National Health Service, England and Wales

Orders of the Day — Civil Estimates and Estimates for Revenue Departments, Supplementary Estimates, 1948–49 – in the House of Commons at 12:00 am on 17 February 1949.

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Motion made, and Question proposed, That a Supplementary sum, not exceeding £52,800,000, be granted to His Majesty, to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1949, for the expenses of providing a comprehensive health service in England and Wales and certain other services connected therewith, including the central purchase of medical supplies."—[Mr. Blenkinsop.]

3.51 p.m.

Photo of Mr Ralph Assheton Mr Ralph Assheton , City of London

Would it be convenient if these Estimates and the Scottish Estimates for the same Service were discussed together?

Photo of Mr Douglas Clifton Brown Mr Douglas Clifton Brown , Hexham

I suggest that that is not desirable. In point of fact, I do not think it was ever done in the past on Supplementary Estimates.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

It really becomes very difficult if we are to discuss one segment of the Health Service without the other, especially as the health of the country is now governed in many cases by United Kingdom action. For instance, the Food Ministry reigns over both.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

As far as I am concerned, and I feel sure I can speak for the Secretary of State for Scotland, it would be very much more convenient if we had a general discussion. If there is a desire to vote separately, the Votes could be taken separately. Roughly the same issues are involved and, if it is convenient to the Chair, it would certainly be convenient to the Committee.

Photo of Mr Thomas Scollan Mr Thomas Scollan , Renfrewshire Western

A large number of Scottish Members of Parliament would take very strong exception to that. That is due to the fact that immediately Scottish matters are merged into the national matters of England, the tendency is to have them completely overshadowed and ignored—[HON. MEMBERS: "Nonsense."] Evidently some hon. Members do not know much about it, but if they had the job of trying to raise Scottish matters they would know that that was the case. I am asking the Committee not to accept the suggestion which has been made, but to leave the matter to the Scottish Grand Committee.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

It is the same Statute, with one or two minor differences in the Health Service, which governs Scotland, England and Wales. The Debates will be largely repetitive if they are taken separately. If the Chairman would permit, I support the right hon. and gallant Member for Scottish Universites (Lieut.-Colonel Elliot). It would be much better if they were taken together. The right hon. and gallant Member is going to wind up for the Opposition, I understand, and he has some association with Scotland.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

Further to that point, may I say, as a Scottish Member, that I think it would be to the convenience of Scottish Members that a general discussion should take place. This is entirely without prejudice to the arrangement secured earlier in the Session by which, first, Scottish Estimates might be separately discussed upstairs and, secondly, at least one or two days might be given specifically to examination of Scottish problems here on the Floor of the House. This is not a diminution but an enlargement of the discussion which Scotland has of her affairs. It is also appropriate that we should discuss the health services and the problems which arise as a whole. That seems an added reason why, if possible, we should have a general and not a particular Debate.

Photo of Mr Douglas Clifton Brown Mr Douglas Clifton Brown , Hexham

May I point out that Scottish Supplementary Estimates have never gone to the Scottish Grand Committee. From the point of view of the Chair it would be very unsatisfactory to have a full Debate under one heading. I could not prevent hon. Members from raising Scottish points when I put the Question on the Scottish Vote. I suggest that what would meet the convenience of the Committee, particularly as the point has not been mentioned to me in any way before, would be to let the Debate on the first Estimate, that of England and Wales, run rather widely and then confine any further discussion on the Scottish Estimates as such, to purely Scottish points. I think that might meet the convenience of the Committee.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

If I might respectfully say so, it would not really meet the situation because, in fact, the problems are almost identical in the two countries and, as you say, the Supplementary Estimates can be reviewed now or never. The danger of pushing the discussion into a separate enclave at the end is precisely what was feared by the hon. Member for West Renfrew (Mr. Scollan)—that it would lead to a perfunctory treatment of them. It is part of the problem of the health of the United Kingdom and I most respectfully submit that it can only be really considered at this stage as part of the general and not a particular problem.

Photo of Mr Douglas Clifton Brown Mr Douglas Clifton Brown , Hexham

I have made a suggestion, which I think I must ask the Committee to accept, namely, that general questions and English questions could be raised on the first Vote and purely Scottish questions, if any, on the Scottish Vote.

Photo of Mr Emrys Roberts Mr Emrys Roberts , Merionethshire

Might it be pointed out to Scottish hon. Members that they are at least more fortunate than the Welsh Members in having separate Estimates, a privilege which is denied to Welsh Members, except in certain items of the Ministry of Health.

Photo of Mr James Carmichael Mr James Carmichael , Glasgow Bridgeton

If we accept your suggestion and deal with England first and the Scottish Estimates are presented later, and if, during the discussion we attempt to relate them, having already completed the discussion on the English Estimates, how far will Scottish Members be permitted to use the English Estimates by way of illustration in the method of the presentation of the Scottish Estimates? How far shall we be in Order, or out of Order, if we try to equate the method of presentation of the English Estimates?

Photo of Mr Douglas Clifton Brown Mr Douglas Clifton Brown , Hexham

I do not think I can give specific Rulings beforehand. The hon. Member will have an opportunity, and every latitude that can be given will be given.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

Will you, Major Milner, give further guidance to the Committee in regard to the allocation of time? As has been pointed out by my hon. Friend, the whole of the health services——

Photo of Mr Douglas Clifton Brown Mr Douglas Clifton Brown , Hexham

The question of the allocation of time, of course, has nothing to do with the Chair. It is my duty to put the Votes to the Committee and for the Committee to pass them as expeditiously as may be. But, short of any agreement, I can do nothing in regard to the allocation of time.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

Would it be possible to take the discussion on the Motion for the Adjournment, because the difficulty in which the Committee will be placed in discussing the two separate Estimates simply means, as the Minister said, that in many cases the same Debate will have to be held twice?

Photo of Mr Douglas Clifton Brown Mr Douglas Clifton Brown , Hexham

I am sorry but that would be quite inappropriate. If a Motion to Report progress is made the only arguments which can be advanced would be the reasons for reporting progress, or otherwise.

3.59 p.m.

Photo of Mr Arthur Blenkinsop Mr Arthur Blenkinsop , Newcastle upon Tyne East

I am grateful for the opportunity of addressing the Committee. In the first place, I have sonic pride in presenting the Supplementary Estimates to the Committee, chiefly because they cover the period of the successful introduction of the National Health Service into this country. I think it was understood that this Debate would be held, as my right hon. Friend has already mentioned, in an atmosphere rather supercharged. I for one am very grateful that it does not appear to be so. I am grateful for the fact that these Estimates will be discussed in a serious and, I hope, constructive manner. We appreciate the fact that the Supplementary Estimates are of a very large size and therefore warrant close inspection by the Committee. As I say, I hope that constructive suggestions will be devoted to the aim of helping to secure a strong and developing Health Service in this country.

Before going into detail on the Estimates it is important that the Committee should be fully seized of the background of the position when these Estimates were prepared. First, it is essential to understand that these Estimates were introduced some seven months before the introduction of the scheme. Of course, at that time there were many factors which could not possibly be properly clarified. For example, it was quite impossible to tell the extent to which this new scheme would be used by the general public. It was impossible to tell just how far the professional services would be available. In particular, it was impossible to tell at that time how far the dental and other professional services would be forthcoming.

Hon. Members will no doubt remember that at that time the dentists were making quite clear their own view that they would not enter into the scheme, and that of course had to be borne in mind when the Estimates were prepared. A third factor of very great importance, which again could not be evaluated at that time, was just precisely what would be the remuneration of those taking part. Very many negotiations followed on the preparation of the Estimates which it was quite impossible to provide for at that time.

A matter of great importance covering the whole field was the fact that at the time the Estimates were prepared it was impossible to tell precisely which institutions would be transferred to the Health Service. When the importance of all these major factors is appreciated it is not surprising that we come before the Committee today to discuss a large Supplementary Estimate. Above all these Estimates reflect the very much wider use that has been made by the general public of the services, and to that extent show the lack of provision that had existed up to that time.

I am anxious that we should consider this matter with some cafe, and go into the precise figures that have been laid before the Committee. In discussing them I shall be referring to figures of expenditure and the additional sums required for England and Wales, if hon. Members representing Welsh constituencies will so allow me. At the head of the Estimates will be seen provisions for hospital services. In fact, this covers the figures in the Estimate both of advances to regional hospital boards and boards of governors of teaching hospitals. A very large figure indeed of additional sums required is laid down in the Estimate before the Committee, a sum altogether of £22,346,000.

I think we should understand the width of cover to which these figures relate. This hospital service covers altogether something over 3,000 hospitals and clinics together with some 36 teaching hospitals. It covers the whole range of hospitals and specialist services. I think the astonishing feature of this great change over, this revolution in hospital service, is that is has been accomplished in as smooth a fashion as I think it will be agreed that it has been accomplished.

In coming to the detailed figures relating to this hospital expenditure we find, first of all, that we can sub-divide the amount between capital expenditure and running expenditure. We find that in the field of capital expenditure there has been an additional expenditure amounting to something of the nature of £3½ million. That of course covers a fairly wide field of capital development. It covers very little in actual new buildings, but it does cover a large amount of special work. For example, the enlargement of special departments and, I am glad to say, the re-opening of many closed wards, due to a factor I will mention later, the very encouraging increase in the number of nurses. I am glad to say also that it covers the extensions to nurses homes, which was a very essential measure indeed to help to attract new nurses into this Service. It covers the repair of war damage, and this was perhaps the largest figure of all.

As I am sure hon. Members will understand, there is a very great backlog of work to be done in the repair of war damage which could not be carried out during the war years, or indeed in the years immediately succeeding the war, and unfortunately there is still much of that work to be done. If hon. Members care to look across the river at St. Thomas's they will see an example of the type of work that is now being carried out, and of much more that needs to be done.

The main reason why the figure under capital expenditure has been so much higher than was originally estimated is because, in preparing the Estimates, we had to base upon earlier experience and chiefly upon the availability of supplies, as was then the position. Very fortunately supplies have become rather more available for this particular class of work, and therefore we have been able considerably to speed up the work which I have mentioned. I am sure that all hon. Members will agree that this kind of work is something which we cannot develop too quickly. There are very serious arrears to be overtaken and it is merely a question of availability of supplies as to how quickly that work can be accomplished.

I should also mention that included in this figure is a certain amount of work carried out in trying to bring up to moderate standards the hospitals built and provided during the war years. Hon. Members will have in mind the case of many of the hospitals provided during the war where the heating facilities, as one example, were quite inadequate for permanent hospital use. In many cases these have been altered and proper central heating equipment has been installed for the use of the hospitals concerned. They were vitally needed and are a great economy. The figures for the running costs are by far the greatest in this amount of extra expenditure for hospital services. There has been an increase of nearly £19 million. That is indeed a very large and serious figure. Here the Estimate that was made was based upon returns supplied by both voluntary and municipal hospitals, and some provision was made for rising costs.

However, I must impress upon the Committee the fact that at the time this Estimate was prepared the question was not settled of which hospitals would be transferred to the National Health Service. There were many hospitals about which the question was still hanging in the balance. It was not at all possible to tell in detail which hospitals would come in. Those remarks apply particularly to the mixed public assistance institutions. Another factor was the heavy arrears of maintenance, again due to the long period of the war years when it was impossible to carry out the ordinary running repairs and maintenance required in hospitals. As in the case of capital expenditure, so too with this type of general repair and reconditioning work it was found possible to undertake much more than had originally been regarded as possible. In fact, a further £5 million above what was originally anticipated has been spent on that side of the work. Hon. Members can see for themselves in many constituencies the value of the work undertaken.

Of course, in the large figure of running expenses, the major cause of the increased expenditure is the increase in salaries and wages. It is of great interest to know that over half the total of the running costs of these hospitals is covered by salary and wage expenditure. The Whitley Council considered this question after the Estimate had been prepared and submitted their recommendations about rates of pay for the nursing staff, domestic workers and other staff in hospitals. In many cases the Government agreed with the increases recommended. For example, the pay of student nurses has been almost doubled at a cost of some £3 million a year. That amounts, taking some improvements in other nurses' pay, in this Supplementary Estimate, to an extra charge of £1,500,000 owing to the date from which the increases were paid.

No one would deny that these increases were needed and no one in this House would in any way question the urgent need to increase the number of student nurses coming into the hospitals, with the hope that they will stay on in the profession and continue to serve the hospital world in the future as they are doing now as students. In addition, the increase of pay of domestic workers in hospitals amounts to £2 million a year, of which about £750,000 is involved in the actual period of this Estimate. There have been other staff increases amounting to about £1,500,000 in a year and special provisions have been made for increases to doctors and specialists in hospitals, as a result of the Spens Report, for which provision here has been made by some £6 million. I do not deny that this may not be the end of the wage increases which may be needed in the professions. Negotiations are proceeding at the moment.

I think that the Committee would like to know that undoubtedly the result of some of these increases has been a very healthy improvement in the recruitment of nurses. Perhaps I should rather say that we appear to be turning the corner in the staffing of the nursing profession so that during the last 12 months we have had an increase of about 3,000 whole-time nurses and 6,000 part-time nurses. I am sure that we all hope that this healthy improvement will continue. It is absolutely certain that no hospital service can possibly work in the way we desire it to work without many more entrants into the nursing profession. I am satisfied that some of the increased expenditure which we are discussing today has brought about that very valuable result. I hope that it will continue to have that effect.

I should like to refer to a figure in the Estimate of the additional sum required for "liabilities transferred to the Minister." It is convenient to discuss it now because that is a reference to hospital liabilities and it covers such items as bank overdrafts of hospitals, bills owing by voluntary hospitals and, of course, loan charges on capital expenditure by local authorities. Here I should say that the assumption at the time the Estimate was prepared—and it was a reasonable assumption—was that the liabilities, such as they might be, of the non-teaching voluntary hospitals would be largely covered by the provision for recouping from the Hospital Endowments Fund. It was impossible at that time to tell with any sort of precision, or with any accuracy at all, what those liabilities would be. It is difficult enough for hon. Members with bank balances, either to the credit or to the debit, to tell some months in advance what their position will be. It was far more difficult when the bulk of these hospitals were not within the National Health Service and information of their position was of a fairly vague character.

Although provision is made for the very large figure of an extra £16 million for liabilities transferred, a large part of that will be recouped from the Endowments Fund, although it has not been possible to do that in the Estimate in this year. It will be recoverable, to a very large extent, and what we expect is that there will be a large part of the amounts of the transferred liabilities from the local authority hospitals, amounting to about £2 million, and the liabilities of teaching hospitals, amounting to £3,500,000, where, as hon. Members know, there is no provision for recouping from the Endowments Fund. Therefore, although this figure may appear to be a serious one, when one comes to examine it one finds that the bulk of the amount will be recoverable, will not be a charge against Government expenditure, in future years.

Photo of Mr Daniel Lipson Mr Daniel Lipson , Cheltenham

Will my hon. Friend answer a question on this point? Is it a fact that the amount in the central Endowments Fund is really more than the liabilities—some £17 million against £14 million? Is it proposed to raid this fund, or will the liabilities be met entirely by the Exchequer?

Photo of Mr Arthur Blenkinsop Mr Arthur Blenkinsop , Newcastle upon Tyne East

There is no intention to raid the fund. There will be a set-off one against the other, but we have no intention of depriving the fund at all. We think it right that there should be some set-off.

I want to turn now to a smaller figure in these Estimates, but one in which I am personally interested, and that is the increased payment to my old late Department, the Ministry of Pensions. It will be noticed that we are providing for an extra sum of £370,000. In comparison with some of the other figures, that is not a large sum, but it is a large increase on the sum originally provided for. I think it is important that we should realise the sort of provisions which will be made out of this extra sum of money which we are now discussing. It covers the provision of artificial arms and legs and artificial aids of most kinds, including surgical boots, motor and hand-propelled chairs, artificial eyes and a multitude of smaller items. I am particularly pleased that it has been found possible to extend to the general public the provision that has been made for many years for the war disabled. It is, indeed, very gratifying to know the work that is being done in this field, and to go to one of the main factories preparing artificial limbs or one of our fitting centres to see civilians now coming in to secure these benefits to which previously they were not entitled.

Here, of course, is a typical example of the case where no fair estimate of what the demand was likely to be could possibly be made in advance. These are very costly items indeed, but I am sure again that every hon. Member of this Committee would agree that these are vital items of expenditure which are of enormous value to the country as a whole. They are positive measures of rehabilitation which in many cases enable men and women to undertake jobs of work necessary for the country but which they could not have undertaken before. The figures of the total numbers supplied up to 21st January, which are the latest figures I have with me, show that the number of artificial arms and legs supplied to civilians since the scheme came into operation is 2,580, and that figure will be steadily growing less. Already we find that the orders coming in are beginning to slacken. Naturally, there was a great rush at the start, because many people had waited for many long years, but now we are beginning to overcome the great rush at the start and the provision will no doubt steady down to a regular figure for future years. With regard to motor and hand-propelled chairs. I find that we have altogether issued 600 of these chairs during the last nine months.

I should like to turn now to the grants made to local authorities. Hon. Members will notice that there has been another large increase in the amount required for this service. I think all hon. Members will agree that the wide range of vital services that are provided today by the local authorities in this health field are very important services which we are anxious to develop. Many of these services did not in the past attract any Government grant at all; today, all of them attract a 50 per cent. Government grant. Perhaps it is wise to point out here that, when preparing the Estimates for this particular field, we had not the advantage of the schemes which were later submitted by the local authorities, and again we were in the position that the Estimates had to be made without any very accurate basis upon which to work. Some of the services, for example, which now attract the 50 per cent. grant and which previously had no grant at all include such important provisions as the care of mothers and young children, health visiting, home helps and home nursing and the ambulance services. All these previously had made no charge upon the Exchequer; today, they all attract a 50 per cent. grant.

To take the example of the ambulance service, I think it is within the knowledge of many hon. Members, if not all, that there were very great gaps indeed in the ambulance services throughout the country in the past, and I agree that there still are, and that it will take some time to fill them all up. Particularly was that true regarding out-patients who needed to visit hospitals for treatment; there was little, if any, provision at all for their transport. I believe it is the case that, because of that fact, many people lacked treatment which they should have had. On that ambulance service, alone there has been an expenditure by the local authorities over the period of nearly £4 million, which attracts a 50 per cent grant.

There is another factor of importance concerning the grants to local authorities. I have already mentioned that schemes have been submitted after these Estimates had been prepared, so that we had estimated that there would be a greater lag in the actual cash payment than has happened to be the case, and, therefore, a rather greater proportion of this expenditure has come into these Estimates as against future Estimates. Again, these are cases where one must have full regard for the value of the services being provided, and no one would wish to question the value today of the services being undertaken by the local authorities, some of them for the first time, and of great importance to the people in their locality.

I know that one item which will be of great interest to the Committee will be the increase in administration expenses for executive councils for which provision is made in these Supplementary Estimates. It will be noticed that there is provision for an extra £716,000 for the expenses of administration. That, of course, covers both office expenses and the actual staff required for the administration and running of this great national scheme. Again, it was very difficult at the start to estimate just what would be required. It depended entirely upon one's estimate of how great a use would be made of the whole scheme.

It has been found necessary to increase staffs in order to enable the work to be efficiently carried out; in order to ensure, among other matters, that payments were made within a reasonable time, and to try to avoid unnecessary delay. Above all, this staff increase has been due to the great pressure upon the whole of the services at the beginning of the scheme. As that pressure eases, as it will when the backlog is overcome, so it may be possible to reconsider some of these administrative expenses. It is also true that some part of this expenditure is non-recurrent. The provision for the setting up of these offices, etc., is expenditure which will not recur.

I return to some of the final group of figures, first of all those for medical services. It will be noticed that in comparison with the total expenditure on medical services there has been a comparatively small increase in the total amounts required. The reason for that increase is partly because of the speeding up of payments to doctors. It has been found possible to make payments rather more quickly than was originally anticipated. In this instance again we are to that extent merely transferring expenditure from one period to another. Provision is also included for an extra £500,000, which has very properly been added to the mileage fund for doctors in rural areas. It should be understood that that very necessary and important provision, which I am sure is of great value to the medical profession, has been made.

With regard to the other services, hon. Members will be concerned at the large figures of increased expenditure on the pharmaceutical, dental and ophthalmic services. To take the pharmaceutical service first, it will be noted that an additional sum of nearly £5 million is required. That sum covers the prescriptions made up by chemists as well as by doctors. Those estimates were based on the old National Health Insurance scheme, under which some 50 million prescriptions were issued in an average nine monthly period. We naturally estimated that there would be a large increase. Provision was made for an increase to a little over double that number of prescriptions. In fact the estimates we can make today show that something like 128 million prescriptions will be needed in that period of nine months. This is again an example of the greater use of the service which has followed its introduction.

There has been some criticism of the cost of prescribing. The cost of the actual individual prescriptions has not greatly increased over the estimate; the figure is about the same. When considering this figure the fact has also to be remembered that there have been payments to chemists in advance of the normal dates, payments which merely represent a transfer from one period to another. There is no evidence of any general misuse of prescribing by the medical profession. There may undoubtedly be individual cases but full provision exists for keeping a watch upon that matter.

As for the other large figure of just under £12 million increase in the Estimates for dental services, Members of the Committee may recollect that we had some discussion about this item a few days ago. I do not wish to go over the whole matter again but it should be said that the Estimates for this service were prepared before the Spens Committee Report had been received. There was no knowledge on which to base estimates about payments. The only guide we had was that of the National Health Insurance scheme. Under that scheme about 7 per cent. of those entitled to dental benefit took advantage of it. Under the present scheme that percentage has been multiplied some three and a half times. If calculations had been made on the basis of the use made of the previous scheme by National Health Insurance scheme patients, the total expenditure would have been nearer to £9 million.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

Was the old National Health Insurance scheme free, as the present one is?

Photo of Mr Arthur Blenkinsop Mr Arthur Blenkinsop , Newcastle upon Tyne East

No, of course it was not. There was part payment of the cost of treatment, as everyone knows. The major factor here, as I mentioned at the beginning, was that at the time the Estimates were prepared it was generally believed that a great number of dentists would not participate in the scheme. It was quite impossible at that date to make the assumption that they would do so. Fortunately that has not now proved to be the case; the great majority of dentists, some 90 per cent., are participating. A large part of the expenditure—some 40 per cent.—is for dentures, and as the Committee will appreciate, that is to a large extent non-recurring expenditure.

Another large increase is shown in the Estimates in the case of the ophthalmic services. The increase amounts to about £11 million. The Estimates could only be based upon National Health Insurance returns. Under that scheme only 5 per cent, of those entitled to benefit actually made use of the provision. As hon. Members in all parts of the Committee well know, that demand has been enormously increased to some four times the estimate which previously existed. It is an example of the greatly increased use which has been made of this service. I think it can be fairly said that it shows the need that had always been there but which could not in the past be satisfied. Up to 31st January last, nearly two million pairs of spectacles had been provided. That figure may be attacked by some, but knowing the conditions under which spectacles are issued, one realises the great need which was there and the value of this new provision. We are not saving that either on the dental or the ophthalmic side we are satisfied with the rates of payment to those who are participating, and discussions are proceeding on that matter which will no doubt assist in future periods.

I have perhaps dealt in rather a mundane way with the Supplementary Estimates before the Committee, but I am anxious that full consideration shall be given to the facts before discussion takes place upon them. These facts and figures cloak real people. They cloak men, women and children whom we all know. I have the honour to represent a part of the country, an area in which I have always lived, that was bitterly oppressed in past years. It is in areas of this kind that the National Health Service has offered perhaps the greatest hope. The proportion of industrial disabled is very high indeed in these areas. I believe that the figures we have been discussing, serious as they are and high as they are, are proving to be a real contribution to the hopes of working men and women in the area to which I belong. They are a bulwark against the fears of insecurity in the past, and to that extent are an encouragement to the economic effort and the difficult period which lies ahead.

4.42 p.m.

Photo of Mr Ralph Assheton Mr Ralph Assheton , City of London

I am sure the Committee will have been pleased at the agreeable manner in which the new Parliamentary Secretary has presented his case. I am bound to say, however, that he has been charged by his Minister with a very difficult task. I cannot recollect any occasion when a Government spokesman has had to come to the Box and explain a more extraordinary set of under-estimates. Anyone who understands our financial position and has paid heed to the remarks of the Chancellor of the Exchequer in recent months must have been deeply shocked and alarmed by the introduction of a batch of Supplementary Estimates which represent in total practically all the money that is being wrung from the taxpayer by way of Purchase Tax.

Photo of Mr Ralph Assheton Mr Ralph Assheton , City of London

I do not wonder that the Chancellor of the Exchequer thought it necessary to take a short holiday. [HON. MEMBERS: "Oh."] No one grudges him a holiday, but the fact is that he took a short holiday when these Estimates came out. We thought it right to put down the Estimates for the National Health Service to be discussed first, because these are the largest Supplementary Estimates and are therefore the most alarming from the financial point of view—[HON. MEMBERS: "Why?"]—perhaps I may be allowed to develop that. Many of us on this side who were in the Coalition Government and had a hand in framing the post-war social services are feeling very great anxieties lest all the hard work should be brought to nought by the shocking administration of the right hon. Gentleman.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

If that be the case, why did the provisional Government suppress the White Paper on the National Health Services in June, 1945, which they had decided to circulate?

Photo of Mr Ralph Assheton Mr Ralph Assheton , City of London

The right hon. Gentleman will recollect that I was not in the Government at that time. In any case, that has nothing to do with this.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

But, with all respect, the right hon. Gentleman spoke of the social services which the Tory Party had prepared for the post-war world. The National Government was succeeded by a provisional Government, and both health schemes presented by the provisional Goverment and the Coalition Government to the medical profession were rejected by them. The provisional Government prepared a White Paper, copies of which were printed and then suppressed during the General Election.

Photo of Mr Ralph Assheton Mr Ralph Assheton , City of London

All I can tell the right hon. Gentleman and the Committee is that in the declaration of policy which the Conservative Party put to the electorate the intention was laid down clearly to provide a comprehensive health service, and that has always been their policy. The party for whom I am speaking is as wholeheartedly in favour of the health services as it ever was. [Interruption.] I know quite well that it is the policy of Members opposite, and particularly of certain Ministers, to make speeches in the country suggesting that if the Tory Party comes into power again the National Health Service will go. That is what the Government are trying to suggest, and that suggestion is absolutely false. In the Coalition we worked out the scheme for a National Health Service with Members of the Government, and they know that quite well. When we come to examine the detailed Estimates we must not forget what the Lord President of the Council so rightly told us, that it is the duty of this Committee to examine them with care.

Do not let us overlook the fact that it is from the pockets of the working men and women that the greatest contribution comes; by far the greatest burden of taxation falls on the ordinary men and women in the country, and they are the people who have to pay for this. These are the people who have to foot the bill, and it is right and proper, therefore, that we should examine these Estimates with every care and without the suggestion being thrown across the Committee that because we do that we are against the health services. As my right hon. Friend the Member for Woodford (Mr. Churchill) said earlier, because we may propose to examine closely the Estimates for the Navy, is it to be supposed that the Conservative Party are against having a Navy? The Minister of, Health may be a very great orator, but I suggest that he is not a very great administrator. He is asking for Supplementary Estimates on an extraordinary scale, and I wish to criticise, firstly, the childish underestimation, of which there has been no satisfactory explanation by the Parliamentary Secretary. Throughout his speech the Parliamentary Secretary told us that he had not expected this and that to happen. He did not expect that when a free service was presented more people would make use of it than of the National Insurance Scheme.

Photo of Mr Arthur Blenkinsop Mr Arthur Blenkinsop , Newcastle upon Tyne East

As far as the dental services are concerned, how could anyone estimate how many people would use them when it was not known whether the dentists would operate the service?

Photo of Mr Ralph Assheton Mr Ralph Assheton , City of London

But an estimate was made, and it was a very bad one, which is what we are complaining about. Secondly, we complain of the rising expenditure in the whole field which may imperil the whole scheme. Thirdly, I want to comment on the obvious growth of bureaucracy which these Estimates show. Then I want to refer to the dental and ophthalmic services and to suggest that the failure of the school dental service is one of the consequences of this. Finally, I want to refer to the fact that the Health Service is costing very nearly three times what we were told when the National Health Service Bill was introduced.

The National Health Service Bill was introduced on 19th March, 1946. In front of it is a Financial Memorandum, and the final figure of that Memorandum is: The net annual expenditure falling upon the Exchequer is £95 million. The original Estimate, introduced by the Minister of Health last spring for England and Wales, was £132 million. He has now come along with an additional Supplementary Estimate for £52 million. We have not taken into account the figures for Scotland, as we are not apparently to discuss that Estimate now. None the less, let us not forget that these figures for the Estimate and for the Supplementary Estimate cover only nine months of the year whereas next year we shall have to foot the bill for 12 months; and that the Estimate and Supplementary Estimate before us, without any provision for anything else, mean a total overall figure for both kingdoms of something like £277 million.

I do not know what the Estimates for next year are to be. No doubt the Minister has some idea. I hope that they will be a great deal more accurate this year than they were last year. I observe in the Supplementary Estimates that no very great provision is made for capital expenditure, much of which will have to come in the future. I was interested to see, when I was reading the "Daily Herald" on Monday, a picture of what was described as the first of London's great new health centres. I was disappointed to find that it has yet to he built, although there is a beautiful picture of it there. It is a picture of something which has not yet been built and it is not even as good propaganda as the picture of the Duke of Kent, as he at any rate does exist.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

Is the right hon. Gentleman against it?

Photo of Mr Ralph Assheton Mr Ralph Assheton , City of London

I am not against it. I am trying to point out to the Minister that these Estimates, which are so large, do not contain a great many provisions for items which he referred to and adumbrated in the Debate when we were discussing the Bill, and when the National Health Service was said to be going to cost £95 million.

Let us come to some of the details. Let us take the ophthalmic service, about which the Parliamentary Secretary told us something. I find the matter very puzzling. The Estimate for the ophthalmic services was originally about £2 million. The revised Estimate is for £12,900,000, for England and Wales alone. That discloses an error of estimating of 600 or 700 per cent. The Parliamentary Secretary suggested one or two reasons why that is so: he did not expect that so many people would ask for spectacles. He perhaps did not realise that when things are free a great many more people want them and order them than when they have to pay for them.

I am given to understand that plenty of other people knew that the service would cost more than £2 million. I have a letter which has just been put into my hands from a gentleman who is the honorary secretary of the Institute of Optical Science. He points out that when the original Estimates were first put forward, a meeting was called at Friends' House at which more than 500 opticians attended. At that meeting he said that the cost would be in the region of £16 million. Some people were able to make a closer estimate than were Members of His Majesty's Government.

I have also gone a little into the details of the cost of these spectacles. The Minister and the Parliamentary Secretary know what these details are, and I will not trouble the Committee with them except to say that, roughly speaking, the cost of a pair of spectacles is from £2 18s. to £3 14s. Before the scheme came in, there were about four million pairs of spectacles made in England every year. Somebody might have guessed that as spectacles were going to be given away, their cost might very likely be four million times about £3. That would have given an Estimate of £12 million. I cannot understand how Ministers came forward with such a fantastic Estimate as this. If a business firm or a contractor made such a ghastly error in estimating he would go bankrupt, yet——

Photo of Mr Robert Young Mr Robert Young , Newton

Is the right hon. Gentleman taking account of the number of spectacles which were exported in that four millions?

Photo of Mr Ralph Assheton Mr Ralph Assheton , City of London

I do not believe that many spectacles have been exported recently. In any case, the Minister has told us that more than two million pairs have been supplied by his Department. Let us not forget, please, that by far the greater number of people who previously bought their spectacles will now get them free. I honestly suggest that the underestimate in this case was very foolish. The right hon. Gentleman and his colleagues in the Government are able to forecast in White Papers how much cotton and timber every country in Europe will consume in 1953, and how many groundnuts, and yet for the very year in which these ophthalmic service Estimates were made, they are 600 or 700 per cent. out in those Estimates.

Now for a word about the Estimates for the dental service. These amounted to £7 million in England and Wales. The revised Estimate is £17,750,000. That is getting on for three times the original cost. I am told that the real cost is very much greater and that there is a considerable backlog to those figures which has been mounting up. I am told that the bill is something like £40 million a year. I do not know what steps the Minister took to get a proper Estimate for this service or what steps he is taking to check extravagance in it. Does he really believe his Dental Estimates Board at Eastbourne, with a staff of 671 people, can be much more than a rubber-stamping set-up? How can they check the dentures that have been provided or the stoppings put into teeth at Newcastle? The idea that a central staff could cover the whole country in that way is an indication of administrative incompetence and is also a sign of the growth of bureaucracy, to which I have previously referred.

On the general practitioner Estimates, it is quite clear that the amount spent on one or two services alone this year exceeds the total amount spent on family doctoring. There have been critics who have suggested that this discloses a lack of proportion. I suggest that doctors up and down the country are in many cases overworked and have not sufficient time to give attention to their more urgent cases. What is more, in some country districts, as I well know, doctors are being badly hit financially, while they have the mortification of seeing enormous and wasteful extravagance in many directions around them, which wise administration might avoid. On an average, doctors are getting far less than the dentists or the eye-men. That is a matter certainly for comment.

I cannot refrain from making one observation about the dental service which arises directly from this subject. It was referred to briefly the other evening when we discussed a Prayer. It is that the fees paid by the Government to the dentists have absolutely wrecked the school dental service. A letter in "The Times" from Mr. Hallett, Reader in Children's Dentistry at Newcastle, said: The public dental service lies broken, almost irretrievably, as an instrument of attack upon dental disease. That is a direct result of Government action. There is one county, at any rate, where there are no school dentists left at all. In London many have left the service, as they have in many of the counties. That is one of the consequences of the administration of the right hon. Gentleman.

On the question of hospitals, the Parliamentary Secretary made several excuses for the faulty estimate. True, the faults are not so grave here as in some of the other services to which I have referred. The teaching hospitals were originally to have £10 million and now they want £18 million, nearly twice as much, and the regional hospitals, which were to have £91 million, are now up to £103 million. I can hardly believe that the heavy arrears of maintenance to which the hon. Gentleman referred ere unknown to his Department in the spring of last year. I can hardly believe that the Minister was so ill-informed of the amount of manpower and building material available that he made such a hopelessly wrong estimate. At any rate, there it is.

How can such estimating be excused? What did the Minister forget? He must have forgotten something. Did he forget that, in future, none of the patients in the public wards would pay? Did he forget that formerly, the specialists and the consultants in the great voluntary hospitals gave their services free, or for a nominal fee? Did he forget that when he was making his calculations, or did he forget, for instance, that the immediate psychological reaction on all boards of governors and management committees was bound to be to some extent a burst of spending? I have no doubt that most of it was expended on highly desirable objects, but did he not realise what would happen? I am challenging him on the Estimate, and I am suggesting that he did not estimate sensibly. He has not told us—although it was put to him in a Question—how many new hospital appointments have been made on the administrative side of the scheme, and at what cost. Perhaps he will tell us that later in the Debate.

We can see from page 56 of the Estimate that there is a very big increase—nearly 100 per cent.—in the superannuation receipts, which indicates, of course, that there must have been a very large increase in the number of employees. I am told that the administration of hospitals has, in many cases, been removed from the hospital itself, that a great bureaucracy is growing up, and that an enormous number of clerks have to be engaged to read the endless stream of directives which flow down from the Minister.

What are the causes of all this? I suggest that one cause—and I believe that hon. Members on both sides of the Committee will agree with this—is that there is a great over-centralisation of administration. That should be looked into. I also suggest that the Central Health Council was not appointed until much too late. This was a council which had to be appointed under the Bill. It was appointed after the main structure of the Bill and the main structure of the Service had been determined by the Minister's directives. It has been suggested to me that there is no serving hospital officer on that Council and no really freely flowing channel through which the day-to-day experience of management and hospital committees can come up to the Minister. The Minister will probably deny that, and say that he meets the hospital boards and all these people. However, I am told that, in effect, there is no free flowing channel of information from the bottom to the top.

I suggest to the Minister that he has a lot to learn from the Minister of Labour in these matters. In the Ministry of Labour, the art of consultation has been developed over the years to a very great degree. If the Minister of Health were to learn a little from the Ministry of Labour it would be a great advantage to all parties. I do not know whether the Committee feels the same, but I feel very strongly that the rush and hurry with which the Minister introduced this service has had all sorts of unsatisfactory results. One result has been that the public have been deceived into thinking that there were far more services available than, in fact, there were. We have heard this said from hon. Members on all sides of the Committee.

We have also to be very careful in saying to people that this is a free service. Of course, it is free to the individual, but it places an enormous burden on every taxpayer in the country, and some means must be found of instilling a sense of responsibility into all those who use and who administer such a service. It is the ordinary wage earner upon whom this burden falls. [An HON. MEMBER: "And the Surtax payer."] Yes, and the Surtax payer. But if we were to take all the money from the people who pay Surtax, and who we may think are the rich, it would have very little relation to the total amount of the Budget. The money has to come out of the pockets of the people, out of their earnings, and out of all they buy. It is up to us to see that they get good value for their money.

I suggest that it is the duty of the Minister to prove to us that all these items are really meritorious. I suggest that it is up to him to prove to us that this faulty estimating could not have been avoided. I say it could and should have been avoided. We are truly anxious lest the Minister of Health, by running up these enormous bills, should put the whole of our social services in jeopardy. There was a time—and many of us can remember it—when the Unemployment Fund went bankrupt. People will remember the Poplar guardians. We must be very careful in the administration of these huge sums of public money.

I suggest to the Committee that there is clear evidence of maladministration and extravagance in this scheme. The estimating was hopelessly incompetent unless, indeed, a lower figure than the true one was deliberately put forward, which is a thing I do not like to suggest. However, it was either that or incompetence. At best the Minister has shown himself quite irresponsible in financial matters, and heedless of the best interests of the patients as well as of the medical profession. Therefore, I suggest that he is quite unfit to hold office and should go.

5.9 p.m.

Photo of Sir Frederick Messer Sir Frederick Messer , Tottenham South

I count myself fortunate in being permitted to follow the right hon. Gentleman the junior Member for the City of London (Mr. Assheton). I never remember hearing a speech which was so lacking a sense of proportion. Certain things were said by the right hon. Gentleman which were a direct challenge, and which, I think, deserve an answer. It may not be my responsibility to give that answer, but I feel it necessary to turn our attention to what is, in point of fact, the greatest measure of social service that has ever been launched.

Anybody who has had any experience of this very difficult service from the point of view of administration, will realise just what a task the Minister and his advisers had in getting anything like what would be an adequate, let alone an accurate, estimate of the cost. This Supplementary Estimate, if it shows anything at all, indicates the great need that there was for the service. If it shows any ignorance on the part of the Government, it shows that even this Government were unaware of the large number of people who were prevented by poverty from getting the things that those who were rich were able to get. I should like to know what the Opposition are really criticising. Are they criticising the machinery of getting out the Estimate, or do they feel that the Estimate having been made, it should be maintained irrespective of its consequences? Do the Opposition suggest that because the number of people who would benefit by an expensive drug like streptomycin was unknown, tubercular people should die because the Estimate was wrong? These are things we want to know.

If that is the position, I think this Debate will be the finest ammunition for the General Election that there has ever been. Nobody was in a position to get within easy reach of the actual cost. I have assisted in hospital budgeting for many years. We were never able to foretell actual costs. In this instance there was no method by which we could have estimated precisely the expense of the service. I do not want to spend much time on the question of spectacles, dentures or the general practitioner service, but when the right hon. Member for the City of London refers to this money coming out of the pockets of the people, does he not realise that it is going back into the pockets of the workers?

In the old days a patient would go to a general practitioner who would do his best and would then say, "You are a hospital case." The patient having been recommended to a hospital, almost the first thing he did at the hospital was to visit the almoner who did her best to find out how much that patient could pay while in hospital. Do hon. Members realise what a deterrent that was? Have they had anything to do with what are called legally liable relatives? Are they aware that a patient in hospital very often had to be maintained by a father or grandfather, daughter or son, granddaughter or grandson? The fact that that practice is not followed now means that money is definitely going into the pockets of the workers. The people ought to understand that this Health Service in itself has raised the standard of the workers by improving the value of their wages. In budgeting it was not possible for the Ministry to have had any idea at all of what this enormous service, with its many authorities, would cost.

I wish to turn my attention to hospitals. It is not just a question of improved buildings, neither is it a question of constructing new buildings. All over the country there were places called hospitals which had no right to be so called. The regional hospital boards in their task of reorganisation found it necessary to staff these hospitals to ensure that the people should get what the service is intended to give them. We find, therefore, that poor law institutions, for instance, have had to be reorganised so that their medical staffs now possess specialists, consultants and medical teams to enable patients to receive what the service ought to give them. I do not know that it was possible to estimate the expense of that reorganisation, but even if there has been an excessive expenditure over the Estimate, people are getting value for their money. It is not merely a question of money in itself; it is what money brings, it is the value.

Much has been said about spectacles and dentures. Do hon. Members know that in this country there are working-class families who were regularly compelled to put money aside because one member of the family needed a surgical appliance? They might need caliper splints costing £30, surgical boots, spinal jackets, costing £40, abdominal belts, trusses and things of that sort which were a constant drain on their resources. If the workers are, in part, paying for this service, they are getting something back in return. At the present time in our hospitals there are people who are getting those appliances without having to go to their Members of Parliament or having to get letters from the Surgical Aid Society. The right hon. Member for the City of London referred to the Central Health Services Council. He complained that part of our trouble is due to the fact that the Minister does not consult those whom, for lack of a better phrase, I will describe as being at the point of production. But is that exactly true? What is the function of the Central Health Services Council? That is a body which, in consultation with the Minister, sets up advisory committees.

Photo of Sir Frederick Messer Sir Frederick Messer , Tottenham South

It was formed comparatively recently, but in view of the type of chairman it has, it is making up for lost time.

Photo of Sir Frederick Messer Sir Frederick Messer , Tottenham South

I want to deal with this matter without creating any bitterness, because, in my view, this subject rises above any political consideration. I do not want to make party capital out of this, and if the Opposition are attempting to do so, they are playing right into the hands of the Government. My view is that these are considerations which rise superior to any party political concept. There is the ground of common humanity which in times of stress in this country has brought parties together. There could be no greater disservice to the people of this country than to throw this service into the political cockpit so that one part is charging the other with doing its best to injure the worker. I do not want to talk politics to that extent, but I want to defend the service because I see in the attack made upon it, the possibility of a demand that there shall be a global sum of money which the Minister will be permitted to expend, irrespective of the needs. In my view that would be wrong.

Let me return to the Central Health Services Council. It would have been formed earlier had it not been for the difficulty of getting those whom the Minister himself required to be there, in the capacity not so much of representatives, as of people who brought experience. It was not the fault of the Minister that it was formed late. It was rather the difficulty of getting the people to agree about proportions. What is its job? The Central Health Services Council does nothing at all in the administration of the service. That is not its job. I will explain what is its function.

In my view the House can take it that in the existence of the Central Health Services Council there is a protection of the public interest. The British Medical Association are there, and they will do their best to look after the doctors. Those who have experience in local government are there, and they will bring a contribution which will be valuable. There are those who represent, in the truest sense of the word, every aspect of this service. That council, in consultation with the Minister, will recommend the formation of certain advisory bodies. There has been talk of bureaucracy. That Central Health Services Council is the negation of bureaucracy because there will be set up advisory bodies which will be completely autonomous and which will be able to advise the Minister on any point of the service. There will be advisory committees on every aspect of the service and they will be able to advise the Minister without having to wait for the consent of the Central Health Services Council. That will not prevent the Council from telling the Minister not to accept the advice, but nevertheless the advice will be given by the autonomous bodies.

A great deal has been said about the administration of hospitals—"the over-administration." I have a reference in a book called "The Hospital," which is a technical book, criticising hospital administration. What has been done? The work of fusing the voluntary hospitals with the municipal hospitals is a greater job than the majority of the people of this country realise. In this scheme the Minister has followed what every reformer in this field has agreed is the right procedure by grouping hospitals together, putting them under a management committee, creating a unit itself so balanced as to provide a service for the area in which the hospital is situated.

In launching a service like this, is no allowance to be made for the necessity of regarding the commencement of it as an experiment? Anybody who ties himself at the beginning of a work of this description to any form, to any set ideas, is heading for disaster. It is essential, in the nature of things, that one should begin with a reservation that, where experience shows adaptations are needed, those adaptations and changes will be made. As a consequence, the management committees of the hospitals inevitably tended, I think, to over-staff, but that is not incapable of correction. Indeed, I think there will need to be regrouping of hospitals in the light of new buildings and fresh interests. There is no reason why we should think that, having launched this enormous scheme, it must travel in the direction in which it has set out without the possibility of any divergence to the right or left.

What is important is to realise that at the present time we are not giving the service which the people need. That is not due to the fact that it is a national service but to the fact that it has been neglected for so many years. It will take years to catch up with the arrears. The people have been without the service for so long that now it has been attempted as a public service, obviously and necessarily it will take some time to catch up with the arrears. I feel that the Supplementary Estimates can very easily be justified. They can be justified on the ground of recognition that human life is more important than cash, that if we are to weigh up the question of whether it is money or life that matters, then life must have priority in our regard.

5.26 p.m.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

I feel disposed to agree with the hon. Member for South Tottenham (Mr. Messer) that it would be a pity if discussion of the National Health Service were dragged into the political cockpit. But I am afraid he has spoken too late. For some extraordinary reason, when the National Health Service comes up for discussion there is always a great deal of acrimony. That is strange when we remember that both parties, indeed all parties, at the last Election had a National Health Service in their programme and that it is difficult for the right hon. Gentleman the Minister of Health to point to any occasion when there has been factious opposition on this score from this side of the House.

Any hon. Member is surely free to point out the fault in any particular scheme and to vote against it, and that is what we did with the National Health Service Act when it was before the House. Nevertheless, at all stages of discussion in this House, both on the Floor of the House and in Committee upstairs, the right hon. Gentleman was never faced with any factious opposition, and ever since this scheme came into operation he has never had anything but helpful action from His Majesty's Opposition.—[Laughter.] The right hon. Gentleman is an expert at laughing when he is sitting in his place, but I challenge him to prove to the contrary to what I have said when he is standing at that Box.

This is a Supplementary Estimate for £52 million on top of a principal Estimate of £161 million for nine months. I think it is important that the Committee should understand that this Estimate does not by any means present the whole financial picture. The public indebtedness at the end of the present financial year in respect of this service will be far higher than the total amount shown in the Estimates. I am making no allegation against the right hon. Gentleman here, but simply pointing out that there is necessarily a considerable lag in the actual payments. As this scheme came into operation only during the course of the current year, there is no carry-over from the previous year and, of course, in all future years there will be a carry-over from the beginning to counter-balance what is carried forward to the next year.

As my right hon. Friend has pointed out, the dental service at the moment is running at an annual cost of somewhere between £40 million and £50 million. That is one of the services for which we can at the present produce the actual cost. I venture to say that, taking these services as a whole, the real Estimates for the current year should show a running expenditure of something of the order of £300 million to £350 million. There is some temptation to discuss the figures in relation to the Estimates generally. Hon. Members opposite, on any suggestion that here is a high expenditure for public health, have cheered; but let it be remembered that the resources of this country are limited, and it may well be that by spending £300 million a year on this National Health Service we are stopping directly or indirectly the building of something like 100,000 new houses.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

I should be out of Order if I were to continue the discussion on those lines, but I think that hon. Members opposite at least appreciate that we are here merely dealing with a Supplementary Estimate, and all that we can do is to look into the particular merits or demerits of that Estimate. It is as extraordinary an Estimate as has ever been presented to the House. The Government's defence is two-fold. They first say that an accurate Estimate was impossible in the circumstances, and, secondly, that they did not realise what the initial rush to use the service would he. I want to examine that defence.

One must examine it necessarily in detail. I will take one item, which is the most extraordinary, in the discrepancy between the Government's original Estimate and the present Supplementary Estimate. Item D.5 deals with ophthalmic services. It shows an increase of between five and sixfold. The Minister of Health has himself admitted that the production of spectacles in this country in the year before this scheme came into operation was of the order of four million pairs. An hon. Gentleman in this connection recently interrupted from the Benches behind, and asked how many of these were for export. That is a question only known to the Government, but I suggest that well under 10 per cent. and probably less than 1 per cent. actually went for export. The right hon. Gentleman must have known that four million pairs of spectacles were being produced and sold in this country every year, and he must have known that the cost of supplying those spectacles to people in this country was somewhere about £3 a pair.

Photo of Mr Cecil Poole Mr Cecil Poole , Lichfield

Has the hon. Gentleman no knowledge of the large number of pairs of spectacles which were sold by Woolworths and other stores at 6d. to 1s. 6d.?

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

I do not know whether the hon. Gentleman is suggesting that those are in addition to the four million or part of the four million. What I suggest to the Committee is that the demand was of the order of four million. If some of the people were satisfied with bad spectacles from Woolworths, that would be all the more reason for adding to the Estimate because it would increase the demand for new ones. Those who had bought bad pairs in the past would want good pairs for the future. I am obliged to the hon. Gentleman for reinforcing my argument. The cost of sight testing, of dispensing, of producing the frames, lenses and cases was before the scheme, and is still under the scheme about £3 a pair. Therefore, it must have been know to the Government that the ophthalmic service provided under this scheme would be running at least at £12 million a year, apart from any increased demand by reason of the fact that we have now a free scheme instead of one for which the people had to pay. On this one item we can prove chapter and verse that the Government must have failed in their duty to take into account all the facts. Looking at all these items, there would appear to be an extraordinary discrepancy between what was expected and what actually took place.

The Parliamentary Secretary, in opening this Debate, said that accurate estimating was not possible. I am quite willing to agree with him, but I say that if an honest attempt had been made to estimate what would happen, the Government would surely have found that some of the Estimates had over-shot the mark instead of all being below it. What we find is that in every single case the Government are far below the mark. The suggestion which I am making, and which I wish to make quite clear, is that the Minister was not only guilty of bad estimating but guilty of reckless under-statement. My right hon. Friend the Member for the City of London (Mr. Assheton) said that he did not charge the Minister with deliberate under-statement. In the eyes of the criminal law there is a point where recklessness amounts to deliberateness. My suggestion is that, wherever it was possible, these Estimates were put at the lowest conceivable figure, and that it must have been known to the Government that when the bill for this year came to be paid it would be far in excess of what they told the House in their Estimates presented at the beginning of the year.

The right hon. Gentleman was determined to get this scheme and the whole of this scheme floated. He had many difficulties. I am quite satisfied that one of the difficulties which faced him was Treasury opposition. I am quite satisfied on the facts before me that the right hon. Gentleman must have known that this scheme would cost so much and that it was at least doubtful whether the finances of the country could carry it. I am quite satisfied that the policy of the Minister had been to keep the Estimates as low as possible so that the scheme would, at any rate, be on its feet, and the House would be presented with a fait accompli in the Supplementary Estimates.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

What conclusion does the hon. Gentleman draw from that; that we ought, therefore, not to go on with the scheme at all?

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

I am going to deal with that point. The allegation which I am making now is that the right hon. Gentleman recklessly allowed the House and the country to be misled by bringing in an original Estimate which he must have known would be falsified in the light of events. The right hon. Gentleman, who is an adept tactician, must have appreciated that a large Supplementary Estimate on the Health Service would put his opponents, the Opposition, in a very difficult position. He must have appreciated very well that when a large Supplementary Estimate such as this was brought before the House it would require that the Opposition either voted for or against it. The right hon. Gentleman no doubt calculated to himself that if the Opposition allowed the Estimate to pass without a vote, then he would be able to make a mock of the claim of the Opposition to stand for retrenchment; and, on the other hand, he said to himself that if they voted againt the Estimate, he would be able to describe their action as an attack on the people's health. I am quite certain that that was in the right hon. Gentleman's mind.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

Judging by the smiles of hon. Members opposite, I am sure they appreciate that it was exactly this dilemma which was in the mind of the Minister.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

What we are really smiling at is the embarrassment of the hon. Gentleman, who does not know whether to take the crown of thorns or the thirty pieces.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

I notice that the right hon. Gentleman puts himself in the position of those elders who thought fit to offer such a price. My charge against the Government on these Estimates is that they have deliberately engineered this dilemma in order to put their opponents in difficulty.

Photo of Mr James Hudson Mr James Hudson , Ealing West

Who is being reckless now?

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

Let me refer the House to an article which appeared in the "Daily Herald" of yesterday's date. The article will no doubt be familiar to hon. Members opposite, and particularly to the right hon. Gentleman whose portrait adorns it. The article is entitled: The Tories Want To Axe Your Health. I notice that it was exactly what I was pointing out was in the minds of hon. Members opposite. The article is written by the hon. Member for Barnet (Dr. Taylor), and contains the following passage: The Tories' aim is to slash the Supplementary Estimates amounting to £221 million, and in particular to cut down the extra £58 million required for the National Health Service and the £52 million for food subsidies. Yet the extra millions for health are to be spent because far more people than was expected are now found to be in urgent need of spectacles, hospital and dental treatment, and appliances. As regards spectacles, the first item referred to: is it really suggested that when the Government brought forward their original Estimate they thought that the people of this country would take advantage of only £2 million worth of spectacles at £3 a pair?

Photo of Mr Cecil Poole Mr Cecil Poole , Lichfield

They are not £3 a pair.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

That is the cost of producing and supplying spectacles.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

I am sure the right hon. Gentleman will agree that £3 is not very far off the average price of supplying a pair of spectacles in this country. As regards the greater demand for hospitals: is that really a candid statement? Are these Estimates really swollen because of the additional accommodation provided for the people? What is the additional accommodation? Six thousand beds. That is the total addition so far produced by the right hon. Gentleman. If he suggests that affords any substantial reason for increasing these Estimates, I hope that he will develop it in the course of his speech.

Photo of Mrs Bessie Braddock Mrs Bessie Braddock , Liverpool Exchange

What does the hon. Member suggest is the cost per patient per week at the moment?

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

I think I am right in saying that the present cost is about £350 per bed per year. The hon. Lady can do some quick arithmetic for herself; I cannot make the division for her in the middle of my speech.

The fact of the matter is that it is not the increased number of patients in hospitals that is responsible for this treatment. There is a hugely swollen Estimate for the hospitals. I concede to the right hon. Gentleman that a large part of that swollen Estimate is fully justified; I do not deny that; I concede that certain wages and salaries were very properly increased, irrespective of the Government's general policy: I concede also that there was much equipment needed and repair work to be done. But what I do say is that the right hon. Gentleman has devised no means of controlling the expenditure of those hospitals.

Let me give a specific example. A hospital board has before it at its normal monthly meeting an estimate for, say, £1,500 for some specialised item of equipment. The question will be asked: "Do we need this equipment? It is very expensive." The reply will be given: "The head of the department concerned says that he requires it." On that statement the board will have no option but to say: "Well, the equipment must be got." I think hon. Members opposite would agree with me there. But that does not really raise the essential question. If that hospital were in any way limited in the amount of money it had to spend, would it choose that item of equipment or would it spend the money better in some other way?

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

The hon. Member, who is a member of a board of governors of a teaching hospital, is now quite properly addressing to the Committee an argument of very considerable importance, but it is the opposite argument from that addressed to us by his right hon. Friend the Member for the City of London (Mr. Assheton), who charged me with having so over-centralised an administration that I had a huge bureaucracy controlling the whole of it. Now, apparently, I am charged with having no direct financial control over the board of governors. Now, which charge is the Opposition making? That too much responsibility is devolved on the board of governors, or too little? Which?

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

In replying to the right hon. Gentleman, I am getting very near to being out of Order. My reply is that this is one of the fundamental flaws in his scheme.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

The hon. Member really must be fair now. So much nonsense has been talked by the Opposition, and indeed by the Tory papers, that hon. Members opposite must now begin to develop a sense of responsibility. Which charge is being made? Is it that the various administrative bodies—the management committees of hospitals and the boards of governors of teaching hospitals—have too much or too little self-government? Is the administration too much over-centralised, or is it too much delegated? Which is the position?

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

The right hon. Gentleman is assuming that I accept his method of organising the hospitals. He will remember that during the passage of the Act, both in Committee and in the House, we always said that this position would be bound to arise if the hospitals were organized——

Photo of Sir Austen Albu Sir Austen Albu , Edmonton

Give us the answer.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

I am giving the answer. If the hon. Gentleman will allow me to complete my sentence, we may get on a little faster. The answer I give is that the right hon. Gentleman's question is based on the assumption that I accept the broad basis of his scheme. Now, I do not accept the broad basis of his scheme.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

Which basis does the hon. Gentleman accept?

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

I would have had a different scheme from this one. I would not have nationalised the hospitals in the way he has done. That is my answer.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

The hon. Gentleman is in an awful dilemma; I know it and he knows it. He has presented to the Committee a concrete case, because out of his experience, he does not remain in the realms of abstraction like his right hon. Friend the Member for the City of London. He comes down to brass tacks. Take the concrete case which the hon. Member has put. It is recommended that an instrument costing a certain sum of money should be purchased. Who should decide whether that instrument is to be purchased? Should it be the Minister or the board of governors? If it were the board of governors, as the hon. Gentleman would have it, and the hospital were not nationalised, who would pay for it?

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

I will answer the right hon. Gentleman in this way. Taking his scheme as I find it——

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

No, under the hon. Gentleman's scheme, what would he do?

Photo of Mr Francis Bowles Mr Francis Bowles , Nuneaton

The Debate must be continued on the basis of the present scheme under the National Health Service. We cannot have any kind of hypothetical discussions about how other schemes might have worked.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

I will continue the argument about the intentions of the Government in making this Estimate. I was referring to this article which, if not official, was obviously published on behalf of the party opposite, or at any rate inspired by the party headquarters.

Photo of Mr Stephen Taylor Mr Stephen Taylor , Barnet

I am sure that it was not inspired at all. I am afraid that it flowed from my brain, such as it is, quite spontaneously.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

Perhaps we are using the word "inspired" in different senses. This paragraph was accepted by the large number of loyal Socialists who no doubt read it as, if not official or inspired, at any rate a view which was reasonable to Labour Members of Parliament. The paragraph said: In 1938, two and a half out of three and a half million school children needed dental treatment. Among forces recruits, 90 per cent. of men and 86 per cent. of women needed dental treatment. One approved society found that over 12 per cent. of its members under 18 needed complete upper and lower dentures. Dentists in the new service are finding that many people need eight or nine fillings.

Photo of Mr Stephen Taylor Mr Stephen Taylor , Barnet

The hon. Gentleman has misunderstood what is explained in the article. I do not think anybody knew that dentists were going to work 70 or 80 hours a week in order to make good these defects.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

The hon. Gentleman wrote that article with a view to persuading the country that the wicked Tories were launching a frontal attack on the Health Service and, in particular, that they were trying to do damage to the dental scheme which was so urgently needed because of the position of the younger members of the community. I do not think that I have done the hon. Member any injustice.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

Time is passing and I am afraid I cannot give way. I will now read what was said by one of the hon. Gentleman's colleagues—the only supporter of the right hon. Gentleman who has any practical knowledge of the dental scheme—only two nights ago in this House. The hon. Member for East Wolverhampton (Mr. Baird) said of the dentists: We all know that they are being paid too much and that the method of the Government to cut them is by saying, 'Let him carry on at the full rate as long as he works 42 hours a week.' Only after he works overtime on behalf of the Government, trying to treat people who need it, is his rate cut by a half, and that is an entirely wrong method. The hon. Member for East Wolverhamp-ton also said: Hon. Members are aware of the state of the priority service in dentistry and the dental service for schools. Because of the shortsightedness of the Minister the priority dental services have already to a great extent broken down."—[OFFICIAL REPORT, 15th February, 1949; Vol. 461, c. 1088–9.] —not because of anything that the wicked Tories have done, but because of what the right hon. Gentleman has done by means of his scheme. There seems to be considerable discrepancy between what the hon. Member for Barnet wrote in a newspaper, where he cannot be cross-examined, and what was said by the hon. Member for East Wolverhampton.

My right hon. Friend has pointed out one feature which may be worth taking a little further. The article has an elaborate photograph of a series of buildings surrounded by roads and growing trees, and underneath is written: First of London's great new Health Centres, to be built on the Woodberry Downs Estate by the L.C.C. I was a little surprised when I saw that. I did not know that the L.C.C. had built a great new centre.

Photo of Mr Stephen Taylor Mr Stephen Taylor , Barnet

The hon. Member has read out the words "to be built." I do not see how one could make it any clearer than that.

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

What this says is: First of London's great new Health Centres, to be built… When that is written under a photograph which has nothing to indicate that it is of an architect's model and not an original, a very large number of people would take it as I did. The right hon. Gentleman has spoken of the prostituted Tory Press. If the Tory Press be guilty of prostitution, I can only say that this article is the whore of Babylon herself. The Minister is like a plumber who has been called in to repair an old-fashioned and war-damaged water supply. Instead of seeking to put it right he has simply torn off the tap and is now shouting, "Plenty for all; help yourselves." At the same time he is defying his critics to turn off the water at the main. We are not going to turn off the water at the main. It is obvious that the people must continue to receive this health service. What we shall do, having discovered the nature of our plumber, is to sack the plumber and get another.

5.59 p.m.

Photo of Miss Alice Bacon Miss Alice Bacon , Leeds North East

I do not propose to answer the points which the hon. Member for South Hendon (Sir H. Lucas-Tooth) was trying to make because I am not sure of the line of his argument. I want first of all to congratulate my hon. Friend the Parliamentary Secretary for the way in which he presented these Estimates. He had a very good story to tell and he told it very well indeed. It was quite different from the unintelligible floundering we had from the right hon. Member for the City of London (Mr. Assheton). The fact that the Opposition have threatened a Vote of Censure shows how completely out of touch they are with the feeling of the people. All this hullaballoo has arisen because we have underestimated the amount to be spent on the Health Service. We find from the speeches which we have had from the Opposition that there is no criticism of the actual expenditure but only criticism of the fact that we underestimated what the needs of the people would be. Hon. Gentlemen opposite are in danger of under-estimating something: the popularity of this service with the people. Indeed the National Health Service is the most popular Measure ever passed by any Government in the history of our country.

I spent last week-end at Batley and Morley, where, I am quite sure, the people today will give an answer to the kind of speeches we have had here this afternoon. I heard on Sunday night in a large cinema the reaction of the people of Batley and Morley to the threatened Vote of Censure by the Leader of the Opposition. Our health today is extremely good. The infant mortality rate, the maternity mortality rate, and all the other health figures speak for themselves. The two hon. Members opposite who have spoken this afternoon said that this scheme was really the scheme of the Opposition and not of this Government. That is rather like a passage which appeared in the "Sunday Express" on 13th February written by a man who calls himself "Cross Bencher." He said: People know that Churchill stands second to none in his desire for first-rate social services. They know it was he who initiated the National Health Service, in the glory of which Mr. Aneurin Bevan now brazenly basks. I put one question to the Opposition: If this is really the health service of the Leader of the Opposition, if it is really the health service of the Opposition, and not ours, why is it that in May, 1946, the Tory Opposition voted against the Health Service scheme, both on Second Reading and on Third Reading?

I believe this attack today is quite hypocritical. This Government has spent a great amount of money on the social services. There are various groups in the country at present who are asking for more. I shall not go into the rights or wrongs of their case; they may have a good case; but it is noticeable that in recent months the Tories have been encouraging those pressure groups to ask for more services of one kind or another. How then do the Opposition reconcile that attitude with the attitude they are taking up today, which is one of advocating cutting down expenditure in the most vital of our social services?

I believe that the real reason why these Estimates are being opposed is summed up well in the leading article of the "Evening Standard" of 10th February, which started in this way: The Supplementary Estimates of £221 million deal a vicious blow to the hopes of a reduction in the standard rate of Income Tax this year. That is the crux of the criticism. In the opinion of the party opposite money has always been much more important than men. But suppose we had our reduced Income Tax, suppose we had reduced the social services, what would have happened? It would have meant that the old age pensioner, the widow, the person of small means, would not have had the reduction in Income Tax but would have had to do without the health services as they have had to do without them in the past. If it is a choice of a reduction in Income Tax and the provision of proper health services and cheap food for the people, I hope this Government will always choose adequate health services and cheap food for the people of our country.

We all know that there have been slight difficulties in the working of different parts of the Act, but having regard to the great venture which it was, it is amazing that the difficulties were not even greater. It has been suggested today that the Act should have been postponed. I do not agree. The Parliamentary Secretary said this afternoon that at the back of all the figures were people. We have all seen these people and we all know their difficulties. One case comes to my mind of a woman who came to me two years ago to see if I could get her an artificial hand. She had not had a right hand for 40 years. Two years ago I could not get her a hand from any source. She came to me again in August of last year, and I was able to direct her to the Ministry of Pensions hospital, and the hand is being supplied. If we had postponed the Health Service we should have postponed the date at which these people received the things to which they were entitled.

The hon. Member for South Hendon referred to health centres. We shall not get an absolutely first-rate general practitioner scheme until we have health centres all over the country. I hope my right hon. Friend will not be deterred in any way by criticisms of expense, from building these health centres as quickly as possible.

I was pleased to hear from the Parliamentary Secretary of the great increase in the provision of nurses. One of the greatest difficulties in getting young women to enter the nursing service is that they leave school at 15 wanting to become nurses and, by the time they are 17 or 18, they have gone into some other employment. In Leeds we have just started a scheme which I hope will be copied in other cities. Our course for girls starts at 14. It encourages the girls to stay at school and take this scheme for three years until they are able to enter hospital.

I want to say a word about a part of the service which is rather in the background. A good deal of the Supplementary Estimate for which the Minister of Health is asking today is for specialist services and teaching hospitals. I believe there has been some misunderstanding with regard to specialists. Can patients have any choice in asking for a specialist, or must it be absolutely on the first recommendation by the general practitioner? Then there is the question of domiciliary visits. I have heard of one or two cases where the patient or the patient's family thought that the specialist was paying a visit under the National Health scheme, when in fact the visit was a private one and they afterwards received a bill for so many guineas. Would my right hon. Friend make it perfectly clear to general practitioners that unless a patient, or the patient's family, specifically asks for the services of a specialist in a private capacity, that visit shall be regarded as being under the National Health Service? There has been a suggestion in one or two cases that a general practitioner has said that it would take longer to get a domiciliary visit by a specialist under the scheme, than it would to bring in a specialist privately.

My other point concerns the teaching hospitals, which include some of our greatest and best hospitals. Hon. Members will remember that at the time the Bill went through Parliament, there was a demand from some of us on this side that the teaching hospitals should be under the control of the regional hospital board like other hospitals. This was not conceded, except in the case of Scotland. The Scots hung on, perhaps, a little more tenaciously than we did, and it was granted to them.

I do not wish to weary the Committee with local matters but a situation is arising in my own city which is likely to arise elsewhere in the country. We have a large teaching hospital—the Leeds General Infirmary—which, together with the maternity and women's hospitals, has 1,000 beds and was regarded by the Goodenough Committee as sufficiently large to be a teaching unit. In another part of the city we have a large hospital which was formerly a local authority hospital. We have reached the position where the teaching hospital is asking for 500 more beds from the former municipal hospital. This request is being strongly resisted by the management committee of the non-teaching hospital, not because the management committee feel they will lose their influence in that hospital or because they do not realise the importance of medical education, but because they feel that they might lose control of the allocation of beds in the hospital.

In our teaching hospitals we still have a system of control of beds by specialists, and I hope my right hon. Friend will allay the impression that not always do the right people get into the beds so controlled by specialists. I hope, therefore, that my right hon. Friend will turn his attention to both the specialist and teaching hospital sides of the scheme. It is a great scheme, it has made a very good start and it is extremely popular with everybody. I hope that the demand by the other side of the Committee for a reduction of expenses in this, our most vital social service, will be greatly resisted.

6.13 p.m.

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

I am very glad to be able to follow the hon. Member for North-East Leeds (Miss Bacon), for I, too, have been in at the Batley and Morley By-election, but I came away with a quite different impression from that of the hon. Lady. I shall disappoint her very much, because she has tried to distort and misrepresent what has been said by us on this side. We have never recommended that these Estimates should be cut. One of my criticisms will be that certain moneys have not been spent. I hope I shall not shock the hon. Lady too much by taking that attitude. All of us in the Committee know that a great scheme like the National Health Service meets with many obstacles and difficulties before it is finally put on a satisfactory working basis. We on this side have had no doubt in our minds how much it would cost. My right hon. Friend the Member for Saffron Walden (Mr. R. A. Butler), in the Debate on the King's Speech, warned the Minister of the increased expenditure on the scheme. It is fantastic that the Minister should have tried to delude himself and his advisers, in preparing his first Estimate, that by the suggestions that the wicked Tories were quite wrong in saying the scheme would cost so much.

I listened with great interest to the excuses and reasons given by the Parliamentary Secretary of why the Government were so much out in their Estimates. It is quite inaccurate—indeed, it is nonsense and misleading—to say it was because they did not know what demands were to be made upon these services nor the terms upon which they were based. My right hon. Friend the Member for the City of London (Mr. Assheton) referred to spectacles. It is generally known, or should be known—certainly at the Ministry, for it is known by others—that the annual consumption of spectacles in this country is four million pairs per year. An hon. Member asked how many pairs have been exported. The "Journal of Trade and Navigation," which I have here, shows that all the optical instruments, of every kind, exported last year did not amount to more than one-third of a million pounds. In the previous year the figure was even less, at a quarter of a million pounds. It is impossible, therefore, to understand why the Government should budget for less than one million pairs throughout the country when they must have known that as soon as spectacles were issued free the demand would most certainly increase.

I am delighted that the Health Services are being used to such a great extent, and that when a mother visits her doctor she takes all her children with her so that they may all be examined at the same time. We are now approaching that desirable state when we shall have not only curative, but also preventive, medicine. This explains to some extent why doctors now have to work so hard. It is, however, essential that they should be contented and happy in their task, for good medicine can come only when you have the contented and satisfied doctors and equally contented and satisfied patients.

I wish to ask the Minister about the increased estimate of £2 million for the general practitioner service. The Parliamentary Secretary mentioned that £500,000, I think, was to be applied for extra travelling allowance. Where is the other £1½ million going? Is it payment for work done by doctors in the last six months in treating foreigners who visit this country or holiday-makers and other temporary visitors to our various towns and resorts? Have the methods of payment for that work and the number of people so treated yet been decided? If so, how much of that additional £1½ million will go to doctors for their services in this direction? In holiday resorts and seaside towns this can make a very large contribution towards the income of doctors.

I am equally pleased that dentists have been so overworked during the last six months for in the past Britain's teeth were not the brightest pearls in our country's diadem. I am glad that such great use is being made of this service and that people are dentally-minded and prepared to visit dentists to have their teeth filled and dentures made. The number of dentists, however, is sufficient to provide only about half the needs of the service. Unless they are to work double their normal hours it will be quite impossible for all the calls which are made upon their services to be satisfied. I must ask the Minister how his estimate could be wrong by anything like as much as £12 million for England and Wales, or by £13 million if Scotland is included. He has stated that he did not know how many dentists were coming into the scheme. Why did he not know? He used fees to bribe the dentists to come in and when he realised the amount of fees his Ministry was prepared to grant he should have known that 90 per cent. of the dentists would come into the scheme.

Photo of Mr Arthur Blenkinsop Mr Arthur Blenkinsop , Newcastle upon Tyne East

I thought it was clearly understood that the Estimates were prepared long before the Spens Committee report had been presented, and that at the time the Estimates were prepared it was quite impossible to say how many dentists would come into the scheme.

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

The Estimates were prepared, I gather, seven months before the scheme was started. It was obvious that the Minister intended to bribe dentists to come in. He has succeeded by bribery in getting 90 per cent. of them, although almost every branch of dentists throughout the country—and sometimes 100 per cent. of them—expressed their unwillingness to come anywhere near the scheme at all.

Photo of Mr Arthur Blenkinsop Mr Arthur Blenkinsop , Newcastle upon Tyne East

So far from there being any truth in the suggestion of what the hon. and gallant Member calls bribery of dentists, at that time a great body of dentists were insisting that they were not coming into the scheme.

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

The Minister very soon spoke about the amount of money he had to agree to pay to the dentists as a great public scandal and he showed great speed in introducing a regulation to reduce their salaries. It is an equally great public scandal that doctors are not being better paid. They have never worked for so long or done so much work, had so many patients to attend, and had so many forms to fill in, and received so little pay. The Minister does not show the same speed in dealing with this public scandal.

Photo of Dr Hyacinth Morgan Dr Hyacinth Morgan , Rochdale

Where is the B.M.A.?

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

I want the Minister to tell us what steps he is taking to prevent abuse of this scheme. What is done to prevent a patient getting two sets of dentures, one from one dentist and another from another dentist? Have the Ministry any method of preventing abuse?

The ophthalmic service has been underestimated for England and Wales to the extent of £11 million. Why is £11 million extra wanted for that service? Is it to provide the children with splinterless glasses, such as they could obtain before the service came into operation? That is a service which should be provided. If it is not provided from this £11 million, is it intended to include it in the next Estimate?

Photo of Mr William Griffiths Mr William Griffiths , Manchester Moss Side

The hon. and gallant Member has referred to children getting splinterless glasses before the scheme came into operation. Will he also tell the Committee that they only got them when they paid for them?

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

Yes, in exactly the same way as they got them under the National Health Insurance scheme. The Minister thought that that was generally known and I thought it was generally known throughout the Committee. What steps are being taken to prevent any abuse of this service or to prevent people from getting two, or three pairs of spectacles? It is possible to get two pairs——

Photo of Mr Arthur Blenkinsop Mr Arthur Blenkinsop , Newcastle upon Tyne East

What is wrong with that? After all, two pairs may be necessary in very many cases.

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

I am sorry if I used the word "abuse." Will the Parliamentary Secretary tell us how many pairs are permitted under the scheme?

Photo of Mr Arthur Blenkinsop Mr Arthur Blenkinsop , Newcastle upon Tyne East

When it is medically necessary to have more pairs, people can have them.

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

If a doctor recommends that they should have two or three pairs that is all right, but if a patient himself decides that he wants another pair, what check is there to prevent abuse taking place?

The Estimate for hospitals is £22,330,000 out, and I do not think it includes Scottish hospitals. How did the Ministry under-estimate to that extent, when the demand upon beds and the cost of local authority hospitals and voluntary hospitals over the past few years was known? It seems extraordinary that one could be £22,330,000 out in that Estimate. After all, over 50,000 beds are closed due to under-staffing at present. It is not as though we had put into operation all the vast number of beds previously used in this country. How is it that there is such an enormous number of beds unstaffed at present? The right hon. Gentleman has told us that the number of nurses has greatly increased from 1938 to 1948. The number of nurses has increased by no fewer than 35,000 in the last 10 years from 96,800 to 132,000. There are no fewer than 35,000 more nurses in the Kingdom now than there were in 1938 yet something like 50,000 beds are unmanned at present.

It is stated that £19 million has been spent on running costs, specialists' fees and maintenance. Can the Parliamentary Secretary break that up and tell us how much went on specialist services and how much on increased administrative services to the hospitals? He referred to the contribution made to the Ministry of Pensions of £500,000 in the whole year. Has the Parliamentary Secretary not yet read the National Health Service Act? He will see in Section 1 the first duty of the Minister. It says: It shall he the duty of the Minister of Health … to promote the establishment in England and Wales of a comprehensive health service. Why is it that the Minister permits, alongside the National Health Service, another health service, that of the Ministry of Pensions, and another, that of the Ministry of Education? The duty that Parliament laid on him was to provide one comprehensive Health Service.

Photo of Mr Arthur Blenkinsop Mr Arthur Blenkinsop , Newcastle upon Tyne East

I am sorry to interrupt the hon. and gallant Member once more. This is rather interesting. Does he suggest closing down the Ministry of Pensions service, or was it not sensible to utilise that service?

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

I do not suggest that the service should be closed down, but that it should be taken over by the Minister of Health. I do not see how we can have a comprehensive Health Service until the health services run by the Ministry of Pensions and the Ministry of Education are all under the same Minister.

Photo of Dr Hyacinth Morgan Dr Hyacinth Morgan , Rochdale

Is it not a fact that hon. Members opposite actually opposed that proposition when it was put forward from this side of the Committee?

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

Indeed, no. It has always been our policy that all health services in the country should be under one Minister. The National Health Service Act instructs the Minister that he shall set up one comprehensive Health Service in this country. Because the dental officers in our schools are under the Ministry of Education, is that the reason why the Minister of Health has shown so little interest in their welfare? The Minister has spoken on many occasions about the priority dental services for children and for nursing and expectant mothers, yet we find that there are counties in which there is not one dental officer——

Photo of Mr Somerville Hastings Mr Somerville Hastings , Barking

May I interrupt the hon. and gallant Member to ask which counties have not one dental officer

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

I think I am right in saying Hertfordshire——

Photo of Mr John Paton Mr John Paton , Norwich

That is quite wrong. I happen to be a member of the Hertford County Council and I know that is quite untrue.

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

I will withdraw and put a Question down to find out the correct number. Perhaps the Parliamentary Secretary could find it out and tell us.

Photo of Mr Samuel Silverman Mr Samuel Silverman , Nelson and Colne

The hon. and gallant Member should find out——

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

I will not give way to the hon. Member for Nelson and Colne (Mr. S. Silverman) as he speaks so often and interrupts so much.

Photo of Mr Samuel Silverman Mr Samuel Silverman , Nelson and Colne

On a point of Order. The hon. and gallant Member has made a quite categorical statement that there are county authorities without one dental officer. He has been challenged to give one instance. He has given one instance in which he was mistaken. Is there not some obligation on the hon. and gallant Member to say on what basis he advances the charge?

Photo of Mr Francis Bowles Mr Francis Bowles , Nuneaton

That is not a point of Order.

Photo of Sir William Darling Sir William Darling , Edinburgh South

Further to that point of Order, is the hon. Member who raised the point of Order right——

Photo of Mr Francis Bowles Mr Francis Bowles , Nuneaton

I have already ruled that there is not a point of Order.

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

If I am wrong I will withdraw. I will challenge the Parliamentary Secretary to clear this up by this evening by producing for us if he can—[Interruption.]—I will put down a Question so that I do not in any way mislead the House. My information is that Hertfordshire is the county that has no dental officer in its school service at the present moment.

I want to speak about the grants to local health authorities, where the Minister is asking us to vote another £6 million. Will he tell us how much of that is to be spent, or has been spent—because I presume this money is being voted because it has already been spent—on building health centres. Can he tell us how many health centres we have at the present moment? Is he prepared to have temporary health centres set up or must they be permanent and specially built health centres? Because I gather that some local authorities have recommended that temporary health centres shall be established, but the Minister has declined to permit them and says that they must wait until permanent health centres are built. These are vital centres around which our practitioner service must work in the future in this Health Scheme and it is important that we do get health centres at the earliest moment. How much of that £6 million is being spent on health centres, or has been spent during the past six months?

The Minister also gives a list of anticipated savings, and I wish to ask a question about the wisdom of having these savings during the past six months. The first is Central Health Service Council, £2,000. He anticipates a saving on that. Why is that——

Photo of Mr Francis Bowles Mr Francis Bowles , Nuneaton

I am afraid the hon. and gallant Member is not allowed to discuss savings at all.

Photo of Sir Malcolm Stoddart-Scott Sir Malcolm Stoddart-Scott , Pudsey and Otley

I am very sorry, because I wanted to raise that question of the refresher courses. I gather that I shall have to take some other opportunity of asking a Question about why money has not been spent on refresher courses and whether those courses are for doctors, and how important I consider that to be.

This large additional Estimate is in my view, due to the fact that the Minister has tried to do too much too quickly. He has built up what I consider to be an over-centralised administration. He has collected many new people to go into hospital administration who in the past have had no experience at all of administering hospitals. He has shown a great unwillingness to accept advice, or take advice, or even to seek advice. He has prevented the setting up of his Advisory Central Health Council which could have been set up long before the scheme started. Now he sets it up and expects them to help to solve some of the difficulties and problems which are of his own making. I believe, too, that we could have avoided having so large an Estimate if he had only been a little more honest with the Committee when we had the Estimate last year. Therefore I think that the Minister must face up to this issue, and I hope that he will be willing in future to seek a little more advice and to take it.

6.33 p.m.

Photo of Mr William Griffiths Mr William Griffiths , Manchester Moss Side

The hon. and gallant Member for Pudsey and Otley (Colonel Stoddart-Scott), along with the right hon. Member for the City of London (Mr. Assheton) and another hon. Member, I think it was the hon. Member for South Hendon (Sir H. Lucas-Tooth) spent some time and went into some detail, to prove that the Minister's Estimate for the supplementary opthalmic Service was wildly inaccurate. It was stated that there were statistics available on which he might have based a more realistic Estimate. We have heard from the hon. and gallant Member for Pudsey and Otley a production figure of four million pairs of spectacles per year manufactured and sold. I profoundly distrust those statistics. I do not think there were, prior to the introduction of the National Health Service, any reliable statistics upon which the Minister could have based an estimate of what was needed. Hon. Members must remember that when they speak of production they have to take into account the amount of frames and lenses that go into stock as well as the relatively small proportion sent overseas for the export trade, which is not inconsiderable.

What I think the Committee should know is whether the Minister's Estimate on the supplementary ophthalmic service was a good one or not. Do the Opposition desire the people in this country to have their eyes examined by people who are properly qualified to examine them, and to be supplied with an accurate pair of spectacles? Or do they prefer that the system which prevailed in the days of their power should be continued, namely, that large sections of the deprived population of this country should have to buy their spectacles from Woolworth's, or have them handed down through generations of the family and so on, or fall into the hands of unqualified quacks? What is the view of the Opposition? It seems to me to make very heavy weather of a relatively small point, as they have done this afternoon.

I think that these Supplementary Estimates are proof of the extent to which what I call the deprived people in the country failed to receive a health service. That is a position which the National Health Service is now seeking to liquidate. If there is a fault revealed by the Estimates it is that we on this side of the Committee, with all our experience and knowledge, failed to appreciate the size of the legacy we had inherited from the past. It really is not good enough for the Conservative Party to tell us that they too stand for a National Health Service, because we are entitled to say to the people of the country that every old age pensioner who gets a pair of spectacles and every mother who gets the set of dentures she has denied herself for years would not have got them if the Conservative Party had had their way. That is exemplified by their action on Second Reading when they voted against the principle. In my view they are today taking up a completely hypocritical attitude.

I am not particularly concerned about these items in the Supplementary Estimates. I regard some of them at any rate as being non-recurring items. It is amusing to note the way the Opposition Press talk about the dental service. I am almost terrified when I go to the dentist, whether I have to pay for it or whether it is free. But from the way the Tories talk about it one would imagine that the workers were flocking to the dentists' chairs to get the drill on the tooth just because it is free. I have never heard such nonsense in my life.

As the Committee knows, I am myself employed in the Health Service. I have an interest in that. I wish to say that in my view the supplementary opthalmic service is a great success. There are administrative faults which perhaps are now revealed, and which I believe will in time be remedied. I always contrast it with my pre-war experience when I first started my own practice in a working class area in the City of Manchester. In those days, four or five years before the war, my prospective patients knew I was in the neighbourhood, but when they came along they very often wanted to pay for their spectacles at the rate of sixpence a week. Very often they could not keep that up, and a large number of them were to be seen—it is a common sight in industrial centres in this country—trying to select a pair of glasses for themselves at the counter in Woolworth's.

I am not unaware of the financial advantages to the practitioner which are inherent in the National Health Service. I always despise the awful hypocrisy of professional men who pretend that participation in the Service is not satisfactory from the point of view of remuneration. They are all being treated extremely well. A man can say that he does not like the Service because it interferes with his personal liberty. One is entitled to hold that view, though I do not share it. It is absolute nonsense to criticise the Service from the financial point of view.

I also get a great deal of satisfaction from being able, for the first time, to devote such skill as I have to people who have a need, without having to ask how much money they have in their pocket and whether they can afford to pay for treatment. That is most satisfying. The view that the system is being abused is greatly exaggerated. My own experience and information from my colleagues show that very few people attempt to get something which they do not really need. In any event, the final decision is in the hands of the practitioner. If he is a man of personal integrity, it is up to him to have the moral courage to say that a person does not need an appliance even if he asks for one. I am aware of the fact that, human nature being what it is, when some people are met with a refusal they are a little disappointed because they cannot get what they want.

I do not think that there is any considerable frivolous demand, though it is true that the demand has been so great that the industry in this country has been completely overwhelmed. Hon. Members will be aware, perhaps from their own experience or from having heard from their constituents, that long delays are involved. I envisaged that this might be the case and I said so in the House in a Debate a month or two before the service came into operation. The main difficulty is the limitation of the industry in its ability to produce ophthalmic lenses. A relatively small industry is concerned, and it cannot be rapidly expanded. I know that the Minister is aware of the difficulty and that steps have been taken to give encouragement to people who want to develop lens production in this country. I suggest that as a temporary measure we might consider the possibility of giving speedier satisfaction to the public by importing lenses from Canada, for example. The lenses could be finished and glazed in this country. I do not know what view the Treasury would take as possibly an exepnditure in dollars would be involved.

I am sorry that hon. Members opposite did not carry the opposition which they expressed on the Second Reading of the National Health Service Bill to this stage today. I am convinced—and I am sure that they realise it despite the outburst of the right hon. Gentleman the Member for Woodford (Mr. Churchill) last Thursday—that this service is extremely popular with people of all political parties. They want it to be a success and they deeply resent the attempt by the Opposition—and I think perhaps the Press have been the worst in this respect—to exaggerate the difficulties attached to the beginnings of what I believe will prove to be the greatest National Health Service that the world has ever seen.

6.45 p.m.

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

I was grateful to my hon. and gallant Friend the Member for Pudsey and Otley (Colonel Stoddart-Scott) for putting the Debate on an even keel when it had tended to lose itself in party controversy. I should like to repeat once again that to-day we are critcising bad original estimating on the part of the Ministry and that we are not criticising the service itself. I join with my hon. and gallant Friend in welcoming the way in which this service has been received by the people and in recognising that this money has been spent on something which the country needs and which the country is glad to have. We on this side of the Committee are doing the duty of His Majesty's Opposition, which is to criticise the demands of the Crown for money. So long as there is a House of Commons which remembers its historical task, that will be a duty which will always be discharged even if it is an unpleasant task for the people who have to do it.

I was particularly sorry that the hon. Member for Barnet (Dr. Taylor), for whom I have some considerable respect and who I regret is not here at the moment, should have chosen for the title of that article in the "Daily Herald": The Tories want to axe your health because that is just the sort of unjustified political sneer which drags a national service down into the arena of political conflict.

Photo of Mr Frederick Lee Mr Frederick Lee , Manchester Hulme

Would the hon. Gentleman, on the same basis of argument, agree that the same comment should apply to the type of political sneer which can be seen in the leading article in the "Evening Standard" tonight?

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

I have not seen it, but if in fact it is as the hon. Member suggests, what I say is as much a criticism of that article as of the other article. I am sure that the Minister will be the first to agree with me that he has found it necessary to cut substantially the capital estimates which have been put up to him by the regions for next year. If I wanted to descend to the level of controversy about which I am now complaining, I would be entitled to publish an article under the heading, "The Minister of Health has axed your health," for that is what has happened. But I say that once we drag a service of this kind into that type of controversy, we are degrading something which we ought to try to keep at a higher level. I most deeply regret that the hon. Member for Barnet should have descended to that type of controversy.

There were three points in the very clear statement of the Parliamentary Secretary upon which I should like to comment. I consider that he was extremely disingenuous in the story he had to tell and we very properly, and I think very kindly, allowed him rather more latitude than we should have allowed someone else. Really he ought to have said to the Committee that one of the reasons why the Supplementary Estimate is so high is that for something like six months there was no control upon expenditure by hospitals anywhere in the country. Human nature being what it is, no one will be surprised if in those circumstances people who had had to suffer from shortages for ten years, through no fault of their own, begin to spend money freely. The Parliamentary Secretary might have owned up that that was one cause of his having to come to the Committee again. Also he might have said that very hard bargains were struck with the Minister by the doctors, the dentists, and possibly by other professions. If the Minister was to get this service on its feet, he had to give way, when in other circumstances he might have negotiated more toughly. I am sorry that those clear reasons were not given by the Parliamentary Secretary in his speech.

May I make one comment about the figure which the Parliamentary Secretary disclosed concerning the pharmaceutical services? I think he said that the number of prescriptions had increased to 128 million in nine months, and, if so, it is an amazing tribute to the efficiency of this service that it was able to withstand that strain with practically no additional staff. I am very glad to notice that the Committee is in general sympathy with that remark.

Speaking as chairman of a hospital management committee, I can touch upon one or two of the main features of the working of this service as we, working in the field, so to speak, see it. There is no need to taunt the service with bureaucracy or any of those easily-spoken words, but there are in any great organisation certain defects which seem almost inevitably to result from its size. Anyone who has been associated with this service must recognise that these defects are showing themselves and they cannot be avoided entirely in any circumstances. The Minister is trying to coordinate, and at the same time to liberate the service from some of the old handicaps under which hospitals were working, but there is a danger that fresh congestion is going to result.

When he picked up the point made by my hon. Friend the Member for South Hendon (Sir H. Lucas-Tooth) about the spending of £1,500 by a teaching hospital, I think he put his finger on one of the fundamental difficulties with which we are faced in the service, namely, the extent to which we must decentralise and the extent to which we must at the same time standardise in the interests of a balanced service. The hospital management committees were told that they would have the choosing of their medical staff of the status of registrar and below. They welcomed that freedom, but along came a directive from the regional board saying, "When you appoint your registrar, will you see that there is a representative of the regional board there, because they are interested in the appointment of these people, from whom they select their specialists." Here we have the regional board coming down to the hospital level. There is at the present time a quite unfortunate and unnecessary competition between hospital groups in the payment of salaries and wages in their efforts to obtain staff, and in offering larger sums to them. How will that be regulated?

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

But when we see, for example, a medical superintendent's secretary being re-graded as records officer in order that a higher salary might be paid to him, we recognise that there are still ways and means of perpetuating inequalities between group and group. I merely point that out to indicate that it is the Minister's problem how to prevent that kind of thing happening where he does not want it to happen.

The second point I want to make is that regions and groups want certainty. I do not think they mind very much if they are told that they cannot have certain things, so long as they do know they cannot have them, but difficulties arise when they are not certain whether they will be allowed to have these things or not. I hope the Minister will be able before long to decide finally whether the present groups are to remain. Can he also give some indication of the amount of capital which is to be available for these groups over a period of four or five years, and then, so far as he can, leave the groups to operate the service with a degree of certainty? If they can have certainty, they can do it; without that certainty, it is going to be unnecessarily difficult.

I think one can also report that there are administrative problems. How are we going to strike a balance between the voluntary work, which means so much to any hospital which has a connection with its own locality, and the work of officials of a service of this kind? A service of this kind is bound to throw more responsibility upon the officials running Somehow, we have to work out a new conception of the relationship between the officer and the management committee and the regional board. It is a new experiment in administration. Officials are bound to have much more interest in policy than in the past. These committees and boards will certainly have to have less to do with day-to-day administration unless they are to be completely submerged, and we must work out a new technique of partnership between the officials and their management committees and regional boards. It will be extremely interesting to see how this works out in practice in a great new national experiment of this kind.

I would emphasise the necessity that the senior officers of the groups and boards, and may I say also the personnel of the boards and of management committees, should be of the highest quality possible. I rather doubt whether the secretaryships of the boards and of management committees are carrying salaries sufficient to keep the type of man with the qualifications and capacity that are required.

Photo of Dr Leslie Haden-Guest Dr Leslie Haden-Guest , Islington North

Does the hon. Member want more money?

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

What I want to see is that this vast sum of money is competently spent. When we are spending millions of money, it is necessary that the people who have the effective day-to-day handling of that money should be people of adequate capacity. We should not make the mistake of putting vast sums into a machine and then under-manning it in the matter of the quality of the people who have to run it. I am only pleading that, as far as some of the more important officials are concerned, the salaries and conditions of employment should be such as to attract and hold first-class people.

The last thing I want to say does not really relate particularly to the hospital service. It was suggested by an hon. Member opposite that the record of the Opposition regarding our enthusiasm for a National Health Service was a poor one. I would remind the Committee that it was towards the end of the war that the first White Paper proposing a universal and comprehensive health service was introduced, when we had a Conservative Prime Minister and Minister of Health, Mr. Willink, and that that was approved by a House of Commons which was overwhelmingly Conservative.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

May I remind the hon. Gentleman, for the sake of accuracy, that the first Minister of Health concerned was a Liberal National?

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

Then it is even more broadly based.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

Those were the two failures.

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

We are not yet in a position to assess the position of the right hon. Gentleman in regard to such a claim. I readily accept the hon. Member's correction and will say it was begun by a Liberal National and was continued in the House of Commons by a Conservative Minister.

Two hon. Members opposite have asked why the Conservative Party divided against the National Health Service Act on the Second and Third Readings. There were several reasons. One of the main ones was that which I shall give in this last point I wish to make. We believe fundamentally that if we are to get a good health service we must grant independence to the professional men and women who have to work it. We believe that they must be primarily the servants of their patients and not primarily servants of the State. That is one of the three or four reasons why we divided against that Measure.—[HON. MEMBERS: "No."]—Hon. Members opposite will perhaps allow me to make the point, for I proposed the rejection of the Measure on its Third Reading, and I have some memory of the reasons that I gave. That Measure having been passed, I am prepared to do what I can to see that it is made to work satisfactorily. It seems to us essential that the profession should be the servants of their patients and not have. as they now have, a divided loyalty.

In so far as the right hon. Gentleman is able to leave professional freedom to the professions, so will he build up a better service than if the professions are confined as direct servants of the State working within State instructions. That is practice as against theory. For example, when we came to prepare the formulary which was published only today for the use of this service, containing certain standard medicines which may be prescribed, the Secretary of the British Medical Association and myself went to one of the right hon. Gentleman's officers, and asked "Are you proposing to prepare a formulary for the service?" We were told "Yes." Our reply was "If you prepare it in the Ministry it will be assumed that the Chancellor of the Exchequer will be sitting on the Committee which prepares the formulary, and it will get the reputation of providing for cheap and nasty medicines"—I say that not with any particular relationship to the Chancellor of the Exchequer at that time. We said "It will be far better if this is prepared by the medical and pharmaceutical professions and afterwards adopted by the Minister. Then there will be no question that it is a Ministry of Health production and that the Treasury has therefore had a hand in it from the point of view of cost."

That book has been prepared and I assume that it will be adopted by the Minister. It is in that kind of way, by not attempting to do within the Department things which are better done outside, by not attempting to circumscribe the freedom of the professions an inch further than there is any need to do so, that the Minister will be able to get the finest type of service out of the operation of this Act.

The main problem with which we shall all be faced in working this service is that of co-ordination versus freedom. I hope that whenever a directive has to be sent out, the right hon. Gentleman will pause and consider whether that directive is really necessary. If it is not, I hope that he will give instructions that it shall not be sent out. I hope that he will leave the professions, the regional boards and the management committees the greatest amount of liberty to put their enthusiasm into doing their job with the very minimum of central control.

7.6 p.m.

Photo of Mr Ernest Fernyhough Mr Ernest Fernyhough , Jarrow

It is not normally my nature to be rude or offensive, but I seldom remember having listened to so much humbug as I have heard this afternoon. Last Thursday, when the charge of the grossest carelessness was levelled at the Minister of Health, we were led to believe that the party opposite intended to go into battle in earnest and demolish once and for all the Minister of Health. What has happened? We now learn that the Minister of Health is high on their priority list from the point of view of esteem and affection. We also know that, it having revealed to the public that this attack was to be made, discretion has become the better part of valour, because the newspapers, almost without exception, have made it perfectly clear that if ever there was a vote-winning Measure, if ever there was a Measure which was popular with our people, it is this new National Health Service.

It is amazing to me that from the fighting attitude of last Thursday till this afternoon, there has been a gradual climbing down. We have now reached the position where hon. Members are all agreed that this service is most desirable. What is more important, they, are trying to make out that they have always stood for a comprehensive National Health Service. They had unlimited power from the years immediately following the last war, with the exception of two brief intervals, right up to 1939, yet millions of our people went without these services which are so necessary to a well-run community. [An HON. MEMBER: "So did the hon. Member's party in 1929 and 1931."] The first time we have had the power we have done the things which, for a generation, hon. Members opposite neglected to do.

It is true that, generally speaking, their attitude is that they believe in a comprehensive Health Service, provided that we can get it on the cheap——

Photo of Mr Ernest Fernyhough Mr Ernest Fernyhough , Jarrow

—but if it is to cost money, then, of course, there are other considerations. One hon. Member opposite talked this afternoon about the fact that the cost may reach £300 million a year. What does it matter what the figure is if the needs of our people for medical, dental and hospital treatment which they require call for such a figure?

Photo of Mr Ernest Fernyhough Mr Ernest Fernyhough , Jarrow

The Americans are not paying for our Health Service. I shall be quite prepared to debate the American loan when the occasion arises.

The Minister is blamed for not having been able to foresee the number of people needing treatment. Yet who could have expected what happened? For example, when the mass-radiology unit goes round our factories, it is revealed that hundreds of people are suffering from tuberculosis, and no one was aware of it. The same is true of a service such as we are discussing. Once we begin to provide it, the people who were denied that service previously because they were too poor, go along and take advantage of it. The right hon. Gentleman who opened the Debate for the party opposite, was most concerned because he said people had spectacles because they got them free. Has anyone ever heard such foolishness? People have spectacles because they need them. The point of view he advanced is the same as saying that one gets a hearing aid simply because it is free.

Photo of Mr Ernest Fernyhough Mr Ernest Fernyhough , Jarrow

Yes, or a monocle or anything else. One makes use of these services as and when one needs them, and the people who have taken advantage of them have obviously needed them. I can quite understand the attitude of Members opposite. As far as they are concerned, and as far as their friends are concerned, nothing has been wrong with the health services, because if a man has a deep pocket, hospitals, specialist treatment and all the rest are open to him.

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

Will the hon. Member explain away the White Paper that was introduced before the end of the war?

Photo of Mr Ernest Fernyhough Mr Ernest Fernyhough , Jarrow

That is only one of the many promises Members opposite have made to our people. Had they been returned in 1945, I believe they would have betrayed the people in that respect, just as they betrayed the people in the years before the war.

Let us look at the Estimates. Twenty-seven million pounds is, in the main, covered by the treatment given by doctors, dentists and opticians. Therefore, if there is extravagance it is a reflection upon the members of the medical and dental professions, because they are the people in whom the Minister must have complete trust. I am sure no Member opposite would go into the country and say that the dentists or doctors are prostituting their profession by giving treatment which people do not require. What is bothering Members opposite is not the Supplementary Estimate, because we know they are willing to pass Estimates of even bigger dimensions in other connections, but that this scheme has worked substantially better than they anticipated. They thought there would be so many complaints and breakdowns that they would be provided with ammunition for their party propaganda. They have been terribly disappointed. The people have given the scheme a welcome, which augurs well for our prosperity at the next election.

Photo of Mr Cyril Osborne Mr Cyril Osborne , Louth Borough

That is all that matters to the hon. Member?

Photo of Mr Ernest Fernyhough Mr Ernest Fernyhough , Jarrow

The hon. Member is now conveying the impression that we had no right to introduce this scheme.

Photo of Mr Ernest Fernyhough Mr Ernest Fernyhough , Jarrow

He either believes that we should have introduced this scheme, or that we should not have introduced it.

Photo of Mr Cyril Osborne Mr Cyril Osborne , Louth Borough

That is not my point. The hon. Member made a statement that the scheme augurs well for the prospects of his party at the next election as if that were the only consideration, apart from whether it is good for the people, or whether it is costing all the money we are getting from the Americans. It was as if all these other things did not matter, and that the only thing which did matter was whether this will do his party any good at the next election.

Photo of Mr Ernest Fernyhough Mr Ernest Fernyhough , Jarrow

If the hon. Member reads HANSARD, he will see that he has forgotten my preceding sentence. I said that the people had given this scheme such a great welcome that it augurs well for our prosperity at the next election. The people will see that the Socialist Government have done something which no previous Government undertook, and have done it at a time when the difficulties are far greater than any difficulties any previous Government has had to face.

Photo of Mr Cyril Osborne Mr Cyril Osborne , Louth Borough

The argument of the hon. Member is that this will be a grand thing for his party at the next election because it will get them votes.

Photo of Mr Ernest Fernyhough Mr Ernest Fernyhough , Jarrow

If the hon. Member will cast his mind back, he will remember that we made a pledge in "Let us Face the Future" to create a comprehensive Health Service if we were returned. What is strange to Members opposite, and what makes them so upset, is that a party observes its pledges when it gets into power.

I agree that £58 million is a lot of money, but I should like to know how many people are better off in health as a result of this expenditure; I should even like to know how many people are alive who would otherwise be dead. If we have a proper sense of values and believe in the real things of life, we must acknowledge that expenditure on the sick and to combat disease is the noblest expenditure a nation can make.

Photo of Mr Cyril Osborne Mr Cyril Osborne , Louth Borough

The hon. Member is claiming that because of this vast expenditure, the health of the people is much better than it was in the bad old days when the Conservative Party was in power. Will he ask the Minister how many hospital beds are standing idle today? He will find that it is something like 60,000. Those beds were being used in the bad old days to help people to get better.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

I am very glad the hon. Member has asked that question. When Members opposite come to debate Estimates they ought to inform themselves of the facts. There are very many more beds and nurses now than there were before the war.

Photo of Mr Ernest Fernyhough Mr Ernest Fernyhough , Jarrow

The hon. Member should realise that because people now have a free medical service, many more are receiving treatment that necessitates going into hospital. Under the old system, people who could not afford medical treatment had to carry on struggling against adversity. These Estimates ought to be considered in relation to their effect on our people. The old age pensioners, the Service pensioners, as well as the workers, would be very much worse off had these services not been provided. There is no doubt that this scheme has tended towards stabilisation during these critical years. For the enlightenment of the hon. Member for Louth (Mr. Osborne) I will quote something that appeared in the editorial of last week's "Sunday Observer": In principle it is hard to quarrel with the present social policy of the Government, bitter though its price is. It is frankly in many respects a policy of re-distributing individual income in favour of the poor at the expense not only of the rich (there are not many rich left) but of the moderately well-off. I think that is true. It is a policy with which as a party we agree and which, as a Government, we were sent here to accomplish.

Photo of Mr George Mathers Mr George Mathers , Linlithgowshire

The hon. Member must relate his remarks to the Supplementary Estimate. At present he is travelling rather far away from it.

Photo of Mr Ernest Fernyhough Mr Ernest Fernyhough , Jarrow

Surely this is part of the Government's expenditure on the social services. I am using the quotation as an illustration. It went on to say: It is natural for the middle-class to grumble at that, but its sacrifice is not without reward. It has saved this country from the bitter class struggle which threatens others.

Photo of Mr George Mathers Mr George Mathers , Linlithgowshire

The hon. Member must do as I tell him, and relate his remarks to the Supplementary Estimates that are before the Committee.

Photo of Mr Ernest Fernyhough Mr Ernest Fernyhough , Jarrow

I bow to your Ruling, Mr. Mathers, but I venture to say that if mine have been extraneous remarks, then many others have been extraneous in this Debate.

I believe that this expenditure in the Supplementary Estimate is justified, if only because it has tended to give to our people in the poorer sections an opportunity of good health that might otherwise have been denied to them. Anything which does that, tends to strengthen the forces of Social Democracy. The article from which I read a quotation stated that it has saved this country from the forces of Communism. When hon. Members opposite criticise the Supplementary Estimates, as they are perfectly entitled to do, and use arguments such as they have used tonight, I wish they would remember to use those same arguments when they are battling on behalf a shareholders and the privileged people, on questions of compensation.

7.23 p.m.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

I am glad that my hon. Friend the Member for Putney (Mr. Linstead) brought the Debate on to a rather more constructive line. I am sorry that the hon. Member who followed him did not follow that example. It is easy for hon. Members opposite to speak upon a subject of this character. They are on an excellent wicket, the health of the people. They can argue against the Opposition and put the onus upon the Opposition to reduce the Vote or to attempt to reduce it, and so make political capital. The hon. Member for South Tottenham (Mr. Messer), whose contributions to our Debates we listen to with the greatest respect on account of his knowledge, said that this was a subject not to be considered on party lines. [An HON. MEMBER: "What about the Leader of the Opposition?"] My right hon. Friend did his fundamental duty as Leader of the Opposition in this House of watching the expenditure of the State. If he had failed to discharge that duty, he would not have been worthy of the position of Leader of the Opposition.

Photo of Mr Charles Hale Mr Charles Hale , Oldham

Has the hon. Member seen the "Evening Standard" tonight. It is headed: "Vanishing millions." They have not vanished. They are still circulating. It goes on: Mr. Churchill fired the opening shots in a Parliamentary battle when he criticised the Government's demand for another £220,000,000 on the Civil Estimates, as evidence of gross financial mismanagement and the most wild miscalculations. Tonight there will be an attack on Mr. Bevan's administration of the Health Service.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

I am sure that the hon. Member for Oldham (Mr. Hale) will appreciate that I have no more responsibility for "Evening Standard" editorials than he has for those in the "Daily Herald," from which we have already had a very spectacular quotation. I am sorry that I did not have the opportunity of listening to the hon. Member who introduced the Supplementary Estimates. I say at once that the Minister of Health and his Department have faced with great enthusiasm, great vision and a certain amount of courage, the tremendous task which they had to undertake. They had to face a number of interests that were involved. It is only right that we should pay a tribute to the Ministry of Health, because of the immense task which it had to undertake in launching the health scheme upon the people.

Now I revert to the speech of the hon. Member for South Tottenham. In order to bring the Debate on to what he considered was a very high level, he said that we must not count the cost because it was a matter of human life. That sentiment is shared in every part of the Committee. Questions of human life and human health are not the monopoly of the Government of the day but concern the whole House of Commons. I defy hon. and right hon. Gentlemen opposite to prove that any hon. Member on this side is not as interested in the health and welfare of the people as is anybody on the other side of the Committee. When it comes to the expenditure of the State, it is then the duty of the Opposition to challenge it, where there appears to be waste.

I remember the day when a Socialist Administration was challenged in the House and beaten in the country on this very issue, and when the unemployed actually voted for a reduction in their own pay because they realised that the financial situation of the country at that time was in peril. I saw the Socialist Party come back to this House 58 strong, almost annihilated, because people realised that there is not a bottomless purse from which we can draw, even for health or for any other service. I would emphasise what is stated today in a leading article in "The Times," which can never be charged with any lack of benevolence towards this Government. The leading article enjoins the Government to bear in mind that however good the object of the expenditure may be, it should not exceed what the nation can afford. The Opposition know that quite well. On these Supplementary Estimates I consider that the Opposition can make a case—[An HON. MEMBER: "Make it then."]—that there is unquestionably on the administrative side, a waste of money going on.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

I could speak for a long time.

Photo of Mr Charles Hale Mr Charles Hale , Oldham

Tell us where it is?

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

The hon. Member has challenged me. I will take the hospital side, which is only one issue. I have a letter from a working man——

Photo of Mr John McGovern Mr John McGovern , Glasgow Shettleston

We have seen these working men before.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

He goes into some detail, with which I do not wish to weary the Committee. He analyses the money that is spent on the administration sector of a large hospital in London, at the expense of the efficiency and equipment of the staff.

Photo of Mr Charles Hale Mr Charles Hale , Oldham

Tell us where it is?

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

This is an extraordinary doctrine. Under the Act of Parliament, I am responsible for the administration, through the various agencies, of every hospital in Great Britain. They are all included in this Supplementary Estimate. If a charge is being made that a hospital is being extravagant, it is the hon. Member's public duty to give the name of the hospital.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

I dissent from the right hon. Gentleman. If a man employed by a certain hospital chooses to write a letter to his Member of Parliament giving detailed facts and information, he has the right to expect that Member of Parliament to respect his confidence.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

I am not asking the hon. Member to give the name of the informant, but only to give the name of the hospital. How do we know that his informant is telling the truth if we cannot investigate his charges?

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

The right hon. Gentleman will be informed of the name of the hospital in due time. The Committee forces me to read some of this letter. It says: A handsome tiled fireplace and surround was purchased for one of the administrative offices—it was the wrong size so was hastily removed to be erected in another room. A fresh surround was ordered, delivered in a few days and erected by a bricklayer working all day Sunday at double time. This bricklayer has now put in another Sunday (at double time) to erect an elaborate brick fireplace surround and arch in the board room—very intricate work—but is it necessary? An office was decorated—the colour scheme was unsuitable—the office was promptly redecorated. An expensive lino adorns offices and board room, walls are newly painted, a three-figure sum has been mentioned as the price paid for velvet board room curtains. Several clerks have been taken on in the administrative staff, at least two at increased salaries. A supply officer has been created at, we are told, a four-figure salary. Now for the other side. Now I am going to give the Committee the other side. [HON. MEMBERS: "What is the name of the hospital?"] The letter goes on: One boiler house bunker"— [Laughter.] I see nothing for hon. Members to laugh at in a boiler house bunker. They are very necessary to the hospitals— One boiler house bunker has water all over the floor when it rains—the stoker must work in water to get his coal. The other boiler house is most depressing, ill-ventilated, has rats at night, no bath. Because of bad coal, complaints are continual from the theatre, yet nothing is done to prepare a road leading to the emergency coal dump—a lorry stuck up to its axle and was towed out two weeks ago. Iron gratings in the kitchen scullery are ill-fitting. Many drain and manhole covers need replacing or repairing.

Photo of Mr Charles Hale Mr Charles Hale , Oldham

Will the hon. Gentleman tell the Committee whether, in fact, he knows that the writer of that letter exists, whether he has checked that he works at the hospital, whether he has seen that there is anything at the hospital to guarantee the truth of it, and would he permit me to point out that, according to the Registrar-General of Births and Deaths, the infant mortality rate for the first three months of the scheme fell to the lowest figure in history, 13 below the normal average. Surely, that is a much greater testimony than this anonymous letter.

Photo of Mr Henry Hynd Mr Henry Hynd , Hackney Central

Before the hon. Gentleman replies to my hon. Friend, may I ask whether what he is now reading does not contradict the argument which he is trying to lay before the Committee, because, as I understand it, he is mentioning a lot of defects which ought to be put right and is, in effect, asking for more expenditure.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

I am asking for expenditure for the right sort of things. I hope the Committee will allow me to proceed with the letter.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

The hon. Member has either a lot of nonsense or a piece of important evidence. If it is the latter I should be delighted to have it. If I rightly interpret what he is saying, there is a hospital management committee who have a defective heating system which ought to be repaired immediately, but who, instead of repairing it, have, in fact, spent their money on an expensive board room. That is a very interesting and important point. If the hon. Gentleman would give me and the Committee the information, we should be delighted to investigate it. Why, therefore, does he not give us the name of the hospital?

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

Surely, the right hon. Gentleman is not so simple as he appears. Time and again Members of Parliament have, by virtue of their position, to maintain a confidence which has been reposed in them. My hon. Friend is maintaining such a confidence, and he is being urged, I think foolishly by some hon. Members, but with full intelligence by the right hon. Gentleman, to break that confidence.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

I am sorry that the right hon. and gallant Gentleman has not done me the honour to listen to my request. I am not asking for the name of the writer of the letter. I appreciate that communications are sometimes confidential, and that without the permission of the writer it would be improper to give the name. All I am asking for—and I am sure the Opposition are anxious to assist me in my administration—is the name of the hospital.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

It will not have escaped the right hon. Gentleman that on many occasions, by virtue of giving the name of the hospital, the name of the writer is revealed.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

I have been compelled to detain the Committee a good deal longer than I had intended. I wanted to refer to many other matters, but I have not yet finished this letter. I am bound to point out to the Committee that there has been extravagance under the Act, and that this Supplementary Estimate could have been avoided but for that extravagance. It is right that I should quote a detailed letter which shows that on the administrative side of a large London hospital at the present moment the expenditure is concentrated on the administrative headquarters at the expense of the hospital and its equipment.

Photo of Mrs Lucy Middleton Mrs Lucy Middleton , Plymouth, Sutton

Is the hon. Gentleman quite sure that this expenditure to which he refers is not expenditure by the local Conservative club, spending their money out of the Woolton millions?

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

I regret that I must ask for the indulgence of the Committee to allow me to finish this letter. It goes on: Recently a door was required for erection in the probationers' quarters—an old workhouse block. The girls naturally require privacy when bathing. An old door was brought from a bombed building where it has stood for four and a half years. The very same day a carpenter was sent to another to take down a handsome mahogany door to be removed and re-hung at the entrance to the administrative block. A wireless set, intended for the use of the nurses, was placed in the chairman's office for his personal use. I say that the things that are done in this hospital for the comfort of the board are done at the expense of the essential requirements of the hospital service.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

I had intended, as I have already said, to refer to many other matters.

Photo of Mr Henry Hynd Mr Henry Hynd , Hackney Central

The hon. Member said he was going to finish the letter, but he has not finished it because he has not given us the name of the hospital.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

It is no wonder that Sir Frederick Menzies, the late County Medical Officer for London, stated on 11th December that if some drastic steps to reduce hospital costs were not immediately taken, those enormous costs might have serious repercussions on the medical services other than hospital work. I invite the attention of the right hon. Gentleman to that statement. If the costs of the hospital service at present are likely to be £200 million for a full year, next year they will be something in the nature of £240 million for hospital services alone, and at that rate of expenditure the whole of the health scheme will be jeopardized——

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

Is the right hon. Gentleman aware that 59 per cent. of the cost of a teaching hospital goes in salaries and that 54 per cent. of the cost of a non-teaching hospital goes in salaries? Does the hon. Gentleman suggest that the salaries should be reduced?

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

I do not suggest anything of the kind. I have given only one example. I am going to give another example from within my knowledge, concerning the cost of administrative services of local authorities. Let me refer the right hon. Gentleman to the ambulance service. I know of a town in the Home Counties—[HON. MEMBERS: "Which town?"] Hon. Gentlemen opposite are very sensitive about names.

Photo of Mr Charles Hale Mr Charles Hale , Oldham

On a point of Order, Mr. Mathers. The hon. Member who has the Floor has read what purports to be an original document which has not been laid on the Table, and in the course of doing so he has made what is either a true allegation or a gross and nearly criminal libel upon the chairman of some well-known hospital in London. He has told us that it is a large hospital. He has narrowed the field to two or three people who in the public Press tomorrow morning will be pilloried as having filched radio sets from the nurses and having spent public money to their own advantage.

An Hon. Member:

Ridiculous!

Photo of Mr George Mathers Mr George Mathers , Linlithgowshire

The hon. Member for Oldham (Mr. Hale) is in the course of putting a point of Order to me.

Photo of Mr Charles Hale Mr Charles Hale , Oldham

I said "On a point of Order" when I rose. I did not realise that it was necessary to make it even more intelligible to the right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot). I seek your Ruling on this, Mr. Mathers. Is it not an obligation upon an hon. Member when he is quoting from a document to lay that document on the Table of the House, having made such an allegation?

Photo of Mr George Mathers Mr George Mathers , Linlithgowshire

No. The hon. Member takes the responsibility as a Member of Parliament in quoting from a document which he has received. He is under no obligation, so far as I know, to lay upon the Table of the House a document from which he quotes.

Photo of Mr Charles Hale Mr Charles Hale , Oldham

Further to that point of Order, Mr. Mathers. Is it not a gross violation of the decencies of this Committee that when a point of Order is put to the Chair, an hon. Member opposite should shout "Ridiculous" before you give your Ruling—[Laughter.]—and should interrupt your Ruling with shouts of "Hear, hear!" and cacophonous laughter of the kind to which we are now listening? Is not this a gross violation of the rules of elementary decency?

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

May I draw your attention, Mr. Mathers, to the fact that interruptions of my hon. Friend the hon. Member for Denbigh (Sir H. Jones) have gone on continuously during his speech, and that it has been impossible for him to deliver his speech as he wished?

Photo of Mr George Mathers Mr George Mathers , Linlithgowshire

I was inclined to regret the interruptions which the hon. Member received. In reply to the hon. Member for Oldham (Mr. Hale), I must say that I cannot from this Chair be asked to become an arbiter on matters of taste.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

A good deal of my speech might have been more effective had I been allowed to deliver it in my own way, and had I not had constant interruptions from the other side. It is quite clear that hon. Members opposite are somewhat hypersensitive about some of the points in my speech.

I am going to conclude by referring to this instance of waste under local, authority administration. [HON. MEMBERS: "Where?"] I am not bound to tell the Committee the name of the place. I think that by now I can claim to be an old Member of this House. Over and over again, I have heard instances quoted by Members on the Floor of the House. It is in my discretion whether I shall tell the Minister the name of the town. All I am prepared to say is that I can verify the facts from my own knowledge. I wish to refer to the ambulance service in a town with a population of 4,000. Previous to the Health Act, at a little hospital there the ambulance service was looked after by a porter at the hospital. He was available day and night for any call. There is no record that I have been able to ascertain that he failed to attend any call to which he was summoned. In that town two whole-time men are now employed in the ambulance service at £6 a week.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

Even with two whole-time men one cannot get any service there after 11 o'clock at night; one has to go to another town. There is a nationalised industry. The Minister was quite right to introduce established officers into the ambulance service but, as is the whole tendency in State and nationalised services, constant log-rolling goes on all the time. With those two instances alone out of the large number I could have quoted, I have established that there is a gross waste in the administration.

7.47 p.m.

Photo of Dr Leslie Haden-Guest Dr Leslie Haden-Guest , Islington North

I am afraid I cannot congratulate the hon. Member for Denbigh (Sir H. Morris-Jones) on his speech. While I agree that the hon. Member should not reveal the name of his informant if that would jeopardise the employment of his informant, he might, for instance, have handed the information to another member of the medical group in the House, who could give it to the Minister in such a way that the man's name would not be revealed. There would be no difficulty whatsoever if the hon. Gentleman really wished to co-operate in making the service efficient. He is not; he is merely attacking it.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

I do not think there is any basis for the hon. Gentleman's remarks.

Dr. Guest:

The basis has been provided by the hon. Member in his speech. I must say that I regret very much that a Member of this House—a medical man of long standing—should have tied himself to what, in fact, is opposition to this service.

We have been asked what is the need for the rush and hurry to get things done so quickly. I shall give one or two very simple reasons. I am not going to discuss hospital administration in detail. One of the reasons for rush and hurry was to get the very large number of women and children, who were not provided for under the panel system, into the National Health scheme. During the operation of the panel system there were many thousands of women in this country who, because they had to pay for medical assistance when they were suffering from the after-effects of confinement and other troubles from which women suffer, did not go to the doctor because they could not afford to pay with the result that many women in this country are suffering from complaints which could quite easily have been cured if they had been dealt with at the proper time. That is one of the great advantages of the National Health Service. The same thing applies to the health of children who, before the National Health Service came into operation, could not be treated without paying for it.

There is another very important thing. I said I would not go into details, but I shall deal with just this point in general. There was a most urgent need for the grouping of hospitals in this country to secure their proper administration. Hon. Members opposite have been talking today as though the administration of hospitals was something which was marvellously efficient, which was perfect, before the introduction of the Health Service. The exact reverse is true. Those of us who had to do with hospital administration and hospital affairs and with health propaganda generally know perfectly well how very many hospitals in the past have been abominably badly conducted, most inefficiently conducted, most extravagantly conducted, and also without much consideration for the patients. I will not pursue that point but there is no doubt about it. Any hon. Member can find out by delving back a little into the past.

I want to say a few words on the subject of what are called health centres. I want to bring some reality into the situation and I hope I shall not offend any hon. Members if I suggest that they should not lay too much emphasis at the present time on the building of new and expensive buildings for health centres. Rather we should spend our energies and our efforts on building up teams of doctors working together in whatever accommodation they can find. The difficulty is not to get doctors into buildings; it is to get groups of doctors to work together. What is needed is drive in the country for the organisation of teams and I hope some of the hon. Gentlemen opposite will help in this drive, if they are really sincere. I hope they will help the doctors in little towns in the country, in areas in London, in the suburbs and in other great cities, to get together and to work together as a team so that the team as a whole will be able to supply what is required in a health centre.

A health centre should be a team of doctors working together. When we have them working together it will be easy enough to find places in which they can work. At the present time there are many old-fashioned, small hospitals in the country with about 20 beds which could be used for the purpose in the country districts. In London and other towns there are places which have been used as general dispensaries for the relief of the sick poor. They could be used as places for health centres. They are not ideal, but they could be used and we could get health centres working in those places. I hope the organisation of health centres will follow the lines of the organisation of teams; put the function before the body, put the corpus around the function.

Photo of Mr William Gallacher Mr William Gallacher , Fife Western

Is it not the case that the health centre is not a group of doctors but is a centre where the people can be treated, no matter what their trouble may be, whether it is body, eyes, teeth, ears or whatever it is; a place where they have all the equipment for giving people the very best treatment?

Dr. Guest:

I am glad that I gave way to the hon. Member for West Fife (Mr. Gallacher). When I am talking about a team of doctors I mean a team of doctors working in one place, which will be a health centre. It can be any house, any building, any dispensary, any cottage hospital which provides a suitable building. If we lay emphasis first on the building of these places, we shall find that we indefinitely postpone the coming into effect of the health centres. If we get the teams of doctors working together and then get those doctors to choose a place where they can work together and provide the services to which the hon. Member for West Fife refers, and which are necessary, we shall find that the health centres will get to work much more quickly. It is really a way of looking at the thing from the commonsense, materialist, down-to-the ground, point of view. That is the way to get the health centres working.

I must say that when I recall tonight the long history of the improvement of the medical services in this country, I can see it has been very largely the work of the Socialist organisations in the past, even before the Socialist Party was formed—the feeding of school children, the institution of school clinics, and other things. Many of these projects were violently opposed by the Conservatives and Liberals in the past, despite the propaganda of the Socialist Party. I do not think the parties opposite can complain if we do not think they are so sincere in their desire for this health work as we are on this side of the Committee, we who have worked in our party for a couple of generations to this end.

One point in conclusion. There was another urgent reason for bringing the Act into operation very quickly indeed. Medicine itself is taking very revolutionary steps forward. It will not have been forgotten how the discovery of penicillin revolutionised medical science in the war and there are many other discoveries which are being made from day to day. Purely coincidentally, I should like to mention that this week in the medical Press—in one article in "The British Medical Journal" and another in "The Lancet," two leading medical papers in this country—there are reports of staggering progress in medical work. In "The British Medical Journal" there is the account of a series of 5,000 childbirth deliveries without one maternal death—very astonishing and very great progress.

In "The Lancet" there is a description of a new discovery which has been made—I do not know where, whether in this country or elsewhere, but it has been confirmed by treatments here in St. Helen's Hospital, Lancashire, in Belgium and in America—for treatment for that most terrible affliction of Parkinson's disease, a disease which leads men and women to tremble and which finally reduces them to a condition where they are only able to lie in bed, unable to turn round themselves, unable to feed themselves or look after themselves. This new drug referred to in "The Lancet," following work done in a number of places for more than two years, throws a new light on this old disease for which at present there is no cure at all and gives a new hope. I mention these two things as indications of the immense work which is now going on.

I want to give an answer to a great deal that has been said from the other side of the House by some hon. Members who seem to regard the payment for medical services as to some extent a waste of money, or at any rate as money which is not going to bring the return they hoped it would bring. I say that money invested in health, as it is being invested in the National Health Service, is an investment of fundamental value to the whole nation. It is not a cash payment; it is not a payment out of income; it is a capital investment in health which will be of most enormous importance and value in the future. We can improve health in this country to even higher standards than is our present view, but we certainly cannot do it if we adopt the narrow, mean and critical attitude adopted by His Majesty's Opposition.

8.0 p.m.

Photo of Mr David Eccles Mr David Eccles , Chippenham

I have not the medical knowledge of the hon. Member for North Islington (Dr. Guest) and I cannot follow him into a discussion on Parkinson's disease. He ended up by saying that what we were concerned with was the investment of money in the Health Service and that is more the subject on which I wish to speak, namely, the size of this Supplementary Estimate. It makes one pause to ask whether we are really getting our money's worth. This is an enormous sum of money.

May I detain the Committee for a few minutes on the financial aspect because I do not wish to speak about individual sections of the Health Service? The Estimate is so much larger than the original cost that one asks oneself how far we are going. The Minister who opened the Debate gave us on several occasions glimpses of the fact that this is only the beginning of the Health Service. No real expansion has yet taken place. It is merely that the existing assets are being used to the full. We welcome that very much, but £52 million, added on to the cost which we were aware of before, does make one ask where this is going to end.

We have to look at these Estimates in quite a different way from the way in which we looked at them in the past. In the old days, the Treasury control over expenditure such as this, was imposed in the interest of the minority of the population who paid most of the taxes. They saw to it that the Treasury controls were there. Those days have gone, and the social services today constitute an immense transfer of wealth, not from one section of the population to another, but from everybody to everybody. That means that the Treasury control over this vast expenditure is now the concern of everybody, and, therefore, it is necessary to see how we can get those who are going to receive all these benefits as much interested in the efficient expenditure of the money as, in the old days, a very small minority of Income Tax payers were interested in Treasury control.

I do not think that at the moment the Minister has control over the way this money is spent. Let us take the cost of hospitals. Would the Minister describe to us just how he keeps control over the expenditure of the local hospital committees? In the county of Wiltshire, as I go about my business, I constantly meet people associated with either the little committee which runs one or two of the small hospitals or members of the county committee. They all say, "We are spending at a colossal rate. There is no check on us at all. We do it because now is our opportunity." We should know what sort of control there is over these hospital committees. Before the war, I was for many years a member of the King Edward Hospital Fund Distribution Committee, and that Committee took the greatest trouble to compare the accounts of the hospitals in the London area. Cost-accounting in hospitals is a new art, and it is exceedingly difficult to do. I would ask the Minister whether he is drawing on the experience of a man like Captain Stone and other accountants who advised the King Edward Hospital Fund. They appeared to me to be far ahead of anyone else in experience of comparative accounting in the hospital system.

What is likely to be the total cost of this service in the next year or two? So far as I can judge from the Supplementary Estimate, the cost borne by the taxpayer would be about £275 million in a full year. How much is that figure short of the truth already? We know that enormous teething troubles occur when one sets up a new service. The book-keeping falls into arrears and all kinds of work is beginning which entails further expenditure, a full account of which has not been rendered. What really is the cost? Would it be fair to say that now in February, 1949, the cost to the taxpayer is running at something like £320 million? I think that the Minister should be able to give us some idea on that point.

We have now reached a stage where it is absolutely necessary to depart from the sort of stand taken by the hon. Member for South Tottenham (Mr. Messer) and the hon. Member for Jarrow (Mr. Fernyhough). They both stated that the need of the people is the only criterion of the amount of money to be spent. We should all like that to be true, but, in point of fact, the choice which presents itself to us is: Shall we spend the revenue on new houses where people will be prevented from getting ill, shall we spend it on education which will teach them their way about the world, shall we spend it on Health Services to cure them when they fall by the wayside or on pensions to support them in their old age? We have now reached a point where it is absolutely necessary to balance one social service against another.

The doctrine of the hon. Member for Jarrow and the hon. Member for South Tottenham is one which will delude the people. It is perfectly possible to come to this House and make out a cast-iron case for any one of the social services. I should like to see the health centres built quickly. I have always been a supporter of the Health Service in principle. I should like to see, especially in the rural districts, many more maternity beds. There is no argument against them, except money and material resources. But, of course, it is very unpopular to produce the argument of money, and, no doubt, it is very bad electioneering tactics to tell the people of this country that we cannot afford to have all the improvements in all the social services at one and the same time.

Photo of Mr Joseph Alpass Mr Joseph Alpass , Thornbury

Supposing a member of the hon. Gentleman's own family were in need, would he put the money question before the remedy?

Photo of Mr David Eccles Mr David Eccles , Chippenham

The hon. Gentleman knows quite well that in the circumstances he has described, one would do all that one could; but the nation is also only capable of doing all it can, and the question that this £52 million raises in my mind is, first of all, is all that money necessary? Cannot we cut out some of the waste and get the same services for less with better administration? That we must leave to the Minister because it is a new service which is shaking down, and I do not know the answer, but I strongly suspect that a lot of money is being wasted. Having done that one must then say: Is it to the best advantage of the people to go on spending more money on these Health Services—and it is obvious that they are going to expand very quickly; it is implicit in all these figures that the expansion is only just beginning—is that the best way to spend the revenue, or would it be better to spend it on one or other of the alternative services?

When we are accused of not wanting the Health Services that is not true at all. What we on this side of the Committee are anxious about is that the maximum amount of money which can be devoted to the Civil Estimates as a whole should be divided in the best interests under the different headings. It is not, I repeat, right for a man so respected as the hon. Member for South Tottenham to say that nothing but the criterion of need in health matters should be applied. He must know that the need is practically unlimited, but that the money that can be applied to it is limited, and that, popular or unpopular, those two things must be threshed out, and we must face our constituents, whether Labour or Conservative, with the obvious truth that we cannot take more than a pint out of a pint pot.

Not only is it very necessary, now that this Estimate is getting so enormous, to decide the priority of the Health Service among the other social services, but surely this Estimate shows that inside the Health Service itself the priorities are not right. I am all for anyone who attempts to cure anybody with anything wrong, be it bad eyes or bad teeth; I am all for their getting a decent living. But can it really be right that the general practitioner's slice of the Health Service should be weighted against him in comparison with the others? It looks to me as though the Minister had got the priorities wrong inside the service.

If it should be, as I believe it will be before long, impossible for us to expand all the social services at once, what is the best part of the Health Service on which to concentrate? Well, the Minister knows quite well, because I have said this in previous Debates. My view has been that we ought to get the hospital system right first. This Estimate is proof that we are trying to go dangerously fast.

If the Minister can assure us that the national revenue will be buoyant, that we can take £320 million this year and more and more as the years go by, well and good, nobody would be more delighted than myself. But I see in this kind of increase in expenditure the very negation of all the appeals for restraint which the Chancellor of the Exchequer has been making.

I do not think that is the Minister's fault, except in so far as there is waste. Having introduced and passed the Act, all this expenditure flowed from it. Yet popular though the Health Service is, I very much question whether there is not something more popular with the people, and that is the value of their money.

Photo of Mr David Eccles Mr David Eccles , Chippenham

My hon. and gallant Friend supports me at a very critical moment. The effect of the Estimate upon those of us who are trying to see how the total demands upon the resources of the United Kingdom can be matched with those resources is that this galloping increase in the demands for the Health Service must be watched very carefully or the result will be inflationary. If the result is inflationary we shall not be doing the best thing by the people.

I yield to no one in desiring that the sick of our country should be cared for in the best possible way and to the maximum amount of money we can divert to that purpose. But sickness is only one portion of life; there are other things that happen. Sickness can be prevented, and there are many other aspects of life for which Parliament must care. I ask the Minister when replying to give us, if he can, some picture of how he relates his enormous increase in demands for money, materials, and labour to the whole of the Government's programme, which we should be trying to keep within bounds.

8.14 p.m.

Photo of Dr Santo Jeger Dr Santo Jeger , St Pancras South East

We have had a series of violently contrasting speeches from hon. Members of the Opposition. The hon. Member for Chippenham (Mr. Eccles) got as near as he could to saying: "Cut these Estimates. I do not care where they are cut, but in the sacred name of our other social services, we must have a cut." True, he said he did not regard that as very good electioneering. Previously we had heard a speech by the hon. Member for Denbigh (Sir H. Morris-Jones), who gloried in the fact that in 1931 the unemployed man voted for a 10 per cent. cut in his own unemployment pay. He spent much of the very considerable time for which he spoke attempting to build up a case based upon a phantom and a nebulous collection of unsubstantiated details.

We also had a speech from the hon. and gallant Member for Pudsey and Otley (Colonel Stoddart-Scott), who almost convinced us that he really did believe in a comprehensive health service; but he made one mistake, for when the hon. Member for South Hendon (Sir H. Lucas-Tooth) was speaking about nationalisation of the hospitals and indicated that he did not believe in them, the hon. and gallant Member for Pudsey and Otley nodded his very vigorous approval; he also did not believe in the nationalisation of hospitals, which of course indicates that the comprehensive nationalised health service in which he professed his belief, had to break down at some fundamental point.

The right hon. Member for the City of London (Mr. Assheton) rather sneered at the idea of free spectacles. He took the view that people only applied for these spectacles because they were free. He did not, however, go into the question of whether or not there was a need. He also made use of the term "extravagant" when talking about the dental service. Well, we have there the complete measure of the whole range of the opposition that we are getting in this Committee.

So far nobody has referred to one very important aspect of these Supplementary Estimates. I see on page 54 under E.5: LIABILITIES TRANSFERRED TO THE MINISTER:(a) Liabilities transferred in respect of voluntary hospitals nearly £14 million. Not a single Opposition Member who said he did not believe in the nationalisation of the voluntary hospitals ventured to criticise the fact that our voluntary hospitals had liabilities of £14 million because they had not been run on a paying basis; they were not paying propositions, and their liabilities, the resultant glory of the now extinct voluntary hospital system with its begging and squeezing from public and patients, had to be passed to the Minister to deal with. That £14 million is almost the largest item in these Supplementary Estimates.

We have been told that there has been a severe under-estimate of the expenditure. There has been under-estimation, but it is not under-estimation which could be measured in financial terms: it is under-estimation of the extent to which our previous maladministration had dealt with health problems and the problem of the poverty of our people. The major under-estimation in these Estimates today is the exact mathematical measure of the failure of those previously in office to deal with these problems which they have left behind.

We are told that an estimate of £2 million for ophthalmic treatment has now become an expenditure of £12 million. To which do the Opposition object? Do they object to the Estimate of £2 million or to the expenditure of £12 million? They have not said, so far. They have criticised both; they swing from one leg to the other, but never do we get a definite statement of their policy. Do they want to cut the expenditure of £12 million, or do they want to cut entirely the granting of free spectacles?

What is the Opposition's policy on dentistry? Do they want us to cut down still further the payments that dentists receive, or do they want us now to say that no more dentistry shall be provided without payment by patients? Let us have their policy instead of merely criticism and carping. Instead of saying definitely, "We do not like this service; we do not like this aspect of the service; we do not like this expenditure," instead of coming out along one of those lines, they merely criticise and carp. What is their policy? What is their policy about free dentistry and the payment of dentists? We are driven to the conclusion that they are afraid to give us their policy in this matter, as in so many others, because, as we have been told by the hon. Member for Chippenham (Mr. Eccles), these things are not good election winners.

I wonder how many hon. Members here have sat on a hospital management committee. In the old days when the voluntary hospitals were dependent upon voluntary contributions or what they could squeeze out of the patients. they were very niggardly and weighed each penny of proposed expenditure very carefully. There is a difference now. I have in mind a large teaching hospital in London. The people on those committees who were so cheeseparing about vital necessities in the old days now go round the hospital looking for ways to send up their estimated expenditure. I know a hospital where one of the officials pointed out that the electrical system of the hospital had to be reconstructed, the whole place had to be re-wired. When it was pointed out that this was a rather expensive and perhaps unnecessary business, he said that it was the committee's job to raise the expenditure as high as possible. That is one of the reasons why I do not think that autonomy in expenditure should be given to hospital management committees and why it is necessary for the Minister to retain control at the centre.

We have had no policy from the Opposition on this. Because the expenditure and the Estimates are mounting, do they want to cut the expenditure in hospitals and run the hospitals on the cheap? Do they want the treatment and care of the sick in the hospitals to suffer? They do not tell us that. They are very careful here, as everywhere else, not to say what their policy is. However, we have had hints of what their policy may be. Some hon. Members have said "Cut" and others "What is your hurry? You are making haste far too rapidly and getting on far too much. This is really our policy. We were going to do this, but we were not going to do it as quickly as you are."

We are not told even by hon. Members opposite who take that view how long their delay would be or how many people would die unnecessarily of preventable disease while they were busy working out what the interval should be. We get nothing from the Opposition in terms of human happiness and health; when we do get something concrete, it is only in terms of money. That is the real difference between the two sides of the Committee. We look at things not in terms of money, but in terms of the best possible service we can provide, but the Opposition look at things only in terms of what they will cost.

Photo of Mr William Shepherd Mr William Shepherd , Bucklow

Does the hon. Gentleman tell us that cost is the only factor preventing the most efficient service? Does he say that cost is stopping many of our sanatoria from being fully manned at present?

Photo of Dr Santo Jeger Dr Santo Jeger , St Pancras South East

I am not saying that cost is the only factor. What I am saying is that hon. Members opposite talk about cost as being by far the most important factor, and it is of that sort of attitude that I disapprove and that attitude which I condemn and will continue to condemn, and no amount of protest from hon. Members opposite will make any difference. Theirs is a totally different attitude to life from ours. Our attitude to life is not based on money, but that of the Opposition is almost entirely a monetary one.

I now come to a different matter. The Minister knows well that I have been one of his most vigorous and enthusiastic supporters in regard to the health scheme and putting the scheme across in the country. I therefore hope that he will not take it very unkindly if I criticise one aspect of his Estimates. I refer to something which I have tried to raise in the House before, the transfer of child welfare functions from the Metropolitan borough councils to the London County Council——

Photo of Mr Douglas Clifton Brown Mr Douglas Clifton Brown , Hexham

Will the hon. Gentleman be kind enough to indicate where this appears in the Supplementary Estimates?

Photo of Dr Santo Jeger Dr Santo Jeger , St Pancras South East

Certainly, Major Milner. On page 54 there appears: C.—Grants to local health authorities:Grants in respect of health centres; care of mothers and young children. These services have been transferred to the London County Council. The London County Council have set up nine divisional offices with nine divisional administrative officers. They have also appointed a nursing officer in each division, and each of these officers will have his subordinates in each of the divisions. At County Hall there are a number of chief medical officers, most of whom were formerly engaged in the hospital administrative work which has now been taken away from the London County Council. However, we still have medical officers of health in the 28 metropolitan boroughs, and there are a large number of other people in the public health departments of those boroughs who do not seem to work any less despite the fact that so much work has been taken from them and that so many other officers have been set up at the County Hall to do the kind of work which the 28 Metropolitan borough councils have been doing.

I do not know how accurate my information is, but I am informed that the cost per head in respect of the day nurseries which used to be run by the borough councils and which are now run by the London County Council has gone up from 5s. to 10s. and that most of the increased cost is entirely due to the changed method of administration. I hope I am wrong about this, and that the Minister will give a reply which will satisfy me. That is the only criticism I have to offer about the service. I approve the Supplementary Estimates, and I think that the way the Opposition have dealt with them has been shifty, dishonest, and not to the best advantage of the people of the country.

8.28 p.m.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

The hon. Member for South-East St. Pancras (Dr. Jeger) was enjoying himself so much that it seemed a pity that anybody should stop the flow of his eloquence for any reason at all. It is true that he fell into one or two fairly grave errors. For instance, he did not realise that the liabilities transferred to the Minister in respect of the voluntary hospitals, according to the statement of the Parliamentary Secretary, were balanced by the assets of the voluntary hospitals which are being taken over. Although the hon. Member attacked us very vehemently for using a financial criterion in considering these Estimates, he wound up by using exactly the same financial criterion when criticising the administration of the child welfare centres by the London County Council as opposed to the boroughs. I might retort to him, "What does it matter whether it is 5s. or 10s.? You think only of money, and we think of the welfare of the children." However, that would be silly. I trust that the hon. Member and other hon. Members who have adopted that argument will realise how silly it is when their own spokesmen find it impossible to discuss these matters without using some sort of yardstick.

It is a fact that the cost of these services is the most convenient yardstick with which to measure the efficiency which the country is getting for the effort it is putting into this. The important things are not money but labour, material and resources of one kind and another, which the money represents, and my hon. Friend the Member for Chippenham (Mr. Eccles) and other hon. Members have criticised the use which the Minister is making of them. This is not a demand for £100 million or £200 million by the Minister; it is a demand for a draft upon the resources of the nation for that amount, and what has been asked from this side is (a) is this draft really necessary, and (b) is the proper priority being applied, both within the social services in general and within this social service?

That is the whole function of the criticism of Estimates; indeed, it is why the Minister brings forward Estimates. We all know that the resources which the nation has to spend are low and that drafts must be carefully measured one against the other. The simplest example is the housing programme, where the Minister has said time and again that if it were possible to take the controls completely off and throw the reins on the horse's neck, houses could be built more rapidly than they are now. [HON. MEMBERS: "No."] The argument has been put forward that if, for instance, it were possible to purchase a much larger amount of timber abroad—[An HON. MEMBER: "Is this on the Vote?"] The argument I am bringing forward is very much on the Vote. The Minister is asking for a draft upon the resources of the country, not merely for a sum of money, and the illustration which I was giving is, I am perfectly sure, in Order or else the Chairman would have called me to Order.

The Committee has had some difficulty tonight in getting to grips with the problem, and there is a wide divergence between the two sides of the Committee. We are only beginning a long series of Debates, and there will be a great deal more hammered out on these problems. The plans for the social services are now becoming so large a part of the redistribution of the income of the country that it may well be necessary to have some sort of unified vote under which they can be discussed as a whole; just as we have found it necessary in the case of the Defence Services to bring forward a generalised vote upon which general defence issues can be debated, subsequently proceeding to an examination of the individual Estimates.

We have been in some difficulty tonight in discussing at the same time both general issues and the particular issue of administration. My hon. Friend the Member for Denbigh (Sir H. Morris-Jones) found himself at loggerheads with hon. Members opposite because he did exactly what one wants to do in the examination of administration—he went into considerable detail. I thought it was a little ungenerous of hon. Members opposite first to interrupt him and, secondly, to demand that the details which he was not desirous of giving should be given. [An HON. MEMBER: "Even if hon. Members ask for them?"] Hon Members themselves will have to give instances in this House, where they are not willing to make a public declaration, of the source of, or the area where the incidents referred to are taking place; and that is not confined to one side or another but is a general experience of Members of Parliament. My hon. Friend really went into considerable detail which, of course, Estimates have to deal with, but then they also have to deal with broad, general questions. If I may, I will address myself more to these in the closing stages of this earliest examination.

I was Minister of Health for some years, and it is interesting to recall that it must be 10 years or more since a Debate on Health Estimates took place. Before the war the Opposition did not challenge the Health Estimates because the progress of the health of the nation was satisfactory. I shall give figures in a moment to show that the improvement in the health of the nation which has taken place since the war—which we are all most glad to see, and upon which we compliment the administration—is a continuing improvement in the health of the nation which was taking place before the war and dates back for a long time.

The rate of the curve has not sensibly altered although it moved differently in certain instances. Maternal mortality has dropped rapidly, other things not so rapidly, while in some cases the curve has turned against us. In general, however, the social services in this country, the health services in particular, are the result of many years of effort by people of all parties and of all kinds of political opinion, and that result is a shining glory to the people of this country.

During the war, and before, I had the great responsibility of bringing into being the Emergency Medical Service. I had the task of organising at short notice a comprehensive service such as the Minister is organising now. I would not be too meticulous in complaining that this particular sum or the other sum has been over-estimated. But I do say that these large Supplementary Estimates demand first, the most careful consideration and, secondly, pruning wherever possible, because they represent a draft upon our national resources which are now so limited.

The accusation has been brought against us by hon. Members opposite that we were either careless of, or actually hostile to, improvement in the health of the people—a strange accusation to bring against the heirs of the party of Disraeli, who was the first man to introduce public health into the politics of this country. And will anyone say that Joseph Chamberlain and Neville Chamberlain were ignorant or careless of the health of the people? We are perfectly willing to put our record in interest against the record of any other party. I will go further and say that we are perfectly ready to state and to justify that the Health Service which is being discussed now is the embodiment of schemes brought forward, discussed, and in some cases carried into effect, by previous Governments.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

Hon. Members seem surprised at that. Will anyone say that the milk in schools scheme is not one of the most important of our health schemes today? I had the honour of introducing that, and placing it upon the Statute Book. I do not claim to have done more than added a brick to this rising edifice; but that the bricks had been added before right hon. Gentlemen and hon. Gentlemen moved into the seats of power, is absolutely undeniable.

The Government spokesmen seemed to me to defend these Estimates on the two grounds, first, that facilities for treatment have been greatly improved and, second, that the public health has been greatly improved by the expenditure of these monies; that, as one hon. Member said, there are many people alive now who otherwise would have been dead. That is a strong claim, and one to which we must naturally give the utmost consideration and deference. As to facilities for treatment, the greatest of all facilities is a hospital bed for a sick man. I thought the Parliamentary Secretary rather skated over that aspect of the Estimates when he was commending them to the House. Admittedly the hospital estimate has gone up. It was originally put at £115 million for nine months, and it is running now at a cost of £136 million for nine months or an annual cost of something like £180 million. What extra beds are we getting for this money? The Parliamentary Secretary indicated something like 6,000 beds. That, surely, is too modest a figure to justify this expenditure.

Photo of Mr Arthur Blenkinsop Mr Arthur Blenkinsop , Newcastle upon Tyne East

I did not mention beds. I think the right hon. and gallant Gentleman is confused with my reference to nurses.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

I appeal to any of my professional colleagues. The two are what we might call pretty closely connected. When we speak of a bed we do not mean something on which to lie down, but somewhere that one can get treatment for illness. When I say that so many beds have been opened I do not mean that somebody has laid down a number of sheets, but that there should be staff ready—[Interruption.] O woman! in our hours of ease,Uncertain, coy, and hard to please…When pain and anguish wring the brow,A ministering angel thou! Surely, then, I must press the Parliamentary Secretary and, indeed, the Minister. He stated that there were many more beds available than there were before the war, but how many more beds are available than during and since the war? It is well known that great sections of hospital accommodation are closed because they cannot be staffed. The Minister is asking for £180 million. How many more beds does he expect to open? That is the acid test of these facilities. I know of one large hospital region with 35,000 beds, 4,000 of which cannot be opened because they cannot be staffed. If the Minister tonight asks for this money, and if we give it to him, how many beds will he be able to open? What is his estimated bed-state for, say, this time next year? When we are dealing with facilities that is the sort of question we wish to ask and to press, because it is vital.

Photo of Mr Douglas Clifton Brown Mr Douglas Clifton Brown , Hexham

The right hon. and gallant Gentleman will appreciate, I am sure, that these Estimates cover a period only to 31st March next. It is not possible, therefore, for the right hon. and gallant Gentleman to deal with any later period.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

Let us ask, then, how many beds he hopes for up to 31st March. I wish to give the Minister more range, but on your Ruling, Major Milner, I shall hold him narrowly to the point: how many beds does he expect to be able to open as a result of this greatly increased Estimate which he now brings before us?

The shortfall, as we all know, and as, I think, the hon. Member for South Tottenham (Mr. Messer) will agree, is greatest in the field of tuberculosis: 18 per cent., I believe, of the tuberculosis beds of this country are unoccupied because they cannot be staffed. How many of these beds does the Minister expect to have open as a result of this expenditure? What is the shortfall now? What would the shortfall have been if he had not had this money? When hon. Members accuse us of wishing to cut down these grants and to stop the treatment of the sick we are entitled, I think, to reply by saying that at present there are many, many beds which are not being used for the treatment of the sick. The Committee is voting money for them tonight. We ask what the results will be, not only in the cash figure about which the hon. Member for South-East St. Pancras was so scornful: let us, then, take the bed criterion, which, he will not deny, is very germaine to the subject of health.

Our resources are again, I think, being maladministered, if I may say so, by the position in which the general practitioner is now being placed. It is admitted that the betterment factor, the Spens supplement to payments which is being allowed for the general practitioner is something like 34 per cent. These are figures far below those given by expert economists. The Oxford Institute of Statistics put the cost of living for May, 1948, at 90 per. cent. above 1938 and the National Income White Paper showed a price index in 1947 as 85 per cent. higher than in 1938. The Minister may say, "Ah, but you are pressing me here for more expenditure." But the fact of the matter remains that the fundamental factor, the foundation stone of the whole thing, the pivot—to change the metaphor—upon which everything turns, is the general practitioner; and if for the general practitioner—the dentist, the ophthalmic surgeon, the actual skilled man administering the skilled treatment; that is the practice of medicine—the payment factor of betterment is so far below the factor which is brought out by economists, we shall find a further draft upon our resources coming forward, and a draft to which every hon. and right hon. Member in the Committee would need to give careful consideration. If the remuneration of the general practitioner comes out far below what the statistical figures show that it ought to be, then I think we should all say that The labourer is worthy of his hire and that the general practitioner would need to be adequately remunerated.

The Committee will see that then the question of balance comes up again. If the money is to come, where is it to come from? That question, again, the Committee will need to address itself to now and, of course, in its major discussions later on when it is faced with the balance sheet for the whole nation in the shape of the Budget. As was said by the hon. Member for Chippenham, it is no longer a Budget which affects the rich or which can be balanced by soaking a few wealthy men. These enormous sums now inevitably fall back upon the people as a whole. The drafts which are made upon the resources of the people are reflected directly in an increased cost of living. The repeal of the Purchase Tax for instance would certainly bring down the cost of living, but until an adequate revenue is available that cannot be done. In so far as unnecessary demands are made upon the people by these Estimates the reduction of the cost of living is postponed. That is the argument we wish to address specifically to the Committee in our criticism of expenditure.

The improved health figures were referred to by the hon. Lady the Member for North-East Leeds (Miss Bacon) and other hon. Members. This is a great improvement, they said, in the vital statistics. They do show a steady and great improvement, but a steady and great improvement which was paralleled by the improvements before the war. The movement of the curves is steady. For the period 1945–47 the fall in the infantile mortality, for instance, has been eight points. That is a great and noble achievement, an achievement upon which the Government is rightly to be complimented. But in the years 1937–39 the fall was also eight points.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

All right. If the hon. Gentleman likes, we can go further back. The percentage is smaller as it continues to fall. But, indeed, to hear hon. Members, and even right hon. Members, talk one would sometimes think that no fall at all had taken place till the doors of Number 10 Downing Street opened to a Labour Prime Minister and hon. Members took up their seats on that side of the House. What I am saying is that the fall which has taken place in the vital curve is in many cases a fall which is paralleled by similar falls taking place during the period which hon. Members opposite are fond of referring to as "Twenty years of Tory misrule"—[HON. MEMBERS: "Hear, hear."] The familiar cliché and the familiar cheer, even when it is launched from the other side of the Committee.

The figures of improved heights and weights of school children are very important; but these also can be paralleled by a similar improvement which was taking place before the war. The fact is that a steady and marked improvement in the health of the nation was taking place before the war and, therefore, we must not measure these expenditures against a fall which has been initiated by these expenditures, but against a fall which was continuing before these expenditures were undertaken and is continuing now. That needs a very different angle of examination of the problem.

Furthermore, the curves are not in every case moving in favour of the Government. We do not blame the Minister for, let us say, the figures as to cancer which, as everyone knows, are moving against us; although, if Ministers and their supporters claim, as they do claim, every movement of every curve in their favour as due to their administration, they must also expect that curves moving against us all may be quoted against them. I do not say that the Minister is responsible for the rise in cancer deaths which rose from 71,688 in 1944 to 75,607 in 1946. But that shows that the main vital curves have to be considered as things of far too long standing to be altered by the operation of any particular Minister in any particular administration.

Photo of Mrs Lucy Middleton Mrs Lucy Middleton , Plymouth, Sutton

In quoting the figures concerning cancer, is the right hon. and gallant Gentleman leaving altogether out of account the Skill of diagnosis?

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

I am surely not leaving out altogether the skill of diagnosis, but these are actual deaths.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

The right hon. and gallant Gentleman is labouring very hard to pull something out. Having been Minister of Health, he should know that cancer is of all diseases, the disease most associated with old age and, as the age of the population rises, it is inevitable that the incidence of cancer should rise.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

Certainly, that is why I said I do not blame the Minister. But I now come to a curve which is not specially associated with old age and which is admitted to be one of the diagnostic curves of public health in general, the curve of tuberculosis. The Minister will know that while the curve in general in this country is satisfactory it shows a very strange slope. While it is satisfactory in the south, as one moves northwards it becomes stationary, and as one crosses the Border, it turns sharply against us. [AN HON. MEMBER: "Housing."] No, housing has not got worse. [Laughter.] Is the contention of the Government that housing has got worse? [Interruption.] Is it the contention of the Government that the maladministration of the Government has been so great that housing has greatly improved in the south of the island and fallen off in the north? Government supporters are so unfamiliar with any counter arguments that they laugh in the wrong place. The deaths from pulmonary tuberculosis in County Durham, a great industrial county, have moved up. In 1945 they were 430, in 1946 they were 414, and in 1947, 474.

Photo of Mr Douglas Clifton Brown Mr Douglas Clifton Brown , Hexham

I am sure the right hon. and gallant Gentleman must agree that the figures he is quoting have no relation to Supplementary Estimates for 1948 and 1949.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

The difficulty in which the Committee are is that the figures for 1948 are not yet fully available. I can quote, and I will quote as an instance only, the only figures for 1948 which are available. I quote them as an illustration, from north of the Border. Deaths in Scotland in 1939 were 2,717 and in 1948, 3,415, a very sharp movement of the curve against us in the year for which the Minister is asking for this Supplementary Estimate. The difficulties in which we are are very acute, but I do not think we can brush aside the fact that there are 18,000 unoccupied beds in the tuberculosis hospitals and a movement upwards in some areas of the mortality curves. As I say, in one case the deaths have moved up in 10 years from under 3,000 to 3,400. These are movements which it is certainly necessary to take into account when the Minister is asking for money he has expended on the health services.

I do not desire to detain the Committee for too long—[HON. MEMBERS: "Go on."]—I should be willing to go on for longer, but this is the third day the Minister and I have confronted each other across the Floor and I see no reason indefinitely to prolong that. But, if hon. Members wish, I should be perfectly willing to continue for a long time yet; for these are things which will have to be said and these are the foundations of the discussion upon which we are now embarking.

The real danger is that a consolidation of our expenditure at a level away above the level before the war may take place. If the cost-of-living figures are established at something like 95 per cent. above pre-war, or, still worse, if at figures 300 per cent. above pre-war, as in the case of building, the shock to the economy of the country will be profound. These are the risks that we run in passing these great expenditures, and still more in justifying them by some of the arguments which have been used here tonight. I say that the impact of taxation upon the ordinary man and woman is profound; that the diminution, the keeping down of that impact by every possible means, is the urgent duty of this House of Commons. It is no longer a matter of the public purse. It is now the matter of the ordinary man's pocket. That is what we are searching. It is the pocket of the people which is being searched by the taxation under which we are now labouring.

We consider that the examination of these Estimates which has taken place, although not as fruitful as one would have wished, has, at any rate, been the commencement of the large examination which will need to be carried out on many subsequent occasions—occasions when the greater issues can properly be debated. I do not in any way complain, Major Milner, that on more than one occasion you have reminded me that we cannot embark on a wide discussion tonight. But when the hon. Member for South-East St. Pancras was urging me to declare the whole Tory policy on health, I could not help thinking that I would run into a very immediate condemnation by you if I were to try any such line.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

The hon. Member is entitled to his opinion. Certainly I am entitled to mine. I am willing to put my record as Health Minister against the right hon. Gentleman if he wishes on any occasion or on any platform in this country or indeed in his constituency.

Photo of Dr Santo Jeger Dr Santo Jeger , St Pancras South East

If the right hon. Gentleman really means that, I am quite prepared to take him on.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

When the hon. Member has become a Minister, I am perfectly ready——

Photo of Dr Santo Jeger Dr Santo Jeger , St Pancras South East

I am sorry, I cannot give the right hon. Gentleman lessons in running away.

Photo of Mr Walter Elliot Mr Walter Elliot , Combined Scottish Universities

When it comes to a question of running away I think the hon. Member would be ill advised also to leave his record to be compared with mine. I am perfectly ready to put my record of running away against his also.

I wish simply to say in conclusion that in our view the miscalculation in these Estimates is certainly very great indeed. It is very difficult to believe that the Government having made these calculations, and re-calculations as they have explained tonight, are in every way satisfied that the new Estimates they are bringing before the Committee are correct. We therefore ask and have asked for further information. For, in general, while yielding to none, either on work on health in the past, or our desire to see a successful and comprehensive measure of health service in the present, we say that that must be combined with a rigorous scrutiny of every penny expended so that value may be obtained for it; because the nation is in no position to expend money, without a reasonable return, on any object, however desirable it may seem in itself.

9.2 p.m.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

I think I am entitled to start off what I want to say by a protest, and that is a protest against the absence of the Leader of the Opposition. [HON. MEMBERS: "Where is the Prime Minister?"] There is no obligation on the part of the Prime Minister to be here. Anyone who has been present during the Debate—and a very large number of hon. Members opposite have not been—will know by now that, while the Opposition is in need of the sustenance that may be afforded by the Leader of the Opposition, I am in no need of the support of the Prime Minister.

We really have reached the point where we should ask the Opposition to try to prevent the Leader of the Opposition from so grossly misbehaving himself as he does on many occasions. Last week he made a statement, and as usual —it has become so much the practice now that we have noticed it—he was egged on by the Conservative Press in blatant, provocative, sensational headlines about extravagance in the Health Service. He came down to the House and said that these Supplementary Estimates are indications of extravagant expenditure and maladministration. He then said, "We will examine them"—having declared the verdict first. If he had used that language after having had the three days' Debate on the Estimates, there would have been some sense in it.

But he told us today that he will consider at the end of the examination whether a Vote of Censure will be moved on us.

If indeed it is the case that this Supplementary Estimate is evidence of gross mismanagement and financial maladministration, then there is no need for the Debate, because the decision has been made by the Opposition. He said it at the very beginning. Whatever the Opposition may do about a Vote of Censure when the three days' Debate on the Supplementary Estimates is over, I am entitled to ask for a verdict on this Supplementary Estimate tonight. Obviously, after being asked for a Debate, and after being asked for it in so provocative a manner, the House and the country are entitled to receive a verdict as to what is the opinion of the Members of the House upon what has been done. Therefore, I hope that the Opposition, after I have sat down and if I have not convinced them of the error of their ways, will go into the Division Lobby against the Government.

The right hon. Gentleman the Member for the City of London (Mr. Assheton) accused me of having miscalculated through incompetence. He was out of the Chamber when the hon. Member for South Hendon (Sir H. Lucas.-Tooth) accused me of having deliberately provoked a Supplementary Estimate by Machiavellian cleverness in order to put the Opposition to the embarrassment of having to decide whether or not they would vote against it. I am not sure, therefore, whether I am to answer to a charge of duplicity or of ignorance—but I cannot be guilty of both. The trouble with the right hon. Gentleman, may I say with all respect, is that he has generally a most amiable presence, but it is always a foolish spectacle for a weak man to use strong adjectives. It is certainly foolish for him, because it creates a sense of melodramatic anti-climax to wind up so pathetic a speech by the kind of peroration that is usually reserved only for highly dramatic moments.

I say with all sincerity that I regret the atmosphere in which the Debate on this Supplementary Estimate was begun by the Opposition. The House of Commons—and I am not now speaking of any particular part of the House— ought not to allow Supplementary Estimates to go by without examination. That is a duty of the House of Commons. Indeed what I object to is not that a Debate has been requested. What I object to is the utter incompetence of the Opposition in the examination of a Supplementary Estimate and, what is much more serious—and I hope the country will take notice of it—the indifference of the Opposition. The benches opposite have been empty, or almost empty, all the evening. I have here a long list which was taken every quarter of an hour of the attendance of hon. Gentlemen opposite. I have the advantage that my Parliamentary Private Secretary counted the number present. He takes an interest in this matter. These are extracts: Conservative, 19, Liberal, 2, Labour, 72; Conservative, 35, Labour 57. I regret to say that for a considerable period the Liberal Benches were a complete blank.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

The right hon. Gentleman cannot surely be referring to the Liberal National Party?

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

I have never regarded the hon. Gentleman and his friends as anything other than Conservative deputies.

Photo of Brigadier Sir Harry Mackeson Brigadier Sir Harry Mackeson , Hythe

On a point of Order. I accuse the right hon. Gentleman of a deliberate political trick——

Photo of Mr Douglas Clifton Brown Mr Douglas Clifton Brown , Hexham

I do not think that is a point of Order.

Photo of Brigadier Sir Harry Mackeson Brigadier Sir Harry Mackeson , Hythe

Brigadier Mackeson rose——

Photo of Mr Douglas Clifton Brown Mr Douglas Clifton Brown , Hexham

I do, however, think the right hon. Gentleman might now apply himself more directly to the Supplementary Estimate.

Photo of Brigadier Sir Harry Mackeson Brigadier Sir Harry Mackeson , Hythe

Will the right hon. Gentleman deny that he saw me behind the Speaker's Chair, when I was there as a Conservative Whip, and said that he wished to get into the Debate early, and that I told him that probably Conservative Members could not be there in the strength we wished to be?

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

That has nothing at all to do with what I have said. I am not complaining about the number of Conservative hon. Members present now. I was discussing the numbers present throughout the evening, and I say that, in view of the highly sensational way in which this Debate was launched, the absence of hon. Members of the Opposition this evening is a disgrace to the House of Commons.

It has been difficult to find out from the Opposition what it is that the Minister of Health is accused of, on this Supplementary Estimate. Is it that the Opposition say that they do not mind that the money has been spent, but that there was a miscalculation? Is it the arithmetic that they quarrel about, or the policy? It has been hard to find out what they are complaining about. Are they saying that it would have been all right to have spent this money in this way if it had gone in the original Estimate, or is it that they object to the spending of the money at all? It is very necessary for us to know which of these two positions is being taken up by the Opposition.

If it is that this represents a grave miscalculation, there was no need for this Debate to proceed after what I thought—and I think most hon. Members will agree—was the very excellent opening speech of the Parliamentary Secretary. The Parliamentary Secretary broke the Supplementary Estimate into its constituent parts, and showed, one by one, how the additional expenditure arose. There was one part of his speech to which no attention has been given, and that was that, when we put in the Estimate seven months before the money started to be spent, I was still in negotiation with practically all the professions, with the chemists, with the dentists, with the ophthalmic opticians and with the British Medical Association, negotiations with whom had not then ceased. Further, the Spens Committee on specialist remuneration had not reported. All these negotiations were proceeding, but it was necessary, because of the financial procedure of the House of Commons, to put an Estimate in.

How was I to know at that stage what would be the outcome of these negotiations? I want the Committee to recollect this point, because it is a very serious matter. When Ministers, whoever they may be, are in negotiation with sections of the community, it is a very serious matter if a Minister in the middle of those negotiations is subjected to pressure lobbies and log-rolling by the sections concerned. He is engaged, or should be engaged, in defending the public interest against the sectional interest with which he is negotiating.

Photo of Sir Douglas Dodds-Parker Sir Douglas Dodds-Parker , Banbury

What about the second front now?

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

The hon. Member really should go back to his school days. It is therefore vital, if the public interest is to be properly protected, that he should not disclose his hand. Suppose I put into the Estimates assumptions that could have formed the basis of a negotiation by those professions, I should immediately have been helpless. If these figures of dental expenditure and if these figures of expenditure on the ophthalmic opticians and the chemists had been put into the Estimates by me, my negotiations would have been hopelessly destroyed from the very beginning. It was absolutely essential not to do so. I think every man who has had any experience of negotiations knows very well that if they could read in the Estimates what I estimated I was going to spend upon those services they would know at once what to ask for and what to expect. It is essential, therefore, that in such circumstances the Minister of the Crown, whoever he might be, whatever party he represents, should be able to—[interruption]—did the right hon. Gentleman say "deceive the House"?

Photo of Mr Ralph Assheton Mr Ralph Assheton , City of London

Is that not what the right hon. Gentleman did?

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

How on earth could I deceive the House when I did not know what the figures were going to be? All I could do was to put in figures based upon the past basis of remuneration. How on earth could I? If I had put in figures based upon a prospective settlement, that itself would have vitiated the negotiations. And these are the people who call themselves competent administrators! The fact is that we had to wait. For instance, there is a Whitley machinery established now, and before the Whitley machinery there is an application from the nurses for an increase in salary. I do not know what may happen to those negotiations. I do say now, however, at this moment, that I do know that a slight increase at least in nurses' salaries is essential. I know that. I do not know how much.

Therefore, when I put my Estimates in I have to put them in based upon past remuneration and if, in the meantime, in between the Estimate being presented to the House of Commons and the Vote being spent, there is an increase, there must be a Supplementary Estimate unless there is a fall in expenditure in some other place. That is not the consequence of any maladministration. These are the ordinary accompaniments of our constitutional practice for making up our Budget. It is therefore really quite foolish for hon. Members opposite to adopt the line they have adopted and to suggest either that false figures were put into the Estimates or that any miscalculations have occurred. I am astonished at the line some hon. Members have taken.

The fact is that I consider, without I think much immodesty, that the launching of the National Health Service has been one of the greatest pieces of civil administration in the history of all civil Government in peace time, and what shocked me last Thursday was the frivolous irresponsibility of the behaviour of the Opposition, and especially of the Leader of the Opposition in saying what he did, because this hospital administration and health administration is carried on in this country by 11,000 devoted volunteers drawn from all parties in the State. What the Opposition were actually doing was accusing all those bodies of maladministration. [HON. MEMBERS: "No."] The hon. Member for Denbigh (Sir H. Morris-Jones), who could not give us factual evidence, charged one hospital with maladministration. I cannot even get the name of the hospital from him. It may be that when I find the name, the majority of the members of the management committee may conceivably be members of the Conservative Party. These bodies responsible for the administration of the Health Service over the last year have given more selfless dedicated service in bringing this great scheme into operation than has ever been known in the history of peace-time government.

What we should have had from the Opposition is some commendation of the work of these men and women, and not, as we have had from them, the suggestion that in nine months already evidence of maladministration and financial irresponsibility has arisen from the administration of the hospital services. I think it is a little hard; indeed, one of the reasons why the Opposition are now running away is because they have already found out that what the Leader of the Opposition said last Thursday is almost as unpopular among Conservatives in the country as it is among Socialists.

Furthermore, the Opposition are in a greater difficulty, because as time goes by it will be necessary for us to evolve inside the administration of the Ministry of Health and inside the whole health service proper principles of administration such as those referred to in what I thought was the most thoughtful speech that came from the Opposition; I refer to the speech of the hon. Member for Chippenham (Mr. Eccles), who put this whole matter in its proper perspective. Nobody suggests that the hospital authorities should be permitted to spend whatever amounts of money they like. The service has got to be in operation at least one year before there are any comparative statistics available to show which particular management committee is not behaving itself properly.

As I understand and envisage the operation of the administration of the hospital system of the future, it will go something like this: we shall have global budgets determined for the regional hospital boards and the management committees of hospitals. Those global budgets will be worked out on principles with which hospital administrators are already quite familiar. Within those global budgets the management committees will have discretion to spend what they wish on this or that item of administration. If they spend more on one, they spend less on another. What would be undesirable would be if no management committee or board of governors could repair a pane of glass without first of all having the consent of the administration, because there bureaucracy would arise.

What we are trying to do is to work out a system of resilient administration with as little bureaucracy as possible, with as much local self-government as possible, and yet at the same time protect the public purse against extravagant administration. I believe we shall do it. In fact, I am convinced we shall do it. We shall show the world how we can centralise financial responsibility and decentralise day-to-day administration in a great service of this sort. I seriously suggest to hon. Members that it is not possible until we have, first of all, at least one year's experience behind us. That is the main answer to the charges made by hon. Members opposite who were so anxious to denigrate the Health Service.

Let them read the newspapers of the last fortnight or three weeks—the newspapers that support the party opposite. Their leading articles have been full of it. There was the case of the "Evening Standard" tonight. All their newspapers have been full of this misrepresentation, and, therefore, I at once give the hon. Member for Chipperrham his reply. That is how we conceive that the hospital administration of the future is going to work. That does not mean, of course, that where a hospital management committee is spending money extravagantly on a particular item and is neglecting its duty to the patients, it will be permitted to keep on with that neglect merely because it is not spending more money than the total. It will still be necessary for the central administration to protect the patient against the misbehaviour of any management committee or regional hospital board.

But what we have to do is to try to prevent the very thing we are charged by hon. Members opposite with having done—having a great bureaucracy. The fact is—it is a fact which other nations of the world cannot understand, and we ought to italicise it here because it is something of which we should be very proud—that the National Health Service is not administered by bureaucratic officials; it is administered, as I have said, by 10,000 or 11,000 volunteers of the various executive committees involved. What has been a source of intense pleasure to me is that I have never had any difficulty at all in getting volunteers. I have always had very many more than I could make proper use of.

Photo of Mr Cyril Osborne Mr Cyril Osborne , Louth Borough

Surely, these volunteers were working in their voluntary hospitals years before the Minister took over?

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

We need not argue that. It is also common ground, and has been for some time, that the voluntary hospital system was financially failing. Indeed, ever since—the hon. Member should really learn the facts of life before he speaks—I took office in 1945 we have been making grants to voluntary hospitals in order to keep them alive.

Photo of Mr David Renton Mr David Renton , Huntingdonshire

Would not the right bon. Gentleman bear in mind that he has taken over the voluntary hospitals' assets, which are worth many millions more than their liabilities, and also their voluntary Endowment Fund of £17 million?

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

We had this all out when the Bill was before the House. The amount of money we are finding with which to keep the voluntary hospitals, vastly exceeds all the money in their Endowment Fund. Once again, the hon. Member does not know what he is talking about. If he wishes to have the figures, and if he puts down a Question for that purpose, I will give him the figures, and then on this matter he will be for ever silent.

One of the items of expenditure which has produced this Supplementary Estimate was the increase in the remuneration of student nurses. I was asked by the right hon. Gentleman how many hospital beds would be brought into use by this expenditure. How can I tell? I cannot tell until I know what the wastage is going to be, and what is going to be the effect of increased pay on student nurses. I cannot tell what is going to be the effect on recruitment in the nursing field of having raised the standard of remuneration of domestic staff. But I want to point out to the Opposition that this is a profession in which we were having great difficulty to recruit girls because of the bad way they had been treated by the Opposition. It is a matter of pleasure that the Parliamentary Secretary has been able to announce that not only have we reversed the tendencies of the last 10 years or so, but in the course of last year we have actually added 6,000 to the number of nursing staff.

Photo of Mr Cyril Osborne Mr Cyril Osborne , Louth Borough

But the right hon. Gentleman is not using all the beds.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

Of course we are not using all the beds that we have in our institutions, but if this increase had begun earlier these beds would now be occupied by patients.

Photo of Mr Cyril Osborne Mr Cyril Osborne , Louth Borough

The right hon. Gentleman has 60,000 beds empty today which were full before the war.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

I suggest that the Opposition should organise a little school and take some of their back benchers into that school. I have already informed the hon. Gentleman that there are many more hospital beds in existence today than there were before the war. There are many more beds occupied than before the war, but the need is very much greater now than it was before the war, and that accounts for the fact that some beds are still empty.

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

Will the right hon. Gentleman give us a little lesson which will explain this point? Why is it that one of the greatest areas in the matter of the difficulty of recruiting nurses was the London County Council service which for 25 years has been under Socialist administration?

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

I will give the hon. Gentleman his answer. It is because in London it was the practice to take all the interesting cases into the teaching hospitals and the chronic sick into the L.C.C. hospitals. As the hon. Gentleman wishes to be taught, I will give him another answer. It is this: the teaching hospitals of London have, for reasons obvious to everybody, always been more attractive to nurses and, therefore, it was very much more difficult to get nurses in the local government hospitals. Those two facts combined resulted in what the hon. Gentleman has described, and that is why the committees responsible for reorganising the hospitals have insisted that the teaching hospitals should take their proper proportion of the chronic sick. If there are any more questions, I shall be delighted to answer them.

It was obviously impossible for us to know to what extent spectacles and dental operations would be required. I have been accused of not having made use of the statistical information that was available, but there was no statistical information available. The National Health Insurance statistics have not been of any use since 1939. How did we know what was going to be the demand? But I will point out to hon. Members that, both in this field and in many other fields, whenever we have been able to relieve in any way the burden of suffering of the people of Great Britain, the burden has always proved to have been heavier than we ever thought it would be. The same thing is true in the housing field; the same is true of pensions. It is an unhappy fact that past conditions concealed a vast amount of inarticulate misery and pain. As these great services come into operation that darkness is now moving into twilight; and before very long will move into the light of day, and we shall see exactly what it is. In so far as these figures represent relief of genuine need, everybody ought to be proud of them; but in so far as it is suggested they represent abuse, point out where the abuse is. If there is abuse, let us co-operate in getting rid of it. But first identify the abuse, and do not merely make generalisations that smear the whole service.

Although the newspapers and hon. Members' letters are full of complaints from this or that person about this or that doctor, dentist, optician or hospital, I would remind hon. Members that only malice is news. Remember the vast majority of people who are really satisfied with the service but never mention it at all. This service was not launched in harmonious circumstances. In fact, no medical service in the world has ever been launched in harmonious circumstances. As our example here is followed by other nations—and they will follow it —we shall read of the difficulties that other Ministers of Health will be going through; and I venture to suggest that it may be that even the Conservative Party will have a few fleeting moments of pride about their Ministers of Health, because they will find that those other Ministers of Health might not be able to get this great scheme into operation so easily.

I could, of course, have emerged from this examination perfectly clear of any charges of arithmetical inexactitude. All I need have done was to have failed as an administrator to have emerged successfully as an arithmetician. And why? Who suspected before 5th July last that in six months, before the end of 1948, these figures would have emerged? Who would have said that we would have in the service many more general practitioners than we ourselves thought would have come in? Who would have suspected that 95 per cent. of the population would have registered with general practitioners by the end of the year? Who would have said that by now even in the most obdurate of all the professions—I do not want to make too strong a statement—the profession whose ethical standards as a profession are not as high as they might be, the dental profession, we should have got 92 per cent. of the dentists in? As these people came into the service, naturally the expenditure went up. But that mounting expenditure was an expression of an administrative success, because if they had not come in I would not have had a deficit: I would have had a surplus, and I would then be praised by the Opposition for being a financial success and a failure as Minister of Health. It is just because all these services expanded so quickly, so harmoniously, and so fruitfully that we find ourselves with this deficit.

Although this financial burden is great, we must nevertheless set off against it the enormous sum of misery we have already alleviated, the general hopes we have already created, and the good health that already starts to flow from what we have done. Why do not right hon. and hon. Gentlemen opposite start ceasing to be so sour? Why is it that as the health of the population goes up, their spirit goes down? The Tory Party used to represent itself as a jocund party. [HON. MEMBERS: "What?"] They do not understand English now. I will give them a clue: How jocund did they drive their teams afield. However, that has all gone now. Pale and miserable lot, instead of welcoming every increase in the health of the nation, the buoyancy of the nation and the vitality of the nation, they groan at it. They hate it because they think it spells electoral defeat.

I have sympathised with hon. Members opposite this evening because they have had a really difficult task. They began by attacking this scheme. Especially in 1947, their hopes were raised because they thought that the economic difficulties into which the country was getting over the balance of payments would result in the jettisoning of the health scheme. Right hon. and hon. Gentlemen opposite have spent most of their time saying how much they approved of the health scheme. I am perfectly entitled to rejoin by saying how much they tried to stop its birth. They always hoped that it would be shipwrecked on the initial difficulties of launching. Indeed, not only did they hope that, but they connived at it.

We have only to go back to 1947 and 1948 to see what the Conservative newspapers were doing and how the Tories were conspiring with some of the most reactionary elements in the medical profession at that time. Mark this, they voted against the Second Reading and they voted against the Third Reading. It is a convention of Parliamentary practice that if one votes against the Bill on Third Reading, one objects to it in principle. One very rarely votes against a Bill on Third Reading if one does not object to the Bill root and branch. That is what hon. Members opposite did. As the scheme has gone on and grown in popularity, they have been trying to forget that dreadful past and they are trying to pretend that they were for it all the time. The Conservative Party has always been in favour of reform in the abstract and against every reform in particular, and exactly the same thing has happened on this occasion.

Later on, when we had negotiations with the dentists and the other professions, we met with hostility. I met with pressure in the House, and every Thursday I was pressed as to why I did not come to an agreement with the dentists and why I did not come to an agreement with the doctors. Instead of supporting Ministers in the negotiations with the professions, the Conservative Party organised itself into a series of pressure lobbies in the Press, pressure lobbies all over the country against every single thing. What they are now saying to the country is, "We were never against it. It is quite true that we voted against it, it is quite true that we agitated against it, it is quite true that we plotted against it, but we were really in favour of it all the time." They say, "You must not read our intentions from what we have said, because we really mean the opposite of what we are doing." Therefore, when the Conservative Party tells the country to vote against us, they do not really mean it, they mean that the country should vote for us.

Really hon. Members opposite ought not to have started this Debate. I say that as this great scheme unfolds itself, it will be necessary for anybody who occupies this position to have the support of the House of Commons in seeing to it that the money which is spent upon the health services is spent where it is intended the best good should be done, and that is not upon doctors. That is for the hon. Member for Denbigh, too, because the hon. Member was organising himself into a small pressure lobby for the doctors.

Photo of Sir Henry Morris-Jones Sir Henry Morris-Jones , Denbigh

The right hon. Gentleman has been enjoying himself very much for the last five minutes, during which he made more inaccuracies than I have ever heard. Would the right hon. Gentleman deny that during the Committee stage of the Bill most of the constructive Amendments were moved from the Opposition side?