories of handicap at all because other new categories of handicap
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might emerge as medical knowledge becomes more available to society.
Our present inclination is to say that whatever handicap emerges, it should be the responsibility of local authorities to provide suitable education to meet it—in other words to eliminate altogether the types of category, leaving the responsibility where it now lies. Even though autism is not at present a special category, I can give the assurance that it is still the duty of local education authorities to provide special education for these children suitable to their needs even though autism does not appear in the Education Act, 1944, as a special category.
In respect of the Regulations which will come before the House, I am glad to say that the old Ministry of Health and my own Department issued a Circular, No. 18/68, in October last year—in connection with defining handicaps and their analysis. I like to think that that was the start of the new philosophy of the Government away from the old idea that any children might be regarded as ineducable and beyond the educational process. That was followed by the announcement by my right hon. Friend the Prime Minister a month later concerning the responsibility for these services.
One other question which remains for me to deal with of all those which have been mentioned is that of teenage autistic children. I share the view that this is a matter of some importance. Perhaps rather less has been done on this front than on all the other fronts in the relatively short time. There is certainly not much point in society trying to diagnose, educate and get the medical research right if at the end of the day, when children come out of the school system, there is nothing for them.
Therefore, the provision of sheltered employment for teenage autistic children is certainly not the least important part of the whole operation, although it can be said in honesty that it has hitherto been the most neglected. I can, however, assure hon. Members who have spoken, and the House generally, that we intend to give a great deal more thought to this aspect as soon as my Department has responsibility for the whole of this problem. It will mean co-operative arrangements being established between

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local education authorities, the voluntary bodies, and schools, in providing care and employment. My inspectors are keen on this; my Department is keen on this: I am keen on this.
I just conclude by saying that I think my hon. Friend has done a service to these children by raising this matter. I certainly hope this is not the last time he or other hon. Members will raise it, because what we would like to do most of all, having fixed public attention on the requirements in this field, is to see that the House gives regular attention to these matters.

DISTRICT GENERAL HOSPITAL, ILFORD (SITE)
2.0 p.m.
Mr. T. L. Iremonger: I should like first of all to thank the Minister for being here personally to answer this debate, and I think the whole House would like me to take this opportunity to say to him how very glad we all are to see him in fine and full health after his recent illness, of which we were all very sorry to hear.
The Minister is responsible at this moment for decisions which will affect the development of hospitals in every region in the country. Every regional hospital board has just completed its review of its own region and has submitted to the Minister its plans which will require his approval, if the taxpayers' money is to be provided for implementing them. Therefore, the nature of the siting of every new major hospital in every area will depend utimately on the decisions which the Minister is now in process of making. My object this afternoon, and that of the hon. Gentleman the Member for Ilford, South (Mr. Arnold Shaw), who may hope to catch your eye, Mr. Deputy-Speaker, is to put into the mind of the Minister and to put clearly on the record the arguments in favour of a particular decision which we firmly believe to be the only right one in the interests of our Ilford constituents in the London Borough of Redbridge.
The proposition with which we have to start is that the hospital service of the future is going to be based upon a number of large, 1,000-bed, district general hospitals for acute cases in each
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district which will also be served by a number of ancillary smaller hospitals for longer-stay patients. The reason for developing such mammoth general hospitals is understandable. The resources of equipment and manpower, the vast capital outlay, and the highly trained medical and ancillary specialists—and, even more, teams of specialists—which are required to exploit the latest advances in medical knowledge and techniques must be concentrated in one place to serve an optimum large population. In every region, therefore, we will accept that the Minister has got to decide, on the recommendations of the regional hospital board, which hospitals from among the existing ones shall be expanded to become the district general hospitals, or what other sites should be developed to accommodate them.
The particular decision which I want to urge upon the Minister now, when he considers the Ilford district in the region of the North-East Metropolitan Regional Hospital Board, is that the proposed new district general hospital should be built on the site available in the huge grounds of more than 40 acres in which stands the present Goodmayes Hospital. This site is more or less in the centre of the Ilford district, and a district general hospital there would serve a cohesive and established community of getting on for 200,000 people.
The medical focus and heart of the Ilford district has for over a generation been the King George Hospital, which is a stone's throw away from the Goodmayes site, just across the road over Eastern Avenue. Ideally, of course, one would wish to expand the King George Hospital building itself into the new district general hospital, but, even if all the adjacent space were to be used the maximum available land there would just not be enough—not half enough, actually, Reluctantly, therefore, one has to envisage the King George building being relegated eventually to the needs of longer-stay and non-acute cases, though, surely, the consultants and specialist staff should have to move no farther than across Eastern Avenue to the new district general hospital close by.
The first reason for my conviction that this decision to develop the Goodmayes site is the only right one is geographical, and a glance at the map of north-east

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London makes it simply and dramatically plain. If we mark every other existing hospital and possible or impossible alternative to the Goodmayes site we see that they all lie along the perimeter of a circle some eight miles in diameter; and bang in the middle of that circle is the Goodmayes site, and close by it, as I have explained, is the hospital, the King George Hospital, Ilford, which at present serves the very purposes which the new district general hospital would ultimately have to serve instead. If we were to develop any one of the alternatives on the perimeter, the people of Ilford would be deprived and disadvantages in a way which no comparable group of the population would be disadvantaged by the development of the new district general hospitals at Goodmayes. While we are looking at the map I would remind the Minister that when we talk of eight miles, in the most densely populated area in the world, we are talking in terms of—in certain traffic conditions even in 1969, without contemplating the year 2000 and after—maybe as much as three-quarters of an hour by ambulance, which can be a fatal factor, especially in cases of certain accident injuries; and the accident hospital which now serves the area is the King George Hospital.
The second reason is administrative, but with implications far more profound and far-reaching than that word might at first sight imply. The whole future tendency in the development of community services will be for all the services, medical and social, to come much more together, and for the needs of the whole person and the whole family more and more to be treated by specialists working as one team, rather than for those needs to be compartmentalised into specific departments such as pre-natal, maternity, child guidance, children in need of care, psychiatric, chiropodic, geriatric, and so on. These are needs which, in the individual and in the family, inevitably overlap, and ought to be treated more and more together. Now, the chosen and, I am sure, the proper agency for ministering publicly to many of these needs is the local authority. Other such needs are ministered to by medical services which must inevitably revolve more and more in the future round the hospital and health centre—in
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fact, round the new district general hospital contemplated for each district. Obviously it will be a snug and sensible arrangement for the area of the local authority to coincide with the area served by the district general hospital. Any other arrangement would be an administrative dog's breakfast. And the areas of the local authorities in Greater London are fixed now, by the London Government Act, 1963, for the next hundred years. The Goodmayes site is pretty well central to the Greater London Borough of Redbridge.
The third reason is that unless the medical focus and heart is retained and developed in the centre of the Ilford area the whole of that community will suffer increasingly over the years from the effects of one of the inevitable consequences, namely, the flight of the family doctor. General practitioners just are not so keen to take on practices in places where the major hospital is comparatively remote from them. If the district general hospital of the future is not in central Ilford more general practitioners are going to be more remote from it, and unnecessarily so, than if it is in the centre of Ilford, and the whole quality of life for every Ilford family will be depreciated accordingly.
It is hard enough as it is to keep our most gifted young doctors in this country, let alone attract them to general practice, and, therefore, anything which positively tells against any locality in the mind of a prospective general practitioner will militate against the interests of every local family, one of the prime requirements of which must inevitably be its good family doctor. The prospective general practitioner's first concern in deciding where he will practise his art is to know what sort of facilities he will have for diagnosis and treatment and care from the best and nearest hospital for his patients. Executive committee advertisements of general practices are always seen to feature the availability of open department facilities and, I add, postgraduate facilities.
Besides, if a district is not to be starved of young general practitioners, it must be able to offer opportunities of combining junior hospital appointments with general practice. In this context, the Minister must know that the King George

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Hospital within one year of the publication of the Report of the Royal Commission on Medical Education has already had its loan sanctioned and is starting fund raising for its academic centre which will bring together undergraduate and post-graduate education and general practice.
Those, therefore, are the three main grounds for deciding to develop the district general hospital on the Goodmayes Hospital site in Ilford—geographical, administrative and in the interests of maintaining the standards of the local general practitioner service.
There remain three incidental factors which tell in favour of this decision and I would not care to omit them. The site itself, as well as being large, is level and, being on Eastern Avenue, ideally accessible. It is so large that car parking and even helicopter landing would present no problems in future. It also happens to be hard by the local ambulance station in Ley Street, Ilford. It also happens that as well as the King George Hospital, which deals with general medicine and surgery and more than 40,000 accident and emergency cases every year, in the close neighbourhood of the Goodmayes site there are the following hospitals: the famous Goodmayes Hospital itself, one of the great psychiatric hospitals of the world and possessing its own power station and supply; the Ilford maternity hospital and the Chadwell Heath hospital, which deals with geriatrics and infectious diseases and medicine. This close agglomeration of existing hospitals could not fail to get the development of the new district general hospital here off to a flying start and sustain it well in its future development.
The third incidental factor is the provision at the present King George Hospital of training for nurses for full registration, the only such training available for both Ilford and Barking.
In conclusion there are two things I should like to say.
I know that it is extremely delicate for a regional hospital board to consider its plans and make recommendations to the Minister and at the same time combine proper discretion and flexibility and frankness with all concerned. Inevitably, such times of flux must cause much local anxiety, and certainly most general practitioners
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and consultants and others concerned with medicine in the Ilford area are feeling very puzzled and isolated and out of touch with the powers that be. But I think the Minister would like me to pay, as I wish to pay, a personal tribute to the North-East Metropolitan Regional Hospital Board and particularly to the unique personality of its chairman, Sir Graham Rowlandson. For anything to be acceptable just now, it has to be said by Marx or Marcuse, or by Lenin or Lennon, but it was actually Kipling who said:
"Ships is all right; it's the men in 'em."
That probably accounts for the confidence which all who have contact with the North-East Metropolitan Regional Hospital Board have in that board, because no organisation could possibly have more imaginative and sympathetic leadership. And, finally, all concerned were most favourably impressed by the receptiveness of the right hon. Gentleman the Secretary of State for Social Services when he answered a Question which I put to him on Monday, and particularly by his answer to my supplementary question. He kindly agreed that the hon. Member for Ilford, South, and I might go to see him and talk about this. It is a good thing that this debate should be on the record, but I hope that we may not fail to avail ourselves of that invitation.
2.15 p.m.
Mr. Arnold Shaw: May I, too, express my pleasure at seeing my hon. Friend fully restored to health? May I also express my gratitude to the hon. Member for Ilford, North (Mr. Iremonger) for having brought to the notice of the House a matter of mutual interest to our two constituencies?
The subject of the future of the hospital services in Ilford is not new to the House. It was raised in an Adjournment debate by my predecessor in January, 1958, when he dealt with this very problem. At that time, there appeared to be a difference of opinion between the local practitioners, who favoured a new hospital in the district, a new hospital of 800 to 1,000 beds, and the North-East Metropolitan Regional Hospital Board, which thought that the situation might be met by an extension of the King George Hospital in Ilford.

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Some improvement has been made since then, but there is now a scheme for district general hospitals in the board's area and the matter is being actively discussed. There is some disquiet about whether the needs of Ilford will be neglected in the resultant plan. The origin of this disquiet was the board's decision not to take over the War Memorial land from the Redbridge Borough Council. Consultations and negotiations have been going on for some time, and it looked as though something would be done on these lines, but a sudden decision was taken and people were a little anxious and felt that it might result in the King George Hospital being run down and possibly eliminated.
I understand that assurances have been received that the King George Hospital will continue to function but that the site is not large enough for a district general hospital of the required size, though even at this stage I am not altogether satisfied that that is the case. It may be, but there is much redevelopment to the north of the King George Hospital site and a feasibility study might produce a scheme to extend the present King George Hospital to the necessary requirements. I hope that my right hon. Friend will take account of that before a final decision is made.
This solution may not be feasible, however, and so we come to the purpose of the debate, namely, the way in which Ilford may best be served by a hospital on the Goodmayes hospital site. This conception has been eloquently adduced by the hon. Gentleman opposite who put forward a most persuasive case. I hope that my words will reinforce his plea. There is no shortage of land in relation to Goodmayes Hospital. There is a powerful case for the possibility of siting a hospital in that area on land which is already in the possession of the regional board.
The claim for a district general hospital in Ilford is not merely a question of local patriotism or of keeping up with the Joneses. It is a matter of life and death to the residents in the area. In the Adjournment debate in 1958 it was said that there were 35,000 attendances at the casualty department of the King George Hospital. Last year the number was in the region of 40,000.
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The high accident rate on the trunk roads passing through the town provides strong argument for a general district hospital in the area with all the facilities necessary for treatment in one place. If the facilities are situated too remote from the needs of the people of the borough, it will provide real hardship to patients and to hospital visitors. A decision needs to be made on this matter at the earliest possible time.
There are fears that suitable candidates for the hospital service, and indeed for general practice locally, are being deterred from coming to the area because of the uncertain future. A modern district hospital, with proper provision for facilities for post-graduate status, inevitably will attract the young consultant and the general practitioner.
I should like to express my pleasure at the reply given by my right hon. Friend on Monday to our request to see him on this matter. Both the hon. Member opposite and I look forward to meeting him in order to press the urgent needs of our constituents. I would ask for consideration to be given, not merely to the Goodmayes site, but to the chances of development of the King George Hospital, which in my opinion would be the number one choice.
2.23 p.m.
The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow): I wish at the outset to thank both the hon. Member for Ilford, North (Mr. Iremonger) and my hon. Friend the Member for Ilford, South (Mr. Arnold Shaw) for their kind remarks, which I greatly appreciate. I wish to thank both hon. Members for their thoughtful speeches in explaining the need for a district general hospital at a particular site in Ilford. They have drawn attention to this particular problem on several occasions recently. Both speeches were couched in moderate terms and exemplified the difficulty with which we are confronted in hospital planning.
As the hospital programme gains momentum, the hospital service has frequently to decide whether a hospital should be rebuilt on its existing site or whether a new hospital should be built on a new site. There are other difficult decisions to make. Perhaps the most difficult of all, because any

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decision will inevitably not satisfy everybody concerned, is to decide whether in a particular area a hospital should be built to meet, most effectively, economically and efficiently, the future requirements of the population likely to live in that area. Essentially this is the problem of the Ilford area, to which both hon. Members have drawn attention.
My right hon. Friend the Secretary of State is well aware of this matter. He visited Barking Hospital on 2nd May and met some members of the Ilford and District Hospital Management Committee.
For many years the development of the hospital service has been planned on the basis of the district general hospital with provision for all the usual acute specialties. This takes its origin from the earliest days of the National Health Service even before the original hospital plan of 1962, Cmnd. 1604, which endorsed the earlier concept. Each district general hospital would provide a wide range of facilities required for modern diagnosis and the treatment of patients. Such hospitals, treating both in-patients and out-patients, would include maternity, geriatric and psychiatric units as well as the usual medical and surgical cover: selected hospitals would provide, additionally, for other specialties such as radiotherapy and neurosurgery, to meet the needs of a wider catchment area than the normal area served by the hospital.
So far as possible, each hospital would be located in, or near, the centre of one of the centres of population it was to serve. Early hospitals were planned to serve 100 to 150,000 persons but hospital planning has generally advanced this figure and the advantages of larger hospitals have been recognised where local conditions permit this: the benefits are not only in general efficiency but also, and most important, in the service to patients. In urban areas particularly it has become not unusual for district general hospitals to be planned and built to serve some 200,000 to 250,000 persons. This, then, is the background to the current studies of hospital provision for Ilford.
When the National Health Service was set up in July, 1946, there were 16 hospitals containing some 1,806 beds, serving the South-West Essex area generally comprising Ilford, Barking,
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Romford and Brentwood. The area covers the band of urban development extending from Ilford and Barking to Brentwood. Following the local government reorganisation in the London area these areas are now the London Boroughs of Barking, Havering, and part of Redbridge; Brentwood Urban District and parts of Chigwell are also involved. The 1961 population was 655,000 and by 1981 the population is expected to have increased to 695,000. In this period there is expected to be a shift in population. The westward parts are declining in population, but this is likely to be more than offset by a considerable increase in the Romford and Brentwood areas, a trend which is expected to continue.
In 1962 the first hospital plan envisaged that the growing deficiency in the number of beds in part of the area and in hospital services generally would be met by large developments in district general hospitals. It was expected then that Oldchurch Hospital, Romford, Barking Hospital, King George Hospital, Ilford, and Rush Green Hospital would be developed into full district general hospitals.
When the hospital building programme was reviewed and put on a more realistic basis in 1966, the North-East Metropolitan Regional Hospital Board still expected that district hospitals for the area would be provided at Barking, King George (Ilford), Oldchurch, and Rush Green hospitals, all of which would be developed and expanded. However, both hon. Members have suggested that somewhere else in the Ilford area should be used for a district general hospital, The hon. Member for Ilford, North will recall that some time ago he was urging the case of the King George Hospital to meet the needs of Ilford. But I think that it is generally agreed now, in spite of the attractions of this view, that the King George Hospital could not cope with what is required for a district general hospital in terms of area and the facilities which could be provided.
This hospital, with 208 beds, and the nearby Ilford Maternity Hospital, with 54 beds, have long provided hospital services for the town. The Regional Board considered purchasing the War Memorial Gardens, just over 12 acres, which would have provided a larger site. Last year, the regional board decided not to buy the gardens because, even

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then, the site would not be big enough to build a district general hospital economically and because of certain other factors of which both hon. Members are aware.
The population of the Ilford area may be some 167,000 in 1981. But Ilford is now part of the London Borough of Redbridge, and that borough, in turn, forms part of a larger densely populated area on the eastern edge of outer London. This larger area is expected to have a population of some 695,000 by 1981. Bearing in mind that the population is tending gradually towards the east and that the lines of communication mainly are east and west, the board had to decide the most reasonable provision for hospital services. It also has to consider the existing hospital facilities, the state of the hospitals, and which could be enlarged if required.
I have mentioned already the attention which was given to King George Hospital, and this has had to be abandoned in the light of the factors that I have outlined. The hospital was only abandoned as a future district general hospital for the area after a great deal of careful planning and consideration had been given to the services which could be provided on such a restricted site. While it is most unlikely that the decision will be reversed, today's speeches will be read carefully by the Board, and any new factor which may have been introduced into the matter will be considered carefully. Incidentally, I understand that the health centre for general practitioners will be built at the King George Hospital site.
Both hon. Members explained in some detail the possible advantages of providing a district general hospital at Goodmayes. Currently, this is a psychiatric hospital with 1,300 beds on 120 acres of land. Understandably, they have paid less attention to other hospital sites on this eastern edge of London. However, other hospitals in this densely populated area could be developed equally well, and perhaps even more easily, to provide a comprehensive district general hospital service. As I said earlier, the problem is to decide the pattern of the hospital provision so that the whole area is covered as effectively and
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as comprehensively as possible within the resources available.
I was a little worried when the hon. Member for Ilford, North referred to an identification of local authority and hospital areas. That is not a logical equation because of population tendencies and future plans, apart from such other factors as the use of land which may be required for other purposes, including what used to be called "the green line" problem.
The regional board has to consider also, for example, the service given by the hospital at Barking on which £2 million has been spent in recent years to provide more maternity beds, outpatient facilities, improved dispensaries, x-ray, pathology, physiotherapy and similar support facilities, as well as more operating theatres and staff residential accommodation. Money has also been spent on improving services at Oldchurch Hospital in Romford and at Rush Green Hospital.
Goodmayes has several attractive features, of course, not the least of which is the availability of a considerable area of land on which a hospital could be built. On the other hand, the site is in a less densely populated area with less satisfactory public transport services and access by road. There are no district general hospital facilities already on the site. The whole pattern of services for the area is being considered very carefully by the regional board to take into account changes of population, transport arrangements and local government reorganisation. Various possibilities for the future provision of district general hospitals are being considered and are to be discussed with officials of my Department.
I thought that the hon. Gentleman perhaps inadvertently was indicating that the discussions had been concluded and that a final decision had been reached, but that is not so. Once the outline principles of the hospital provision to be made are clear, the regional board will undertake at any early stage of planning to inform the authorities concerned with the provision of hospital services for the areas, including the hospital management committees, the local health authorities and representatives of the general practitioners, probably through the local medical committee.

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I fully accept that we must support and help general practitioners in present circumstances as much as possible. My right hon. Friend has indicated on more than one occasion the value that he attaches to the relationship between general practitioners and the hospitals.
My right hon. Friend gave an assurance on the subject of consultations as recently as 19th May, when he said that development on the Goodmayes site was one of several possibilities under consideration, that there were major decisions to be taken, and that he would like local community interests to be fully appreciated and consulted when ultimately they are taken.
The adoption of more modern planning concepts was facilitated for the North-East Metropolitan Regional Hospital Board at the same time as the basis of distributing capital funds to regional hospital boards was modified. Particular account was taken of forecasts in population and, in the case of the metropolitan boards, of the investment in teaching hospitals in London. I hope that both hon. Members will bear in mind that, if there is any tendency which is slightly worrying my Department at the moment, it is that in future the big teaching hospitals in London, which are probably the finest in the world, ultimately may be under-used because of developments elsewhere. In reviewing its programme to take account of the latest allocation, the Board took the opportunity to suggest significant alterations in its programme so that district general hospitals could be built more quickly or could be built in larger stages.
As I have said, the regional board is aware of the possibilties of developing a district general hospital at Goodmayes. But it is only one of several alternatives being considered very carefuly. The arguments deployed today by both hon. Members will be considered by the Board and my Department. I think that I have said enough to explain why it is not possible with any precision to say what we feel about the Goodmayes site. The position is still fluid, and both speeches today will be taken into full account at various levels of consultation.

PLAYGROUPS
3.38 p.m.
Miss Joan Lestor: May I join in the warm welcome back to the House extended to my hon. Friend the Under-Secretary of State for Health and Social Security after his recent illness?
In an earlier debate today, my hon. Friend the Member for Gravesend (Mr. Murray) raised the question of the autistic child and referred to the 3,000 children who are desperately in need. I want to refer to a slightly larger number of young children who are also in great need of help, and I have in mind 116,000 children between the ages of three and five.
This week has been what those of us in the playgroup movement have called "Playgroup Week", in that we chose this week to draw the attention of the public, the Government and local authorities to the existence of the movement and to the fact that large numbers of children deprived of normal nursery school education attend playgroups largely run by voluntary effort.
A playgroup is a group of children, numbering between six and 20 ideally, which meets regularly most mornings of the week so that its members can play together. The rôle of the adults in this group is to provide an environment rich in opportunity for the children to become sociable and to learn together by doing things. The adults within the playgroup movement have maintained and supported these organisations and establishments for their children very often with little help from local authorities, since the means whereby local authorities may help them have been, and even now with some additions are, on the whole pretty meagre.
One reason why we have seen over the last nine years a mushrooming of the playgroup movement is, as I said at the beginning, because of the failure of us all to develop adequate nursery school education for children between the ages of three and five. I am very pleased that the urban aid programme is including provision for under fives in deprived areas. This is to be welcomed. Those of us who have raised this question in the House regularly over the last few years are naturally very pleased that at

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last we have come round to recognising the severe deprivation that exists in this age group, which has been the most under-privileged of our educational section. But this provision in the urban aid programme, and even the extra deviations that have taken place from the original ban that was imposed on nursery schools, still means that roughly one child in 50 will get the opportunity to attend a State nursery school. Although it is difficult to arrive at the precise figure, at the moment it is roughly one child in 63 of the three to five age group.
The Children's Playgroup Association has under its auspices over 4,000 playgroups controlling and providing for 116,000 children. This considerable number has grown over the past few years because everybody interested in children has recognised the needs of the young child for play facilities, the need to indulge in activities where it meets other children, and the need for mothers to be involved in this work. Yet we have failed to supply, through the Government and through local authorities, the necessary provision. Therefore, this has mushroomed.
The situation now is that the playgroup movement really belongs to nobody in terms of Government administration. It is registered under the Nurseries and Child-Minders Regulation Act. It does not belong to the Department of Education and Science. In a sense one can see that it could not if one was trying to equate it with nursery schools, since the provision of nursery schools by the Department of Education and Science requires people to be trained in the care and teaching of that particular age group.
Equally, although it is registered under the Nurseries and Child-Minders Regulation Act, it is not a process where children are merely minded. Neither is it a provision of day nurseries—another sphere where there is a tremendous shortage, which I and other hon. Members have mentioned in the House.
Since 1944 we have not been able to make provision for the under fives. Incidentally, I cannot help thinking that the advocacy and the commitment for nursery school education in 1944 was intended for those who are now the mothers of the present under fives who took part in the lobby last year on this
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question. Because of this we have arrived at a situation where both the Plowden and the Seebohm Report, have recognised the important rôle that the playgroups are playing in meeting the need and filling the gap of the nursery schools.
The Plowden Report recommended that the playgroup movement should become the responsibility of the Department of Education and Science. The Seebohm Report recommended that it should come under the Department of Health and Social Security. Clearly we must make up our minds as time goes on that the playgroup movement is here to stay and that somebody has to accept responsibility for it at least in part being an educational provision and also making up the necessary gap that exists in nursery schools for most of our children.
The Government, through the urban aid programme and the relaxation of the original ban on nursery schools, have done more and are committed to do more for the under fives than has been done in previous years. Nevertheless, the playgroup movement is here to stay. It has enormous problems and difficulties, many of them financial, and it is on this that I want to speak for a few moments.
I say that the movement is here to stay, not because I or those people associated with it regard it as necessarily an adequate substitute for nursery schools, but because, if we are realistic about the future, with the best will in the world we recognise that it will be many years before we get adequate provision through the Department of Education and Science. The need for these play facilities for young children, which rightly involve their parents and neighbours, will be intensified with the tendency towards building high blocks of flats where local authorities still have to put families with young children where there is no play space. I have never understood why we have such a high priority in providing garages for cars instead of play space for young children and why we still ban children keeping pets in local authority flats and fail to provide adequate means outside where this could be done. The tendency in planning today often forces us to provide the type of home that does not lend itself to the social environment and play needs which young children require and benefit from enormously.

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I was particularly pleased that the second phase of the urban aid programme mentioned that local authorities could put in a request for help in providing supervisors to start and run play groups in their own areas. This is a welcome step forward. Voluntary supervisors, particularly in rural areas, who are doing this simply out of love, are known to travel as much as 1,300 miles in two months trying to supervise playgroups that they have set up in areas where they have not sprung up as spontaneously as in other parts of the country.
1 should like the Department to consider the desirability, irrespective of whether an area is a deprived area and has special needs within the meaning of the Act, of doing all that it can to encourage local authorities to appoint these supervisors to see that playgroups get off the ground in areas where they are lacking.
One criticism of the mushrooming of playgroups has been that they have tended to grow up in areas that are perhaps a little better off and where mothers are prepared to take the initiative because many of them have had the kind of education which would encourage them to know the approaches to make and where to go to make inquiries about starting these things. It has not always been so easy to start them in the poorer areas. Therefore, many areas not covered by the urban aid programme will still be desperately in need of these play facilities. We could well encourage local authorities, irrespective of any definition, to start providing these facilities almost as of right.
All concerned with the under fives are conscious that playgroups are mainly run by unqualified people. This is why they do not claim to be nursery schools. People running them may, by accident, be teachers, but this is not a requirement. By and large, they are run by mothers with a great deal of heart and, very often, a great deal of efficiency. If we could encourage the Department of Education and Science, and perhaps the Home Office and the Department of Health and Social Security, to consider the possibility of organising a short, nationally recognised, training course for people who would like to take part in the running of playgroups, I am sure that we would find a ready potential among many young
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mothers who have previously been reluctant because they did not feel they had the necessary understanding of what they would be trying to do.
Some local authorities have co-operated in setting up short training courses but the future of the playgroup movement should be considered nationally, not as being compulsory—I should not like that—but in terms of encouraging people to take up playgroup work. It is being done haphazardly by some local authorities, but if the standard of playgroups is to be raised the question must be considered nationally.
I want to make it clear that I see an enormous advantage in the voluntary nature of movements such as this. The co-operation of parents in these movements and the assistance received, in terms of courses and supervisors, should not be seen as in any way taking away from the voluntary effort involved. We want to keep that. Where community effort has sprung up and is fulfilling a social need it is to be welcomed and encouraged.
I have mentioned the question of finance. It must be clear that 116,000 children in over 4,000 groups represent a situation in respect of which a lot of maintenance is required. The playgroup movement receives a very small grant from the Department of Education and Science—a little for secretarial expenses and the expenses of the national organiser. That is all that we receive. Some local authorities do much better than others in making grants available to local groups and associations.
The question of finance is actively militating against the development of the playgroup movement. If we are to maintain standards—and in the movement we try to get people to adhere to the standards that advisers and experts have set—and continue to make the claim that we can meet the requirements that many people seek to place upon us, the question of finance is very much involved. Because of recent legislation many groups now find that if they are to meet all the requirements of the health regulations, for example, they must either charge a fee that militates against poorer children attending their groups or keep their standards low, which means that they do not meet the requirements that they would like to meet.

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We do not want to bring about a situation which will work against the child who may most need the service. A fee of 4s. or 5s. a morning may not mean much to a person in a higher income group, but £1 a week out of the wage packet of the average wage earner is a considerable amount, and many people would be stretched to meet it. Among the difficulties that we are experiencing is the financial one of meeting the necessary requirements—the cost of equipment and of trained personnel—and this often means making the difficult choice between maintaining the necessary standards and providing a service which will meet the needs of those children who most need it.
There is one other problem that I want my hon. Friend to think about, even if he cannot make any detailed comment on it today. I recently handed to his Department a copy of a circular giving particulars of a survey which had been carried out in respect of the sanitary facilities provided by playgroups. This was done because when we amended the Nursery and Child Minders' Act we imposed upon all playgroups a requirement to register with the health authorities. Previously, if a person had minded a child for only a short part of a day he or she did not have to register. Now, all people who look after children must register with the local health authority. That is right, and I and many others have argued for it in the past.
But what it meant was that all playgroups were made subject to the requirements laid down by local health authorities. A circular from the Department of Health and Social Security was sent out explaining what was desirable, in terms of the provisions made in a playgroup or a day nursery. This has led to some confusion. There are differences between those who are registered under the Nursery and Child Minders Act, who are minding children or running private day nurseries from 8 in the morning until 6 at night, and those in the playgroup movement with a small number of children attending for three hours a day. The needs that require to be met are very different.
One difficulty that has arisen concerns the provision of toilets. It has been suggested that there should be one toilet
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for every eight children. That is a far higher proportion than exists in many State nursery schools, and certainly in many infant schools. We must remember that there are differences between a self-help voluntary group, run by mothers for a few hours a day, and a day nursery which caters for 20 children a day over a long term. The latter undoubtedly needs to provide the facilities that the health authorities are demanding.
There is a further complication. Many playgroups are run in hired premises The local church hall is a favourite location. In many cases church halls demand little rent, because the church authorities want to feel that they are part of the service. When a local health authority states that it requires the provision of two or three more toilets in such premises it sometimes causes difficulty. It is not always possible to obtain permission from the owners to knock down walls in order to make the extra provision. In such cases it is not possible to meet the demands of the health authority.
I should like to know what the playgroup is supposed to do in those circumstances. Even where the owners give permission, since playgroups are nonprofit-making organisations they are not always able to meet the cost of making the extra provision without help. I hope that that help will ultimately be given by local authorities. The local authorities cannot have it both ways. If they expect playgroups to raise their standards they must provide some help to allow the movement to make the extra provision.
But there will still be many cases in which, although permission to make the necessary alterations is not forthcoming, the playgroups concerned have been running for a long time without dysentery or any other ill effects having manifested themselves. One of the things that the Department might do is to point out to the local authorities the fact that there is a great difference between children attending a playgroup for only two or three hours on three mornings a week and 20 children attending an establishment for six or seven hours every day for five days a week. This distinction must be made if we are not to force playgroups to close down for lack of finance or ability to provide what the health

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departments require. Many of their requirements are totally unrealistic.
I have not time to go into the detailed survey that many playgroups did on toilet use by young children, but some of the demands made are totally unnecessary; the children do not need as much provision as is required. We went into this matter very carefully in the playgroups, and found that one toilet to 10 or 12 children would be much more realistic, and more in line with what is demanded in our nursery and infant schools.
Nobody wants to lower standards or run health risks, but we do not want to risk having to close playgroups and deny to many children a play and social facility from which they benefit because the play groups cannot meet unrealistic requirements based on an overall assessment of the situation. Playgroups are rather different. In the provision for the under-fives they fit in somewhere between nursery schools and child-minding. There must be a clear definition at some stage. They are a separate provision. They are not day nurseries—they do not cater for the working mother—and they are not nursery schools. These matters must be considered by the Department, particularly as it is clear from the Seebohm and Plowden Reports that the playgroups are recognised to be here to stay and to be making a valuable contribution to play provision for the young child. We want to keep the standard as high as possible.
I do not want what I say to be interpreted as an attack on local authorities, many of which have been very helpful to the playgroup movement. But, for example, in interpreting the Nurseries and Child-Minders Regulation Act and applying it to playgroups a medical officer of health in an area which I will tell my hon. Friend about later has said that no child under 21 must be allowed on the premises while the playgroup is running. This means that a mother with a child of four who would dearly love to help in running a playgroup will not be allowed to do so since she will not be able to bring her younger child with her. There have been many arrangements that have worked out entirely satisfactorily with the little child tagging along with its older brother or sister, enjoying the benefits of the playgroup, and in such cases as I have mentioned local authorities
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are a little officious in their interpretation of the regulations.
I have no doubt that all the things I have mentioned are done with the best will in the world. I do not question the motives behind them, but having been involved in running a group for many years, and knowing something of the difficulties, I think that it would benefit all if there were a little guidance from the Department to local authorities not to be too rigid in their interpretation of regulations but to look at the realities of the situation and the requirements.
We heard earlier this afternoon about the autistic child, this is a very important subject. As I go around the country in my capacity as adviser to the playgroup movement—I hasten to add that I receive no remuneration, lest this be misunderstood in the light of recent discussions—I am very impressed by the way in which mothers have taken into their folds handicapped and subnormal children, because the provision for that group of pre-school children is totally inadequate in most areas. I am impressed when I see blind, deaf and physically handicapped children being warmly welcomed into a group. But the time has come to look very closely at the needs of the pre-school subnormal, maladjusted and handicapped child to see whether we can help the playgroup movement to take them under its wings. If this is not possible we should make far more adequate provision through local authorities.
These are just some of the points we wanted to raise in Playgroup Week. We recognise that when the bowl is small we cannot get as much as we would like, but now that the movement has for many years filled the gap in nursery school provision it is time for recognition of what has been done by voluntary effort. Voluntary effort cannot be stretched any further to meet needs as great as those we are now being stretched to meet. Some of the difficulties I have mentioned could be overcome by a sympathetic attitude on the part of both Government Departments and local authorities.
The playgroup movement is very conscious that high standards are essential, and that proper equipment and trained people are also desirable in any organisation dealing with young children. But if we are to meet the requirements and

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to come anywhere near being a reasonable substitute for nursery schools we shall need a great deal of help for the thousands of young children now under our care.
Mr. Speaker: Order. I must remind the House that despite my interest in children this debate must end at 3.30.
3.5 p.m.
Sir Edward Boyle: The hon. Lady the Member for Eton and Slough (Miss Lestor), who speaks with very great personal experience, has done a service in bringing this subject to the House in playgroup week. I must apologise to you, Mr. Speaker, and to the House for the fact that immediately after speaking I shall have to leave because I have to catch the 3.45 train for my constituency in order to fulfil an engagement.
I agree that the playgroup movement is expanding rapidly, for a number of reasons. A growing number of mothers want it; a growing number of parents are reading the large amount of material about the part which play can take in the life of even the youngest of our children; a great many people are coming to realise that proper nursery education, even in educational priority areas, will only spread slowly. I suggest, therefore, that the Government ought to do something and regard it as their responsibility to keep playgroups, as it were, on the right lines, and to foster them as the best means of countering the various unsatisfactory types of child minding that can exist. Equally, I am sure that the hon. Lady was right to draw attention to the large number of highly public spirited mothers who are anxious to do something here and to try to tackle the needs of a wide range of very young children, including a number of handicapped children as well.
I underline what the hon. Member said about the importance of the Department continuing its grant for a national playgroup adviser. I think I am right in saying that the present sum of £3,000 a year was granted for three years, so about 18 months of that period has now gone. We should not forget the importance also of some grant aid towards administrative overheads which are bound to be quite high. The P.P.A. could do with considerably
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more administrative help and I think that we must remember the importance here of full-time office staff and of a telephone to deal with the voluminous inquiries for help and guidance. I am indirectly associated with a body called the National Extension College, closely linked to the A.C.E., and I am struck by the enormous number of requests which come from parents all the time to deal with various stages of education.
I also underline the importance of positive encouragement to local education authorities to appoint playgroup advisers and organisers. The P.P.A. is right to think that one of the most important and economic ways of helping is to appoint playgroup advisers for every area—something which already happens in inner London and a number of other authorities as well. It is important here to find one good person, preferably with some real understanding of playgroups, and not just some reluctant, perhaps retired, professional person with orthodox classroom prejudices. It is important to have someone who has sympathy and a feeling for the responsibilities and possibilities of playgroups.
There is a great danger of too much strain being put on one person in a widespread area. Too much crucial work in this country rests on the shoulders of a very few people. It is worth remembering that playgroups can get by often with a quite small grant. Often a £50 foundation grant can help a playgroup to get started in an area where the parents cannot afford the initial outlay.
I have mentioned the importance of direct help and of contributions to initial outlay coming from a number of sources. When we were discussing the urban programme, I drew attention to the importance of a larger budget for the Community Relations Commission so that it could give grants to a number of special groups in multi-racial areas. I am certain that grants coming from a number of sources can be highly important.
I echo and support what the hon. Lady said about mothers bringing very young children along with them. One of the first relaxations in relation to nursery schools was that relaxation to encourage

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married women to get back to the primary schools. By the same token we want here a system of administration which will help more mothers to come along bringing with them their very young children.
I realise that we cannot today talk about legislation. I am tempted to say that I hope there will be a time when we can discuss what should be in the new Education Bill. Purely in terms of policy it is important that playgroups should be recognised in our education law, that local education authorities should be enabled to grant-aid them if they wish, and—this is one point on which the hon. Lady and I will begin less agreement—to charge fees from those parents who can afford to pay. I am still impressed by the minority report arguments in Plowden that in the sphere of pre-school education and playgroups a certain amount of private money might help to get ventures off the ground—
Mr. Speaker: Order. The right hon. Gentleman has warned himself that this would require legislation.
Sir E. Boyle: Perhaps as this point has already been raised, Mr. Speaker, you will not rule me out of order if I say that I agree with the hon. Lady about not forgetting the burden of charges for playgroups on those who are not well off.
It is important that the Government should be able to give guidance to a powerful and growing movement which could become administratively too complicated for a voluntary part-time organising staff. One of the main lessons we tried to set out in the Fulton Committee was the importance of professionalism and a professional approach in a wide range of activities. In playgroups, too, it is important to have a professional cadre who can advice, just as it is important to have a national playgroup adviser.
I believe that in the most difficult areas of this country playgroups can be one of the quickest, cheapest and most effective means of helping children and mothers, and we must remember that it is the needs of children and their parents which can be helped by this organisation.
3.12 p.m.
The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow): I know you will acquit me, Mr. Speaker, of unfairly trying to involve you in this discussion if I say that your well known interest in children is equalled only by the interest which has always been shown by the hon. Member for Eton and Slough (Miss Lestor)—
Mr. Speaker: Technically, the hon. Gentleman needs the leave of the House to speak again; I am sure that he will obtain it.
Mr. Snow: I ask leave to address the House again, Mr. Speaker.
May I first address myself to the remarks made by the right hon. Member for Birmingham, Handsworth (Sir E. Boyle). My departmental responsibility makes me cautious about too much talk of professionalism in a subject of this sort. This is a human problem and we must guarantee against too remote influences being employed.
My concern with playgroups arises from the duty which local health authorities have under the Nurseries and Child-Minders Regulation Act, 1948, as now amended, to register and supervise private nursery establishments, including playgroups, and the powers those authorities have been given to require satisfactory standards of care for the children looked after.
While we have no precise figures of the number of children attending playgroups, we know that at the end of 1968 there were just over 155,000 children receiving care on a sessional basis in nursery establishments registered under the Act. No doubt a large proportion of this total relates to children attending playgroups run in church or village halls or similar premises.
I take my hon. Friend's point about the need, where such privately owned or semi-officially owned establishments are used, for small capital investment for the provision of lavatories and so on, and I will look carefully at the remarks she made.
We welcome the valuable contribution which playgroups can make to the opportunities for the development of the

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under fives. Playgroups provide opportunities for developmental play and for the children to meet and mix with others of the same age.
The advice of medical and other authority is that the proper place for the child under 2 is at home with his mother and that provision for children between 2 and 5 should normally be by way of nursery schools and classes where the hours are shorter than those, for example, at publicly provided day nurseries. Playgroups have an important contribution to make in the day care of children precisely because they operate for relatively short periods and so avoid difficulties which sometimes arise as the result of maternal deprivation when very young children are separated from their mothers for a whole day in a nursery.
Local health authorities have no powers under the Nurseries and Child-Minders Regulation Act to give financial assistance to playgroups. They are, however, empowered under the Health Services and Public Health Act, 1968 to give assistance to non-profit making organisations which provide care for children who have a special need on health and welfare grounds.
Authorities were informed of this power in a circular sent to them in October last year, and were told that where there were insufficient groups to meet the needs of priority children the Secretary of State hoped that authorities would encourage suitable people and organisations to start a nursery group and offer them advice and, where possible, surplus equipment or premises that were not used for the whole of the day. The circular also commended the placing of children in special need in private and voluntary playgroups, the authority bearing the whole or part of the fee where appropriate.
Although I would like to say more later about Government help to playgroups, I have thought it right to indicate to the House my Department's attitude of help and encouragement to the playgroup movement because I want to say something about the standards of care which local health authorities are empowered to require in the day care of children.
These standards have become a focus of discussion since amendments to the
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Nurseries and Child-Minders Regulation Act, 1948 contained in Section 60 of the Health Services and Public Health Act 1968 were introduced on 1st November last year. These amendments extended the requirement of nurseries to register with local health authorities and strengthened the powers of authorities to supervise standards of care. They also provided heavier penalties for evasion of the law.
The amendments were introduced because my Department's enquiries had shown that the standards of care for some children in nursery groups were unsatisfactory and because it was essential that authorities should have the power to deal with the situation so as to safeguard the health and welfare of the children looked after. When the amendments were brought into force my Department took the opportunity to issue further advice to authorities on the question of standards of provision.
The House will, of course, appreciate that in the matter of standards the Secretary of State must ensure that the guidance given to local health authorities properly reflects the need for ensuring the welfare and safety of the children and providing the environment for their proper physical, emotional and intellectual development. Many of the children who are looked after outside the home during the day may be described as emotionally vulnerable and it is especially important that standards of day care for them should be such as to compensate for the disadvantages with which they may be faced in that respect.
I fully recognise that the standards recommended should not be so high as to discourage provision of day care facilities altogether, especially in areas where the lack of such facilities might result in mothers making wholly unsatisfactory arrangements, possibly with unregistered minders. I hope that is on the decrease. It is a matter of fine judgment to strike the right balance. In formulating our general guidance to local health authorities we were very conscious of the special position of playgroups and we were at pains not to make life unnecessarily difficult for them. The advice therefore took full account of the nature and duration of playgroup care.
My hon. Friend has drawn attention to the recommended standards of space,

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toilet and staffing provision, and some people have felt that these standards are too high. They were, however, drawn up in consultation with the Department of Education and Science in the light of their standards for children in nursery education. We are satisfied that they represent, as a whole, reasonable standards of care which will enable children to enjoy the benefits of playgroup activities without hazard to their health and welfare.
I should make clear that the Secretary of State has no statutory control over the standards of provision which are essentially a matter for each local health authority. I take note of what my hon. Friend has said. Perhaps in one or two cases there has been rigidity of mind in this matter. If she lets me have details, I should like to look at the cases she has in mind. The question of standards is very important, and we would expect our advice to be heeded. It is necessary not to let enthusiasm for standards outrun judgment in these matters.
I return to the question of Government help to playgroups. Assistance or encouragement has been given to the playgroup movement by both central and local government. For example, the Department of Education and Science gave a grant to the Pre-School Playgroups Association for the salary of an adviser and some of the office and administrative costs. The right hon. Member for Hands-worth was right when he said that we must take into account the likely burden on the telecommunications and other communications requirements, which tend to be a big burden on costs. I am sure that hon. Members will support the Government in considering that aid to playgroups would be a particularly useful object of expenditure in the second phase of their programme of aid to urban areas of social deprivation.
Perhaps I should point out to my hon. Friend that the benefit deriving from the special financial help which the Government are making available to these special areas can also be made available when a major local health authority can demonstrate that socially deprived areas are included in its responsibility. Therefore, the assistance is not so tighly drawn as was previously envisaged.
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The programme is designed to assist urban areas which bear the marks of multiple deprivation—for example, deficiency in housing, over-crowding, persistent unemployment, a high proportion of children in trouble and—a matter which I have very much in mind—the child, not only of the unmarried mother, but of the divorcee. Departments are now considering authorities' proposals for giving assistance to playgroups which meet this kind of social need. As with other forms of expenditure under the programme, approved financial assistance to playgroups will attract a 75 per cent. Exchequer grant. I can speak only for my own Department when I say that the response from local authorities has been rather good. It must be for authorities to determine which groups need help and the form in which it would be most effective, but it is available, for example, to provide for improved premises, to help with salaries of organisers or leaders, or to support running costs. I took particular note of what my hon. Friend said about providing lavatories in perhaps rather old-fashioned designed halls.
I am sure that we all agree about the desirability of playgroup leaders and others having some training in understanding the needs of children so that they can obtain at least some of the skills necessary for them to encourage the children's proper development. Authorities were reminded in 1965 and again last year of the need to provide training courses for people engaged in the nursery care of young children. I am glad to say that a number of courses have been established in recent years. We are currently exploring what more needs to be done, and the three Departments concerned are in close discussion with the Pre-School Playgroups Association on this matter. Yesterday afternoon my Department and the Department of Education and Science had a most amicable and useful exchange of views with the Association about the training of playgroups staff.
We have also encouraged local health authorities to secure closer contact with local education authority advisers and teachers so that staff can be helped to increase their understanding of children's needs.
We must be very cautions about amending the requirements of local health authorities, particularly the need

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for ensuring that adults in charge of playgroups are 100 per cent. fit medically. It takes 30 seconds or less for infection to pass, and we cannot take risks. However, I take my hon. Friend's point that there should not be rigidity in other respects and that as much help as possible should be given to make the regulations enforced by local authorities reasonable and efficient. The House is indebted to my hon. Friend for raising this matter.
Mr. J. E. B. Hill rose—
Mr. Speaker: I call Mr. Hill, with the reminder that he must sit down by half-past three.
3.25 p.m.
Mr. Hill: First, I congratulate the hon. Member for Eton and Slough (Miss Lestor) upon the moderate and extremely convincing way in which she stated this important case, and I should like to associate myself with everything that my right hon. Friend the Member for Birmingham, Handsworth (Sir E. Boyle) said. We all thank the Under-Secretary of State for the reply which he has given. It reflects the present position.
If I might summarise the position in relation to the description of the Regulations, and so on, it seems clear that the existing Regulations can be either interpreted to assist the movement or enforced so as to frustrate desirable voluntary effort. I therefore urge the Under-Secretary to try to advise local authorities that they should adopt a flexible attitude in regard to playgroups. My reason for saying that is that the extent of the need is extremely great, the resources available are limited and, therefore, if effective action is to be taken, it is essential not to let the best provision become the enemy of the good.
In considering this whole problem we must bear in mind that whatever the returns and statistics may say, below the level of knowledge there undoubtedly persists a good deal of unsatisfactory child-minding and, what perhaps is more important, a great many children who are lonely and longing to play with other children but who are cooped up in some of the very small, one-family homes, often isolated, in high blocks of flats.
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Nor do I think that this country should be anywhere but in the van of the playgroup movement. I would point out to the Under-Secretary that Australia and New Zealand have made progress which is probably ahead of us in intensity. For example, in Australia, I understand that in Victoria alone there are over 800 playgroups among a population which is only a fraction of the size of London or Birmingham. Likewise, in New Zealand, playgroups have for a long time received a £50 grant to start them off.
The problem falls into two sectors. There is the sector of acute social need as is covered by the intentions, if not yet the achievement, of the urban programme. In that field, quite clearly the quickest and most effective remedial action will come through encouraging the playgroup movement, because there is the expertise and the willingness standing by. I do not want to rehearse the detailed arguments and figures that we gave in the debates on the legislation which brought in the programme. If one wanted to get quick action, I think that the voluntary societies should be rather more encouraged than at present.
This week is also the 50th jubilee anniversary of the Save the Children Fund. That fund has great expertise. It could move into other deprived areas if its advice was sought. I understand that so far there has not been quite the appeal for the fund to move that was expected. I hope that as a result of this debate, more local authorities who face this problem will think in terms of asking the Save the Children Fund to come in with its advice and experience on how best to tackle the problem, because it has great experience, particularly with a high proportion of immigrant children.
The other side of the coin is the area of voluntary movement, where, as my right hon. Friend the Member for Hands-worth has said, development will go ahead in spite of the Government. Here, the important thing surely is to keep it on the right lines.
In the short time available, I do not want to enter into the discussion of which Department should be responsible. What is important is that the Government as a whole should take an interest in this movement and, where necessary, provide the—
Mr. Speaker: Order. I remind the hon. Gentleman that, so far, everyone has kept to the timetable.

TRANSPORT PROBLEMS (NORTH-EAST ESSEX)
3.30 p.m.
Mr. Julian Ridsdale: In an Adjournment debate on the transport problems in North-East Essex it is difficult to select priorities: time is not on one's side. I should have liked to have raised the problem of increased fares, especially the large increase in bus fares which has affected so many retired people in North-East Essex; I am tempted to go into detail of some of the difficulties of railway season ticket holders who have been so tried by the unpunctuality of their trains; I felt that I should say something about the cuts in train services between Harwich and Ipswich and press for later nightly trains to the North-East Essex coast. However, I fear that I shall have time to raise only what I consider to be the most pressing of the transport problems in North-East Essex, those affecting the Harwich and Dovercourt area and, more particularly, what has come to be known as stage 2 of the Dovercourt by-pass, because of the vast increase in this area over the last few years of traffic in exports throughout the world.
Before I get down to the details of the problem I feel I must say a word about the national problem concerning the financing of transport, be it roads, railways or airports, because this affects the speed with which local projects can be carried out. If we had had the same rate of growth in each of the last five years as we had over the average of the 13 years of the Conservative Government the national income would be £2,800 million more than it is today, and obviously a much bigger proportion could have been allotted to the county council for road building, and the county council would not have been faced with a 50 per cent. cut, in real terms, of the annual increase in the rate support grant. This has led to cheeseparing economies.
It is obvious that road repairs are having to be delayed, and all the indications are that there will be a considerable cut by the Government in specific capital
914
grants towards principal road schemes in Essex, and a considerable cutback in loan consent for non-principal road improvement schemes.
Is the Minister in a position to say how much these cutbacks will be? More particularly, every delay tactic that can be seems to be being employed over what to the inhabitants of Dovercourt and Harwich is a project which is of most vital importance, their bypass to the Navy Yard at Harwich. Soon after the establishment of the port at Navy Yard I raised this with the Chairman of the Essex County Council, in 1963, and established the point that this by-pass was a vital project, being a road to the rapidly expanding port. I underlined then that this should be given the utmost priority. Alas, since then this project has had a sad and sorry and continuing story of delay and procrastination, of procrastination and delay.
What has been the cause? Perhaps the Minister will give us an explanation. Or is it that the real cause is shortage of funds and the fact that over the last five years we have not been making enough nationally? And is it not a fact that Essex has not been getting a fair share of the national funds for its road building projects such as the roads to the ports, be they Harwich, Parkeston or Tilbury? Could the Minister say what has been the allocation of funds for highways in Essex over the last five years at the 1964 value of the £ either through specific capital grants or in loan consent? Could he say how that compares with what has been done elsewhere? Has account been taken of the fact that Essex is a rapidly growing area?
Has the Minister taken account of the fact that the road from Colchester to Harwich, according to the Green Paper, "Roads of the Future", issued by the Ministry of Transport this year, is to be a focal point of a motorway coming from the Midlands to Harwich? Naturally I welcome this, for I have pressed for it long enough, but the Green Paper says:
"Plans for inter-urban roads must make allowances for the increasing need for road improvements in urban areas".
In view of this, I claim that the utmost priority should be given to the road from Colchester to Harwich, including the bypass to Parkeston and Harwich Navy Yard, particularly as not only transport

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container traffic, but an increasing number of cars and passenger traffic arrive at these ports each year. Last year, more than one million tons of cargo and 100,000 passengers passed through these ports. It is obvious that this area is to be a focal point not only of a motorway from the Midlands, but of a growing industrial complex trading ever more closely with the Continent.
Delay in completing both stages of the bypass as soon as possible is making planners forget the potentialities of the area. It is certainly preventing the development of an ideal industrial estate on the mud flats at Bathside. This is why I think that it is part of the cause of the grave mistake of placing a prison at Wrabness rather than develop a natural industrial site with great potential.
What is the intention of British Railways with the site at Bathside known as the mud flats? Are British Railways prepared to sell it, or do they now need it for their own expansion plans at Parkeston. If the mud flats were sold, would i.d.c.s be available for industrial sites? I estimate that about £500,000 for each stage of the by-pass will be needed. This may seem a large sum of money at this time, but is it not small in relation to the long-term potential of what is bound to be an expanding port complex?
I hope that this afternoon we shall hear that delay and procrastination have ended. I hope that the Parliamentary Secretary will not tell me this afternoon as he wrote to me on 27th February that he is awaiting planning approval from the Ministry of Housing and Local Government. Has planning permission now been given for stage 2 of this road? Why is the Ministry asking for more information before stage 2 is included in the urban preparation list? Has not application already been made for this by the Essex County Council? Why is the Ministry still asking for details?
When can the long suffering inhabitants of Harwich and Dovercourt expect to get their bypass and stop having to endure the ceaseless rumble of transport container traffic not only through their shopping centre, but in their homes all day and night long? Casualty figures underline the importance of something being done. Since 1965, there have been
916
15 fatal casualties on the road from Colchester to Harwich and 229 people have been injured. Has a preliminary assessment of the economic cost benefit of the scheme, which was asked for months ago by the Ministry, been completed? Is the Minister in a position to give these facts today?
Because of all the proscrastination in the past, I hope that the Parliamentary Secretary will now say that both sections of the by-pass are now in the same stage of preparation. But what other projects in Essex have financial priority over this road? Surely it is Government policy to give priority to roads to the ports. When will a date be given for the start of stage 1 and stage 2 of the by-pass? It is said that where there is a will, there is a way. I hope that after this debate it will at long last be shown that there is a will to get on with this task as quickly and as speedily as possible.
I do not believe that the requirements of Essex are properly accepted by the Ministry. We have a more rapidly expanding population than any other county in the United Kingdom. We have a coastal recreation zone to which most of North London is drawn. We have the major port of Tilbury now greatly expanding and the probability that the third London Airport will be established at Foulness. We have the rapidly expanding ports of Parkeston and Harwich, and if these communications are increased more rapidly, then these ports would expand more quickly. We have increasing traffic from the Midlands, and we have the Dartford Tunnel which carries the major flow of cross-Thames traffic. We have the big industrial area along the north bank of the Thames.
I am sure that the Minister should be making a bigger allocation of funds for major schemes in Essex. I am certain that the reason for the delay is because these funds are now so limited in relation to requirements. I ask the Minister to look most carefully at the requirements in this vital area of the country if we are to go ahead and get growth in our economy. I believe that there has been delay and procrastination because of the failure to allocate sufficient Government funds for proper industrial development in Essex, and particularly the Harwich area.

917
I ask him to look most carefully at the importance of stage 2 and the possibilities of Dovercourt and Harwich. We must get ahead of events and not always be pushed by them. Harwich is a growing and enterprising port, and it should be given far more of its fair share of available funds.
I hope that at long last the Minister will show some understanding of the difficulties that Harwich and Dovercourt have had to suffer because of the slowness in getting the new by-pass, particularly since 1964, when this became a class of first priority because of the establishment of the navy yard at Harwich. I hope that today we shall hear a powerful reply from the Joint Parliamentary Secretary.
3.43 p.m.
The Joint Parliamentary Secretary to the Ministry of Transport (Mr. Bob Brown): I compliment the hon. Gentleman on the detail and range of the subjects he has raised clearly, in the short time available, I cannot deal with them all in detail. I will attempt to deal with them briefly, and I am sure that we will continue the mammoth correspondence which the hon. Gentleman and I seem to keep up with one another.
Turning first to roads the hon. Gentleman has in the past, and again today, pressed upon us the importance of a good road link betwen the Midlands and the port of Harwich. My right hon. Friend's recent Green Paper "Roads for the Future" includes amongst its proposals a strategic East/West link between Harwich and the M1. The strategic routes, of which this is an example, have been planned not only to meet future inter-urban traffic needs but also to take account of the requirements of industrialists and exporters and to meet the social and economic needs of the regions. The proposed Harwich link is a blending of all three of these major considerations.
We fully accept the importance of improving communications between North-East Essex, particularly the rapidly growing port of Harwich, and the industrial Midlands and the North. It is for this reason that we are proposing the construction of a high-standard dual-carriageway route from M1 to the coast at Harwich. Whether it should be a motorway and where exactly the road would run are not matters which I can
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settle today: the precise standard of the work its timing and the actual alignment will be determined as detailed planning proceeds.
I ought in fairness to point out that, as with all proposals in the Green Paper, the suggested new route could be modified as a result of the public representations which my right hon. Friend has invited and which he has undertaken to take fully into account before deciding on the final form of the strategic network—probably at the end of the year. But I can say that the Ministry's present assessment, based on a wide range of facts and estimates, leads us to the conclusion that a high-standard route from the Midlands to North-East Essex is likely to be an essential link in the country's highway network for the 1970's and early 1980's.
There are, of course, a significant number of other road schemes designed to benefit North-East Essex which are already in the programme or in preparation. I have not time to deal with each of these schemes, but the hon. Gentleman particularly referred to the Dovercourt by-pass, and I would therefore like to say a little about this proposal. The by-pass will be a principal road, for which the Essex County Councill will be the highway authority; as such, it will qualify for a 75 per cent. grant from us. Stage I will form a new approach to Parkeston Quay, and is estimated to cost £320,000. This section was included in the principal road preparation list announced on 10th May, 1967. It will be considered for a place in the firm programme according to its state of readiness, cost and relative priority, and the resources available for the road programme from year to year. All I can say at the moment is that schemes now in the preparation list are expected to be ready to start within the period from 1972 onwards. Stage II of the by-pass will be an extension from Parkeston Quay to Harwich Docks. The county council is considering possible lines for this section; we are awaiting a report from it to enable us to give further consideration to the inclusion of Stage II in the preparation list. In this consideration, we shall take full account of the views expressed by the hon. Gentleman today, as well as the wish of the county council that the construction of the by-pass

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should be concurrent with, or follow immediately, the improvement of A604 for eight miles from Elmstead market to west of Ramsey which is expected to start around 1971.
The hon. Member has asked me for the highway expenditure figures for Essex over the past five years. I will not take up the time of the House by giving these now, but I shall be pleased to give them to the hon. Member after this debate. Suffice for now to say that, over the past five years, a total of £16,675,000 has been spent on trunk and Class I or principal roads in Essex.
Speaking of expenditure on roads, it gets a little tiresome to hear this constant talk of cuts when, this year, we are spending twice what the hon. Gentleman's Government spent in their last year of office and six times what they spent 10 years ago.
Mr. Ridsdale: Do these prices take devaluation into account?
Mr. Brown: The figure that I have quoted is the actual figure of expenditure.
The hon. Gentleman referred also to the development potential of the Bathside mud flats, and the enhancement of this potential which would follow the construction of the Dovercourt By-pass. We know his keen interest in port development in this area. I am sure he will admit that the Government's record in relation to port investment is impressive. From an average rate of £18 million per annum in the years before 1964, we have boosted it to over £45 million per annum, and it is likely to continue at this rate for some years. But we could not encourage purely speculative investment in port facilities. It is for British Rail in the exercise of their commercial judgment to assess probable demand and, in the light of their assessment, to decide when and how to develop the Bathside land. For our part we shall be ready to consider any firm proposal which British Rail wish to put to us.
Perhaps I may now say a word or two about railway services. Bad time-keeping must always give rise to concern, but this is primarily a management matter for British Rail. I know that the hon. Gentleman has been in correspondence with
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them, and I understand that time-keeping for example on the 0720 train from Clacton, about which particular concern was expressed, has improved.
So far as the level of service is concerned, we are well aware of the importance of rail services in rural areas, and my right hon. Friend bears this very much in mind in reaching decisions on applications for grant or proposals for closure. Indeed, it is because we are concerned that we have made provision for the payment of grants in respect of those services which the community needs but which do not pay their way. British Rail are also constantly seeking to improve the service, and I am glad to be able to tell the hon. Gentleman—indeed, he may already know this—that they have now re-instated in the time-table the 10.50 train from Ipswich to Parkeston and the 16.15 train from Ipswich to Harwich. But in all these matters we must have regard to the need for British Rail to pay their way, and to the need to see that the community gets value for the money given in grant.
Lastly, the hon. Gentleman raised the subject of bus fares. My right hon. Friend has been active in promoting means to assist the bus companies to minimise the impact of rising costs upon fares. I need mention only the grants in relief of fuel duty; the direct grants of 25 per cent. towards the cost of new buses of an approved type suitable for one man operation; the empowering of local authorities to give financial assistance to rural bus services, half of which the local authorities can get back from us; and our grants of 25 per cent. towards expediture on structures such as bus stations. There is full refund of S.E.T. The excise duty on a double-decker bus is only £41 against £25 per annum for a private car and £229 for a heavy lorry.
I am sure that what I have said indicates to the hon. Gentleman that the Government are clearly anxious to do all that they can to strengthen and further improve public passenger transport, particularly in rural areas.
I am grateful to the hon. Gentleman for giving me this opportunity to explain some of the steps which the Government have taken which will be of benefit to those who travel in North-East Essex.

TRAFFIC CONGESTION, READING
3.52 p.m.
Mr. John Lee: I am grateful for this opportunity of raising the subject of traffic congestion in Reading. I do not pretend that it is necessarily the case that the position in Reading is so very much worse than in many other boroughs of comparable size in this country. Nevertheless, there are one or two peculiarities which give rise for concern and justify singling out for special attention in this matter.
The situation in Reading has been getting steadily worse over the last five years. The basic reason for this is paradoxically, not because the Government are not doing something, but because they are doing something very useful, namely, constructing the M4 Motorway. As the motorway extends from its two ends—either from South Wales in an eastwards or westwards from London to Maidenhead—so the amount of traffic that is enticed to go along that route grows steadily more extensive. That situation is bound to continue and bound to create worsening problems for the Borough of Reading until such time as the M4 actually passes south of the Borough. It is not anticipated—indeed, it is not scheduled—that it will be completed before 1971. In the meantime the citizens of Reading, who have enough internal local problems of traffic congestion with which to contend, have to live with a situation over which neither they nor their local authority have very much control.
This at the moment is the situation in which—I have the figures of traffic control—in a 24-hour traffic control period the percentage of heavy commercial vehicles is 30 per cent. of the total volume, and the total volume of vehicles is about 40,000. Through non-stop traffic on the A4 in Reading is between 25 and 30 per cent. of the total volume of traffic taken in a 24-hour period.
The particular source of the problem is Berkeley Avenue in the southern part of the borough where 23 per cent. of the traffic flowing through in a 24-hour cycle consists of heavy commercial vehicles.
There is no question but that the borough has been doing its best to cope with the situation. There is a twophase
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system of traffic control, the first of which was introduced for one-way flow in June of last year and the second of which came into operation as recently as last month. This consists, broadly speaking, of providing an extensive, one-way working system for traffic flowing from east to west and west to east.
From June last year the A4 eastbound traffic was routed through Sidmouth Street, Queen's Road, King's Road, and Cemetery Junction. Within the last few days the system has been extended to bring in Southampton Street and Mill Lane, and a further section of Queen's Road. I will not bother my hon. Friend with the details because the situation can be better seen by consulting a map. The borough, under both political parties, has done its best to cope with the situation.
It is right to mention that the east-west and west-east traffic is the real source of the problem. The north-south traffic does not provide much trouble. Though a difficulty arises in the area of Berkeley Avenue and Elgar Road, for a certain amount of traffic flowing from north to south, destined ultimately for Basingstoke, the A30 and Southampton, but provided the system of yellow boxes or clear junctions is kept operating it is not working too badly.
It is worth putting on record the number of accidents that have occurred on the A4 within the borough. This is quite apart from accidents outside the borough. Those were the subject of a Parliamentary Question which I put down last December, to which I shall refer shortly. In spite of the increase in the volume of traffic there has been a slight diminution in the number of accidents. This is attributable partly to the fact that the borough has tackled the problem as best it could. In 1967 there were 117 accidents on, the A4 within the borough. Two involved fatalities, 34 others were serious, and the remain-81 were slight. In 1968 the total number fell to 90. There were no fatalities, 28 accidents were serious and 64 were slight. In the period from January to 14th May 1969 there were 28 accidents, with no fatalities. Eight accidents were serious and 20 were slight.
It should be added that the figures for 1968 do not take account of certain other parts of the road included in the

923
one-way system—including Sidmouth Street which—whilst not strictly part of the A4, are nevertheless an integral part of its traffic flow. In 1968 there were seven accidents on those parts of the road, which have to be added to the total. Two were serious and five were not. For the period for this year so far, there must be added five accidents, one of which was serious and the other four not so serious. Those figures must be added to the total in order to get a true picture of the traffic flowing through the town. The problem is not, as I have said, confined to the borough. In a Written Answer on 9th December last year, I was told that on the 41-mile length of the A4 in Berkshire there had been 24 accidents involving fatalities alone in 1968.
It being Four o'clock, the Motion for the Adjournment of the House lapsed, without Question put.
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Ioan L. Evans.]
Mr. Lee: My Question referred only to fatalities, so that does not give the full picture. There were many other serious accidents, and still more which the Ministry would classify as slight.
Everyone knows that in Berkshire the A4 carries far more traffic than is safe; this has been the situation for a considerable time. The answer is the completion of the M4. I do not complain that it has not been completed. Everyone would have liked to see it begun earlier and completed by now, but I do not criticise the Government for this. We know that there have been protracted delays as a result of all the inquiries that had to be made before the route could be properly determined. The fact that there has been strong feeling in some quarters about demolition and the amount of land that must be taken up by the feeder routes as well as the main trunk road is an indication that the inquiries were necessary. It would have been impossible and improper to try to ride roughshod over those who wanted to object.
But the citizens of Reading and the adjoining areas to both the east and the west have to live with the situation. My purpose in raising the matter is to ask my hon. Friend whether steps can be taken to divert some of the traffic which
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passes through the town. Traffic diversions are commonplace. The only thing that would be new is the idea of trying to sift out the traffic of various kinds and encourage that which is not destined for the town to go around it. This is not easy, and I do not pretend that it would be without a certain amount of inconvenience to those who would have to be diverted. But about a quarter of the traffic flowing along the A4 in Reading is through, non-stop, traffic. A considerable portion of it consists of heavy vehicles, and it does not take much imagination to visualise how much this adds to the town's problems.
All I ask for is an interim measure to help make life easier for people who work and live in and around the town between now and the completion of the motorway. I have no doubt that the problem will not disappear once the motorway is complete. Indeed, one cannot foresee such problems disappearing in this country for many years, if at all. But once it is complete there will obviously be a considerable reduction in the volume of traffic and a considerable change for the better in the character of the traffic passing through the town.
Many of my hon. Friends have approached me on this subject, because they have experienced the difficulties of going through Reading when they have been making their way to the West Country. This is not just a question of human inconvenience. Every time traffic is clogged in a borough it represents a degree of economic inefficiency, which should be minimised.
I do not suppose that my hon. Friend will be able to suggest a solution here and now, but I earnestly ask the Ministry to consider whether it can arrange in conjunction with the Thames Valley police and the borough authorities a permanent or semi-permanent diversion of heavy traffic around the town both for the benefit of the through traffic and more especially for the safety and comfort of those who live and work in the borough.
4.5 p.m.
The Joint Parliamentary Secretary to the Ministry of Transport (Mr. Bob Brown): My hon. Friend the Member for Reading (Mr. John Lee) has chosen an apt time to raise the question of

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traffic congestion in Reading, for we are on the eve of a Bank Holiday weekend when most motorists will be using their cars, many on quite long trips where they must pass through towns on their journeys. Reading, of course, is just such a town, standing as it does astride the important and busy A4 trunk route from London to the West and with six other main roads converging on to its centre.
It is apt, too, because Reading has very recently introduced an extensive traffic management scheme. The primary aim of this, of course, is to deal more effectively with the ordinary day-to-day traffic into and through the town centre. But an essential element of the scheme is to provide improved conditions on the A4 route which skirts the town centre. This is not only to benefit the through traffic but to dissuade drivers from taking alternative routes through the very centre of the town to the detriment of all the many other activities which must take place there. By its nature, this will not only help to keep out of the centre the many heavy vehicles on weekdays but will help to speed the weekend and holiday traffic on its way.
Through traffic and by-passes are closely associated in most people's minds. For the A4 route the most complete of all by-passes is planned, a parallel motorway M4 from London to South Wales. The eastern and western ends of this motorway are already in full use. The bit in the middle is still missing and, of course, it is this, more particularly the two sections between Holyport and Theale, which will help Reading. Work on these sections is due to start later this summer and this part of the road completed by the end of 1971. The programming of a link between M4 at Winnersh and the existing trunk route through Reading will be such as to permit its completion shortly afterwards. But to be realistic, we must appreciate that M4 will not be anything like a complete cure for Reading's troubles. It is estimated that the motorway will reduce the traffic in the centre of Reading by little more than 10 per cent. Naturally, this will be a boon to the road users of Reading as much as it will be to the through drivers, not least in diverting away from the town many of the large number of heavy commercial vehicles which the A4 carries.
926
There remains a need to serve the quarter of a million people living in and around Reading who want to make local journeys, the vast majority of journeys in a town of this kind. Because of natural barriers of rivers and railways with limited numbers of crossing points, local motorists have no option but to pass through the centre of the town if they need to get to the other side as well as into it. These needs are being met by a new modern dual carriageway inter distribution road circling the town centre. The first stage, the western section from Caversham Road to Castle Street, is already being built and should be complete in the autumn. Work on the second stage, the southern section from Castle Street to Southampton Street, has already started and is due to be finished early in 1971. The third stage, the eastern section from Southampton Street to Vastern Road is expected to start in 1971–72 and be completed by 1974–75. Together, these stages will provide 1½ miles of new road at a cost of some £6½ million on a loop round the central area. When complete there will be little or no need for drivers to penetrate into the town centre itself unless they need to reach premises there.
Work of this nature and scale takes time. It is not entirely a matter of money, though this is, of course, important. There must be a limit to disruption caused by building this kind of road which a town can absorb at any one time. Work has to be staged. While this is happening, the situation has to be met by other means. This is where the third line of attack, traffic management, is needed.
Reading is active in this as well. For a long time it has operated sensible street parking control in its town centre and approach roads as well as dealing with the conflicts between moving vehicles and vehicles and pedestrians in a variety of ways. I have already mentioned an extensive traffic management scheme. This consists of one-way streets brought into operation on Sunday, 4th May. This is the second of three phases of a comprehensive system designed not only to hold the position until the inner distribution road can do its work, but to fit in with the stages of its construction to encourage the maximum use of it at each stage. The first phase of the management

927
scheme, a local scheme round Cemetery Junction, was put into operation last summer. The third phase, dealing with the town centre roads themselves, is likely to follow at the end of the year.
This scheme was prepared from a joint study by the council and my Department as a demonstration project. We have been actively involved in the design as well as heavily contributing to the £¼ million cost. Extensive studies are being made to evaluate the benefits and dis-benefits arising to improve advice and guidance to other people. The scheme has as its aims the four main objectives which have since become embodied in the request for traffic and transport plans from urban authorities with 50,000 population or more. These are to relieve congestion, improve public transport, improve road safety and safeguard the environment.
The removal and simplification of conflicts helps traffic to move. It helps to prevent accidents as well and to extend this pedestrian "cross now" facilities have been provided at 11 sites. An avoiding route intruding into unsuitable minor residential streets has been cut and the attraction of others is reduced by freer movement on the main roads. The final stage of the scheme will reduce substantially the amount of traffic using Broad Street the main shopping street. On completion of the second stage of the inner distribution road the opportunity largely to exclude traffic from substantial parts of Broad Street and St. Mary's Butts is likely.
Mr. John Lee: Of course I appreciate this and it is common ground between us, but there is one aspect which is of the greatest importance. Until the schemes are completed, of the nature of things, there are bound to be added problems because of the actual workings. For instance, while the inner distribution scheme is being constructed, the M4 will be constructed. That is one of the things which temporarily makes matters even worse.
Mr. Brown: I take the point.
The need to provide specially for buses is well to the fore. It is recognised that this is a way to help most travellers and the way to help buses to offer an attractive and competitive service.
928
Already a contra-flow bus lane has operated in Kings Road since June, 1968, to the considerable advantage of the operators and passengers alike, both in improving travel time and in saving the need to put on extra buses purely to make up for delays on schedules. The possibility for comprehensive bus priorities on two to three miles of route, including passage of the town centre, is now being examined.
So in all three respects, by-passing through traffic, building new town roads and managing existing streets to make the best use of them, there is strong and vigorous progress in Reading. But this cannot be the whole story. There is a limit to the amount of new road space that can be provided in towns without destroying their essential character. In the end there must be a sensible balance between the number of vehicles attracted into towns and the road space they can use.
Consequently, the amount of parking space for the town centre and where it is sited become crucial. Here, again, Reading is making progress. Already street parking is preserved for the short-term caller only. Other needs are met by off-street car parks, which are well distributed round the town centre, providing opportunities for drivers to park before penetrating the busiest central streets. These car parks are sited so that they can be reached from the inner distribution road in due course. Two of them are now multi-storey at the east and west sides of the centre providing for more than 1,700 cars between them, and further car parks are planned as parts of the inner distribution road come into use to serve them.
Consequently action is being taken on all possible fronts to ease traffic difficulties in Reading. Reading is being extremely active and in this it has the full support of my Department. I am grateful to my hon. Friend for raising some of these problems. In the cold light of print we shall be able to study further what he has said and possibly draw some more lessons.
Question put and agreed to.
Adjourned accordingly at a quarter past Four o'clock till Monday, 9th June, pursuant to the Resolution of the House of 19th May.

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BOARD OF TRADE
  M.S. "Blenheim" (Fire)
  M.S. "Blenheim" (Fire)
  Holiday Accommodation, Spain (Trade Descriptions Act)
  Holiday Accommodation, Spain (Trade Descriptions Act)
  Frozen Plaice Fillets
  Frozen Plaice Fillets
  Buyer Credit Transactions
  Buyer Credit Transactions
AVIATION
  Civil Aviation Act, 1968 (Section 8)
  Civil Aviation Act, 1968 (Section 8)
TRANSPORT
  Vienna Convention Road Traffic
  Vienna Convention Road Traffic
  Driving Licences (Recognition)
  Driving Licences (Recognition)
  British Waterways Board (Capital Debt)
  British Waterways Board (Capital Debt)
ROADS
  Potteries D Road
  Potteries D Road
  Road Projects
  Road Projects
  A12 Road, Wangford (Bypass)
  A12 Road, Wangford (Bypass)
  Humber Bridge
  Humber Bridge
  Minor Roads (Maintenance)
  Minor Roads (Maintenance)
  Braunstone Lane, Leicester (Safety)
  Braunstone Lane, Leicester (Safety)
NATIONAL FINANCE
  Overseas Aid and Development
  Overseas Aid and Development
  Duties (Surcharge)
  Duties (Surcharge)
  Amusement Machines
  Amusement Machines
  Selective Employment Tax
  Selective Employment Tax