I beg to move, That the Bill be now read a Second time.
Both in the debate on the social services on 19th March and again in the Ways and Means Resolution prefacing this Bill, I have referred to the Government's proposals which form the contents of the Bill to which I am asking the House today to give a Second Reading. During the debate on the Ways and Means Resolution, both my hon. Friend the Financial Secretary to the Treasury and I emphasised that the object of the Bill was two-fold. The first relates to the proportion of the cost of the National Health Service which is to be financed by a direct contribution from all insured persons. This contribution is not new. The Bill merely seeks to bring into line with current costs and earnings something established in 1946 and which formed part of the National Health Service Act, 1946.
The second object, which is new, is to establish a separate Health Service contribution, as opposed to the present method whereby the contribution forms part of the National Insurance contribution. I propose to discuss briefly each of these objects before dealing with the contents of the Clauses. I am not sure to what extent it will be in order to debate today the total expenditure on the National Health Service, but on a recent occasion I have informed the House that the total cost of the National Health Service for Great Britain rose from about £ 450 million in 1949–50 to an estimated expenditure of £ 690 million for the current year, 1957–58.
Although much of this increase is, of course, due to the increase in earnings and prices, there has been a substantial increase in real terms. If the current year's estimate of £ 690 million is adjusted for changes in the Consumer Price Index since 1949–50, the figure comes to £ 515 million, representing an increase of about 15 per cent., or £ 65 million during the period. That is an increase in real terms. I mention this in case any hon. Member today falls into what would be the error of suggesting that there has been a reduction in the real expenditure on the Health Service in recent years.
The right hon. Gentleman will agree that even that does not take account of the increase in population and matters of that kind to which the Guillebaud Committee gave attention.
I accept that, but I hope that the hon. Member will take the point that in real terms there has been an increase and not a decrease in the period in question. Moreover, I hope that he will accept that though he and many hon. Members, including myself, claim that much more needs to be done, it is undeniable that during this period there has been an advance in almost every branch of the Service.
As you, Mr. Speaker, will probably tell me, the Bill, however, is not concerned with the total finance provided, but with the method of financing the Service. Of the total estimated cost of £ 690 million for this year, about £ 550 million, under present arrangements, would have fallen on the Exchequer, compared with £ 345 million in 1949–50. That figure would have represented 80 per cent. of the total cost, and compares with the 72 per cent. which it was estimated, in the original calculations made in 1946, would fall upon the Exchequer. The Government, therefore, have decided that this heavy and growing burden is more than the taxpayer can reasonably be expected to bear.
It would seem to me obvious that no Government can allow any particular service to impose a completely unlimited annual charge on the Exchequer. Indeed, the party opposite, when it formed the Government, as late as April, 1951. affirmed its intention at that time of working to a ceiling of £400 million. I am sure that my right hon. and hon. Friends are waiting today with interest to hear what the Opposition would have done to maintain the limit it set on the proportion of the cost which could reasonably fall upon the taxpayer. Of course, I accept that it would have been possible — and this might have been the method of the party opposite— to reduce the scope of the service by removing some part of it, perhaps the dental service, from the National Health Service. Alternatively, it would have been possible to impose further charges upon patients.
In this Measure, the Government decided that none of these possibilities commended itself to them. They decided that the proper course was to increase the direct contribution in accordance with the rise in earnings and costs. There are at least three very good reasons for adopting this approach. In the first place, surely it is better, within limits, and consistent with past tradition, that people should be asked to contribute when well towards the cost of the burden which would fall upon them when they are sick. The idea is in no sense a new one. It was adopted by the Opposition when they introduced the National Insurance Act in 1946 and, in that Measure, provided for the existing National Health Service element in the National Insurance contribution.
After all, the facilities of the Health Service are available to everyone on a basis of equality. It is, therefore, reasonable, in my view, that there should be a contribution from everybody during the period in which they are fit and well towards the cost of a Service which helps them when they are sick and in youth and in old age, when they do not contribute to it.
The second reason is that the share of the total cost met from the existing National Health Service contributions is now far less than was ever contemplated. When the original National Health Service Bill was before Parliament it was expected that the contribution from the National Insurance Fund would pay for about 20 per cent of the gross cost of the Service. In 1956–57, that is last year, the contributions provided approximately 6 per cent. only of the total cost. Despite increased earnings, the contributions to the Health Service during the last ten years have remained unchanged at approximately £40 million a year.
Although people will appear, therefore, to be making a greater monetary contribution to the cost of the Service when these new rates are in force, they will, in fact, be providing in this way only about 11½ per cent. of the total cost, a figure considerably less than the 20 per cent. estimated before the Service started. Even after the increase in contribution, the proportion of the cost falling on the Exchequer will be greater than was envisaged in 1946.
My third reason is that incomes have been steadily increasing since the present National Health Service elements were fixed. Average earnings today are approximately twice what they were in 1946. For these three reasons there is nothing new, or, to my mind, particularly immoral, in the first object of this Bill, that is, to double the contribution.
At the same time, it seemed wise— and this is the second object of the Bill — to take the opportunity to do everything possible to remove the frequent misunderstandings that either all or none of the National Health Service is financed by weekly contributions. In fact, when this Measure is enacted about three-quarters of the cost will still be found by the taxpayer and the remainder from contributions, from charges, from rates and from superannuation contributions— I repeat, about three-quarters will be the share found by the taxpayer,
Hitherto, the contributory element towards the cost of the Health Service has had no separate existence from the insurance contribution and the money has been paid over in the form of a lump sum from the National Insurance Fund. This Measure will rid the National Insurance Fund of responsibility towards the Health Service. Although, for reasons which I shall explain later, the health contribution will be collected by the Ministry of Pensions and National Insurance on behalf of the Secretary of State and myself, it will be regarded as a separate contribution, and we shall do everything possible at the appropriate time to make it clear to the public that a proportion, but only a proportion-11½ per cent.— of the cost of the Health Service will be financed by weekly contributions; and the stamp itself will indicate separately the health contribution. I will say a word about this in due course.
I now turn to the contents of the Clauses themselves. Clause 1 of the Bill provides that as from the appointed day every person who pays, or is liable to pay, contributions under the National Insurance Acts, whether an insured person or an employer, shall be liable to pay contributions towards the cost of the National Health Service. These contributions are to be known as "National Health Service contributions" and the new rates are set out in the First Schedule to the Bill.
This Clause gives effect to an important basic principle in determining liability for the payment of the new contribution. As I said earlier, the intention of the Government is that those who might need the Health Service when they are ill should contribute to it when they are well. Moreover, on administrative grounds it is essential that the Health Service contribution should be collected with the National Insurance contribution. Duplication of the collection machinery would incur tremendous expense and would be quite unjustified.
The same criteria for liability have, therefore, been adopted as applied to the existing weekly payment towards the cost of the National Health Service which is included in the National Insurance contribution, namely— and this is important— that payment of the one contribution is directly dependent upon payment of the other. At present, whenever the National Insurance contribution is paid, whether by persons who are statutorily required to pay such a contribution or by persons who are not liable to pay contributions but who may do so if they wish, a Health Service contribution is also collected. The same principle will apply throughout to the new increased Health Service contribution.
The existing National Health Service elements— those paid at present in the weekly National Insurance contribution — are as follow: for a man 10d.; for a woman 8d.; and for a juvenile 6d. In the case of employed persons, 1½d. of this money is regarded as payable by the employer. Under subsections (2) and (3) of Clause 1 of the Bill, together with the First Schedule, the weekly Health Service contributions will become, for a man, 1s. 8d.; for a woman, 4d.; and for a juvenile, 1s., with 3½d. of these amounts payable by the employer in the case of employed persons.
Broadly, therefore, the National Health Service contributions have been doubled with, however, an adjustment between the employers' and employees' shares to ensure that, for administrative convenience, halfpennies do not occur in the combined employers' and employees' contributions. Altogether, the increased contributions will provide roughly £80 million a year compared with the present £40 million a year.
Subesection (4) of Clause 1 provides that the Health Service contributions are to be collected by the Minister of Pensions and National Insurance on behalf respectively of the Minister of Health and the Secretary of State for Scotland towards the cost of the Health Service.
Clause 2 deals with the effect of the new Health Service contribution upon insurance rates, and under this Clause payments hitherto made out of the National Insurance Fund in respect of the cost of the Health Service will cease. These payments amount to about £40 million in a full year. The new, reduced National Insurance rates of contribution are set out in the Third Schedule to the Bill.
Clause 3 makes the necessary provisions for ensuring that the Health Service contributions and the National Insurance contributions are collected together as one combined contribution, and that the appropriate provisions of the National Insurance Acts, and the regulations made under those Acts, relating to collection and enforcement, apply to the combined contributions.
As I have already mentioned, for reasons of convenience and economy it is not proposed to set up a completely separate system for collecting the Health Service contributions. The reduced National Insurance contribution and the new Health Service contribution will thus be collected together, so that where they are paid by stamp, a single stamp will continue to be used.
The fact that the Health Service contribution is separate and distinct will, however, be made clear in the first place, and in the immediate future, by the inclusion of the overprinted words on the existing stamp "includes (rate) Health Service". Thus, on each stamp there will be an indication of the rate of the Health Service contribution. When an entirely new stamp design is introduced, words will be incorporated into the design to make it quite clear that there are separate National Insurance and National Health Service contributions.
There are only two further points in Clause 3 which I should explain to the House at this stage. Subsection (4) has already been forecast by my hon. Friend the Financial Secretary to the Treasury in the debate on the Ways and Means Resolution. This subsection repeals the present rule that the Health Service element in the National Insurance contribution is allowable as a deduction from income for Income Tax purposes.
As my right hon. Friend the Minister of Pensions and National Insurance stated in a Written Answer given on 17th April, the Government do not consider that tax relief should be given on a contribution of this nature. If it were to be given, of course, it would have the effect that the higher the income earned, the less, in effect, would be the cost to the individual taxpayer of his contribution to the Health Service. This subsection secures that the Health Service contribution paid by the insured person, or in the case of a domestic servant, by the employer, shall no longer rank for Income Tax relief.
It will, however, be open to employers in other cases to claim such relief where appropriate, as a business expense, and, as I said in the earlier debate, I would say to those who may be tempted to regard this Bill as a regressive Measure that this particular provision remedies what may well be considered a regressive provision which has existed since 1946.
The other remaining point on Clause 3 concerns subsection (7), which deals with the masters and crews of foreign-going ships. A reduced rate of National Insurance contribution, including a reduced Health Service element of ½d. instead of 1½d., is at present payable by the employer in respect of such persons domiciled in the United Kingdom because of the wages and the health services he is by Statute required to provide for seafarers during periods of incapacity abroad. Quite rightly, I think, is the intention under the Bill to continue to provide by regulation for a reduced National Health Service contribution to be paid by the employer in these cases. The contribution which we have at present in mind, and which will be brought in by regulation, will be 1½d. instead of 3½d.
The second point about this subsection concerns the power to except from payment under paragraph (a) of subsection;(7). This power is intended to be used for employers of masters or members of crews employed on foreign-going ships who are not domiciled in the United Kingdom.
May I ask my right hon. Friend a question? He said a moment ago that the employers' contribution would rank for relief as a business expense for Income Tax purposes. [HON. MEMBERS: "No."] Suppose the employer is a corporation. Presumably, as has always been the case with National Insurance payments, the employer's contribution would rank as a charge for calculating liability both to Income Tax and Profits Tax?
I should like to look at that point. What I said was that employers' contributions could be treated as a business expense. I was dealing earlier with employers who are employers of domestic servants and other individuals who at present claim, or are allowed to claim, the National Health Service element as a tax expense, but I will take note of the point made by my hon. Friend.
To say that it is to be allowed as a business expense is only using other words with precisely the same meaning. Employers are allowed to set it off against their Income Tax claim. Do I gather that that will apply to the employers' proportion, which is now to be 3½-d. as their contribution towards the National Health Service, so that they will be able to set it off as a business expense?
As I understand the position, it will in future be possible for any employer to claim business expense relief under this heading, but it will be a very limited measure, as compared with the present arrangement, which is of much wider application.
May we get this point clear before we proceed? There will be a National Health Service contribution, a portion of which, to which we shall be referring later, will be paid by the employer. Hitherto, the contributor and the employer have both been allowed to set off this particular part of the contribution against Income Tax. As I understand the position, there is to be a separate Health Service contribution, and of this separate contribution, which is to be doubled, the contributors, meaning ourselves, will be unable to set it off against Income Tax, while the employers will be allowed to do so. It means, therefore, that the contributors, including the lowest-paid contributors, will get no advantage, but that the employers will get an advantage. Is that the right interpretation of the Bill?
I think that the right hon. Gentleman has got it right, but it does not affect the point I was making earlier. Under the existing arrangements, the higher the income the less the contribution paid to the Health Service, and, therefore, so far as the individual is concerned, the amendment now being made in this Bill is the opposite of a regressive measure; but this matter can be discussed further at appropriate stages of the Bill. I am not trying to delude the House in any way.
To return to the point I was making about foreign-going ships, this is dealt with in Clause 3 (7). The power to except from payment is intended to be used for employers of masters or members of crews employed on foreign-going ships who are not domiciled in the United Kingdom. The contributions paid by the employers in these cases contain at present no separately identifiable Health Service element, and these contributions are not paid into the National Insurance Fund, but are applied wholly for the purposes of the Merchant Navy Welfare Board and the Seamen's Special Fund. It is the intention to continue this provision, and the regulations under this subsection will be subject to the negative Resolution procedure.
Clause 4, together with subsections (4) and (5) of Clause 1, contains the financial provisions. Briefly, the procedure will be that the contribution will be collected by my right hon. Friend the Minister of Pensions and National Insurance, who will pay the money received, less the expenses of collection, to the Secretary of State for Scotland and myself. This money will strictly require to be paid into the Exchequer, but, in accordance with a direction to be given by the Treasury, will be applied as Appropriations in Aid of the National Health Service.
The only other financial supplementary provision which may be of interest to the House is contained in Clause 4 (4). At present, payments are made to Northern Ireland and the Isle of Man in respect of National Insurance contributions, including, of course, the existing Health Service elements, attributable to members of Her Majesty's Forces treated as belonging to those two countries, and also in respect of seamen employed on foreign-going ships whose homes are in Northern Ireland and the Isle of Man. This subsection will ensure that the Minister of Health pays over the Health Service contributions in respect of the same categories of persons.
Clause 5 of the Bill enables the Government of Northern Ireland to pass legislation for purposes similar to that contained in this Bill. Under the Government of Ireland Act, 1920, the Northern Ireland Parliament is precluded from legislating in respect of the Crown, and is subject to certain other restrictions, and these two Clauses enable it to pass legislation for all purposes.
I hope that I have made clear to the House both the objects of the Bill and the contents of its Clauses. Perhaps I should say that my arguments apply with equal force to Scotland as they do to England and Wales. I have no doubt at all that arguments will be advanced to the effect that the increased charge will bear heavily on those least able to bear it, but two considerations should be borne in mind.
First, no one who is not already liable to contribute to the Health Service via the National Insurance Fund will be compelled to contribute as a result of this Bill. The existing exemptions and optional classes will continue to apply. For those who do contribute, I would again remind the House that the new weekly contribution of, shall we say, 1s. 4½d. which an employed man will make under this Bill, will impose no more of a burden on him than did the 8½d. under the original Measure.
I realise, of course, that for a great many people an extra 8d. a week is not easy to find, but I would point out to those who speak for them and to those people themselves that three-quarters of the cost of the Health Service— more than was originally envisaged— will still be found out of general taxation. Those categories which do contribute will find that for their contributions they will be getting extremely good value for their money in the Health Service.
I am convinced, therefore, that this Measure, which, I can say, has been received with general approval— [HON. MEMBERS: "No."] As far as I have been able to judge from my own correspondence and comments in the general Press, it has been received as a sensible Measure with general approval, and is desirable, not merely in the interests of my right hon. Friend the Chancellor of the Exchequer, but because it is in the interest of the National Health Service that there should be a contribution of this nature; and, for that reason, I ask the House to give it a Second Reading.
Last week, when the Minister of Health said that he would speak on this Bill today, I wondered why he was the Minister chosen for the purpose. Having listened to his speech, I am wondering even more why he was chosen. The Bill does not in any way deal with the national health of our people, of which the Minister of Health is supposed to be in charge.
It would have been much better if the Financial Secretary to the Treasury, or the Chancellor of the Exchequer himself, had introduced the Bill, because it is purely and simply a financial Measure. Indeed, instead of having a separate Bill brought before us today, it would have been very much better if these provisions had been in the Bill that we discussed yesterday, because in the Finance Bill the provisions would have been in their proper environment. The extra charge, which the Minister tells us will bring in £40 million a year, would then have been seen in its true light as a regressive poll tax —
Not at the moment. I have only just begun.
The extra charge would have been seen in its true light as a regressive poll tax if it had been placed in the Finance Bill side by side with the provisions giving £34 million to Surtax payers. I am certain that the people will compare the extra £40 million to be collected in contributions, some from people who can ill afford another ½d., with the £34 million which the Chancellor felt he could afford to give to the Surtax payers. I will now give way to the hon. Member for Ormskirk (Mr. Glover).
The hon. Gentleman should get his facts correct before he makes an intervention. In the National Health Service Act, 1946, relating to England and Wales and the Act relating to Scotland there was no provision for a contribution. The contribution was dealt with under the National Insurance Act, 1946. If this alteration had been dealt with under a National Insurance Bill it would not have been the Minister of Health who was introducing it today.
The increase means that the adult male worker will now have to pay 7s. 5d. a week as a combined contribution. In 1948, his contribution was 5s. Id. It means that since 1948 there has been an increase of 51 per cent. in the contributions from the workers, and the Tory Government are responsible for 46 per cent. of that 51 per cent.
At present, I am dealing with what the increased contribution will mean to certain wage earners. If the hon. Gentleman will wait a minute or two and let me develop my case he may find his point answered.
We particularly oppose the increase in the contribution because of the effect that it will have on the lower-paid wage earners and their families. The increased contribution is only one of many measures which have been taken by the Government. The Government have made what I can only call a ruthless attack over the years on the standard of living of the people, and particularly on the standard of living of the lowest-paid wage earners. These measures include the increase in the price of school meals, the latest increase in the prices of welfare foods, particularly for children, and the almost complete removal of the general food subsidies.
All those subsidies benefited, in one form or another, most the families of the lowest-paid wage earners, and what the Government have done by those measures has harmed most just those families. The Government's actions make a complete mockery of the speech of the Leader of the Government when he spoke at Election time at North Berwick and told the nation that if the Conservative Party was returned to power there would be no cuts in food subsidies or interference with the National Health Service. A similar statement was made by Lord Woolton.
Another matter which has borne very heavily upon the lowest wage earners has been the rise in the cost of living. The E of October, 1951, was worth only 16s. 1d. in February this year, a drop of almost 20 per cent. in the purchasing power of the £. My indictment of the Government on this score is that that drop in purchasing power or increase in the cost of living was due not to any increase in import prices, for they have fallen, but to the deliberate policies of the Government.
I have here some figures from the Index of Retail Prices showing increases between February, 1956, and February, 1957. Food prices have increased by 3·9 points in the twelve months, housing by 4·8 points— we have not yet had the effects of the latest housing Measures— transport by 9·7 points, and fuel and light by 6·3 points. All these figures must have a serious effect on the standard of living, particularly of the lowest-paid wage earners.
Last week, the Minister gave figures relating both to rates and earnings; today, he used the figure which he thought better for his case, and referred only to earnings. We must look at the wage rates, because some people have only the wage rate, with no increases by way of bonuses or for overtime. The Minister said last week that the average increase in wage rates since 1946 was 70 per cent. In this matter, averages prove nothing. The relevant measure is the number of pounds, shillings and pence that the individual worker brings home.
This increase of 8d., the previous increase in contributions, the increases in the cost of living, and the slashing of the social welfare services might mean little to millions of our people; and for those people I need not speak. But these very same actions of the Government spell very grave hardship for the families of the low wage earners. Every one of these charges, every step taken by the Government to increase prices and every increase in the contribution means a cut in the standard of living of the low wage earners.
Upon the question of health, and the cost of the Health Service, if we take this 8d. arid add to it all the other things that I have mentioned, the families of the low wage earners may suffer in health because of the lower standard of living in their homes, and if they do will not that be an additional cost upon the National Health Service? Is there not really a vicious circle, which this Measure in no way helps to prevent?
Great play has been made by the Financial Secretary to the Treasury about the fact that the original intention was that the 10d. of the National Insurance Contribution should cover about 20 per cent. of the cost of the Health Service, and much has been said today on the same point. This percentage was never mentioned at any time during the passage of the National Insurance Bill, and Lord Beveridge himself does not refer to it in his long Report. Paragraph 279 of his Report says that insurance contributions should contain a payment towards the cost of health and rehabilitation schemes. A payment is referred to, but no percentage or proportion is mentioned.
Appendix A, which is the Actuary's Report, estimated that the 10d. per week would bring in £40 million which, according to the calculations, would cover about 23 per cent. of the cost of the National Health Service. Lord Beveridge had this Actuary's Report when he was considering his recommendations but, in spite of that, he made no reference at all to any fixed proportion of the cost of the Health Service being covered by the contribution.
In one respect the Actuary was correct; the contribution gave us £40 million. But the Actuary was wrong in anticipating that £40 million would cover about 23 per cent. of the cost of the Service. He was not the only one who was wrong; many people were wrong because they did not realise how great was the need for a comprehensive Health Service, especially among the lowest wage earners. They did not realise how many of those people and their families were denied the service which they now get under the comprehensive Health Service because they did not have the finance to meet it. Paragraph 427 of the Report says:
Restoration of sick person to health is a duty of the State and the sick person, prior to any other consideration.
I hope that the Minister and the Government will give as much consideration to that statement as they have given to the words of the Actuary's Report.
In the calculation of the cost of the Health Service, has any account been taken of the saving to other funds caused by the prompt medical attention which people now receive? That ought always to be considered as a factor in relation to the cost of the Service. In the first year of the Service the 10d. per week contribution did not cover 20 per cent. of the cost; it covered only 10·3 per cent. Last year the amount of contributions represented 6·3 per cent. of the cost. If the provisions of the Bill are unamended, however, the proportion of the cost of the Service covered by contributions will be 12·6 per cent. By this action contributors alone will be paying a greater proportion of the cost than they paid when the scheme was introduced in 1948.
I now turn to the question of charges. In 1950, the first charges were made, and it was made abundantly clear in the discussion which took place then that these charges were temporary. The Minister has said that he would be interested to know what is our policy. He ought to have known what it is even before I rose. We made it perfectly clear in our policy statement, "Challenge to Britain," that these charges would be completely abolished.
In talking about the cost of the Service the Minister was at great pains to show that there had been a rise in real terms. I want him to re-examine the figures that he gave. His statement took no account whatever of two factors of the greatest importance, namely, the rise in Britain's population and the increase in the number of aged people. If these two factors are taken into account it can be seen that the rise in real terms is much lower than the figure given by the Minister today.
I do not have the exact figure with me, but I am sure that the hon. Member, who has an inquiring mind and who has the Digest of Statistics with him, will easily find it. I think that I have enough figures, perhaps too many, in my speech. If the hon. Member wants to develop this point, I am sure that he will be called, as he usually is in these debates.
Today, as in previous debates, great play has been made with this question of a ceiling. It was made abundantly clear that the ceiling was not a ceiling for all time. If the economic circumstances not only in this country but elsewhere are remembered, one can clearly understand why it was said at that time that it was not a ceiling for all time.
The charges will now give the Chancellor of the Exchequer more than 5 per cent. of the cost of the Health Service. These charges, particularly those which have been imposed by the present Government, penalise people when they are actually sick. They bear most heavily on low wage earners and, in many cases, have proved an almost intolerable burden for them and for their families. We have had a great deal of propaganda from the Government and their propagandists in the country about the great improvements which they have brought about. Indeed, one of their leaders glibly spoke about doubling the standard of living in twenty-five years.
The British electorate is an intelligent electorate and the Tories cannot have it both ways. They cannot boast, on the one hand, of the great improvements which they have brought about and, at the same time, impose cuts in the standard of living by the miserable proposal in the Bill. The contributions and the charges together will cover almost 18 per cent. of the cost of the National Health Service; that is to say, a 7·3 per cent. increase will be paid through contributions and charges compared with what was paid in 1948.
The Minister said that he would be interested to know how we would have met the increased cost. I referred at the beginning of my speech to the £40 million of these charges and the £ 34 million given to Surtax payers in tax reliefs in the Budget. The one almost balances the other and, therefore, the moral thing for the Government to have done would have been to take the money from taxation, instead of giving relief to Surtax payers. If the Minister waits for a few weeks, he will have, in very clear language, our general proposals on many of these matters.
I want to deal with the separate Health Service contribution. The Minister dealt with it last week and did so again today. He suggested that the stamp would indicate to the public that a definite part of the contribtuion was for the Health Service and that the other part was for other benefits. He has told us that one of the reasons for definitely separating the contributions is to make it clear to the British public that only a part of the cost of the Health Service is paid from their contributions. That is a very clumsy way of making that clear. Surely the Government could have used all the other methods of publicity to make it clear. I do not accept that as a reason for a separate Health Service contribution.
My right hon. and hon. Friends and I criticise the separate contribution for a much more grave reason. On this side of the House, we are very suspicious of this deliberate separation and we have very strong grounds for being suspicious. The Tory Party has always opposed the National Health Service. It voted against the Third Reading of the Measure which introduced it, and one votes against a Third Reading only if one is opposed to the principle of the Bill. The main opposition of the Tories to the Service was to its method of financing.
The Minister of Labour, who was the previous Minister of Health, devoted the whole of his maiden speech in the House to advocating charges for the Health Service. He followed that with other speeches voicing the true feelings of the Tory Party about financing the Service. As a result of those speeches he became
Minister of Health, and before I conclude I want to give one or two quotations from his speeches, because they are most relevant to our suspicion about the separation of this contribution. On 24th April, 1951, the Minister of Labour, now an important member of the Cabinet, said:
I do not under-rate the financial importance of these proposals. Indeed, as I will show in a moment, I am quite prepared to go further."— [OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 301–2.]
That was to go further with the charges.
Later that year the right hon. Gentleman said:
Of course, we on this side of the House want to see the Bill on the Statute Book, Of course, we are delighted that the Chancellor of the Exchequer and the Minister of Health and the Secretary of State for Scotland are at last plodding down the right road. Of course, we are quite prepared, now we have them on that road, to urge them on."— [OFFICIAL REPORT, 7th May, 1951; Vol. 487, c. 1687.]
That, again, was a clear indication that the policy of the Tories was a policy of taxation or charges on the Health Service.
In March, 1952, the right hon. Gentleman said:
It remains the belief of this party, apart from economic circumstances, that there should be charges in the Health Service.
In other words, no matter what the cost of the Health Service to the nation should be, the Tory Party would charge for it. On the same day, he said:
I suggest that between now and the next Budget we should study the proportion which health ought to bear to the whole of our national expenditure."— [OFFICIAL REPORT, 27th March, 1952; Vol. 498, c. 962–66.]
I was especially interested in that quotation, but no doubt the Minister, who has an inquiring mind, examined this question and, being surprised and disappointed by the results of the inquiry, he has made no more of the suggestion.
The Guillebaud Committee made that inquiry and the results are there for everybody to read. What do we find? In 1948, the cost of the National Health Service was 3·57 per cent. of the national expenditure. In 1949, it rose to 3·8 per cent. In 1953–54, it fell to 3·42 per cent. In other words, in 1954 and today the proportion of the national income being devoted to the Health Service is less than that devoted to the Service when it was introduced in 1948.
I am sorry, but I cannot give way. I have already spoken for too long, but I felt that it was important to develop this matter. The hon. Member can develop it in his speech.
On the other hand, it may be that this Bill is the result of that examination by the Minister of Health because, although a diminishing proportion of the national income is being spent on the Service, I have no doubt at all that the Tory Party wants ultimately to finance the National Health Service from contributions by the workers and charges on the people. I have no doubt about it at all, and it is the greatest fear which we have about the introduction of the Bill and the provisions contained in it. Over a number of matters this Government have done their best to mutilate the whole basis of the comprehensive National Health Service.
We shall oppose this Bill as strongly as ever we can. We shall take it to a vote tonight because we feel that in this Measure, as in many other Measures which this Government have introduced, the Government show no trace of humanity for the children and the wives of the lowest wage earners in this country. We feel that in matters of health these people should be safeguarded by the nation. The Bill is taking away some of the safeguards. We shall vote against it and do our best in Committee to alter it.
We have heard an astonishing speech from the hon. Lady the Member for Lanarkshire, North (Miss Herbison). She must know perfectly well that many of the things she said were said with her tongue in her cheek. She ended by accusing the Conservative Party of wanting to see charges made for the Health Service. Of course we like to see the contributory principle in the Health Service, but who except the Socialist Party introduced charges into the Service in the first place? She accused us of being opposed to the National Health Service. She cannot have read the Estimates for the expenditure on the National Health Service for the year 1957–58, which show a substantial increase of £ 56 million, I think, over the amount spent last year.
Yes, it is higher in real costs, and more is being spent on hospitals, too. That is not the action of a party opposed to the National Health Service. The hon. Lady's speech was a speech of crocodile tears— a speech so attractively delivered that one might almost call them crocodile tears of lavender water tinged with pink. That was the impression which the speech gave.
She referred to this as a financial Measure rather than a Measure to do with health, and she talked about the charges as being a regressive poll tax. She criticised us for separating the contributions for the National Health Service from those for National Insurance. The reason for the separation is that the contributions to the Health Service are not allowed as a deduction for tax purposes. If the hon. Lady had her way and the contributions remained unseparated, it would be far more a regressive poll tax. By separating the two— the National Insurance contribution and the Health Service contribution— my right hon. Friend has seen to it that the person who is better off and who pays Income Tax or Surtax does not have Income Tax and Surtax deducted in respect of that part of the payment which applies to the National Health Service.
The hon. Lady also said that we were cutting the standard of living. The trouble with right hon. and hon. Members opposite is that they do not read their own Press. The hon. Lady cannot have read the advertisements, for example, of the Co-operative movement, in the Daily Herald just before Christmas, referring to the way in which the standard of living of the people was steadily improving and the way in which the Cooperative movement claimed to be contributing to that improvement.
If this is a financial Measure, as the hon. Lady claims, what are its financial implications? Surely they are, first of all, that the proportion of the cost of the National Health Service which is being paid for by contributions is substantially less, even with this increased charge, than in 1948, when the party opposite were in power and when they introduced the charges on the Service. Under their Government the contributions were one-fifth of the cost of the National Health Service. [HON. MEMBERS: "No."] This fell to one-fourteenth of the cost immediately before this Measure, and this Bill restores it merely to one-ninth. To put it another way and to take the amount being paid as a proportion of the national level of earnings, under the Socialist Party the proportion which went in social service charges was 3·6 per cent. of the national level of earnings, whereas in future, in spite of this Bill, it will be only 3·2 per cent.
It has been said that in 1948 20 per cent. of the cost was covered by the contribution. In fact, the figure was 10·3 per cent. covered by the contribution in 1948.
I am sorry that the hon. Lady has the wrong figure on the subject. The Minister gave the figure in his own speech as 20 per cent., as the hon. Lady will see if she reads my right hon. Friend's speech in HANSARD. Anybody who looks at the Bill objectively will give general support to it as a Bill which maintains the contributory principle in a reasonable proportion.
I want to concentrate this afternoon on one problem, that of the increasing costs of the National Health Service which have made this Bill necessary, and, in particular, the increasing cost of drugs, which has been a factor in the increasing costs of the Service.
I should like to take this opportunity of congratulating my right hon. Friend on having reached agreement with the Association of the British Pharmaceutical Industry to protect the National Health Service against that very small minority of firms who are anxious to exploit it. I think it would be appropriate to pay tribute to the large majority of reputable firms which have constantly urged their colleagues to hasten the agreement with my right hon. Friend. The conclusion of the agreement will improve the general climate of opinion to the advantage both of the National Health Service and of the industry.
The charge has been bandied about in some quarters against the industry that it has exploited and is exploiting the National Health Service. Notably, such charges were made by the right hon.
Lady the Member for Warrington (Dr. Summerskill) in recent debates. On 29th November she did so, and again on 19th March. On 29th November, the right hon. Lady said:
In recent years, there has been an invasion of this country by American firms. Of the total value of proprietaries prescribed under the National Health Service, it is estimated that 65 per cent. come from American firms. These American firms have concentrated on the profitable lines. These astute businessmen, recognising that the British Government have given them a blank cheque to sell here as much as they can, at any price they choose to ask, and to take their profits out of the country in dollars if they so wish, have poured all their resources into capturing this market." —[OFFICIAL REPORT. 29th November, 1956; Vol. 561, c. 668–9.]
It will be noticed that that introduction to the subject is definitely charged with a prejudice. I therefore felt it my duty, knowing that this Bill was to come before the House in the comparatively near future, to try to find out whether or not exploitation is, in fact, taking place. I believe it is only right that the other side of the case should be put. I wish to start by saying a word about the speech made by the right hon. Lady the Member for Warrington— I told her that I was going to refer to her speech— on 19th March and with the specific aspect of tranquillisers about which she made much play in connection with the increase in Health Service charges.
There is much misunderstanding about the problem. Tranquillisers fall into two categories. First, there is the category which is valuable in mental hospitals for treating major psychiatric disorders, things like Reserpine or Chlorpromazene, and that type of tranquillisers. The head of the United States Psychiatric Research Department of the Veterans' Association announced at the end of December, 1956, that electric shock and insulin shock treatment for mental illness had declined by 90 per cent. in Veterans' Association hospitals where tranquillisers are used.
At one mental hospital in this country, St. Andrew's Hospital at Thorpe, Norfolk, the medical superintendent stated in his annual report in March last that tranquillising drugs are being used rationally in that hospital with undoubted benefit. He said:
There has been a marked decline in leucotomy "—
the operation of cutting the white nerve fibres in the frontal lobes of the brain.
The Medical Superintendent of Hereford Hospital, Dorsetshire, has described the results of treating mental patients with tranquillising drugs as "amazing". He, too, stated that they were reducing the need for leucotomy. That is one category of tranquillisers. The other— and this is the one that gets most publicity in the Press is for the treatment of light, every day psychoneuroses.
All I want to say about tranquillisers is that when they are developed I believe they may well do for mental hospitals what the latest drugs in their field have done for tuberculosis hospitals. Therefore, I think that we must be careful before we attack tranquillisers as a whole for increasing unnecessarily the cost of the National Health Service. I believe that they play a part already and will play an increasing part in reducing the general overcrowding of mental hospitals.
I now come to a more general point —
— and that is that the increase in price of drugs generally, which is admitted, and the increase in the use of proprietaries, must be set against the marked fall in the time that patients spend in hospitals. The quicker turnover now taking place in beds in hospitals due to modern methods has a double advantage. It not only speeds the recovery of the patient himself, but with the present shortage of hospital accommodation and nursing staff, the quicker turnover means that a larger number of serious cases can be dealt with effectively. That, I believe, is not unconnected with the new drugs which have come under a certain amount of attack.
I have dealt with mental hospitals. The hon. Gentleman could not have been here.
I now come to the problem of sales, upon which a certain amount of criticism has been levelled to the effect that undue pressure has been brought to bear on doctors in the Health Service. The first point I wish to make on the sales side is that for every drug that successfully reaches the market, there are some 300, or may be more, which fail completely to do so, and upon which the research carried out is entirely wasted. Therefore, the sales of the successful drug have to pay for the research that has gone into those drugs which ultimately prove not to be of general use and benefit to the public.
When a successful new drug has been found, no one knows how long it will prove to be the best in its field. No one knows how soon somebody else— and this is a highly competitive industry — will find a competitor to it. It may be a week, a month or a year before another drug comes to take its place.
— because the relationship of the Bill to what I am saying is that it increases the charges for the National Health Service, and the right hon. Lady the Member for Warrington made some pretty strong attacks on the pharmaceutical industry.
Yes, indeed— in relation to the cost of the Health Service and, consequently, charges. Having found a successful drug, one does not know how long it is going to last and how much time the manufacturer will have to recoup the cost of the research which has been put in to it. If a manufacturer fails to recoup the cost he goes bankrupt. Therefore, I suggest that it is not unreasonable that at the outset the price of a now drug should be high and should gradually decrease the longer the drug has been in use.
In conclusion, I should like to ask the House to look at this problem from the point of view of earning foreign exchange. If we create a climate in which the pharmaceutical industry can thrive in this country plant will be set up here for the manufacture of drugs to be sold all over the world. Exports will thrive and prices will come down at home as the basis of sales broadens. If, on the other hand, we discourage the pharmaceutical industry from coming here and curtail the research of the industry that is here now, we shall suffer in the long run. Our industry will go bankrupt and we shall have to go to the United States for our drugs and for the "know-how". The ultimate cost in dollars and the ultimate damage to the National Health Service will be incalculable.
I hope that, in considering the Bill, hon. Members will pause before attributing too much blame for the increased costs to the industry which has done so much to keep Britain in the forefront of scientific development.
It is quite clear that the Government are anxious to see this Bill on the Statute Book. They have the votes in this House to have their way. We can take it for granted that they will lose no time at all, once the Bill becomes law, in seeing that these additional charges are imposed.
Hon. Members opposite. whose case is so bankrupt, enjoy themselves occasionally by trying to make out that there is really no difference between the two sides of the House on these matters. My hon. Friend the Member for Lanarkshire, North (Miss Herbison) has already made quite clear that the real Tory mind believes in health charges whatever the economic situation of the country. I do not know of one hon. Member on this side who believes in health charges as a matter of principle.
I have already said that we shall not have to wait any length of time once this Bill becomes law in seeing these additional charges imposed. Hon. Members opposite are very anxious to get hold of this extra £40 million which will be taken penny by penny and shilling by shilling from many poor people. The Government have passed a Budget giving £ 13 a week tax reduction to the man with £ 10,000 a year, and one cannot give £ 34 million back to the Surtax payers without getting it elsewhere. I think that is a cruel and mean business, but, alas. the Tory mind operates in that fashion.
I ask hon. Members opposite to recall that, although the Labour Government passed legislation making it possible for a limited time for the 1s. prescription charge to be levied, not a single Is. was charged for any patient in this country until we had a Tory Minister of Health. What is the significance of that? The significance is simply that it is alien to our spirit to impose such charges. There were differences of opinion at the time, as everyone knows, as to whether it should be done, but it is worth while noting that so long as we had a Labour Minister of Health not one single 1s. was collected from patients.
It was typical of the Tories when they became the Government— this is precisely what they enjoy doing— that they hastened to impose the 1s. prescription charge. More recently, they cheated in their presentation of tax burdens. My hon. Friend the Member for Lanarkshire, North quite clearly made part of this point when she said that there was no reason why these present provisions should not have been included in the Budget. In addition, there was no reason why the change in the prescription rates which means that people have to pay 1s. for each item should not have been included in the Budget. There is no reason why, when we are making a general survey of Great Britain, estimating its assets and needs, these various changes in taxation should not have been joined together in one operation, the adding to the prescription charges, making the cost of milk for children dearer and, at the same time, reducing the charges to Surtax payers. It is typical of the furtive way in which the Tories go about their business than they prefer to have these little Bills before and after the Budget.
I am sure that before the end of this debate we shall have someone from the benches opposite saying that people want to pay for the Health Service; that they enjoy doing it; that it is a real pleasure to do it when one is running a home with a father, mother and three children living on £ 7 or £ 8 a week or even £ 10 or £11 a week. It may be that in bad weather everyone in the family has flu or a cold— we have most of us been through that phase this winter. Is it really suggested that it is a pleasure for mother, when budgeting on limited means, to have to go to the chemist and find the shilling needed for father's cough mixture, a shilling for the baby and so on? Very soon she may find that she has spent 10s. or 15s. or even more, all in a week or two.
I am not at this moment dealing with the great tragedies, which have again and again been referred to in this House, of invalids suffering from malignant diseases. My hon. Friend the Member for Kirkcaldy Burghs (Mr. Hubbard) made a speech, which every hon. Member should know about, in a previous health debate, stating what it costs when there is an illness which goes on and on. I am dealing with the more routine experience of having someone in the house ill— maybe several ill at the same time— and having to pay all these extra shillings on prescriptions. I should have thought that the Shylocks opposite had had their pound of flesh already without today's additional imposition.
I suppose that there will be hon. Members opposite who will say that the people of Britain do not want a free Health Service; that they want to feel they arc contributing and will enjoy having the insurance principle enlarged in the way that is now being done. We are a proud people, and it is a fallacy to think that there can be a free Health Service any more than there can be a free Defence Service. But the issue is not that. It is how we pay for it. It might be a salutary experience if we put defence on an insurance basis. After all, we need defence as well as a Health Service.
What typical Tory logic, and what a lack of compassion this Bill reveals; a real itch always to give to those who have most and take from those who have least. Why should the Health Service be treated in this way? What is the sum that hon. Members opposite are after? It is £40 million. If any hon. Members like to come to me privately or publicly, I will tell them how they can save a great deal more than £40 million on defence alone. Or, if they prefer it, we can get together on the cost of patent drugs. I am not a natural coalitionist, but I am willing to form a coalition with the hon. Member for Dover (Mr. Arbuthnot) if he is really serious in getting sense in the drug situation. When people are ill doctors arc under a great deal of blackmail to give patent medicines. We all know the cost of patent medicines, particularly those paid for in dollars. This is one issue where there ought to be no party advantage.
If hon. Members opposite are really eager to see the Health Service successful, cannot we stand austerely behind the serious doctors? Where there are non-patent medicines that can be given which are equally good, this problem ought not to be made a football between the political parties. We could give reassurance to the sick, sustain the doctor against pressure, save this country precious dollars and conduct our drug bill on a very much more sensible basis than at present.
I am glad that my right hon. Friend agrees with me. We are all of one mind on this. If it is desired to save money on the Health Service, it can be saved in that way. The real difficulty is that hon. Members opposite do not believe in the Health Service. They want to make people who use it feel that they are second-class citizens. One has only to go into hospitals these days to find much that is saddening to hon. Members on this side of the House. It is most improper to generalise about hospitals or doctors. Some are doing a magnificent job, sometimes against great discouragement by hon. Members opposite.
It is a wicked thing that at this time of day when our Health Service should be gradually improving we find that some hospitals still cannot make a proper appointments system. There are some wonderful consultants, but there are other consultants who think the measure of their importance is the length of time they can keep patients, matrons and nurses waiting before they turn up to do the job. Does the hon. Member opposite wish to disagree?
I think the hon. Member has not quite grasped the point I am making. If he or I pay a consultant to do a job in a hospital, that consultant must do it. I am coming to the conclusion that it might be a good thing if consultants were either entirely inside the Health Service or entirely outside the Service. What ought to be a point of honour is that the consultant who is part of this great Service should not seek to make patients feel that they are second-rate citizens, but should realise that patients also have work to do and should not be unduly delayed. It is very important that there should be a proper appointments system.
While agreeing with some of the things the hon. Lady said, I am sure She would wish to make it clear that very often the lateness of consultants is due to their busyness and that it can be very rare that there is any such motive as she is imputing to a splendid profession, although she may be right in individual cases.
When people are sick, they should be treated with concern and dignity. I would like them to have extra financial help at such times, not extra financial burdens. I hope that when my right hon. Friend winds up for the Opposition he will not only reiterate that a Labour Government is pledged to an entirely free Health Service. I wish he could also say that a Labour Government will undo this Bill. I should like to go further than that. I should like to ask that our Health Service should be entirely removed from the insurance principle. It is no more disgraceful to pay for our health through the Budget than for us to pay for our defence through the Budget. That does not mean that we should get it free, but it does imply what, I think, is a very wonderful principle, that we would all pay according to our means. I do not want to press my right hon. Friend too far, but we must make plain that we are not engaged in a false war this afternoon.
We are deeply concerned about this Bill. I warn hon. Members opposite that if they think it is going to save them £40 million, it is going to cost them a great deal more than £40 million. We have a restless industrial situation. Men's wives at home, handling their pay packets, are impatient with rising costs. There may be many knife-edge situations in which men have to decide what they are going to do about wages and working conditions. If they think they are being shabbily treated and this Bill is shabby— they are going to be resentful. I warn the Government that this is not a Measure to save them money. It is a Measure which is more likely to break the temper of many men and women. Hon. Members opposite may have to pay a great deal more than £40 million for their folly.
At least we on this side of the House have clean hands. We have an absolutely clear pledge that the next Labour Government will remove all health charges. I shall do my best to try to persuade my colleagues that it would be a good thing to take away from hon. Members opposite this dangerous toy with which they are playing— insurance contributions— and to make the whole health charge payable by us as taxpayers through the Exchequer. I hope we shall make quite clear to the people of the country the depth of our opposition to this Bill. If we cannot improve the manners of hon. Members opposite during the Committee stage, let us at least make it quite plain that this is one more Tory Measure which the next Labour Government will remove from the Statute Book.
I am very glad that my hon. Friend the Member for Cannock (Miss Lee) concentrated on the essential point of the Bill, which is the question of making formal and legal "for the first time"— in the words of the Minister of Health— the Health Service contribution within the National Insurance Scheme. Those are the words the right hon. Gentleman used in discussing the Financial Resolution, and they are the kernel of the Bill. The other matters we have heard of from other hon. Members, while in order— I would not presume to reflect on the Chair — are irrelevant to the main theme of the Bill.
The hon. Member for Dover (Mr. Arbuthnot) argued about tranquillisers. It is almost beyond my comprehension that an argument about tranquillisers could come into this debate, but I do not think the hon. Member should get away with his argument. He misquoted, misread, or misinterpreted the words of my right hon. Friend the Member for Warrington (Dr. Summerskill) in trying to claim that she launched a barrage of criticism against the use of all tranquillisers. It would seem very unwise— not to say inaccurate— for the hon. Member to do so.
The hon. Gentleman concentrated his defence of tranquillisers on their use in mental hospitals and sought to imply that, somehow or other, as their use for other spheres was so minor it could be excused in view of the grand job which is done by mental hospitals. The fact is that the vast bulk of tranquillisers used in the Health Service, about which my right hon. Friend was complaining to the Minister of Health, are used in so-called light psychoneurotic cases. I do not understand the word "light" in this connection, but, accepting that for a moment, the impression was given that these drugs are used to a minor extent. Yet the Minister could tell us now that the vast majority of tranquillisers are used for that so-called category. Some time ago I asked the Minister about this. I asked if he was aware that the World Health Organisation had denounced the misuse of tranquillisers, and if he was aware that their use in the Health Service was increasing to a great extent. His answer was "Yes, Sir."
I shall be happy to answer the hon. Member's question, if he will give me one moment to make my point.
I am drawing his attention to a mistake in his argument, when he seemed to me to claim that my right hon. Friend the Member for Warrington was making out a case against tranquillisers as such. My right hon. Friend was addressing herself to the misuse of tranquillisers. As to the question asked by the hon. Gentleman. the answer is that some doctors often prescribe one drug when, in fact, they would prefer to prescribe another. They do so because their patients insist upon it. They "blackmail" the doctor and say to him, "If you do not give me this drug, I shall go to the doctor down the road." They do not tell the doctor down the road that they have been to another doctor or for what reason they are leaving the other doctor.
It is within my own experience as a doctor in general practice that because a certain drug was not given to one member of a family, the whole family left the doctor. In fact, in my part of the world the occupants of whole tenements will leave a doctor because false rumours have been put about. If it is not out of order to do so, I should like to refer to an occasion in general practice when I knew that a woman could not have a particular kind of drug, but I dared not tell her why. She forsook the doctor in whose practice I was an assistant and took the whole of her family with her. Because my medical employer had the good sense to realise that I was being professionally honourable, although economically unwise. he excused me for the financial loss to himself in losing the members of that family as patients.
It is very important that doctors should be professionally honourable, but why should they be under the compulsion of having to choose between being professionally honourable and economically unwise? As we all know, the position regarding the remuneration to doctors is very critical today, and, as doctors, we should not be faced with this conflict of choice. To my mind, the sooner we doctors are in a full-time salaried service. the sooner this form of blackmail will be removed and medical men will be able to practice their profession honourably and without reproach. The over-prescribing of transquillisers at the present time is a reproach to medical men, and most of them are aware of it.
The other argument used by the hon. Member for Dover was in relation to the tranquillisers being British products which were earning us dollars overseas. The fact is that the vast majority of the tranquillisers are provided in this country by American. firms, and that is one of our major objections. Instead of gaining dollars on the exchange, we lose them. We must try to encourage the British side of the pharmaceutical industry to provide more drugs and not rely on foreign suppliers. Surely the hon. Member for Dover is sufficiently patriotic to want more British firms to supply drugs rather than that foreign firms should come to this country?
Well, I think that we are indebted to the hon. Gentleman because now we know why he raised this question in the first place and why a matter has come into the debate which. to my mind, seemed so irrelevant to the main subject which we are discussing.
I am surprised that the hon. Member should be willing to argue a general case upon a particularity. Has the hon. Member any figures to bolster up his general assertion and not just the particular case he mentioned? I doubt it. I should be very interested to read any article which he cares to write in the medical Press on the matter which would supply information on the subject. Or perhaps he could stimulate his friends to do so. It would be appreciated by the medical Press. This is news to me, and information which does not seem to be consistent with the presently known facts. However, I think I ought to congratulate the hon. Member for having successfully drawn me from my main argument t but I felt it right to ensure that his comments should not go unanswered.
The central theme of the Bill is the making of the contributory principle legal, valid and formal. I sympathise with the argument about the imposition on the lower-paid workers of this increase of 8d. and I realise that it is an important part of the argument against the Bill. But to my mind the central argument is the question of whether this should, in the words of the Minister of Health, be made for the "first time" a formal, legal and valid contribution to National Insurance.
As a young man who in his early 20's became interested in politics and in the great upheavals of our time, I remember that there was great conflict and argument about the way that the Labour Government, front 1945 to 1951, governed the country. They seemed to do everything wrong according to the Conservative Opposition of that time who decried them for misgoverning the country. I rarely heard a word of praise for the Labour Government from a Conservative spokesman during that period. Therefore, it is passing strange to me that the present Minister of Health should now suddenly say, in effect, "You know, gentlemen, the Labour Government were infallible in the things the) did. For example, not only was Lord Beveridge right in his original assumption, but the Labour Government were infallible in their judgment at the beginning of the scheme to use £40 million taken from the Insurance Fund for the Health Service."
It seems ridiculous to me that we are suddenly crowned with infallibility. If this infallibility is so, apply logic. We are told that in the first year of the Health Service— remember that now we are infallible— we spent 3·5 per cent. of the national income; and therefore, because we are infallible, 3·5 per cent. of the national income is the correct amount to spend on the National Health Service. If we are infallible in regard to the contributory side, surely we are infallible with regard to the sum spent. Very well then, please give us back the correct proportion of the money. We should be spending 3·5 per cent. of the national income on the National Health Service. It should rise to a substantially higher sum than the Minister talked about. It should be well above £ 670 million.
If we are infallible in one thing, and we are given full marks for that, surely we are entitled to claim the full consequences and logic of the other part? But no. We arc infallible only in the things that suit the Minister, and it happens to suit him to say that on the contributory principle we were right, but that on the other matter we were wrong. Did we ever say that the contributory principle was formal, valid and legal? No, we did not. How can I prove it? In many ways. But if we read the speech of the Minister of Health on the occasion when the Resolution was before the Ways and Means Committee we shall see that the right hon. Gentleman admits that it was "for the first time" that it would be made so. Therefore, it was not formal, legal and valid. It was informal— it was not invalid or illegal, but it was informal. It was accepted at the beginning that £40 million would be taken from the Insurance Fund; that there would be nothing about separate stamps or a proportion of the amount, but simply that £40 million would come from the Insurance Fund on the strict principle that there had not to he an unemployment rate in the country exceeding 6 per cent. or 8 per cent.—
Yes, it was 8 per cent.
That meant that if it so happened in the years when the Labour Government were in office that there was an unemployment rate in the country exceeding 8 per cent., it would follow that we would not use the £40 million from the Fund, because the demand for benefits from the Fund would be so great that it would be put out of balance were the money taken. At least, I assume that is the argument which was used at the time. Therefore, the £40 million was not an unconditional gift. There was an understanding that it could not be used if there was a high proportion of unemployment in the country.
The next interesting argument was about it being 20 per cent., although we now understand that if one looks at it more accurately it is, in fact, 10 per cent. of the actual cost. We hear arguments that a certain percentage should be laid down, but when the Labour Government came into power and passed these Acts, they allowed only £40 million, first of all, in a bill of £ 197 million, and £40 million the next year in relation to a bill which ran up to well over £ 200 million. The bill, ultimately, was £ 460 million in 1951–52. If a contributory principle had been adopted informally, which somehow had statistical justification, why did not the Labour Government raise the figure of £40 million in all those years? There were hosts of economic reasons for which they could have done so.
I think hon. Members opposite are being very dishonest in all their propaganda, because they endorsed and supported this country's participation in the Korean war, but ever since have refused to accept the economic consequences which flowed from it. Apart from the effect on the cost of living, one of the consequences which flowed from the Korean war was that we had serious fiscal difficulties. One of the solutions which the Labour Government found, one which I have ever since regretted, was the employment of a charge on the provision of spectacles and dentures. It was a retrogressive charge which was bemoaned by many people in my party and in the country, but in which hon. Members opposite rejoiced. Their party at that time not only said that these charges were long overdue, but said that as soon as they obtained power they would impose more charges. That is one election promise which they have kept. The trouble is that very few people knew about it during the election. It was never contained in the election manifesto or the election broadsheets which they submitted to their constituents. Nevertheless, they have honoured at least that pledge.
Let it also be remembered that in these difficulties the Labour Government said, "We shall have to economise all round, including on the National Health Service." They did not say, "We will not impose charges in respect of spectacles and dentures because it will cause a great row in our own ranks." If, as hon. Members opposite allege is true, we wanted the contributory principle and wanted to maintain these statistics, we could easily have turned round and increased the £40 million, raising the National Insurance contribution and meeting the financial difficulty that way instead. I put it to hon. Members opposite that by not doing so at that time of great crisis in the country, the Labour Government showed quite clearly that they had never accepted the contributory principle in relation to the Health Service in any more than an informal way and simply at the inauguration of the scheme.
I join with my hon. Friend the Member for Lanarkshire, North (Miss Herbison) and many other of my hon. Friends— and I have no doubt many others in the country, and even, possibly, just one or two on the other side of the House who see the logic of our argument— in looking forward to the day when we shall not have a contributory element at all in relation to the National Health Service. Such a contributory principle is all wrong.
Let me take the Minister's own speech today as probably the best justification for my statement. He said the idea is that we should allow those who are working to contribute to the well-being of the young and the old. That is the principle which he enunciated, and he used that statement as justification for this unjust and unfair scheme of insurance contributions. Those who are working and who, from their wages, pay our taxes, those goods of different kinds which carry taxes and which are the produce of the labour of those men, and the profits which are made by the various firms for which these men work, all these ought to carry the burden of the National Health Service.
Socialised medicine— and we make no apology for it— rests its case entirely on the concept that the country provides the money according to its ability and that the people in need can go to that Service and obtain it without immediate cost. It is not a free Service in the strict sense that no one makes a contribution towards it and that somehow it appears like manna from Heaven, but it is a free Service in its operation; at the point at which the person needs the Service, it is completely free.
That is the policy of the Labour Party. We may have been misled in several years, enjoined by the exigencies of events to compromise and temporise here and there, but this is the clear principle which we have enunciated and do so at this moment. At times, we may have had to look at it again in the exercise of governmental function, but it is nevertheless our clear policy and one which many of us have supported for a long time.
The young men of the Conservative Party are enjoined by their seniors to go to the country and talk expansionism — the expansion of industry and the expansion of the standard of life. They are given this sense of buoyancy and bounce in our industrial future. But there is no comparable buoyancy and bounce about the social services. That is what I cannot understand. If I were a young Conservative politician, I should be terrified in case I ended up at the Ministry of Health. It would ruin me. It would ruin all my ideals and all my views of the good practice of medicine and of good health in this country.
I advise hon. Members opposite to think again about this Bill. I put it to them that we have this expansionism in industry, but that when we come to the Health Service the attitude is restrictive. First of all, the cost has been restricted. As a proportion of the national income, the expenditure on the Service has fallen over the years. The Government appointed the Guillebaud Committee. It was in no philanthropic sense that that Committee was appointed. We have only to look at the speeches of the Minister of Health at the time to see what he hoped would happen as a result of that Committee. In fact, it did. not happen. The true facts emerged and hon. Members opposite, previously blinded by their own propaganda, at last began to see the light and to see clearly that the National Health Service had been badly raided by the Conservative Party.
The last Minister of Health, poor soul, was a well-meaning man. What was his penance for being a Conservative? He had to introduce, no doubt much against his better nature and better judgment, a charge per item on prescriptions. This is probably one of the most vindictive pieces of social legislation which we have had in this country. Hon. Members opposite who know their constituencies will know that to be true. They know that many an old person, many a person dying of a malignancy, many who have suffered from chronic diseases, are having to pay a great deal of money in prescription charges; and this is money which they can ill afford. Hon. Members opposite will not be honest if they do not admit that to themselves. Even if there were only one such person in his constituency, the hon. Member concerned ought to be most anxious to get the charges removed from the Statute Book as quickly as possible.
The new Minister of Health, the bright now pin, has to introduce this Bill. Of all the Acts and Regulations which have flowed from the Ministry of Health in the last few years, to my mind this is the most important. It does not seem so important at the moment because, in degree, it is very small, but in principle it is the undoing of the Health Service. This is the beginning of the end of the concept of a socialised service, for which many of us hoped in this country. This is the damaging blow which the Conservative Government seek to aim at the National Health Service.
If the young men in the Conservative Party do not mean this and do not want it to happen, and if they want the Service to march together with thriving industrial and economic well-being, linked with an expanding standard of living, with the social services growing side by side, they should think again. This Bill has to, be opposed. If we cannot win tonight, we must win some other day.
I regret that I have not been present throughout the whole debate; I have been serving on a Committee upstairs.
I join issue with the hon. Member for Greenock (Dr. Dickson Mabon) when he sees in the Bill a restrictive move in relation to the National Health Service. It seems to me that, properly used, the new finance which the Bill will produce for the National Health Service can provide a very real enlargement of the Service. The hon. Gentleman has only to look back upon the restrictions which Chancellors of the Exchequer of his own party found themselves, obviously unwillingly, compelled to apply under the original method of financing the National Health Service. Now, for the first time, we find in the contributory system, whether we like it or not, a method of opening the door towards an enlargement of the Service. I should have thought that that was cause for gratification rather than complaint and criticism.
The starting point of the Bill must surely be that the commitments we have to the National Health Service are such that they cannot be fitted within an imposed Budget by a Chancellor of the Exchequer. We know at the moment, for example, that some additional money will have to be found for the payment of medical practitioners; we do not know when or how, but we can see it coming. It is quite clear that the continued use of new drugs will increase the cost of the Health Service. We shall reap the benefit of that in the quicker turnover of patients, curing people more quickly and putting them back to productive work; but nevertheless that additional money has to be found, and cannot be found by a method of finance such as that which the Health Service has worked under hitherto
Those of us who are closely linked with the Health Service feel about it as we feel about education.
I am merely saying that, in actual fact, Socialist Chancellors of the Exchequer, who must have been as anxious as anybody to give the Health Service its wines, found it necessary, one after another, to impose a ceiling. The whole history of the National Health Service since 1948 has been a history of an underfinanced Service. One must accept that as a political fact, in the financial circumstances of the country. We have been able to get by up to now because certain sections of the Service, such as the hospitals, have been living on their fat, to use a crude expression —
And some starved. Sir H. Linstead: — but what they cannot do is make any further economies now. Maintenance and other charges facing hospitals quite clearly will call for increased money.
The question which the House and my right hon. Friend have to face is this: how are these developments— not these restrictions— to be paid for? Are they to be paid for by taxation, by insurance contributions, or, to take the only other two possible ways, by payment out of the rates or by payment as people use the Service?
We can, I think, exclude payment from the rates unless we are prepared to take the necessary major step in reorganisation and hand the hospitals back to the local authorities, with all that is implied by that. I do not believe that either side
of the House is anxious to see any substantial extension of the system of payment for services rendered. That has been discussed already this afternoon, and it has been a matter of controversy all the way through. I rather quarrelled with the hon. Member for Greenock when he suggested that any payment by the user was a thing completely to be deplored. It is interesting to find Lord Beveridge, who was a wholehearted supporter of the National Health Service if there ever was one, specifically saying in his Report that
the British people are clearly ready and able to pay contributions for institutional treatment ".
Beveridge was not putting on one side the possibility of payment for hospital treatment. Guillebaud, on the contrary, who has been criticised by the hon. Member for Greenock, examined that possibility and turned it down on the various grounds which he explained. I do not, however, believe that there would be on either sire of the House any enthusiasm for substantially increasing payments by users.
We are left with the simple choice: is the additional money which the Service clearly needs to come out of insurance payments or from taxes? It is worth while remembering that, however it is found, ultimately it has to come out of the productive capacity of the country. It is interesting to note that, at the present time, five-sixths of the cost of the National Health Service, even if this Bill comes into operation, will be paid by taxes. The dispute, if there is a dispute, relates to one-sixth of the cost only.
The person who has made the most authoritative and objective examination of the balance of advantage between paying for a health service out of taxes and paying for it out of insurance contributions is Lord Beveridge. It is instructive to read extracts from his Report today and see how matters struck Lord Beveridge, objectively examining this particular problem a good many years ago. He first said that it was important to bring home to the public the fact that the National Health Service had an important preventive role to play, and he made the point that:
People will take what they have already paid for without delay, when they need and they pay for it more directly as contributors than as taxpayers.
Whether that is a sound argument or not, it appealed to him at the time— that it was an encouragement to people to make early use of the Service that they themselves had paid something towards it.
Have we not sufficient experience in working the National Health Service over a number of years to be able to say whether or not that is valid? There has not been any indication that, because people have, in the main, been getting the benefit of the Service through taxation, they have been unwilling to avail themselves of it.
All that one can say, as a generalisation, is that, by and large, people do value something for which they have paid more highly than something for which they have paid nothing.
The hon. Gentleman is changing his argument. He quoted Lord Beveridge, not on the question of valuing, but actually using. I am suggesting that we are now in a position to have sufficient knowledge of the working of the National Health Service to be able to say that people value the Health Service and have used it; they have used it readily, which shows that they valued it.
In quoting that opinion, the hon. Gentleman is using it to bolster the case which he is trying to make for an extra contribution rather than taxation, because, he says, people would be more willing if they contributed. My hon. Friend the Member for Kilmarnock (Mr. Ross) is quite right in drawing to the hon. Gentleman's notice the fact that people do not seem to have had any hesitation in using the Service from 1948.
I am gradually building up this case, and I am trying to be as objective as I can about it. One of the most objective witnesses we can quote in a matter of this kind is the man who was virtually the originator of our social
service schemes. Lord Beveridge went on to make this interesting point:
One of the reasons why it is preferable to pay for disease and accident openly and directly, in the form of insurance benefits, rather than indirectly, is that this emphasises the cost and should give a stimulus to prevent.
He then went on to discuss domiciliary treatment and the family doctor, and he said:
There is no obvious reason, apart from a desire to keep the insured contribution as low as possible, why insured persons should be relieved of this burden wholly, in order that they may bear it as taxpayers. If importance attaches to preserving the contributory principle for cash benefit, it attaches also to contribution for medical treatment. There appears to be a case for including part of the cost of domiciliary treatment in the insurance contribution.
On that, as we know, he recommended, and the Socialist Government of the day accepted, the principle that there should be a transfer from the Insurance Fund of £40 million to the Ministry of Health.
I think the hon. Member would agree that Lord Beveridge did not, in fact, recommend that precise sum. He merely made the recommendation that there should be a contribution. That matter was dealt with by my hon. Friend the Member for Lanarkshire, North (Miss Herbison) in opening the debate from this side of the House.
I should need to refer to the paragraph in the Beveridge Report, but Lord Beveridge said quite clearly that insured persons ought to pay 19 per cent. of the cost of medical treatment and rehabilitation. That is in paragraph 287 of his Report. What sum 19 per cent. may have been at that time I cannot calculate, but he was very careful and precise about the contribution that should come out of the Insurance Fund.
My note says that it is paragraph 287. If the hon. Lady refers to it, I am sure she will find the figure of 19 per cent. as the employee's contribution and some other figure as the employer's contribution quite clearly set out in that paragraph.
My last quotation from the Beveridge Report is an interesting one from the same paragraph. When talking about
the division of the costs of the Service as between the State, the employer and the employee, Lord Beveridge said that nothing was sacred about the division suggested in the Report. He said:
It may be argued that it is dangerous to shift too many financial burdens from the citizen as consumer on to the citizen as taxpayer because that may lead to extravagances. All men know themselves as consumers but do not always realise themselves as taxpayers.
That is a fundamental and important principle for us to bear in mind.
In paragraph 287, Lord Beveridge concluded that insured persons ought to pay 19 per cent. of the cost of medical treatment and rehabilitation. According to his calculations, £40 million out of £ 170 million, or 23·5 per cent., was to come from employees plus employers together. The present percentage, when the proposals in the Bill become law, is 12·6 per cent. I should have said that that difference between 23·5 per cent., which Lord Beveridge suggested as the reasonable percentage that the Insurance Fund should bear, and the 12·6 per cent. which is to be the percentage when the Bill comes into operation, is the substantial justification for increasing the insurance part of the cost of the Service.
Finally, one has to remember, as has already been said, that Lord Beveridge made his recommendation on the assumption that 8·2 per cent. of the working population would be unemployed and, therefore, drawing substantially off the Insurance Fund, whereas at present, taking the latest available figures the unemployed percentage is only 1·8. Those figures alone are a substantial justification for the salutory change which the Bill proposes to bring about.
I cannot help thinking that the Bill, providing for increased contributions for those who are subject to the National Insurance Act, is related to Clause 12 of the Finance Bill. This is the worker's contribution towards the £ 25 million which has to be met as a result of the reliefs given to those in receipt of incomes of £ 2,000 a year and upwards.
The Bill is one of the worst for which this Government are responsible. Now I understand why the present occupant of the office of Minister of Health was chosen, because from time to time in the field of social insurance he has shown himself to be a radical reactionary.
There are reactionaries and reactionaries. I would describe the right hon. Gentleman as one of the most extreme in that category. I hope he understands now why I chose that phrase to describe him.
The Bill is typical of Tory mentality. I think I would carry the House with me in saying that there are certain obligations that the State cannot avoid. One is that it is the duty of the State to defend the country. That is the primary responsibility of the Government, whichever party is in power. Secondly, the Government must take steps from time to time to ensure that everything is done by the State to guarantee that people can work. The only way that we can get people to work for the benefit of the State is to see that they get at least three square meals a day. If they do not, they will not render the work that is necessary to maintain the economy of the country.
Implicit in that is that if we are to maintain the working capacity of the population, we must see that their health is maintained. That is a joint duty of both the State and the individual.
I am glad to hear that response. I hope that I carry the hon. Member with me to the end.
Among those who have to work for the country are manual workers as well as those in receipt of salaries. They have to be considered, because they are the major basis of our economy. There is no question about that.
Why do I regard the Bill as typical of Tory mentality? We are agreed that it is the obligation of the State to ensure that men are fed and kept in health so that they may maintain their physical working capacity, and yet the Government come along and say, "In order to keep you fit, we propose to tax you to the extent provided in the Bill by increasing your contribution". That is imposing a penalty upon the duty of the worker to do what he can, in conjunction with the State, to maintain himself in a reasonable standard of health and subsistence for working purposes. Therefore such an imposition, such a penalty, is not an economy but sheer, rank Tory stupidity.
I thought that one of the best things which my right hon. Friend the Member for Ebbw Vale (Mr. Bevan) ever did was to avoid, when preparing the provisions of the National Health Service Act, the defects of the Education Act, 1944. I thought that he showed great judgment when he said, "I am not going to base my health service upon the local government service, I am not going to base the machinery of my service upon the voluntary hospitals. I propose to create my own machinery so that it shall be national in concept and so that it will be commensurate with the needs of the service which I envisage."
That is what he did, and he avoided the geographical injustices implicit in the Education Act, under which the kind of education which a child receives all depends to some extent upon where the child lives. That is true, is it not? The Minister of Health knows because he was until recently Parliamentary Secretary to the Ministry of Education.
It was part of the same good judgment of my right hon. Friend the Member for Ebbw Vale that he insisted that the National Health Service should be free, so that no one at any time should be prevented from doing the right thing in maintaining his or her health, and should not, in fulfilling his or her duty in doing the right thing for health, be in any way penalised by having to pay a contribution. Had the Education Act been based, as was the National Health Service, on those two principles, that the service should be completely free and national, then no matter where a child lives, whether in Wales or in Scotland or in England, whether in Cornwall, Northumberland or Carmarthenshire, it would have the same rights and obtain the same benefits from one, and the same service.
Here we have a Tory Government departing from those principles which are enshrined in the National Health Service Act. This Bill is rather a violation of principle and not an aid to economy, which was the view which the Minister expressed of it.
This is the first time that a beneficiary under the National Health Service has been called upon to make a direct contribution. Of course we cannot run any service without somebody paying. Somebody has got to pay. We cannot provide for Clause 12 of the Finance Bill, which we discussed yesterday, and which proposes to give £ 25 million of relief from taxation to a certain section of the community, unless somebody pays for it. Anybody who understands the simplest principles of national finance knows that to provide that £ 25 million for a certain section of the community some other section has to pay it. As I have already said, it is the workers who are, by this Bill, called upon to pay the major part of that contribution, and of course it is a departure from principle. When this Bill is passed we shall not be able to say that the National Health Service is a free service. In referring to it as a free service I mean that a service which is financed by taxation and not by contributions.
I cannot see why the hon. Member for Putney (Sir H. Linstead), who has just spoken, should accept as a good thing the fact that five-sixths of the expenses of the service should be provided by the taxpayers but should break down on that one-sixth, which he seemed to think it was necessary others should provide. Why did he say that that was necessary? In order to make the workers realise, through paying contributions, that they cannot get something for nothing. There was a very patronising ring about that remark.
Lord Beveridge is not here to be dealt with. I want to deal with the hon. Gentleman. He made himself responsible for the argument because he supported it. I would not acquit the noble Lord of a similar, patronising approach to this question. It is the kind of approach which people sometimes make who really think that their standard of morality is a little higher than somebody else's.
I put this to the hon. Gentleman. Why is it contributions have to be imposed upon the workers to remind them that certain benefits come to them from the State and have to be paid for? Why is it necessary to do that? It is a kind of seventeenth century argument applied to twentieth century people, but we are no longer dealing with the working class of the seventeenth or eighteenth centuries. We are dealing with a body of intelligent citizens who have received a measure of education, and they understand, to precisely the same degree as anybody else, whatever his rank in society, that they get nothing which is not paid for by some means or other.
However, the worker says— and this is my point— that, taking for granted our present principles of taxation, there is a greater degree of equity in collecting the necessary revenue to run the Health Service by means of taxation than by the imposition of contributions. I say frankly that one of the greatest contributions which we have made to the Welfare State is by proving the practicability of providing a socialised medical service which is free; that is to say, free in the sense that it is based upon taxation and not upon the individual contributor who is in receipt directly of the benefits from the service.
I regard this Bill as a reactionary Measure, one of the worst reactionary Measures we have had from this Government. I hope that when my party returns to power— and, judging by the municipal election results which we already know and by the recent by-elections, I am perfectly certain that it is an immediate prospect— one of its first aims, announced in the first Speech from the Throne, will be the restoration of the free Health Service. I hope, therefore, that the present Government will not be in office very long. The longer they are in office the more reactionary they become.
What I cannot understand was why the Government wept those tears— but they were crocodile tears, of course— over the recent industrial unrest, for almost every legislative Measure of theirs makes it more difficult to maintain stability. Almost every Measure which they produce contributes to the rising cost of living, and the result of the increasing cost of living is to unsettle existing wage rates in such a way as to reproduce industrial unrest and industrial turmoil, which are directly attributable, in my view, to the woeful incapacity of this Government to understand how to maintain and improve in equity the economy of this country.
The hon. Member for Oldbury and Halesowen (Mr. Moyle) devoted much of his speech to criticising the use of contributions to support the National Health Service, as indeed other hon. Members opposite have done. Yet, in my primarily industrial constituency, my experience has been quite the opposite. The view often expressed to me is that the weekly stamp put on the card is a contribution to the Health Service. Not so many seem to realise that it is also a contribution to insurance.
Whatever we may say here for political purposes, that surely is our experience in the constituencies. It dates from the original Insurance Scheme of 1911, which is still sometimes called "The Lloyd George". People got used to putting stamps on their cards for sickness benefit. They still look upon the stamp as being primarily for the purpose of financing the present National Health Service. They understand that they are paying for the Service, but they think that they are now paying a great deal more for it than they paid in the past.
The speeches of the hon. Lady the Member for Cannock (Miss Lee), the hon. Member for Greenock (Dr. Dickson Mabon) and the hon. Member for Oldbury and Halesowen clearly indicated that they had in mind the possible unlimited expansion of the Health Service. It is a problem which confronted their own Government. I thought that some of the arguments of the hon. Member for Greenock, who unfortunately is not now in the Chamber, were vitiated by the fact that he made a great point about the Labour Government imposing charges to deal with the fiscal problems which arose out of the Korean war. I tried to interrupt the hon. Member, but his spate of eloquence was such that he would brook no interruption. My recollection was that the charges were imposed in 1949 and that the then Government, having placed the Measure on the Statute Book, never enforced it because of disagreement within their own ranks.
Charges in the National Health Service had absolutely nothing at all to do with the Korean war, but they had plenty to do with its rapidly increasing cost, which all of us recognised within two years of the Service starting. The problem has been with us from that day to this, and both sides of the House have tried to deal with it by variations on the same theme.
In the absence of my hon. Friend the Member for Greenock (Dr. Dickson Mabon), who has gone for a cup of tea, I should like to ask the hon. Member whether he was in the House when my hon. Friend made the point that the Health Service now absorbs a smaller percentage of the total national income than it did in its first years? Why, therefore, is the hon. Member making so much of its cost?
I think that the hon. Lady will find from the Titmuss Memorandum in the Guillebaud Report that the argument was that the Service was not taking less of the national income but that it has been taking the same proportion probably since pre-war days. The hon. Member for Greenock, whom the hon. Lady is defending, was rather inaccurate in his references to the Guillebaud Report in that respect. He was also very unfair to my right hon. Friend the present Minister of Labour, whom he accused of setting up the Guillebaud Committee in order to try to axe the Health Service. That is a view which my right hon. Friend, who was then Minister of Health, repudiated with vigour and, indeed, with violence, as it was entirely untrue. The Guillebaud Committee was set up to do what it eventually did, that is to report to all of us, without prejudice and as objectively as it could, on how the Service had been working for the best part of ten years.
The hon. Lady the Member for Cannock is apparently unconcerned about the unlimited expansion of the Health Service. As far as I understood her, she took the view that all we had to do was to remove the charges, remove contributions, put up taxation and let the Service expand. She mentioned no method of preventing that unlimited expansion.
The hon. Member for Greenock wished to see a full-time general practitioner service established. There was a strong indication in his speech, which I was not able to explore by intervention, that if there were a full-time general practitioner service, it would be possible for a Socialist Minister of Health to lay down to doctors rules and regulations about treatment and prescribing and in that way prevent the unlimited expansion which has been the difficulty with this Service from the start.
Assuming that we are all aware of the problem of trying to keep the Service within bounds financially, what choice have we before us? The first is one of stopping certain developments and of having a Minister of Health who would say, "This we cannot do because we shall not have the money to do it". Perhaps that is what is in the minds of hon. Members opposite when they talk about a salaried service. The second is to impose charges which, as my right hon. Friend the Minister of Health said, have the great disadvantage that they arc charges on the sick. None of us wants to see those charges go further than they have gone already.
The third choice is the one which is put before us today, that of increasing the contributions. My hon. Friend the Member for Putney (Sir H. Linstead) argued, in a way which compelled interest if not support on both sides of the House, in favour of the contributory method for supplying part of the cost of the Health Service. I will not go over those arguments again because they certainly seemed to me to be powerful ones. We on this side of the House want to hear from the Opposition— and perhaps the right hon. Member for Llanelly (Mr. J. Griffiths) will reveal to us later today what he certainly failed to reveal on 16th March— what alternatives the Labour Party will put before the country other than to say, "We will withdraw all charges and all contributions and will let the Service go free and expand as it will and increase taxation to meet the cost." What is the Opposition's alternative? Let us hear that clearly before hon. and right hon. Members opposite vote against the proposals in the Bill
I listened with very great interest to the hon. Member for Clitheroe (Mr. Fort). I could not help being struck by his constant repetition of the word "expansion." He referred to it in a way that seemed to indicate that he thought there was another alternative, which was restriction of the Service. I can see no reason why the hon. Member should use the term "expansion" other than because he believed that restriction, perhaps. would accomplish something with which he would agree.
The first thing I want to say is not in defence of the National Health Service, but in explanation of why it may be apparently costly. I do not think anybody can disagree that the Service has proved itself a complete success. Obviously, we measure success by certain standards. and what standards could we use in connection with a service of this description? Let us look at some of the things we have done, because we have heard from many quarters that one of the reasons why the Health Service is expensive is the cost of drugs. I do not think that they represent more than one aspect, but if drugs have been responsible for making some contribution to the expense of the Service, have we got value for them?
In 1950 or 1951, speaking from memory, there were 20,000 people in this country who died from tuberculosis. In 1952 that figure had dropped, and there were 12,000 people waiting to get into hospitals and sanatoria. The following year we were paying, by contract with Switzerland, for tubercular people to go to that country for treatment under a Government scheme.
Since then we have been able to eliminate the waiting list, and there are now tuberculosis beds which are being devoted to other types of treatment. According to the latest figures available, there is a mortality list of 5,000 instead of 20,000. That is what we are getting for what we are paying. I think we were paying Switzerland about £400,000 under that contract, but now it is ended, and there is no need for us to renew it. So the National Health Service has justified itself there.
We were able to make that attack on this disease because of expensive drugs. At one time, aureomycin and streptomycin were so expensive that only wealthy people could afford the treatment. In the early days, injections of those drugs were so expensive that the Health Service had to open certain centres for their distribution. Everybody considered that there was only one qualification required for treatment, and that was the qualification of need.
I hope my fears will never be realised, but I see in this Bill the grave danger of a qualification for benefit that will depend upon a contribution to insurance. I cannot believe that the Government want to introduce a Bill of that description. I do not think that this Bill is introduced merely for the sake of getting £40 million. If we do, as the hon. Member for Clitheroe said we may do, expand even further, we must either have such a preventive service as to reduce the number of people requiring hospital treatment or we must have a domiciliary service.
The real economy, of course, lies in a preventive service. It is far better to prevent a patient needing hospital treatment than pay for a patient to stay in hospital where he can be cured of his complaint. A reorganised service for patients to be treated at home might be a little more costly, but it might, at the same time, be much cheaper than treating them in hospital, where £ 20 a week is not an unusual figure for an acute case. However, until we have reorganised the Service in such a way that it would enable us to have a preventive or even a domiciliary recuperative, remedial service, there will be a need for expansion.
We are suffering as a result of events which have prevented any kind of hospital service getting, as it should have done, the machinery essential for its proper working. Let us look at the history of the hospital service, which is the most expensive side of the Health Service. In 1929, the then Minister of Health was the late Neville Chamberlain. Whatever else might be said about him, he was a good Minister of Health. He did remarkable work in the Local Government Bill which transferred from boards of guardians that part of their service which was later better done by county and county borough councils. They inherited the hospital service which then required to be rebuilt. Those who have had experience of those days and of the old workhouse infirmaries will remember that they were like forts, which cost as much to pull down as to rebuild. The county boroughs took over in 1930. In 1932 the May Committee came into existence. That economic Committee stopped the spending of public money, and the county boroughs did not recover until 1935 or 1936. By 1937 we were getting ready for the next war.
So that if this Service is costing a lot of money, it is money that ought to have been spent years ago. We would in all probability not need to spend the amount we are spending, or at least a large proportion of it, if we had been able to use the capital to rebuild the hospitals, which should have been done years ago. The waste in many of our hospitals is due to the fact that they are out of date and do not meet the needs of the situation today.
It is a frightening figure— £ 600 million — but we forget that this is not entirely new money. If it were possible to assess the cost of dealing with the sick before the Service was introduced, we would have some basis for knowing what is the new money. Whatever the new money is, we are getting something for it. We are getting a better organised service, but the important thing is that in the minds of the people there is the knowledge that they need no other condition than the fact that they are ill and can get treatment for their sickness.
As I see it, the evil of this Bill lies in the fact that it is largely in the nature of camouflage. New money is not being created. All that is happening in the Bill is that we are going to get a small sum of money, comparatively speaking, that otherwise would need to be raised from national taxation, and we are pretending to ourselves that, as a consequence, we are doing something to meet the cost of the Service. We are not. All that we are doing is taking money from another pocket, and, in my view, that is by no means an honest way of dealing with the situation.
I have never been one of those who thought that we ought to justify expense, no matter what it may be, because the Service is of such importance. I think there ought to be economy. I do not think that we are justified in spending a shilling that could be spent on the health of the people in any other way than on the health of the people. If we can save in administering this Service, we should save, but the Bill does not do that. The Government themselves could not find a way of doing it, and that is why they set up the Guillebaud Committee. That Committee was headed by a man without prejudice, because he knew very little of a service like this. He was a brilliant economist.
At the time when the Committee was set up, I questioned whether it would be able to recommend anything that would be generally accepted, because I considered that, whatever evidence the Committee received, it ought to be tested so that its value could be assessed. The Committee reported that a smaller pro. portion of the national income was being spent on the National Health Service than had been the case at the beginning. The hon. Member for Clitheroe said that that was not right, but, if we leave the Guillebaud Committee out of consideration, the Ministry of Health's own Report said so.
Will the hon. Gentleman allow me? I am following his argument, and I hope to deal with it if I have the good fortune to catch Mr. Speaker's eye. I must protest against the constant misuse of statistics. Of course a smaller proportion of the gross national income is being devoted to the National Health Service because the gross National income has grown by so very much since those days in new resources— [Interruption.]
Perhaps you will permit me, Mr. Deputy-Speaker, to thank the hon. Member for Leeds, North-East, (Sir K. Joseph) for making my case for me.
The cost of the National Health Service has risen to the figure of £ 600 million because so many other things have risen too. It will cost more because general practitioners want a rise, and they claim they want a rise because everything has been made more expensive for them. Let me tell the hon. Gentleman that if he goes to any management committee of any hospital group in the country, he will find that its estimates are higher because the costs have risen.
We cannot have the cost of food rising, for instance, without it being reflected in the cost of running a hospital. After all, the time has gone by when we could say to those who are responsible for the care and maintenance of patients in hospital, "We are going to economise by putting you on rations and cutting down on what you eat." The Minister himself— let us be quite clear about this—discourages economy of that description, and we ought to be fair about this. The Minister asks for economy, but he has never asked for it in that direction.
It would be wrong for us to attempt to make a case of that description, but we are entitled to say that it is the Government themselves who caused this rise in prices. If it is the case that these rises in prices are the result of Government policy, then, clearly, we cannot be held responsible for the figure having reached what it has. Not only has the cost of the maintenance of patients increased, but everybody's wages and salaries have risen in the hospital world, and some of those who work in the Service are not getting enough. Those of us who receive the Service literature and medical and hospital literature know of the complaint that hospitals cannot get staff of the standard they require because they cannot attract people from private industry. They cannot get catering officers, who might be able to economise, because they cannot pay them enough to attract them from private industry.
The cost of the Service is high. I do not want to labour the point because I realise that the Bill does not deal with it, but that cost is high, not because there is any expansion that could be avoided, but because the expansion is attributable to causes over which hospital administrations have had no control. There is something to be said, as has already been said, in regard to the organisation of medical services, even in hospitals. I know hospitals which, prior to the introduction of the Service, had a very high standard of medical service which was proportionately cheaper than it is at the present time but, having given certain rights of freedom, we must not boggle at paying for them. There are those who can economise in the Service, in my opinion, without affecting the standard of the patients, but the Bill does not attempt to do that
What the Bill does is for the first time to establish what I had hoped would never be established, and that is that treatment for a person who is sick will be paid for by a contribution enforced by law— a stamp on a card. Reference has been made to Mr. Lloyd George, as he then was, and the National Health Insurance Scheme, and there were many of us who thought. after a period of experience, how wrong it was that a man who put a stamp on a card could go to his panel doctor, while neither his wife nor his children could do so. The man who put a stamp on a card could get medical treatment as well as sickness benefit, but his wife could not. We thought that to be wrong, but we are now going back to the days when people will only be given medical treatment because they have a qualification other than that of need.
I should like to apologise to my right hon. Friend the Minister of Health for missing his opening speech and to all hon. Members whose speeches I have not heard because of a very urgent constituency matter requiring me to go to the Home Office in the middle of the debate.
It is a pleasure to follow the hon. Member for Tottenham (Sir F. Messer), whose recent pamphlet on disabled persons I was most interested to read, and I should like to take up one point which he made in his speech. He suggested correctly that the Bill now before us did not in any way try to find further finance for any desirable expansion of the National Health Service. What this Bill does, the hon. Member said, is to take money from one pocket rather than another. I could not agree with him more. In fact, if the contributions were not being raised in this way, then taxation, indirect or direct— I hope that the hon. Gentleman is following this part of my speech— would have to be invoked for the £40 million now to be raised in this way.
The hon. Lady the Member for Lanarkshire, North (Miss Herbison) and the hon. Lady the Member for Cannock (Miss Lee) both told us that if their party were in power it would fill the gap by taxing those who could afford it. That is very interesting in a theoretical way, but we have evidence about the putting of further taxes on those who can afford it. In his last Budget, the Leader of the Opposition had a gap to fill, but he did not rely entirely, or even largely, on increasing Surtax or removing concessions to Surtax payers. He increased the Entertainments Duty and the petrol tax and he also increased Income Tax by 6d. in the £. If it is said that it is easy to fill these gaps by taxation by simply "putting it on the rich," surely the evidence of what the right hon. Gentleman himself did shows that it is not the only way in which the Opposition would deal with the gap.
I gave way to so many hon. Members today, and one cannot give way all the time. The hon. Gentleman is comparing one Budget with another. but they are very different Budgets indeed. The Budget that we discussed yesterday on the Finance Bill is one in which the Chancellor found that he could give away millions of pounds to Surtax payers.
I am simply telling the hon. Lady that if she says that the solution from her party's point of view is to put the full extra burden on the Surtax payers, that is not the solution which was adopted by her right hon. Friend the Leader of the Opposition when he had a similar problem. The right hon. Gentleman had to spread the burden very widely.
The hon. Lady told us that the Bill was another example of a ruthless Tory attack on the wage earners. Another hon. Member has told us that it represents the Tory aim, intent and pleasure. If it does represent the Tory aim, intent and pleasure, the charges imposed have limped very lamely behind the prosperity which has spread very widely among the people. It is surely a joy and pride to every hon. Member that the entire population is now demanding, quite rightly, higher standards of living, and more or less broadly and largely achieving that higher standard of living. If hon. Members opposite will read their own Daily Herald or look at the trading returns of the co-operatives or any other evidence which even they will accept, they will not be able to refute that argument.
To turn to the National Health Service, I do not think that there is a single major resource or amenity connected with it which is not more plentifully supplied by my right hon. Friend and his colleagues now than at any time since the war. There are now more real resources for the Health Service— for example, more nurses, more beds, more doctors, more health visitors, more district nurses and more midwives. Only a few days ago my right hon. Friend gave me an answer about the increase in occupational centres for ineducable children so dramatic in its purport that I remember that the number had almost been doubled in the last five years.
Those are real resources. As the hon. Member for Tottenham pointed out, they are yielding fruit in lower disease rates. The blessing of lower tuberculosis figures is not one that redounds to the credit of politicians. It is to the credit of scientists and doctors, but the scientists and doctors need the resources which politicians, through the people who make the resources, can allot to them.
This is not to say 'that this happy picture is spread over the entire population. In general, however, I heard the present state of the economy very well described by a large retail distributor, who told me that today the economy is one no longer of bread but of biscuits.
There are on the economic side two prospects with which the House has to deal. There is the short-term prospect. in which every improvement, however desirable, has to be paid for by higher taxes, higher charges, or higher contributions, or, as I believe, by a combination of those methods. There is also the longterm prospect in which the expansion that we all desire— some in one part, some in another— must surely depend on the expansion of the gross national product — the national resources— which has already enabled the real resources devoted to the National Health Service to rise so dramatically, as I have explained, while a lower percentage of the gross national product has been devoted to it.
The hon. Gentleman must be aware that the main difference between us is that he is contending for a contributory Service while we are contending for a Service financed from taxation. Therefore, the point that he makes about the expansion of productivity as a prerequisite to the expansion of the National Health Service is by no means a dispute between us.
I am grateful to the hon. Gentleman, but surely the immediate problem is that if we want the National Health Service to remain even at its present size we must raise £40 million now either by extra contributions or by extra taxes. It is all very well for me or for the hon. Gentleman to talk about the desirable future when a greater national product will permit lower taxes to produce a greater yield, but at the moment the difference between the two sides of the House is whether there should be contributions or not. Hon. Gentlemen opposite would have raised this £40 million by higher taxation whereas we prefer to restore the percentage contribution to what it was in the first place. The entire Bill does no more than restore the previous position.
I hope that all hon. Members will realise that only by this desirable national expansion can we achieve improvements in all the social services. A number of my hon. Friends and I recently sent a letter to The Times in which we used a phrase to the effect that social, defence, economic and industrial policies are all facets of one organic whole. That is true of the National Health Service, as it is true of the entire industrial system.
I want to take up the argument of the hon. Lady the Member for Cannock at the point where she thought it possible to ask for improvements in the Service and at the same time to argue that the only way to finance the Service is by putting further tax burdens on that very class, whose initiative and enterprise alone create the wealth out of which expansion can be financed. Hon. Members opposite will, I am sure, realise that it is only profits, be they public or private, which can permit good wages, good standards of work, good security in work, and, above all, taxes out of which to pay for these amenities.
I must be being misunderstood. This country limps far behind both America and Russia in respect of the heavy burden that it puts on the people who make the wealth, the dynamos of mind, energy and personality in public enterprise or private enterprise who invent, administer, organise and run things. There is no party point in this; it is common to all hon. Members.
May I now modify the rather bright impression that I have been trying to paint by recognising from my point of view that the lowest-paid wage earners and those on fixed incomes cannot be included in this comparatively sanguine picture? As the hon. Lady said, we cannot deal with them by averages. I was interested to read a survey conducted by the Salford and Sunderland local authorities, which showed that far from all people knowing their rights, as some of us are apt to think, there appear to be large sections of the population, particularly among the old, who are not yet in full exercise of their rights. I hope very much that those excellent institutions, the old people's welfare committees all over the country, will note that there is much still to be done to point out, particularly to old people, that there are Government institutions available for their help which they may not be fully using.
The hon. Gentleman has referred to the result of the survey made by the medical officer for Sunderland. He has quoted only extracts from it. Will he be good enough to quote the whole of it and the relation of the cost of food to old people in the present economic situation?
I was interested in a reply of the Minister of Pensions, who pointed out that fully one-third of the people whose cases were ventilated in the Sunderland report were entitled to assistance— supplementary pensions, if they asked for them. I hope that they will now ask for them, or have already been put in touch with the proper authorities.
I was referring to the condition of those who receive the lowest wages, and there seems to be no difference between me and any hon. Member opposite. The answer is that this contribution merely restores the previous position, and that everybody must hope that wages will continue to rise, provided that productivity rises. Surely everyone in the country wants the highest wages combined with the highest productivity.
About the Health Service as a whole no one can be entirely happy, because we are all aware of a number of gaps. I have a list of items, but every hon. Member has his own preference. We all know that there is much to be done, as outlined in the McNair Report, to make sure that in the next decade there are sufficient dentists, even more than now. It has been a great comfort to see how dentists spend 50 per cent. of their time dealing with priority cases, that is maternity cases and children. Those cases are given free treatment, so there is no question of charges affecting these priority people.
There is much to be done in the dental service. Many of us hope that there will come a time when chiropody will be given proper attention. Here we must rely on more taxation, more contributions, more charges, or expansion of the national income. We cannot just say that we must have these things. They must be paid for. There are those who say that more should be spent on mental health and research and I should like to plead for more expenditure on those, when the time comes.
We should give more time to the whole question of domiciliary visits. I realise that the Younghusband Committee is sitting and should be giving much attention to this. Health visitors, who are extremely highly trained people, often with five years' training as nurses or sisters, are trying to do two completely contradictory jobs. At one and the same time they are meant to try to cover an enormous case-load of families and simultaneously to concentrate on the health of the mother and child, and they cannot do both. We either have to get a situation where health visitors have selected case-loads, that is families who need them most, or only mothers and children, or have many more health visitors.
I was interested last week, when I happened to be in France, to have the chance, by the courtesy of the authorities there, of spending a day seeing how the French health visitors' service works. There they have what is called the assistante polyvalente instead of our assistante spécialisée. Instead of having as health visitors experts with five years' training, they have social workers with one year's training who do the visiting and who call in the experts as necessary. I am sure that the Younghusband Committee will look at the comparison. The rather shaming circumstance is that although the French health service falls far below ours in almost every other factor, they have about 15,000 social visitors in operation against our 8,000, which includes district nurses and midwives— though this is an unfair comparison because the French have some district nurses and midwives also. In this one example the French authorities go further than ours, but they need to do so, because their housing and other amenities are far below our standards.
Next, there should be more focus on preventive medicine. Here I was very interested to read a speech which my hon. Friend the Parliamentary Secretary made to the Royal Society of Health last week, when he said:
There is still plenty of educating to be done as shown by deaths from diphtheria which occur among unimmunised children. In the fact that only three out of 20 children first attending school have healthy teeth. The number of burning and scalding accidents among young children in the home shows no sign of diminishing.
I recognise that the Press, televison and magazines have done a great deal to improve the knowledge of the mass of the people, but education is an economic way of spending money.
Another thing on which we should spend money is industrial medicine; and the Government's record in larger legislation like clean air and the provision of housing is very closely relevant to the policy of maintaining health rather than curing illness. What I am leading up to, in discussing preventive medicine, is that I want to venture into the most dangerous of all topics, a discussion of the family doctor.
I should like to give my diffident praise to the B.M.A. for its bigness in recognising a change of circumstances and in now agreeing to co-operate with the Royal Commission. It seems to me that at the very heart of preventive medicine must be the family doctor. If the family doctor is to do what we know he can do, and what I am sure he wants to do, we must spend money to get shorter lists. It seems to me that that is possibly the trend for which we should work.
My approach is to give doctors shorter lists while keeping the same standard of living. There should be in return some sort of bargain by which doctors guarantee, by their own internal discipline, to ensure a very high standard among themselves. I have in mind the system in America whereby doctors undertake that they will spend so much time a year in post-graduate study, in clinical assistantships and things of that sort. That is essential— and I know that it is almost impossible to generalise about general practice.
There are as many practices as there are towns. There is a great gulf between a rural practice and an urban practice, between a practice in a city like Bournemouth, where the age level is high, and a practice in a city like Cambridge, where the age level is lower, between a seaside town and a northern industrial city. We cannot generalise about the profession, but the burden on a doctor in an area of heavy morbidity must surely require that one day there will be shorter lists in the areas where health is harder to keep, compared with areas where health is relatively easy to keep.
Meanwhile I hope that my right hon. Friend is encouraged by the success of Tory incentives in the great growth of group practices, which enable a combination of men and women to maintain, for the benefit of the public, a standard higher than each one would be able to achieve on his harried own. There are a number of things which we hope that in due course the general practitioner and the family doctor will undertake to maintain, if shorter lists are one day granted. He should have a high standard of ancillary services, of medical records, and of premises, and a high standard of skill by means of post-graduate or clinical assistance work, research, a certain amount of specialisation, which group practice permits, and good use of pathological and X-ray services when they are available in local hospitals.
Above all, what is needed in good family and preventive medicine is time, and that is what only shorter lists can provide. If the family doctor is to return to his key position in preventive medicine, then we shall only be able to judge the human effectiveness, combined with economy, of the Health Service by having better statistics than are now available.
I know that the Ministry issues excellent reports, with full tables at the back, each year, but all that that enables most of us to do is simply to measure one year's performance against that of another. We can never measure against bogey; we have no yardstick— no absolute. It is like a business as it would be if it had only cost analysis and no work study or method study. I hope that the Minister or perhaps a voluntary body will consider carrying out some study in this matter in order to see whether it is possible to measure health or morbidity, or to measure the relevant costs of keeping people in their homes or in hospitals, as was recently attempted by the Nuffield Trust.
I believe that the College of General Practitioners is already carrying out some such survey. I was personally disappointed that the idea of a social service staff college which I ventured to produce in a recent debate dropped as flat as any idea could, but it has at least led to the suggestion— which I believe is being taken up— that there should be a social service quarterly journal in which these statistics and subjects could be canvassed by those who are interested. Only if we have better statistics will the Minister be able to judge whether the improved family doctor, whom I hope one day will be possible, is having any effect on reducing the burden on hospitals.
It is only proper that any hon. Member who suggests further expenditure should try to suggest economies. This is the hardest of all things in the case of the National Health Service. The only suggestion that I have to make is that my right hon. Friend should treat very seriously the method which industry has found invaluable, namely, work study, organisation and methods research, and all those techniques by which industry, both private and public, is constantly seeking to cut out wasteful uses either of machinery or human resources, so as to ease the burden of human effort and to cheapen costs.
As I have said, all who wish to till in the gaps in what we all recognise is a wonderful Service must look primarily to an increase and to the expansion of our national resources, which has been so remarkably achieved and sustained under a Tory Government. To whichever party we may belong I am sure that we all want that increase in national resources— and I am sure that a fair share of those resources will go to the National Health Service.
I had not intended to take part in this debate, but I thought that it provided me with a glorious opportunity to bring to the notice of the Minister and the House a problem which has worried me and also many of my colleagues who represent North Wales constituencies— the problem of inadequate hospital services. If the people of North Wales are to pay these outrageous increased contributions, they are entitled to far better and more efficient hospital services. Although the medical and nursing staffs of Merioneth, Caernarvonshire and Anglesey achieve excellent work under the most difficult circumstances, much more can be done to improve the facilities available. I believe that my hon. Friend the Member for Anglesey (Mr. C. Hughes) gave the House particulars of the position with regard to Bangor Hospital about four or five years ago. I do not know whether there has been an improvement there in the meantime.
In order to illustrate the position, I will concentrate my remarks upon one small hospital, which is typical of others in North Wales and is situated in Towyn, in Merioneth. I know that the Minister very often visits Merioneth for his holidays, and as the author of the Bill that is about the nearest that he will get to heaven. However, he knows the district very well, and he will know the town of Towyn. The problem in Merioneth is a geographical one, and because of this it is very difficult to organise a comprehensive medical service for its people. The transport of patients is obviously a very costly business, and it entails much hardship and strain. At Towyn there is a first-class little hospital, which is one of the busiest and best run in the area. I understand that in 1956 the total attendance was no less than 1,875.
I want specially to refer the Minister to the consultative clinics associated with that hospital and that area. All the people who attend orthopaedic clinics have to go to Dolgelley; chest cases have to go to Machynlleth, and all special X-ray cases, such as those connected with barium meals, enemas, gall bladder and kidney X-rays, have to go to Aberystwyth. They all have to go from Towyn to other hospitals for those purposes. Towyn Hospital comes under the jurisdiction of the Mid-Wales Hospital Management Board, and in addition to the comparatively small central hospital of Aberystwyth there are four small peripheral hospitals, including that at Towyn.
Towyn Hospital is the only one in Merionethshire, and it has the least number of good roads and is the farthest from any centre. It is thirty-two miles from this hospital to Aberystwyth and when the River Dovey is flooded patients have to travel a further thirteen miles. In spite of the fact that Towyn is the most inaccessible of all the hospitals and has by far the biggest turnover of patiens, it has the worst services. All the other hospitals that I have mentioned have a radiography service, which practically obviates any need for patients to travel from those hospitals for any form of X. ray examination, and they have regular orthopaedic clinics, which are conveniently placed. The problem arises only in the area of Towyn.
The number of patients attending Aberystwyth from Towyn Hospital in 1955 for special X-rays was 226; the number who had to go to the chest clinic at Machynlleth was 599, and those who had to go to the orthopaedic clinic at Dolgelley numbered 200. This is because there is no accommodation at Towyn for X-ray instruments. The X-ray instruments are available but there is no accommodation for them. I want to impress upon the Minister the importance of providing this accommodation.
All over the Continent, in countries which were far worse hit than we were during the war, hospitals are being built. Here we are going backwards. The Bill is a true reflection of the minds of those hon. Members opposite who have never believed in the National Health Service. Let us be frank about this: the Conservative Party has never believed in the National Health Service.
I will not follow the arguments of the hon. Member for Merioneth (Mr. T. W. Jones), who spoke so engagingly about Towyn, which I remember as a very pleasant place for a holiday, and also about Aberdovey, for I should like to bring the debate back to the Bill before the House, which concerns National Health Service contributions.
Although I found the hon. Member's speech interesting, I did not think it had very much to do with the Bill. That comment can also be applied to many other speeches made, from both sides of the House, during the debate. I think the reason is that all who have taken part in the debate are very interested in the welfare of the Health Service. The accusation made by the hon. Member for Merioneth that hon. Members on this side of the House have had a desire to wreck the Health Service is the most untrue and unjust accusation he could make. Without a shadow of doubt, the Health Service today £ for £ is very much more efficient, and the public are getting better value for money, than was the case five years ago.
Let me come back to the Bill. Personally, I welcome it warmly. I listened to the speeches of the hon. Lady the Member for Cannock (Miss Lee) and the hon. Member for Greenock (Dr. Dickson Mabon), and I have a great deal of sympathy with their point of view, but my point of view and my approach to the problem is different from theirs.
This is only a problem of the method of payment. We are not dealing with the Services themselves. As I see it, it is the responsibility of a Government in their planning and thinking for the State to try to produce the best sort of State in which the people will live. One of the great arguments of those who have transgressed the narrow limits of the Bill has concerned the day when increased resources will be available for the Service. They have said that when this day comes, this and that shall be done. I believe that a Government have the responsibility so to organise their affairs that those increased resources are available earlier.
If all the benefits of our Welfare State are paid for directly out of taxation, that inevitably means that the burden of taxation is so heavy that it begins to act as a direct disincentive. I will try to make my reasoning clear. The average level of earnings of male workers today is £ 12 a week, or £ 600 a year. If that is the average, a large proportion must be earning over £ 12 a week.
Even for those who are earning less, under the present system of taxation in this country, taking into account direct and indirect taxes, hardly a single person in employment is not paying in taxation about the contribution which is involved in the National Health Service. Consider the position of a man working in a steel works or in an engineering shop, who is moving into the highest Income Tax bracket. I have discussed this matter with the men themselves. Taxation begins to act as a big disincentive. Previously they may never have paid tax at the highest rate. If increased earnings incur a penalty of 8s. 6d. in the £ for them, taxation begins to act as a strong disincentive to increased productivity.
The whole of the country's problems will be solved satisfactorily only by increased productivity per man-hour, per man-year and per machine. Any system which we can evolve which will help to remove the taxation disincentive at that marginal earnings figure will bring the required increased productivity earlier.
I was very impressed by the speech of the hon. Lady the Member for Lanarkshire, North (Miss Herbison), although it does not agree with my thinking. In my view, it is important that a substantial amount of the social security benefits which we receive should be received as a result of a direct social security payment — in other words, as a contribution paid by means of a stamp week by week for that benefit.
In this respect, I was very impressed by the speech of my hon. Friend the Member for Putney (Sir H. Linstead), who cited Lord Beveridge. Lord Beveridge's thinking was that responsibility should be engendered by a contribution through a stamp. If that were his thinking at a time when he was working in the concept of 8 per cent. of the people unemployed, how much more wise would that thinking be today after we have had ten years of running the economy with less than 2 per cent. unemployed the whole time?
It seems to me that a great deal of our thinking on this problem is conditioned by the pre-war picture of 2½ to 3 million people out of work. I do not blame anybody whose thinking is so conditioned, but, in fact, we are running a full employment economy, and most of us hope that we shall continue to run a full employment economy.
The future of the country depends on how our productivity increases within a full employment economy. If, by providing that all these social service benefits are paid for by taxation, we create a load of direct taxation which is a direct disincentive to prevent the man on the workshop floor from increasing productivity, we shall be making a mistake. With such a load of taxation, a man's higher earnings will incur an increasing burden of tax. If we create such circum- stances, then we as a Government and a nation will not be producing the atmosphere which will overcome our problems by helping to increase productivity. I believe that in the Bill the Government have taken a modest, but wise, step in making this contribution a statutory obligation.
I do not agree with the hon. Member for Tottenham (Sir F. Messer). If I thought that the idea behind the Bill was that the man would benefit, but that his wife and children would not, nothing would persuade me to vote for it. But that is not the case. That was a "red herring" which the hon. Member, who is so wise and who made such an excellent speech, should not have attempted to draw across the trail. There is no question of making benefit conditional upon payment. Those who are in full work will be putting the stamp on the card, and upon the stamp will be clearly laid down how much is the contribution for the very big benefits they are entitled to receive as of right under the National Health Service. I do not think there is anything wrong about that.
In what I thought was a very good speech, my hon. Friend the Member for Clitheroe (Mr. Fort) said that in talking to many people he had found the view widely held that most of the money paid each week was for the Health Service. Of course, all hon. Members know that, up to now, the contribution for the Health Service has been under 1s., but many people do not know that. I have heard people criticising the Health Service and saying, "This is what we get for 6s. 8d. a week." But they do not pay that amount; they pay only 1s. for the Health Service. Because that fact is not realised there is not that sense of responsibility towards the Health Service which should be shown by the nation collectively.
I have advanced the reasons why I support the Bill. I believe that it represents a step forward which, although it is not a big step, will help rather than hinder that productivity on which the future of the nation depends. I believe that the Government are wise to introduce the Bill and I congratulate my right hon. Friend on its presentation.
I should be happy if hon. Members opposite would refrain from talking about the need for increased productivity every time they try to justify an increase in the charges which have to be paid by working people. We have heard it so often that we are becoming a little tired of it. The hon. Member for Ormskirk (Mr. Glover) often quotes the importance of increased productivity. Not only are hon. Members on these benches aware of that, but we have seen the work of the people who increase our productivity and who, as a result, are entitled to a share of what they produce and our increased productivity. The hon. Member for Ormskirk is right to state the reasons why he supports this Measure, and we on this side of the House are justified in criticising it.
I wish to advance some criticisms and tell the Government what I think about this Bill. The British people possess many characteristics. There is no race on earth which possesses so many outstanding characteristics. I am happy to say that one is that they arc prepared to pay provided that they obtain value for their money. Long before the introduction of the National Health Service, which began to operate in 1948. the workers were paying to protect themselves in the form of contributions to benevolent societies, permanent relief societies, sick clubs and burial clubs.
An argument has been advanced about the value of the National Health Service, but no one, however clever he may be— even though he may be a genius like Lord Stamp, the famous statistician, or Sir Leo Chiozza Money— can estimate in terms of money the value of the National Health Service. It has been of value to the aged, the sick and the infirm, and I hope that we shall do nothing to interfere with the Health Service as it exists at present. If it is to cost more, we must face that fact, and we must do so whether productivity is increased or reduced. We must look after the sick. the aged and the infirm, although it would be of assistance in that connection if productivity is increased.
One of the disturbing features about this Bill is that this is the third time that the amount to be paid by the workers has been increased. I am not complain- ing, but I maintain that while the workers and the employers— they are both concerned with this have been paying increased amounts, the grant from the National Exchequer has been decreasing. I have been making a close analysis of what is paid by employers and workers and by the Exchequer, and I find that every year since 1948, with the exception of one, the Exchequer contribution has gone down.
If there is to be an increase in the charges; if we have to cope with a situation created by the increased cost of administration, of drugs and of doctors' fees, there should be a fair increase in payments all round. I suggest that there is a responsibility which must be borne by the Exchequer and not all the time by the workers. We want to pay our share, and we will do so. I have never yet found among those who earn their living by the sweat of their brow, anyone who objected to paying his fare share. But all the time we are trying to bridge this gap we are asking the workers to pay more than their share in comparison with the Exchequer.
I should be happy if I could be assured that this increase would result in the abolition of the charges made for prescriptions. I shall be out of order if I develop that argument, but it would please me if the Minister said tonight that this increased revenue would be used to help poor people who find it difficult to pay the prescription charges. It would be very helpful if he could give us that assurance, but I do not think that he will.
Let us examine for a moment what the Exchequer has paid. According to the returns made by the Ministry itself, we find that in the first year of working, 31st March. 1948–49, the payments made by the workers and the employers represented 57 per cent.: that paid by the Exchequer was 18·6 per cent. In the following year, the amount paid by the workers and the employers —
I am quoting the Ministry's returns, which indicate how much is paid by the employers and employees and how much by the Exchequer. What disturbs me is that in the span of years from 1948 to 1957 the amount paid by the former has been increasing. It is true that there has been a variation, and that variation in the amount paid by the workers and the employers is obvious to anyone. What is not obvious to me as an ordinary chap is why the Exchequer grant has been going down considerably.
I thank my hon. Friend — and I will call him that— for giving way. His hon. Friend the Member for Lanarkshire, North (Miss Herbison) made great play of the fact that the workers' contribution was 11 per cent. of the total expenditure on the Health Service in 1948 and that, as a result of this increase of £40 million, it will now be 12½ per cent. At the present moment, without the Bill, it is 6 per cent., so I do not know how that tics up with his figures.
I think the hon. Gentleman must have misunderstood my hon. Friend. She said 11 per cent. of the expense, not of the contributions, and there is a vast difference. The contributions are classified as income. What I am trying to show is the great difference there is between what the workers and the employers together pay and what the Exchequer pays. That is one of my complaints. The Exchequer grant has been going down all the time, and it is that continuing trend that makes me complain.
In 1956, the total from the employers and the employed was 52·2 per cent.: from the Exchequer it was 8·4 per cent. Therefore, from 1948 down to the year ending in April of this year, the Exchequer contribution has gone down from 18·6 per cent. to 8·4 per cent. My contention is that the Exchequer is not bearing the financial responsibility it should in this connection. And, be it remembered, a lot of the improvement in our economic circumstances has been brought about by the increased productivity of the working people. If I may use pit parley— most of it comes from the pick point. It comes from the working people, and I say, once again, that if we call upon the working people to increase their contributions in order to bridge a gap created by many factors and circumstances, then, at the same time, we are justified in asking that the Exchequer should increase its grant to the Fund and not let the full, 100 per cent. responsibility rest on the working people.
I conclude on this note. We cannot and must not let our National Health Service degenerate. We have to keep it up to scratch. Much has been said about expanding the Service. We know that there are very many branches of medicine which ought to be brought in, and which we advocate should be brought in. We cannot bring them in unless we have the money to pay for the administrative and other work involved.
I ask the Parliamentary Secretary to examine the whole aspect of the case— he does not need to go into a lengthy review— and I say to him that if he can so administer the Fund and so use the increased contributions as to bring to an end the prescription charges, he will be doing a grand job of work for the chronic sick, the infirm and the aged people of these islands.
I know the hon. Member for Ince (Mr. T. Brown) too well to imagine for one moment that he would try to mislead the House, but I must say that he has, in fact, rather tended to do that in what he has said this evening. It is not true, of course, that the percentage contribution which the Exchequer makes to the National Health Service has been going down. It has been rising very rapidly. What he has been doing is to confuse, as quite a lot of people do, the National Insurance Fund with the National Health Service, and that mistake somewhat underlines the need to make the position clearer. I should like to see the whole matter treated in an entirely different way, and then we would not get these mistakes.
To put the matter right in finality, let me say that in 1948, when the Scheme was first mooted, the percentage covered by contributions was one-fifth, and it sank to as low as one-seventeenth. It is, therefore, perfectly clear that the contributor is not paying an increasing share, but that that increasing share is being paid by the Treasury. If one looks at the figures, one sees that, from the time when we on this side came to office, that contribution has risen from £ 390 million to £ 550 million net. That is a very large sum indeed, and it is that increase which hon. Members opposite have not faced this afternoon.
I have not heard one hon. Member opposite really face the basic problem of these increasing costs. Even the hon. Member for Tottenham (Sir F. Messer), who is very learned in these affairs, had, in order to criticise this Measure, to bring in fantasy, and talk of the possibility of there being discrimination amongst those who were to be treated that the Bill was not really introduced in order to save money but as a screen which, at some later date, would be used to introduce that discrimination.
We all know that that is not so, and that there is no basic objection in equity, and certainly none on economics, to individuals contributing towards the National Health Service. What is important is, of course, that there shall be no discrimination. We must treat the sick when they are sick. At the same time, no case can be made against saying that all who are gainfully occupied shall pay a proportion towards the cost of the service which they are receiving. No hardship can arise from requiring those who are gainfully occupied to pay an increasing contribution towards the National Health Service. There is spent every year on three things which are by no means necessary, namely, drink, tobacco and entertainments, about £ 2,000 million, but what we are doing today is asking for a contribution towards a very expensive Service to the extent of £40 million. No one can honestly say that this contribution will cause any hardship to those gainfully occupied.
I believe that the present contribution is inadequate, and we ought to work, albeit by easy stages, towards an arrangement whereby at least one-third of the total cost of the National Health Service is covered by contributions. If we could do that, or something towards it, we should be able to do away with at least one unpleasant feature of the present arrangements, that is, the prescription charges, which I think have failed in their purpose and are altogether an infernal nuisance. I support the Bill and regard it as only one step towards getting a much higher level of contributions, with the intention as early as possible of doing away with the prescription charges.
I very much doubt whether employers are now paying enough. It would, in my view, be wise to increase the employers' contribution under the National Health Service and do away with prescription charges. We should look at the pattern of what is happening in countries overseas. Although they may not be absolutely right in what they are doing, there is a very wide range of experience throughout the world in the financing of insurance schemes for pensions and health services, and I should like for a moment to run over what happens in a number of other countries and compare it with what we ourselves are doing.
The percentages apply, in most cases, to both pension schemes and national health services, and in most other countries they lump them together, a procedure which, in my view, might well be considered here. In Austria. these services are provided for by the insured person paying 3·5 per cent. of his earnings, the employer paying 3·5 per cent., and the Government nil. In Belgium, the insured person pays 3·5 per cent., the employer pays 2·5 per cent., and the Government pay only 16 per cent. of the total contributions of insured persons.
Yes, they do, and the Government pay 16 per cent. of the total contributions of insured persons. In Bolivia, a country in which one would not expect to find a service of this kind, insured persons pay 2·5 per cent. and employers pay 5·5 per cent., the Government paying a very small contribution towards the total sums expended on the service. France is a more common example. There, as hon. Members know, the insured person pays 6 per cent., the employer pays 10 per cent., and, again, the Government pay nothing at all towards the maintenance of the national health service in France. In Mexico, the Government are a little more generous and pay 50 per cent. of the contributions of both employers and employees. In the Netherlands, the Government pay nothing, and the rates of contribution by employer and employed are roughly the same. In New Zealand, there is a very high percentge of contribution, 7·5 per cent. by both employers and employed, the Government again paying only a small amount. If we look at the pattern of what is happening all over the world, we see that we are absolutely unique in maintaining a situation where the vast bulk of expenditure is, in fact, met by the Government and not by employers and employed as contributors. We ought seriously to consider whether our method is not, in fact, the least suitable, particularly in our present position.
I was about to come to that; I think the hon. Gentleman has a point there. I was looking at the figures of indirect taxation in various countries of the world, and there is a very considerable variation which does not enable one to draw any very specific conclusions.
I should like to say a word now about one aspect of this matter which has not, I think, been appreciated as much as it ought. My hon. Friend the Member for Ormskirk (Mr. Glover) did refer to it. but only in part. I wish to delve a little deeper. The level of taxation which has obtained in this country over the past five or ten years has, in many ways, been not only disagreeable, but has acted as a disincentive. We know that we cannot obtain from our people amounts of taxation higher than they are providing today. But that is not the whole story by any means.
In the United Kingdom today, we face a very disastrous inflationary pressure which can rob us of the fruits of our work and cause a great deal of hardship. The Government have not yet succeeded in dealing with inflationary pressure as effectively as they would have wished, and one of the reasons is that they cannot have a Budget which finances and has a surplus even below the line. One of the reasons why we cannot have a surplus below the line is that we have some very large payments to make. One of them is required to finance the nationalised industries, a matter to which I referred in a speech I made in the Budget debate. The other is expenditure of this kind, amounting to over £ 500 million a year.
It is a substantial factor. The cumulative burdens we have to meet are so large that we cannot get truly the surplus Budget which is necessary to beat inflation unless we can get rid of some of these commitments below and above the line. As the hon. Member for Bilston (Mr. R. Edwards) implies, we cannot finance our armaments out of contributions. That would obviously be impossible. We can deal with certain capital expenditure in other ways, and I think we can deal with some of the expenditure on the Health Service by contributions in order to enable us to have a better method of dealing with inflation. I urge hon. Gentlemen opposite who, I know, are as much concerned about inflationary pressure as we are, to consider whether it would not be wise, in order to have a truly surplus Budget below the line, to lift some of the expenditure from the Budget and transfer it in the form of contributions.
I believe that higher contributions would tend to give a greater sense of independence to those who use the Service. The higher contributions would, on the whole, tend to answer some of those wretched people who go about this and other countries decrying the National Health Service and decrying their own country. We hear these, as I call them, crabs and carpers almost everywhere. They are to be found, of course, more readily in the more expensive watering places in this country and among the more sun-drenched delights of the south of France. They stand up loudly at cocktail bars and tell the assembled community what a dreadful state we have got into in this country because we have a National Health Service and how, because of the social services which we now afford our people, the whole of the morale of the country is sinking lower and lower. Most of these people are distinguished by the fact that
they toil not, neither do they spin,
and we do not want to pay too much attention to them. I think, however, that any change in the system of raising the total sum required for the National Health Service which would increase the sense of independence would be a good thing and, on the whole, would give an answer to those who most unjustly criticise our social services.
Indeed, whilst dealing with this point, I should like to say how much I regret that we have got this wretched phrase "the Welfare State."
I do not agree with the right hon. Gentleman I think it is a wretched phrase. I have always objected to it, because it conjures up a concept of people living in the lap of luxury— [HON. MEMBERS: "Oh, no."] Hon. Gentlemen opposite say, "Oh, no," but that is what it does in the minds of a lot of people. It conjures up a concept of people living in the lap of luxury without having to fend for themselves. That, I know, is not true and it is because I know it not to be true that I consider it unfortunate that we have such a phrase as "the Welfare State."
The hon. Member for Lichfield and Tamworth (Mr. Snow) interrupted me to ask about indirect taxation. It is true — let me say this in defence of those who attack the Welfare State— that the total contributions paid by workers in the form of direct and indirect taxation exceed, by a calculation made six or eight months ago, the benefits they receive under the various social services. The contribution in taxation paid by the mass of wage earners has gone up very considerably since before the war. It is true that they are paying more in total taxation, direct and indirect, than they receive in social benefits. I deprecate these attacks upon our present social set-up.
There is really no serious cause for concern about the effect of the social services upon our morale as a nation. Many people confuse the effects of inflation upon morale with the effects of the social services. We know that we have some people who are not pulling their weight in the community, at all levels. The cause of that is not that they can get a doctor when they are ill or a pension when they become old and can no longer work. The reason is that we have an inflationary pressure under which it is not possible to exert a discipline on those who will not discipline themselves.
That, however, is not the result of the social services. It is the result of excessive demand for goods and services and, in turn, an excessive demand for labour. Many people generally confuse the effects of inflation upon certain performances of work and the effects of the social services. I believe that it is a very good thing to increase the percentage of contribution paid by the individual. As I said earlier, I would be very happy to see the percentage of contribution paid by the employer to the Health Service increased. I would not mind it going up right away if we could do away with the prescription charges, to which I am completely opposed.
I hope that my right hon. Friend will regard the reception given to the Bill today as a very favourable one. I believe that hon. Members opposite, in their hearts, really know that this is the right step to take. The trouble is that the progressive Socialist is so much of a stick in the mud. [Interruption.] He really is. Having set a pattern in 1948 and then seen a whole mass of social change, he must stick glued to the spot on which he stood in 1948.
It really is not very intelligent. Whilst we in the Government must expect opposition, we are entitled to expect intelligent opposition. We are not getting intelligent opposition on this issue. Not one single speech to which I have listened from the benches opposite has given any sound reason, on the ground of economy or ethics or on social grounds, why the increased contribution should not be asked for. No hon. Member opposite has provided an effective answer to the question how we can fight the battle of inflation and have the necessary Budget surplus to do it if at the same time we try to meet the increased costs of the National Health Service from taxation.
Not one single hon. Member opposite has dealt with the real problem facing the country in the financing of hospital building. In the next ten or twenty years, we shall be facing a huge bill for the building of hospitals. We are hopelessly out of date in terms of new hospitals. To build the hospitals that we shall need in order to put ourselves even on a par with some of our poorer companions on the Continent of Europe will mean a very considerable increase in the cost of the National Health Service. Not one single hon. Member opposite has made a practical suggestion of how this huge sum is to be met. Hon. Members opposite have merely said, "We had an idea in 1948. We have got this idea and, like true Socialists, we are stuck to it."
I appeal to hon. Members opposite to abandon their reactionary ideas, to take a fresh look at this problem, to realise that there are changed conditions, to realise that we have to battle with inflation and must provide a rising standard, both in the National Health Service and in social services in the community, and that, if we arc to do it effectively and combine it with a sense of independence and national solvency, ideas and measures such as we have today arc indispensable.
I listened with great interest to the hon. Member for Cheadle (Mr. Shepherd). I always enjoy his speeches because they are always sincere and, from his own economic angle, profound and constructive, but he will forgive me if I dispute some of the basic economic arguments that he has submitted in support of the Bill.
The two sides of the House have entirely different conceptions of the Welfare State--a description which the hon. Member does not like. When the Labour Government unified the social insurances of the country. which were in a fairly chaotic state before 1945, and commenced the building of the Welfare State. they wrote into the history of the world something basically important. They wrote into the alphabets of the world the new conception that we were our brothers' keepers and that a nation was not civilised if it allowed the sick, the poor, the unemployed and the aged to live in grinding poverty whilst there were millionaires in our society not facing up to their full responsibility to those unfortunate members of our society.
The hon. Member, I am afraid, has a very short memory. Missions came from all over the world to study our Welfare State and the unified social services that an enlightened Labour Government proceeded to build. They literally came from all over the world to study this great revolution in social security. The fundamental principle of that social revolution was that through the medium of taxation everybody in our community should pay for these social services.
We object to this Bill, and we object to the continued activities of the present Government, who are using fiscal policy to try to solve the economic problems which they have created for the people of this country because they are anarchists in economics. Yes, anarchists; for they want a free-for-all, everybody for himself, and say, "Get rid of all the physical controls. Get rid of every kind of control over the economy. Let us have unlimited profits. Let us have the kind of incentive that enables share-pushers to make fortunes."
We cannot discuss this Bill in a vacuum. We have to discuss the Bill on the basis of the whole economic policies of the Government. We have to consider the Bill in the light of the fact that in the Budget the £ 1,000 a year man gets nothing in relief of taxation, the £ 700 a year man gets nothing, the £ 10 a week man gets nothing, but the £ 5,000 a year man gets £ 300 a year in relief of taxation and the £ 10,000 a year man gets £ 600 in relief of taxation— relief of taxation in one year equal to the whole annual income of a process chemical worker whom I am very proud to represent as the general secretary of the Chemical Workers' Union.
It is in that light we have to consider the Bill, and this niggardly method which the Government are adopting to try to deal with the problem of inflation. Their method is to take it out of the people, and by all means they can to prevent the people from spending. This is the way in which they are trying to solve the problem of inflation, a way which has been supported, and rightly so in relation to this Bill, by two hon. Members opposite who have spoken on this subject. This is the background of the whole business.
My hon. Friend the Member for Ince (Mr. T. Brown) is one of the most learned and one of the wisest men in this House on these subjects, and has spent half a century, I think, in creating the will for the Welfare State, in moulding and building public opinion among miners and among trade unionists to try to get a unified service. He gave expression to some of his wisdom to this House tonight, and was taken to task for it. He was taken to task because he insisted that the percentage contribution of the Exchequer to the Welfare State was declining, and that this was a fundamental change in the whole principle of financing social insurance.
I have details here of the percentage of the Exchequer contribution between 5th July, 1948, and 31st March, 1956. My source is the annual accounts of the National Insurance Reserve Fund. What do they show? They show that in March, 1949, the Exchequer contribution was 18·6 per cent.; in 1950 it was 17·8 per cent.; in 1951, 15·3 per cent.; in 1952, 10·1 per cent; in 1953 it dropped to 5·8 per cent.; in 1954 it jumped to 7·8 per cent.; in 1955 it dropped again to 7·5 per cent.; and in March, 1956, it was 8·4 per cent. The total amount was £ 92 million.
In that last year the contributions from industry, workers and employers, amounted to 52·2 per cent., against the Exchequer contribution of 8·4 per cent. The amount of money contributed from industry was £ 570 million-odd compared with £ 92 million from the Exchequer. There is no doubt at all about this. Step by step the Exchequer percentage contribution. which is what matters, is declining, and the contribution expected from industry, including the workers is increasing.
I take the point, legitimately made by the hon. Member for Cheadle, about the contribution of the workers and industry. I have heard the criticism and complaint of French industrialists and French trade unionists, Belgian industrialists and Belgian trade unionists, and Dutch industrialists and Dutch trade unionists, that we in this country have an unfair advantage against them because the contribution of our industry to our social services. is so small in comparison with their contribution to theirs.
It is a very strange argument, I must say, coming from a Conservative who argues about the necessity for incentives and the necessity to maintain and expand our production and our export markets to suggest that the way to solve this problem is to increase the burden upon industry and the industrial workers and to lessen the centralised burden of the Exchequer.
I intended to refer to that in my own speech. It is true that as we enter the European Free Trade Area we shall get into considerable difficulties because of it. Those countries are bearing on their production costs the whole of the cost of their social services, and we are jockeying ours on to our taxation system. Therefore, we are in effect subsidising our exports. It is a fact we must face in negotiations about the Free Trade Area.
This is a very strange argument. I take a very intelligent interest in the Common Market and I am a very keen supporter of it, and I hope we shall go into it, and that both sides of the House will support our doing so. It is news to me, however, that we have to discuss the whole of our fiscal policy as part of the Common Market and that we have to make changes in the whole of our taxation policy. The hon. Member knows perfectly well that is just nonsense.
It is not stupid at all. Does the hon. Gentleman realise that the social security contribution in France is about 50 per cent. of the wages bill and in Germany is between 25 per cent. and 35 per cent. and that that adds to the actual wage costs of the industries of those countries? It is not just nonsense but a very important matter.
I know that, of course. but I suggest that it is nonsense for us to argue their case. In the process of the negotiations we may have to make a number of concessions, but I am sure that we are not prepared— and I am certain that it is not asked of us— to make concessions in relation to the whole of our taxation system and the method of financing our social services. That is not an issue at all. However, we are moving far from the Bill which is before us.
I was not tempted to speak in the debate until I was provoked by one of my hon. Friends. In case I am preventing some other hon. Member from speaking, I will bring my remarks to a close by saying that we should be proud of our social services and of our Welfare State. These services represent a further advance towards civilisation. The way in which we protect the poor and the sick and those less fortunate than ourselves is the measure of our moving towards a higher destiny.
We should never be afraid of increasing the grant from the Exchequer for noble, majestic purposes of this nature, and we should be ashamed of ourselves if we accept the decisions of any Government who dare to undermine these great advances in the social services. We on this side of the House oppose the Bill because we believe it to be the thin end of the wedge of an effort to destroy the basic principle embodied in our magnificent achievement in building a unified social service.
I am glad to have the opportunity of speaking, because I am a supporter of the Welfare State. After having had a certain amount of experience, first as a nurse in a children's hospital and later as a member for nine years of a hospital committee of the London County Council, I realise the enormous benefit wrought through the National Health Service. I recall seeing in one hospital children being brought to what had been an old public house to have their tonsils and adenoids removed. If they were well enough, they were then taken home by their mothers. If they were not well enough, it was my duty to put them in a double pram and push them back to hospital. That was not so very many years ago. Then the London County Council took over a great many of the old Poor Law hospitals and since then, through the years, we have seen an enormous amount of welfare service embodied into the National Health Service.
It is important, therefore, to consider the Bill in relation to its effect on the individual. It is well known that the area that I represent is not one of those high-earning areas about which we hear so much. I think that I am right in saying that the average earnings in my area are only about £ 9 a week. We should consider what happens to the individual on these low earnings. I was very interested to see from the report of the National Savings movement that in Plymouth a sum of 15s. 8d. per head was saved, whereas the national average was 11s. That proved to me that if people can afford to save they can afford to contribute something towards the Health Service.
We have heard a great deal about Clause 12 of the Finance Bill, but it should be remembered that whereas many people pay high taxation the man who receives £ 12 a week and who has children, aged 11 and 16, pays no direct taxation at all. I believe that he is willing to pay something while he is in work towards a service of this kind for himself and his family. That is why I was unable to support my right hon. Friend's predecessor on the question of prescription charges.
I very much regret that this Bill did not come into being before that proposal was made. I believe that, on both sides of the House, 'we all think that the Service must be paid for, and I submit that the way to do it is through the individual who is in work contributing something towards it. As we all know, old-age pensioners and those on National Assistance do not have to do that. I should prefer to see the principle established that the Service should be supported through these contributions rather than that money should be taken from a person who is sick, whether it is deducted from his National Health benefit or unemployment benefit, or even from his savings.
When we discuss the question of what value people get for their money, we have to consider the question of drugs, to which several references have been made today. I am very much in favour of all experimentation in the use of these drugs. I believe that an enormous number of people, particularly diabetics and those suffering from various forms of rheumatism, are kept in daily work who would not be able to work if it were not for the service they receive through the National Health Service. A great deal of the money spent in this way has been very well spent.
Therefore, when he considers the future of the National Health Service, I ask my right hon. Friend to do all he can to ensure that it is supported by contributions by those who are able to pay through their earnings and their productivity and not by those who are sick. There are many ways in which the Service could be considerably helped. One is the reduction of costs to avoid the need to raise contributions in the future.
Far too many old people remain in hospital, occupying beds which are much needed for other sick people, when they would be much happier in some sort of home. Greater attention to this problem would help to lower the cost of the Health Service. My right hon. Friend, perhaps through the almoners, might give greater encouragement to the practice of boarding out old people. I know of a scheme which is running excellently, although it has been going on for only just over a year, whereby over 100 old people are boarded out. They are mostly old-age pensioners. They pay £ 3 a week. Their pension is £ 2, £ 1 comes from National Assistance, and they are given a little extra pocket money. That is a more humane way of dealing with the problem than keeping such people in hospital, which adds to the cost of the Service.
I would also suggest— this may seem to be a small point— that when people go to a chemist for a prescription, the cost of the medicine given to them, if over 5s., should be marked on the bottle of medicine or on the box of pills. One knows only too well that if someone is given a bottle of pink medicine, he may be inclined to say, "It is only a bottle of pink medicine," whereas some cost 25s. each. I had an example the other day of a man who went to the chemist and asked what was in the prescription On being told, he said, "I already have a dozen of those bottles at home." That was a very expensive drug. It is only human nature, if one knows what a thing costs, to take more interest in it. so I suggest that a great deal of money might be saved in this way.
If we ask people to pay this extra contribution, they have the right to see that they are getting value for their money. I suggest that in some ways they are, particularly in regard to the tuberculosis service. I do not think that this has been mentioned, but it shows the benefit of drugs. I understand that now for the first time T.B. beds in many parts of the country are empty. Indeed, in my own district one hospital has been shut recently. I am sure that many hon. Members will be pleased to learn that we have been able to offer these beds to patients from Malta suffering from the disease. That proves the benefit of the Service, and I do not think anybody who realises that this is taking place will mind paying the extra contribution.
Mental hospitals have been worth while contributing to because there are now 15,000 extra beds. I am certain that this Service will mean eventually that we shall know far more about mental processes, and this will lead to a general improvement in mental health and more people in work, which is so desirable.
In common with most other hon. Members, I want to raise one local point about the hospitals in my constituency. People who are contributing towards the Service have the right to expect full benefits. My right hon. Friend may know that for a long time we have had difficulty with an operating theatre in one of the hospitals. I think that if we are spending large sums of money— and we have been discussing large sums today— direct action should be taken to repair or rebuild accommodation when, as has happened in this hospital and another one, there are cases of gas gangrene, and when a patient has actually died and his relatives have been told that this was the cause. This does not give people either confidence in the Service or their dues in regard to the money we are taking.
Also in regard to the contributions which people are making to the Health Service, I hope that we shall get more poliomyelitis vaccination in the near future. There is considerable anxiety because children are not getting the vaccine. My right hon. Friend will correct me if I am wrong, but I understand that the type used in America is not the same strain as is beneficial to children in this country. If that is so, I hope he will be able to make a statement, because people are beginning to feel that this is being held up unduly when, at the same time, they are willing to make their contribution towards the Service.
I only hope that in future it will be those in work who contribute towards the Health Service and not those who arc chronically sick or disabled or who are unable to work for themselves. I have always thought that it was a Conservative principle to ensure that the weak were protected and that the strong would be given every opportunity and help to encourage them, through their initiative, to help themselves and their families.
This has been proved by the legislation passed through the House even during the present Session. I am referring to extra family allowances, and so on. I hope that in all administration in the Welfare State, and particularly in the hospital service, we shall see that the benefit is given to those who are sick and in need, and that there will be nothing to prevent them from getting the service they really require.
In regard to individuals, I should like to suggest that a great deal of money is being wasted in administration. When I was a member of the London County Council, we had many fewer clerks, and so on, than now seem to be necessary, and if more people could go into the nursing field instead of into these other forms of activity I am sure that would be of benefit to the Service. I should like to congratulate my right hon. Friend on the number of extra nurses who have been brought into the Service, but I should also like to make a plea that they be given far more electrical and other equipment to facilitate the cleaning of the hospitals, so that nurses do not have to do the ordinary donkey work of the domestic duties— either the domestic helpers or the nurses themselves— and so that more attention can be given to the patients.
I sincerely hope that in all future legislation the Minister will bear in mind that these contributions are the right way in which to try to finance the National Health Service, in preference to individual charges for medicines being imposed on sick persons.
I think we all listened with enjoyment to the well-informed speech of the hon. Lady the Member for Devon-port (Miss Vickers), who spoke from a wealth of experience. Except in so far as she gave her version of Conservative principles, I found much in her speech with which to agree.
If it is a fact, as the hon. Lady said, that we can now provide beds for Maltese tuberculosis sufferers, I think that is a fact which might be brought to the attention of a much wider public. In fact, it demonstrates that we are trying to give a lead, and are accepting our Commonwealth responsibilities. I well remember at the time of the controversial discussions in this House on the National Health Service Bill, I think before the hon. Lady was a Member, the criticism against giving that sort of medical treatment to people who came to these shores, let alone our Commonwealth fellow-subjects.
I well remember the right hon. Member for Ebbw Vale (Mr. Bevan) describing the activities of mediaeval religious orders in maintaininc, hostels throughout Europe towards the maintaining East so that pilgrims going from England to Jerusalem would be assured of medical treatment on the way. He went on to say, I remember, that the mediaeval religious abbot was more progressive than the contemporary Tory in this matter. However, these are really matters into which we need not go in detail now, and I shall be more likely to be in order in sticking to the real subject of the Bill, with which I propose to deal in a few minutes.
I hope that the Minister will accept from me that I have been very strongly tempted tonight to deal with certain matters of current interest in the Midlands regarding the structure of the National Health Service. I am not going to deal with them, because I know that they are receiving his attention, and I hope that there may soon be a decision.
Within the context of that point, I think that we ought to be critical of the National Health Service, even on this side of the House, and should be quite certain that we are getting the sort of service which we originally thought was necessary. Let us face it. Some things have gone wrong. I am not at all sure that the structure of the hospital service has not gone somewhat wrong. I am now speaking particularly about the area of financial responsibility at regional and local hospital management committee level. I am certain that a lot of "horse-coping" goes on to try to attract patients in order to obtain more financial support. Those are matters which I think ought to be looked at.
I find it rather tragic that many of the recommendations in the Guillebaud Report are not now being observed and are even held in contempt at certain levels in regional and local administration. More the pity, for much money was spent in obtaining the Report, and many of its recommendations ought seriously and quickly to be enforced.
One of the weaknesses is the service provided in rural areas. One has cases brought to one's attention of people who live in deep rural areas and somehow or other do not get to hospital at the right time. Why is that? I can only assume that it is because there is a fairly close area surrounding a general hospital and there is a tendency for cases to be taken in from the immediate periphery of the hospital area and not from the rural areas. I do not know how it happens. All I know is that somehow or other one finds too many instances of patients waiting for one, two or even three years before they can have a fairly ordinary operation.
I wish to comment on the whole question of accountancy under the Service. I have a feeling that the little men in black coats who mill around the Treasury and try to record the humanitarian and health problems of the nation in terms of double entry simply do not understand that a health service, if it is considered in normal accounting terms, is bound to become more and more expensive and a greater charge on the nation.
I read somewhere— I think it was an article by Professor Titmuss— that, actuarily speaking, it costs less now to keep a man at work than it did before the war. If that is true— I believe it is— it is something about which the public ought to know. How can we maintain a heavy and necessarily increasing expenditure on building new hospitals and yet maintain an overall figure for the Service that begins to look reasonable? Of course it will not be reasonable. We have years of backlog to make good.
One has to go round the provinces to understand what deplorably low levels of construction and maintenance we accept as reasonable. Hon. Members who have travelled in such countries as those in Scandinavia will know that the standards of some of our provincial hospitals would not be tolerated in those places. I refer not only to accommodation for patients. Let us consider the conditions under which nurses have to live and those under which many doctors have to work. I should like also to go into the question of mental health, in which I am very interested. Some of our mental health hospitals remind us of some of the things that we read in Dickens.
Therefore, it is a problem which if one considers it in terms of normal Treasury accountancy— by that I mean inhuman accountancy— one will simply never get a reasonable picture in conventional terms. It is for that reason that I suggest that the financial effect of the Bill with which we are now concerned, which I read as being £ 41·2 million a year, is chicken-feed compared with the saving which is being achieved under the National Health Service by keeping people at work and by removing anxieties from the minds of workers because they know that their wives and children will be properly looked after.
That is the sort of accountancy that we ought to consider. But no— we are all guilty of this— we knuckle right down to little black-coated men at the Treasury who, by virtue of their local surroundings and professional upbringing, cannot and will not understand a Minister's problems. I sympathise with the right hon. Gentleman. My right hon. Friend the Member for Ebbw Vale had a terrific fight. With great respect, the right hon. Gentleman has not the same political experience as has my right hon. Friend. He will no doubt one day, but he has not got it yet. All power to him if he can resist the sort of pressure to which he is being subjected, not only economic but political, and the sort of pressure coming from the Treasury, which does not take account of ordinary human accountancy.
I rise to support the Bill, because we all know that it is a necessity, if a somewhat disagreeable necessity. We all agree with the absolute necessity that the National Health Service should continue. The memories of my hon. Friend the Member for Devonport (Miss Vickers) brought back some of my own memories of general practice when the dependants of insured industrial workers were not covered by any scheme and of how when one called at a house to see a sick child one was handed 3s. 6d. and asked not to call again. The Health Service has, fortunately, finished for all time anything of that nature, and we cannot fail to give it our absolutely wholehearted support, even if some of us feel that it might have been arranged better and in a different way and that many adjustments are necessary.
The effect of this increased contribution is not only to make people pay more for the Health Service but to make them pay in a more direct fashion. One only hopes that it will lead to an increasing interest and informed public opinion concerning the economies in the Service. I am glad to have this opportunity to express my sense of disappointment with the Report to which we looked forward for a long time, namely, the Guillebaud Report. I wish to say something in particular about the appendix to the Report, in the shape of the reservations made by Sir John Maude about possible rearrangement and economies in the Service.
It is rather too glib a charge to make that economies necessarily impair efficiency. That is not so. On the other hand, it is often the case that waste and inefficiency go together, and so, accordingly, can economy and efficiency. The first thing to which Sir John Maude draws attention in his reservation, the first point of importance, is that we have not one Health Service but three health services working side by side with three separate administrations. That is not only expensive but inefficient, and it is frequently against the interests of the patient.
I will instance just one point, and that is in connection with the mental health service. It is a fact— and I am anxious not to get on contentious ground on this matter— that people get into mental hospitals and stay there because nobody knows what to do with them after they have been there a certain length of time. There is no medium of rehabilitation. That medium could be created only by local authorities— as has happened in some places— forming a rehabilitation and local authority service by taking advantage of their powers under Section 20 of the National Health Service Act, 1946.
However, at present, even though over all it would save money if such a service were in being, there is no inducement for local authorities to establish such a service, because it would be an extra charge on their funds. It would cost local authorities something, but there would be a saving by the hospital board. Although it might cost the local authority only a quarter of what it costs a regional hospital board to keep a person in hospital as an almost permanent patient, there is still a lack of inducement for it to do so, owing to the fact that those responsible think only of the immediate charge upon the rates and local authority services. There may be other inducements, but there is no financial inducement to get a rehabilitation service going. That is an outstanding instance of the way in which money could be saved and economies effected, to the benefit of the patient, by an increasing integration of our services in certain instances. I have no doubt that it would be possible to give many other instances.
The second thing that Sir John Maude has drawn attention to is the predominant position of hospital services. He points out that nearly two-thirds of the money spent upon the National Health Service is attributable to the hospital services. Their estimated cost alone during last year rose to over £ 300 million. As Sir John Maude says, hospital treatment must always be expensive, but the hospital system is bearing too much of the burden.
In tackling this problem of economies, we must have it firmly fixed in our minds that the most costly form of medical care is that given in hospitals. At the present time it seems to be public opinion that all but the most trivial ailments need the attention of specialists. One has only to be in general practice a short time— as I was immediately before I became a Member— to realise how impossible it is, in the present climate of public opinion, for a general practitioner always to give of his best and to take full responsibility in every case.
A patient has only to see him once or twice before, if he does not feel a little better, making an immediate demand to see a specialist— a request which it is impossible for an ordinary practitioner to resist. That means a letter to the hospital. General practitioners' surgeries at present are no longer filled with instruments of healing but are places with files, in-trays and out-trays containing specialists' letters from hospitals. In some instances, although not always, patients are being treated more efficiently by these means, but this is certainly the most expensive possible way of treating them.
In this respect, the British Medical Association points out that practitioners are even complaining that there is a tendency for hospitals to retain unnecessarily patients sent to them for consultation. They are required to return to the hospital at too frequent intervals for inspection and after-care, whereas they could well be sent back to the general practitioner's surgery, where he could keep an eye on them. I can certainly confirm that that is so from my own experience in recent times. Once a hospital has had a patient it seems to have a peculiar tendency to hang on to him in a quite unnecessary fashion.
I must say that this appears to be one of the mysteries of the Health Service. Why hospitals, these busy institutions, wish to take on more and more work when they are already stretched to capacity, I do not know. It is as if they acquire some peculiar momentum of their own which so far it has been impossible to stop, and it has even been impossible to find its source. We see it, too, in our mental hospitals where more and more cases are being accepted in the unnecessary fashion to which reference has been made by me at other times.
I should like, in conclusion, to turn to the question of drugs, which is another important item in the cost of the service and perhaps the most difficult and intractable problem in these rising costs. We have to admit the necessity and indeed the desirability of extensive pharmaceutical research and of the use of more and more modern antibiotics. Obviously if, by the use of an expensive antibiotic, we can cut short a serious illness so that a breadwinner can return to work after three days instead of having an illness of six to eight weeks, the cost of the drug, even if it is £ 2 or £ 3 for a small bottle of tablets, is justified.
Nevertheless, the variety of these complex drugs is building up all the time. There is unquestionably an advertising pressure on the general practitioner to buy them, which tends inevitably to replace his naturally acquired skill in prescribing for the patient and in using what he learned as a student.
I was practising for several years in the 1930s and there was then a gap in my general practice experience for fifteen to twenty years. When I returned after that I found a completely different climate of prescribing, particularly among the younger doctors. Some of us older men remembered the prescriptions of our younger days, the more or less inexpensive bottles of medicine which so often appeared to meet the case, but we found that our younger colleagues were often prescribing expensive tablets for similar and quite simple ailments. It is right that they should do so, if necessary, because a doctor is justified in treating the patient in the way that he sees fit.
But I think the problem perhaps arises in the medical schools in the lack of pharmaceutical training at present. This is a science which I think has been going downhill, not only for the last twenty years but for twenty years before that. I can go back even further in my reminiscences and consider not only my own days but my father's days as a medical student, which takes us back to 1890. In those days it was one of the priorities in the training of a doctor that he should learn prescriptions, lists of drugs and so on. I learned nothing of that kind in my day. I picked it up from experience, and today I imagine that it is even less a priority. In attempting to solve this problem of the cost of drugs, we must recapture something of the old fashioned spirit and inculcate into medical students and younger doctors the value of using simple remedies as well as the more expensive ones.
I ask my right hon. Friend to direct his attention to the recommendations of Sir John Maude with a view to economy, and also to bear in mind the points which I have endeavoured to make about drugs.
The debate has ranged beyond the detailed provisions of this Bill. None of us would complain about that, because some things have become refreshingly clear to people like myself who remember the stormy debates on the original National Health Act. It is now agreed that the Health Service has come to stay, although had hon. Members opposite had their way we should not have had a National Health Service at all.
Hon. Members have brought to the discussion of these problems their wide knowledge and experience, and it is clear from the many valuable speeches which have been made that there is a need not for the curtailment hut for the expansion of the National Health Service, particularly the hospital service. Hon. Friends of mine who have had wide experience of hospital administration speak with concern about what they fear may one day result in a scandal and a catastrophe. Suppose, for example, a great fire broke out in one of our crowded mental hospitals. There is urgent need for expansion in that part of the Service.
Reference has been made to the proportion of the total cost of the National Health Service represented by the money spent on drugs. The hon. Member for Dover (Mr. Arbuthnot) took to task my right hon. Friend the Member for Warrington (Dr. Summerskill) for speaking about this problem. I hope that the party on this side of the House will come to power before long and have an opportunity to consider this matter. As these requirements are essential to the nation, is not there a case for considering whether the State should manufacture these drugs as part of the National Health Service? That would render the Service more effective and enable economies to be made.
The Minister introduced this Bill in a charming speech and tried to make us believe that it was an innocent Measure. I do not think it is as innocent as it looks or as the Minister tried to make out. Last week, during the debate on the Ways and Means Resolution, the Minister said that the purpose of the Bill was twofold. I want to remind the Minister and the House of what he said, for it is essential for us to understand that this is an important Bill, and one which, since 1946, represents an important new departure in the whole of our social service system.
He said that the purpose of the Bill was twofold:
First, it is to double the contribution at present paid to the National Health Service and, at the same time "—
and I ask the House to note this—
to relieve the taxpayer … of an equivalent amount.
He went on to say:
Secondly, it is to establish for the first time a separate National Health Service contribution."— [OFFICIAL REPORT, 1st May, 1957; Vol. 569, c. 237.]
Those are the Minister's own words—
for the first time.
I therefore beg the House to realise that what we are being asked to consider is not merely in what proportion the cost of the Health Service shall be distributed between the National Insurance Fund and the Exchequer. By the Bill we are doing something that no Government have done since 1946, which is to establish— as the Minister said, for the first time— a separate and distinct National Health Service contribution.
It is quite right to say that this is the first time we have had a National Health Service contribution since 1946. Before that, under the old scheme, the health services that were provided as part of our social insurance system were part of the old National Health Insurance system, established by David Lloyd George in 1911, and amended and expanded from time to time.
Under the original Act there was a contribution towards the health services that were provided as set out in that Act. The worker, the employer and the State each made a contribution, and the contributor was entitled to certain benefits. Standard benefits were provided in the Act, and there were additional benefits provided by the approved societies, or some of them, through which the old Act was administered. But they were insurance benefits; benefits provided for the contributor by virtue of the contributions which he made, and many other benefits were provided without any further cost. Many of the initial benefits were free, although some of them had partly to be paid for, but all were received by virtue of contribution.
That was the old system which we had before the war, and which continued until the new scheme came in, first in 1946, and fully and finally in 1948. Since then, we have had no separate National Health Service contribution. Therefore, what the Government are doing is not merely finding £40 million from the insurance contributor towards the cost of the service, but something far more important and fundamental. They are separating the Health Insurance contributions from the rest of the National Insurance contributions. I note with interest that neither the Minister of Pensions and National Insurance nor anyone representing that Ministry are taking part in this debate.
The Ministry of Health is taking it up and, as a Ministry of Health, is establishing a separate National Health Insurance system, and making contributors pay for it without even the advantages that they enjoyed under the old system, because, in addition to the contributions they make, the contributors pay for their prescriptions. From 1911. no contributor ever paid a penny for his prescription. But now they will pay the contribution and they will pay for their prescriptions. They will pay for other charges. They will pay charges which, in their range and amount, will be greater than those which they paid under the old system. This is, therefore. a step backwards.
The Parliamentary Secretary is to reply. I ask him the question: Is he going to tell us that the Government propose to get £40 million, and is that all? Why then, as they themselves say. have they established for the first time a National Health Service contribution? Is it because they propose to go back to the old scheme? They could have got their £40 million just by increasing the National Insurance contribution. Why separate it? We have never had an explanation. I will come to the 20 per cent. in a moment; they could have got the 20 per cent. by increasing the National Insurance contribution anyhow.
Quite frankly, it is this aspect which arouses our suspicions. The Government not merely want to get £40 million from the contributors, but they want to establish the National Health Service as a contributory system. If they want to do that, why not do it openly, not through the back door? Why not say that that is their purpose? Indeed, the hon. Member for Cheadle (Mr. Shepherd), making a very thoughtful speech this afternoon, as he always does, said that he himself would like to see the contributions equal to one-third of the cost of the National Health Service. If that is what the Government want, why not say so? In any case, we, and hon. Members opposite, are entitled to know before we give a Second Reading to the Bill whether this is the beginning of a return to a National Health Service dependent upon, and financed out of, contributions.
There have been proposals made today, very sincerely, calling for an expansion of the Service. Another point arises here, because one of these days we shall have an award about doctors' salaries, Do the Government propose that part of the increase given to the doctors shall be found out of contributions? The cost of the Service will probably be substantially increased when the final award is made about doctors' pay. I put this question to the Parliamentary Secretary: Is that to be paid for by the taxpayer through the Exchequer, or is it to be financed again by an increased contribution?
Right hon. and hon. Gentlemen opposite, speaking in the debate today, have been evoking the name of Beveridge, It was my privilege to bring before the House the legislation originating from Beveridge's investigations. I had the great privilege of starting the organisation which incorporated a great deal of the Beveridge plan. This is a very important matter, and I want to refer to what Beveridge said.
The proposal for a National Health Service in Beveridge's Report is separate from the plan for social security. Beveridge said, "I devise this plan for social security, on three assumptions, first, that the Government will initiate a system for family allowances, secondly, that they will establish a comprehensive National Health Service, and, thirdly, that they will pursue economic policies which will maintain full employment. If we can have those three assumptions fully realised— family allowances, a comprehensive National Health Service, and full employment— on that basis my plan is practicable and I recommend it ". In the course of considering these things, Beveridge himself sought to lay out what
he meant by a comprehensive National Health Service plan, and it is relevant to this debate, particularly since his name has been so often mentioned, to refer to paragraph 437 on page 162 of his Report, where he speaks about his conception of a comprehensive National Health Service:
From the standpoint of social security, a health service providing full preventive and curative treatment of every kind to every citizen without exceptions, without remuneration limit and without an economic barrier at any point to delay recourse to it, is the ideal plan.
He hoped that that plan would be accepted by the Government and put into operation.
He then went on to consider whether in the plan that he was outlining in the main body of his Report any contribution should be made from the Insurance Fund towards the cost of the National Insurance Scheme. Here he was in difficulty, and it is fair to him to point it out. His name is being used as if he committed himself to the view that the National Insurance contribution should fulfil the rôle of providing 20 per cent. of the cost of the National Health Service.
The first difficulty of Lord Beveridge was that when it came to providing in his plan for sickness benefit, unemployment benefit and retirement pensions, he was enabled to have the assistance of an actuary to give him an estimate at certain levels of benefit of what the cost would be, but he came to consider the cost of a national health service no one could give any precise estimates. How could they? There was no comparable experience in any other country. I hope that we are proud of the fact that we were the first country to have a comprehensive health scheme.
I therefore quote from paragraph 437 of the Beveridge Report:
This review of some of the problems involved in establishing a comprehensive medical service makes clear that no final detailed proposals, even as to the financial basis of this service, can be submitted in this Report.
All that Lord Beveridge had was a rough, tentative estimate from the Ministry of Health and its officers that a health service might cost £ 170 million. He made it clear that it was not a precise estimate. It was, in fact, a guess and the Government admitted it. They had scarcely any information to work upon. It was a guess which was found to be very much on the low side.
Lord Beveridge then said that he would provide that there would be a contribution of 10d. The Coalition Government accepted that and introduced its White Paper. As Minister, I accepted it and embodied it in the National Insurance Bill, 1946. It never provided anything like 20 per cent. of the cost of the National Health Service. My hon. Friend the Member for Lanarkshire, North (Miss Herbison), in opening the debate from this side this afternoon, gave the facts. In the first year, 1948–49, the contribution provided for only 10 per cent. of the cost— and that was not a full year. Eventually, the percentage to be provided went down to 9 per cent. and to 6 per cent. and we have been told what the figure is now. The Government have been in office for a long time— far too long. When did they discover that it was proposed that the National Insurance contribution should provide 20 per cent. of the cost of the Health Service? How have they just discovered it now?
During the past few years, we have had increases in insurance contributions. In 1954, the then Minister of National Insurance introduced a Bill, to which the House gave a Second Reading, increasing the contributions under the National Insurance Act by 1s. a week for Class 1 contributors. The Financial Memorandum accompanying that Measure in 1954 stated quite clearly that the increased contribution of 1s. included, as hitherto, 10d. towards the cost of the National Health Service.
The Government accepted it then at 10d. That 10d. contribution, which has been there since 1946, has never been equal to anything like 20 per cent. of the cost of the National Health Service. I therefore ask the Government, since they invoke that, since the Financial Secretary to the Treasury spoke about it last week, and as we are entitled to an answer, do they propose to make it so? Do they propose that the National Insurance contribution shall provide 20 per cent. of the cost? If so, let them say so frankly.
Let us consider what it would mean. The cost now is £ 690 million. I think that in these days of inflation we are all becoming rather bemused by these figures and rather frightened by them, but the fact is that even £ 690 million is a lower proportion of the national resources going to the National Health Service than was the proportion when we began it. The Guillebaud Report said that people would be surprised by the fact that the National Health Service was costing a smaller proportion rather than a bigger proportion of the national resources. However, the figure is £ 690 million.
If the Government propose that 20 per cent. of the cost shall be met out of the National Insurance contributions under these provisions, then the flat rate contribution to that 20 per cent. of the cost would be 3s. extra per week above the National Insurance contribution. Is that what the Government propose to impose? Do they accept that? Do they propose increase the flat rate contribution by an amount like that?
Now I come to a reason why I think the Minister of Pensions and National Insurance should have taken part in the debate. I hope that he will take part next week in subsequent debates on the Bill. Let me put clearly before the House what all this means. Beveridge himself was very deeply concerned about the flat rate contribution. So was I. I have said so before. I said it on the Third Reading of the National Insurance Bill. I said that the time might come when we might, perhaps, have to consider it. Beveridge came down for a flat rate contribution because it was the method of financing the old insurance scheme, because it was the method which had been accepted by us since the beginning of the insurance system, and because it would provide a flat rate of benefit. So he accepted it. At the same time, he uttered a word of caution— several words of caution— that the flat rate contribution was a poll tax which was not "capable of indefinite expansion." It reaches a point at which it becomes so regressive we must think of another.
I put this to the Minister, and to the Minister of Pensions and National Insurance and other Ministers. We are to have a stamp, I gather. It will contain two sets of figures, I gather, the amount to be paid towards National Insurance, which is 5s. 7½d., and the amount which is for the National Health Service, and it will be paid by every employed Class I contributor, all those of 18 years of age and over, working under a contract of service, whatever their wages or salaries. The total for such a contributor is 10s. 5d. At that figure already this has become a regressive tax, and the burden of it bears most heavily upon those least able to bear it. It is a most unjust way of financing any of our services, including this one. I put this to the Minister of Health, and I hope that in Committee on the Bill I shall be able to put it to the Minister of Pensions and National Insurance who, I hope, will also join in our debates on the Bill.
It is not being quite fair to the House that in a debate on a Bill which affects Scotland not a single Ministerial representative for Scotland has been here all evening.
For these reasons, we propose to vote against the Second Reading of this Bill, for we recognise in it only an extra charge upon the contributors and, we suspect— and we have the right to suspect— the beginning of the introduction of the contributory principle in the National Health Service in negation of Beveridge and all we have done.
It has become in debates such as this an almost customary cry from hon. Members opposite to ask us, "What did you do?" I would remind them that it is their business that we are discussing. They have to answer for what they do at the moment. We will answer for what we have done and for what we shall do. We have been doing something which the Government should have done. I provided in the National Insurance Act that at the end of five years, when we had had a reasonable experience of its working, there should be a comprehensive quinquennial review. It was not carried out.
The whole system should have been reviewed and examined thoroughly and a report should have been presented to the House, but all we had from the present Government was a tiny leaflet of one-and-a-half pages from the Minister of Pensions and National Insurance. Here was an opportunity of discussing all these problems. Why was it not taken? The whole system of financing the scheme and the whole level of contributions could have been examined.
Hon. Members opposite ask what we propose to do. We are making an examination of the whole social insurance system and of our social services. There is one conclusion which we have arrived at and which I propose to give to the House. I wonder whether the party at Chequers will come to a different conclusion. We have examined very thoroughly the whole provision for retirement pensions. We have come to the conclusion that an adequate retirement pension which would guarantee to men and women who have served the nation all their lives —
I said "all of them". We have come to the conclusion that a retirement pension that would bear a reasonable relation to their standard of life when they were working could not be guaranteed to them on the basis of a flat-rate contribution. Hon. Members opposite need not exercise their patience much longer. Our plan will be published on 19th May. I ask them to examine it when it is published. I believe that it will be acceptable to the vast majority of our people. Because we have come to that conclusion in relation to that one great service of retirement pension, it obviously follows that all the other provisions must come under review, including this Bill and the method incorporated in it. It is for that reason that we ask the House to reject the Bill on Second Reading.
The Minister said that in addition to the purpose to which, so far, I have devoted all my remarks, there was a second purpose. It was that this contribution was being doubled in order to relieve the taxpayer. I hope that hon. Members opposite will tell that to their constituents. It was not the Minister of Health who first announced this increased contribution, and that is significant. Nor was it the Minister of Pensions and National Insurance. It was announced by the Chancellor of the Exchequer, and announced by him as part of the savings that he wanted to accumulate in order to present his Budget.
What happened? Here is an increased poll tax to reduce the Surtax—10d. on the lowest-paid worker in the land to make gifts to the Surtax payer. [Laughter.] Hon. Members may laugh, but that is what the Minister said it was for. Those were his words. He said that we were doubling the contribution to relieve the taxpayer. Yesterday, the Finance Bill was read a Second time, and in that Bill we found the kind of taxpayers who are being relieved. It is for these reasons that we have no hesitation in saying that the Bill is wholly objectionable, and we ask the House to reject it.
Perhaps, Mr. Speaker, I might say that I speak at this Box, if not for the first time, at any rate for the first time not on the Motion, That this House do now adjourn, which I can assure you for a Parliamentary Secretary in my position is a pleasant change.
The debate has ranged far and wide and has included a number of interesting constituency points. It has been pleasant and good tempered. It has been far more restrained in its tone than, frankly, I had expected. Whether this was due to my hon. Friend the Member for Dover (Mr. Arbuthnot) introducing the subject of tranquillisers at an early stage, I do not know, but certainly the tone struck by all the speeches on both sides of the House has been happy and interesting. Some of the tranquilliser was beginning to wear off when the right hon. Gentleman the Member for Llanelly (Mr. J. Griffiths) began to wind up his speech. He then became a little less restrained and began to make suggestions as to our motives, which I think I shall be able to prove to the House we can completely repudiate.
If I may deal with one or two of the minor constituency points, if I may so put them without offence, I hope the House will bear with me. I do not think that the hon. Member for Merioneth (Mr. T. W. Jones) is here at the moment, but he raised a point about a hospital at Towyn. My right hon. Friend is visiting the Welsh Board of Health next week, on Tuesday, I think, and he will certainly look into the matter raised by the hon. Gentleman.
We had particularly good speeches from my hon. Friend the Member for Carlisle (Dr. D. Johnson) and, although I did not hear it, from my hon. Friend the Member for Devonport (Miss Vickers). My right hon. Friend will look into the points she raised.
My hon. Friend the Member for Carlisle mentioned two things: first the question of the prescribing of drugs. If he reads HANSARD, he will see that my right hon. Friend has taken some steps in this direction. Although I have crossed swords with him on another occasion on a related matter, I would like to say how much I agree with the spirit of what he said, about the necessary development of local authority domiciliary services to deal with mental health. He is absolutely right, and I think we may see a big change— if I may put it that way without being too indiscreet— in the course of the next year or two.
My right hon. Friend has no reason on the whole to be displeased with the way in which this Bill has been received by the House today. He has had the remarkable experience in one and the same day of being described as a bright new pin and as a radical reactionary. I understand that he is not quite happy about the latter phrase, but I can assure you, Sir, that he really is a bright new pin.
The hon. Lady the Member for Lanarkshire, North (Miss Herbison) complained bitterly, and the complaint was repeated by the right hon. Gentleman the Member for Llanelly, that this Measure was being brought in by the Minister of Health and being dealt with by Ministers from this Department. Whatever the right hon. Gentleman may say, the fact is that this is a Health Bill, because the fundamental fact lying behind the necessity for the Bill is that we have a National Health Service in this country the cost of which has gone up and is continuing to go up. What we have learned today is that all hon. Members on both sides of the House appreciate the Health Service. They wish it well. But those who have listened to the demands that have been made for more expenditure, even in this debate, will have some idea of the problem facing my right hon. Friend.
The hon. Member for Lichfield and Tamworth (Mr. Snow) complained about the present methods of accounting. At times any Minister in a spending Department has some sympathy with him in his views, but that does not get us away from the reality of this situation. If I can repeat the figure which my right hon. Friend gave earlier, the estimated total cost for the coming year will be £ 690 million, which compares with some £ 450 million in 1949–50. Of course, it is true, as hon. Members have said, that much of this increase is due to changes in earnings and prices. That is perfectly true, and it is perfectly fair and legitimate comment to make, but there has also been a substantial increase in real terms, and I shall revert later to that.
Faced with this growth, and it is not an unwelcome growth, except in so far as it brings problems with which we have to deal in the resources being devoted to the Health Service, the Government have to consider how much of the cost should or can be allowed to fall on the Exchequer.
Out of the total estimated cost of £ 690 million this year, before the present proposals were made, about £ 550 million would have fallen on the Exchequer; that is, on the general taxpayer. This would have represented 80 per cent. of the total cost, which compares with the 72 per cent. which it was estimated, in the original calculations in 1946, would fall upon the Exchequer, and it compares with 81 per cent. in 1950–51. So, in fact, there is no great alteration in the percentage borne by the Exchequer. It has gone up from the original estimate of 72 per cent. to 80 per cent., and it was about 80 per cent. when hon. and right hon. Gentlemen opposite left office.
So the Government have had to consider what proportion of this growing burden can reasonably be expected to be borne by the general taxpayer. Obviously, no Government can or should allow any particular service to impose a completely unlimited charge on the Exchequer, and it was no doubt for these reasons that the Labour Government itself, as late as April, 1951, affirmed their intention at that time, no doubt as a temporary measure, to work to a ceiling of £400 million.
It is quite true that prices have changed, but the House should note that the equivalent of £400 million, adjusted in terms of the consumer price index, is today about £ 500 million. The Exchequer expenditure for this year was put at £ 550 million before the decision to increase the National Health contribution, so that that increase will now reduce Exchequer expenditure from a date later this year to the equivalent of £ 510 million a year We are, therefore, in fact adhering to a comparable ceiling of expenditure to that which was laid down by hon. and right hon. Gentlemen opposite.
I am grateful to the hon. Lady. I am going to discuss the whole question of the proportion of the national income to which she has referred, but, if I may, at the moment I will continue with my speech.
Faced with the dilemma of this growing expenditure— which I am quite certain no hon. Member on either side of the House has any desire to change, where it makes a real and tangible contribution to the health, prosperity and productivity of the nation, as hon. Members on both sides wish it to do— faced with that dilemma of the growing, but I will not say unmanageable, expenditure, the Government have decided that some further contribution should come from those who, together with their dependants, derive the benefits of the Health Service, particularly since the contributions will fall to be paid at a time when they are in good health.
The alternative to placing on the general taxpayer the burden of higher expenditure is either to ask for greater contributions in the way of further charges, which we must reject, or that people should be asked to contribute when well towards the cost of the burden which would otherwise fall upon them when they are sick. Surely it really is not unresonable that there should be a modest contribution by everyone during the ages when they are fit and well towards the cost of a service which helps them in both youth and old age or when they are sick, at times when they do not contribute to it.
Throughout this debate, and throughout the preliminary canter on the Ways and Means Resolution, no right hon. or hon. Gentleman opposite came out into the open as to what the Labour Party's alternative would be. The hon. Lady the Member for Cannock (Miss Lee) reminded us that it was part of the programme of the Labour Party that it would abolish charges, but, after having listened to the speech of her right hon. Friend the Member for Llanelly, can she honestly say that the Labour Party would abolish the charge in the Bill?
I listened particularly carefully to every word the right hon. Member for Llanelly said. We were told that we had now got to wait until 19th May, C-Day, to hear what the proposals of the Labour Party are for social security, but the right hon. Gentleman did not in any way today commit himself to any change in the contributions which we are proposing to make. I do not know whether the hon. Lady is satisfied with that or not, but I suggest that she will find that her Front Bench will be very chary of committing itself to adding an extra £ 120 million to the cost of the National Health Service without much more mature consideration than appears to have been given to it up to the present.
One of the charges has been that it is our intention to convert the Service from its present comprehensive form into one in which there would be entitlement only by virtue of contributions. This was most explicitly put by the hon. Member for Newcastle - upon - Tyne, East (Mr. Blenkinsop) when he spoke on the Ways and Means Resolution. If I quote what he said, it is because it is so very clear. He said:
… I believe it is also their desire…gradually to convert the finances of the National Health Service so that it is a Service paid for by contributions in one form or another, either by flat rate insurance contributions or by charges imposed on the Health Service itself. This is a good opportunity to look at that principle rather seriously."— [OFFICIAL REPORT, 1st May, 1957; Vol. 569, c. 224.]
That charge was repeated by the right hon. Member for Llanelly. if the hon. Member for Newcastle-upon-Tyne, East meant by that quotation or by his speech that it was our desire to shift the whole burden on to contributions or on to charges, I can and will categorically deny that. Now and in the future the bulk of expenditure will always come from general taxation.
The right hon. Gentleman made great play with the old days of the Lloyd-George insurance scheme, but he forgot— I do not think he really forgot it, but he did not exactly include it— the great change between the two, that the dependants were not included then but they are now. For that reason alone, it becomes obvious that the bulk of expenditure must, as I have said, be borne by general taxation.
As to the proportions which will come from the various sources, it is for any Government to make up its mind as to what it proposes to do at any given moment. Right hon. and hon. Gentlemen opposite have not exacty clarified any of our minds as to what sources they will use for the National Health Service in the unlikely event of their being returned to power. I have dealt with that point already, but if it is part of the Labour Party's election programme that there should be an entirely free Health Service, it ought to have been stated from the Opposition Front Bench tonight.
Perhaps I can amplify that by giving a quotation from the speech which the hon. Member for Newton (Mr. Lee) made in the debate on the Ways and Means Resolution. He said:
The Government have decided that they will not only introduce a contributory service,but will do so in such a way that it will be virtually difficult for the Labour Party when going into office to reinstitute a free National Health Service."— [OFFICIAL. REPORT, 1st May, 1957; Vol. 569, c. 231.]
Pondering on that statement, I found it very hard to follow. If, as I suspect, it is intended to create a face-saving excuse for the dilemma which might face the Labour Party in the event of its taking office, let me say here and now that there is nothing whatever in the Bill which will prevent a Labour Government, or any other Government, abolishing this contribution at any time when back in power. All we have done is to restore the status quo of 1948.
The right hon. Gentleman the Member for Llanelly dealt with what he called the new and pretty stamp. He read into the introduction of the new stamp a great many misinterpretations of our intentions. Frankly, not enough has been made of the fact that the contribution to 'he National Health Service has been separated out. If he will read the Guillebaud Report, he will see how it commented on the confusion which there has always been in the public mind about how the Health Service is financed. The hon. Lady the Member for Lanarkshire, North referred to publicity in this connection, and to the need for explaining the position to people. I could not help thinking that it was a little late in the day to bring that forward. The time for the publicity was 1946 or 1948. If at that time people had been made to understand the real basis of the finance of the Health Service, that would have been a very useful contribution.
Of course, many people— as has come out in the debate— particularly in the older generation, were so used to the words "National Health Insurance "that the idea has been carried over into the new era that the whole of the Health Service is paid for by the weekly contributions. A contributory factor was also that in 1948 the appointed days were the same both for the National Insurance Scheme and the National Health Scheme. That accounted for a great deal of the confusion which arose in the public mind. Candidly, no steps have been taken since then in any way to bring it home to the public that the bulk of the Health Service has been, is and always will be financed out of general taxation.
At least now, with the visible evidence of the stamp before us, it will be simpler to explain to our constituents that Is. 8d. a week is being contributed direct to the cost of the National Health Service, rather than try to explain, as the right hon. Gentleman rather lamely did in his speech, that what has been happening all these years is that out of their weekly contribution to cover themselves for retirement pension, unemployment and sickness benefits a certain amount was paid through the Insurance Fund to the Ministry of Health.
The right hon. Gentleman referred to the 20 per cent., and I shall deal with that later. He ought to recognise that what the Bill is really doing in the separating out of the contribution is to legitimise a contribution towards the Health Service which hon. Gentlemen opposite willingly accepted when they were in office. All that we have done is to legitimise and publicise that fact, and I think that it will be at any rate a slight clarification of a rather difficult position.
Many hon. Members opposite— especially the hon. Member for Lanarkshire. North— commented upon the table given in the Guillebaud Report as to the proportion of the gross national product devoted to the National Health Service. I am in no way criticising the use of the figure given there, but I am a little doubtful— although I have used it myself upon many other occasions— how far it is a really valid argument. In actual, real terms, the amount devoted to the Health Service has increased and, thanks to extraneous factors, such as the improved new medicines, the effect or the impact of that expenditure has increased even more.
If hon. Members will refer to paragraph 20 of the Guillebaud Report, they will see that the figures there carry us up to the year 1953–54, and they show that the percentage of the gross national product devoted to current expenditure from public funds upon the Health Service had declined from 3·51 per cent. in 1948–49 to 3·24 per cent. in 1953–54. These figures obviously need bringing up to date. Unfortunately, the figures which I could have given to the House differ slightly, since they are not compiled on the same basis. But the trends are the same. I know that it will be a source of great pleasure to hon. Members opposite to know that in the last two years— that is to say, the years since the figures given in the Guillebaud Report— this trend has been reversed, and the percentage going to the National Health Service has risen.
I rather hoped that that announcement would have been greeted at least with a cheer from the party opposite.
I am sorry if the hon. Lady is accusing me of any discourtesy. In order to give the figures, it would have taken some time. The Guillebaud Report figures were composed upon a different basis. If the hon. Lady had been so interested in the matter she could have asked a question and the figures could have been made available. I have them here, but I could find them only by rummaging all through my papers. In any case, they are composed upon a different basis from those contained in the Guillebaud Report.
Surely the Minister can give us comparative figures to those contained in the Guillebaud Report, as to the cost of the National Health Service expressed as a percentage of the gross national income. Can he give the same figures as are given in the Guillebaud Report from the mass of figures that he has?
I am afraid not, because the Guillebaud Committee used its own method of calculation. If a Question is put down the figures can be given, because they are available.
The important point is that there can be no final fixed relationship between National Health Service expenditure and the national income. Although they are rather interesting in showing trends, the figures are in no way a yardstick of efficiency. In any case, any Government, as a matter of policy, must take cognizance of the other social services and national commitments which are competing for the available resources. However much we argue as to how much of the national income ought to be devoted to the Health Service, the facts as to what has been done with a static or even a diminishing percentage of the national income are astonishing.
Throughout the last seven years every part of the Service has continually developed. In the hospitals, the number of beds has risen and the number of staff has risen, with all that that means for better service for the patient, shorter waiting lists, and the benefits, particularly, which these improvements bring to older people.
We all deplore how out of date our hospitals are. Anybody in my place and that of my right hon. Friend is only too anxious to get a move on. But let us face it. Within that percentage of the national income the hospital building programme has gone up and is going up even more next year, and the same applies to the general medical services. We have a splendid record. Whatever side of the general medical services we consider, the public as a whole are getting far better service than ever before. Faced with the problem of meeting the bill for this increased expenditure, we have resolved it in the manner which seems the most reasonable to us.
A great deal of use has been made of the argument that this is a regressive Measure. The fact is that the National Health Service contribution is no more regressive now than it was when it was constituted in another form in 1946. The House knows perfectly well that incomes have risen since then. If it is regressive or burdensome now, it must have been so in 1946 when it was used by hon. Members opposite.
Some hon. Members have made play of concessions made in the Budget to taxpayers in contrast to this charge on the Service. It is a matter of historical interest to remember that within twelve months the Labour Party reduced the Purchase Tax on Rolls-Royces and slapped charges on the provision of teeth and spectacles. In fact, there are elements in the new Bill which are less regressive than the proposals which were put forward in 1946 because for the first time the Health Service element in the individual Insurance contribution will no
Finally, may I quote some words used by the right hon. Member for Llanelly, who tonight told us a great deal about what he did in 1946? Speaking on this very point in 1946 he said:
Remember what other benefits it covers. Of the 5s. 9d. and of the 4s. 7d., 10d. is the contribution, and the only contribution, that he will make towards the complete National Health Service: a doctor, a consultant, hospital treatment for himself, for his wife, and for his children— all for 10d. a week. Why, he pays more than 4s. 7d. for that alone now in thousands of homes in this country." — [OFFICIAL REPORT, 6th February, 1946: Vol. 418, c. 1751.]
|Division No. 103.]||AYES||[9.59 p.m.|
|Agnew, Sir Peter||Butler, Rt. Hn. R. A. (Saffron Walden)||Fort, R.|
|Altken, W. T.||Campbell, Sir David||Foster, John|
|Allan, R. A. (Paddington, S.)||Carr, Robert||Fraser, Hon. Hugh (Stone)|
|Alport, C. J. M.||Cary, Sir Robert||Fraser, Sir Ian (M'ombe & Lonsdale)|
|Amery, Julian (Preston, N.)||Channon, Sir Henry||Freeth, Denzil|
|Amory, Rt. Hn. Heathfioat (Tiverton)||Chichester-Clarke, R.||Galbraith, Hon. T. G. D.|
|Anstruther-Cray, Major Sir William||Churchill, Rt. Hon. Sir Winston||Garner-Evans, E. H.|
|Arbuthnot, John||Clarke, Brig. Terence (Portsmth, W.)||George, J. C. (Pollok)|
|Armstrong, C. W.||Cole, Norman||Gibson-Watt, D.|
|Ashton, H.||Conant, MaJ, sir Roger||Glover, D.|
|Astor, Hon. J. J.||Cooke, Robert||Godber, J. B.|
|Atkins, H. E.||Cooper, A. E.||Gomme-Duncan, Col. Sir Alan|
|Baldock, Lt.-Cmdr. J. M.||Cooper-Key, E. M.||Goodhart, Philip|
|Baldwin, A. E.||Cordeaux, Lt.-Col. J. K.||Gough, C. F. H.|
|Balnlel, Lord||Corfield, Capt. F. V.||Gower, H. R.|
|Barber, Anthony||Craddock, Beresford (Spelthorne)||Graham, Sir Fergus|
|Barlow, sir John||Crosthwaite-Eyre, Cot. O. E.||Grant, W. (Woodslde)|
|Barter, John||Crowder, Sir John (Flrtchlcy)||Green, A.|
|Baxter, Sir Beverley||Crowder, Petre(Ruislip— Northwood)||Grimond, J.|
|Beamish, MaJ. Tufton||Currle, G. B. H.||Grimston, Hon. John (St. Albans)|
|Bell, Philip (Bolton, E.)||Danoa, J. C. G.||Grimston, Sir Robert (Westbury)|
|Bell, Ronald (Bucks, S.)||Davidson, Viscountess||Gurden, Harold|
|Bennett, Dr. Reginald||D'Avigdor-Goldsmid, Sir Henry||Hall, John (Wyoombe)|
|Bevins, J, R. (Toxteth)||Deedes, W. F.||Hare, Rt. Hon. J. H.|
|Biggs-Daviton, J. A.||Digby, Simon Wingfield||Harris, Reader (Heston)|
|Birch, Rt. Hon. Nigel||Dodds-Parker, A. D.||Harrison, A. B. C. (Maldon)|
|Bishop, F. P.||Donaldson, Cmdr. C. E. McA.||Harrison, Col. J. H. (Eye)|
|Black, C. W.||Doughty, C. J. A.||Harvey, Air Cdre. A. V. (Maoclesfd)|
|Body, R. F.||du Cann, E. D. L.||Harvey, Ian (Harrow, E.)|
|Boothby, Sir Robert||Dugdale, Rt. Hn. Sir T. (Richmond)||Harvey, John (Walthamstow, E.)|
|Bossom, Sir Alfred||Duthie, W. S.||Harvie-Watt, Sir George|
|Bowen, E. R. (Cardigan)||Eccles, Rt. Hon. Sir David||Head, Rt. Hon. A. H.|
|Boyd-Carpenter, Rt. Hon. J. A.||Eden, J. B. (Bournemouth, West)||Heald, Rt. Hon. Sir Lionel|
|Boyle, Sir Edward||Elliot, Rt. Hon. W. E.||Henderson-Stewart, SirJames(Fife,E.)|
|Braine, B. R.||Elliott, R. W.||Hesketh, R. F.|
|Braithwaite, Sir Albert (Harrow, W.)||Errington, Sir Erio||Hicks-Beach, MaJ. W. W.|
|Bromley-Davenport, Lt.-Col. W. H.||Erroll, F. J.||Hill, John (S. Norfolk)|
|Brooke, Rt. Hon, Henry||Farey-Jones, F. W.||Hinehingbrooke, Viscount|
|Browne, J. Nixon (Craigton)||Fell, A.||Hirst, Geoffrey|
|Bryan, P.||Finlay, Graeme||Hobson,J.G-S.(Warwick&Leamington>|
|Bulkis, Wing commander E. E.||Fisher, Nigel||Holland-Martin, C. J.|
|Burden, F. F. A.||Fletcher-Cooke, C.||Holt, A. F.|
|Butcher, sir Herbert||Forrest, G.||Hope, Lord John|
|Hornby, B. P.||Macmillan, Maurioe (Halifax)||Rodgers, John (Sevenoaks)|
|HortKby-Smith, Mitt M. P.||Macpherson, Niall (Dumfries)||Ropner, Col. Sir Leonard|
|Horobin, Sir Ian||Maddan, Martin||Sandys, Rt. Hon. D.|
|Howard, Gerald (Cambridgeshire)||Maitland, Cdr. J. F. W. (Hornoastle)||Sohofield, Lt.-Col. W.|
|Howard, Hon. Creville (St. Ives)||Maltland, Hon. Patrick (Lanark)||Scott-Miller, Cmdr. R.|
|Howard, John (Test)||Marmingham-Bulier, Rt. Hn. Sir R.||Sharpies, R. C.|
|Hughes Hallett, Vlce-Admiral J.||Markham, Major Sir Frank||Shepherd, William|
|Hughes-Young, M. H. C.||Marlowe, A. A. H.||Simon, J. E. S. (Middlesbrough, W.)|
|Hulbert, Sir Norman||Marples, Rt. Hon. A. E.||Smithers, Peter (Winchester)|
|Hurd, A. R.||Marshall, Douglas||Smyth, Brig. Sir John (Norwood)|
|Hutchison, Sir Ian Clark (E'b'gh, W.)||Mathew, R.||Soames, Christopher|
|Hyde, Montgomery||Maude, Angus||Spearman, Sir Alexander|
|Hylton-Foster, Rt. Hon. Sir Harry||Maudling, Rt. Hon. R.||Speir, R. M.|
|Iremonger, T. L.||Mawby, R. L,||Spence, H. R, (Aberdeen, W.)|
|Irvine, Bryant Godman (Rye)||Medlicott, Sir Frank||Spens, Rt. Hn. Sir P. (Kens'g'tn, S.)|
|Jenkins, Robert (Oulwlch)||Milligan, Rt. Hon. W. R.||Stanley, Capt. Hon. Richard|
|Jennings, J. C. (Burton)||Molson, Rt. Hon. Hugh||Stevens, Geoffrey|
|Jennings, Sir Roland (Hallam)||Moore, Sir Thomas||Steward, Harold (Stockport, S.)|
|Johnson, Dr. Donald (Carlisle)||Morrison, John (Salisbury)||Stoddart-Scott, Col. M.|
|Johnson, Erio (Blackley)||Mott-Radolyffe, Sir Charles||Storey, S.|
|Johnson, Howard (Kemptown)||Nabarro, G. D. N.||Stuart, Rt. Hon. James (Moray)|
|Jones, Rt. Hon. Aubrey (Hall Creen)||Nairn, D. L. S.||Studholme, Sir Henry|
|Joseph, Sir Keith||Neave, Airey||Summers, Sir Spencer|
|Joynson-Hioks, Hon. Sir Lancelot||Nicholls, Harmar||Sumner, W. D. M. (Orpington)|
|Kaberry, D.||Nlcolson, N. (B'n'm'th, E. & Chr'ch)||Taylor, Sir Charles (Eastbourne)|
|Keegan, D.||Noble, Cmdr. Rt. Hon. Allan||Taylor, William (Bradford, N.)|
|Kerby, Capt. H. B.||Nugent, G. R. H.||Teeling, W.|
|Kerr, H. W.||O'Neill, Hon.Phelim (Co. Antrim, N.)||Temple, John M.|
|Kershaw, J. A.||Ormsby-Gore, Rt. Hon. W. D.||Thomas, Leslie (Canterbury)|
|Kimball, M.||Orr, Capt. L. P. S.||Thomas, P. J. M. (Conway)|
|Lagden, G. W.||Orr-Ewing, Charles Ian (Hendon, N.)||Thompson, Lt.-Cdr. R. (Croydon, S.)|
|Lambert, Hon. G.||Orr-Ewing, Sir Ian (Weston-S-Mare)||Thorneycroft, Rt. Hon. P.|
|Lambton, Viscount||Osborne, C.||Thornton-Kemsley, C. N.|
|Lanoaster, Col. C. G.||Page, R. G.||Tiley, A. (Bradford, W.)|
|Langford-Holt, J. A.||Pannell, N. A. (Klrkdale)||Turner, H. F. L.|
|Leather, E. H. C.||Partridge, E.||Tweedsmuir, Lady|
|Leavey, J. A.||Peyton, J. W. W.||Vane, W. M. F.|
|Leburn, W. G.||Plokthorn, K. W. M.||Vaughan-Morgan, J. K.|
|Legge-Bourke, MaJ. E. A. H.||Pike, Miss Mervyn||Vlokcrs, Miss Joan|
|Legh, Hon. Peter (Petersfield)||Pilkington, Capt. R. A.||Vosper, Rt. Hon. D. F.|
|Lennox-Boyd, Rt. Hon. A. T.||Pitman, I. J.||Wakefield, Edward (Derbyshire, W.)|
|Lindsay, Hon. James (Devon, N.)||Pitt, Miss E. M.||Wakefield, Sir Wavell (St. M'lenone)|
|Llnstead, Sir H. N.||Pott, H. P.||Walker-Smith, Rt. Hon. Derek|
|Llewellyn, D. T.||Powell, J. Enoch||Wall, Major Patrick|
|Lloyd, Rt. Hon. G. (Sutton Coldfield)||Price, David (Eastleigh)||Ward, Rt. Hon. C. R. (Worcester)|
|Low, Rt. Hon. A. R. W.||Prioe, Henry (Lew.sham, W.)||Ward, Dame Irene (Tynemouth)|
|Lucas, Sir Jooelyn (Portsmouth, S.)||Prior-Palmer, Brig. O. L.||Waterhouse, Capt. Rt. Hon. C.|
|Lucas, P. B. (Brentford & Chltwiok)||Profumo, J. D.||Watkinson, Rt. Hon. Harold|
|Lucas-Tooth, Sir Hugh||Rallies, Sir Victor||Webbe, Sir H.|
|MoAdden, S. J.||Rawlinson, Peter||Whitelaw, W. S. I.|
|MoCallum, Major Sir Duncan||Redmayne, M.||Williams, Paul (Sunderland, S.)|
|Macdonald, Sir Peter||Rees-Davles, W. R.||Williams, R. Dudley (Exeter)|
|MoKibbin, A. J.||Remnant, Hon. P.||Wills, G. (Bridgwater)|
|Mackie, J. H. (Galloway)||Renton, D. L. M||Wilson, Geoffrey (Truro)|
|McLaughlin, Mrs. P.||Ridsdale, J. E.||Wood, Hon. R.|
|Maclay, Rt. Hon. John||Rippon, A. G. F.|
|Maclean, Fitzroy (Lancaster)||Robertson, Sir David||TELLERS FOR THE AYES:|
|McLean, Neil (Inverness)||Robinson, Sir Roland (Blackpool, S)||Mr. Heath and Mr Oakshotl|
|Macleod, Rt. Hn. lain (Enfield, W.)||Robson-Brown, W.|
|MaoLeod, John (Ross & Cromarty)|
|Ainsley, J. W.||Brockway, A. F.||Dalton, Rt. Hon. H.|
|Alnu, A. H.||Brown, Thomas (Ince)||Darling, George (Hillsborough)|
|Allen, Arthur (Bosworth)||Burke, W. A||Davies, Ernest (Enfield, E.)|
|Allen, scholefield (Crewe)||Burton, Miss, F. E.||Deer, G.|
|Awbery, S. S.||Butler, Herbert (Hackney, C.)||de Freitas, Geoffrey|
|Bacon, Miss Alice||Butler, Mrs. Joyce (Wood Green)||Delargy, H. J.|
|Balfour,A.||Castie, Mrs. B. A.||Dodds, N. N.|
|Bellenger, Rt. Hon. F. J.||Champion, A. J.||Donnelly, D. L.|
|Bence, C. R. (Dunbartonsti lire, E.)||Chapman, W. D.||Dugdale, Rt. Hn. John (W. Brmwch)|
|Benn, Hn. Wedgwood (Bristol, S.E.)||Chetwynd, G. R.||Dye, S.|
|Benson, G.||Clunie, J.||Ede, Rt. Hon. J. C.|
|Beswiok, Frank||Coldriok, W.||Edwards, Rt. Hon. Ness (Caerphilly)|
|Bevan, Rt. Hon. A. (Ebbw Vale)||Collick, P. H. (Birkenhead)||Edwards, Robert (Bilston)|
|Blackburn, F.||Collins, V.J (Shoreditch & Finsbury)||Edwards, W. J. (Stepney)|
|Blenkinsop, A.||Corbet, Mrs. Freda||Evans, Albert (Islington, S.W.)|
|Blyton, W. R.||Cove, W. G.||Evans, Edward (Lowestoft)|
|Boardman, H.||Craddock, George (Bradford, S.)||Fernyhough, E.|
|Bowden, H. W. (Leicester, S.W.)||Crenin, J. D.||Fienburgh, W.|
|Bowles, F. G.||Crossman, R. H. S.||Fletcher, Eric|
|Boyd, T. C.||Cullen, Mrs. A.||Forman, J. C.|
|Fraser, Thomas (Hamilton)||Mabon, Dr. J. Dickson||Ross, William|
|Gaitskell, Rt. Hon. H. T. N,||MacColl, J. E.||Shawcross, Rt. Hon. Sir Hartley|
|George, Lady Megan Lloyd||MacDermot, Niall||Shinwell, nt. Hon. E.|
|Gibson, C. W.||McGhee, H. G.||Short, E. W.|
|Gooch, E. G.||McKay, John (Wallsend)||Silverman, Julius (Aston)|
|Gordon Walker, Rt. Hon. P. C.||MacMillan, M. K. (Western Isles)||Silverman, Sydney (Nelson)|
|Greenwood, Anthony||MacPherson, Malcolm (Stirling)||Skeffington, A. M.|
|Grenfell, Rt. Hon. D. R.||Mahon, Simon||Slater, J. (Sedgefield)|
|Grey, C. F.||Mainwaring, W. H.||Smith, Ellis (Stoke, S.)|
|Griffiths, David (Rother Valley)||Mann, Mrs. Jean||Snow, J. w.|
|Griffiths, Rt. Hon. James (Llanelly)||Mayhew, C. P.||Sorensen, R. W.|
|Griffiths, William (Exchange)||Mellish, R. J.||Soskice, Rt. Hon. Sir Frank|
|Hamilton, W. W.||Messer, Sir F.||Sparks, J. A.|
|Hannan, W.||Mitchison, G. R.||Steele, T,|
|Harrison, J. (Nottingham, N.)||Monslow, W,||Stewart, Michael (Fulham)|
|Hastings, S.||Moody, A. S.||Stokes, Rt. Hon. R. R. (lpswich)|
|Hayman, F. H.||Morris, Percy (Swansea, W.)||Stonehouse, John|
|Healey, Denis||Morrison. Rt. Hn. Herbert (Lewis'm, S.)||Stones, W. (Consett)|
|Herbison, Miss M.||Mort, D. L.||strachey Rt. Hon. J.|
|Hewitson, capt. M.||Moss, R.||Strauss, Rt. Hon. George (Vauxhall)|
|Hobson, C. R. (Keighley)||Moyle, A.||Summerskill, Rt. Hon. E.|
|Holmes, Horace||Mulley, F. W.||Swingler, S. T,|
|Houghton, Douglas||Neal, Harold (Bolsover)||Sylvester, G. O.|
|Howell, Charles (Perry Barr)||Noel-Baker, Francis (Swindon)||Taylor, Bernard (Mansfield)|
|Howell, Denis (All Saints)||Noel-Baker, Rt. Hon. P. (Derby, S.)||Taylor, John (West Lothian)|
|Hoy, J. H.||O'Brien, sir Thomas||Thomas, lorwerth (Rhondda, W.)|
|Hubbard, T. F.||Oram, A. E.||Thomson, George (Dundee, E.)|
|Hughes, Cledwyn (Anglesey)||Orbach, M.||Thornton, E.|
|Hughes, Emrys (S. Ayrshire)||Oswald, T.||Timmons, J.|
|Hughes, Hector (Aberdeen, N.)||Owen, W. J.||Tomney, F.|
|Hunter, A. E.||Padley, W. E.||Ungoed-Thomas, Sir Lynn|
|Hynd, H. (Accrington)||Paget, R. T.||Usborne, H. C.|
|Hynd, J. B. (Attercliffe)||Paling, Rt. Hon. W. (Dearne Valley)||Viant, S. P.|
|Irving, Sydney (Dartford)||paling, Will T. (Dewsbury)||Watkins, T. E.|
|Isaacs, Rt. Hon. G. A.||Palmer, A. M. F.||Weitzman, D.|
|Janner, B.||Pannell, Charles (Leeds, W.)||Wells, Percy (Faversham)|
|jay, Rt. Hon. D. P. T.||Pargiter, G. A.||Wells, William (Walsall, N.)|
|Jeger, George (Goole)||Parker, J.||Wheeldon, W. E.|
|Jenkins, Roy (Stechford)||Parkin, B. T.||White, Mrs. Eirene (E. Flint)|
|Johnson, James (Rugby)||Pentland, N.||White, Henry (Derbyshire, N. E.)|
|Johnston, Douglas (Paisley)||Plummer, Sir Leslle||Wigg, George|
|Jones, Rt. Hon. A. Creech (Wakefield)||Popplewell, E.||Wilcock, Group Capt. C. A. B.|
|Jones, David (The Hartiepools)||Price, J. T. (Westhoughton)||Williams, David (Neath)|
|Jones, Elwyn (W. Ham, s.)||Price, Philips (Gloucester, W.)||Williams, Rev. Llywelyn (Ab'tiliery)|
|Jones, J. Idwal (Wrexham)||Probert, A. R.||Williams, Ronald (Wigan)|
|Jones, T. W. (Merioneth)||Proctor, W. T.||Williams, Rt. Hon. T. (Don Valley)|
|Kenyon, C.||Pryde, D. J.||Williams, W. T. (Barons Court)|
|Key, Rt. Hon. C. W.||Pursey, Cmdr. H.||Willis, Eustace (Edinburgh, E)|
|King, Dr. H. M.||Randall, H. E.||Wilson, Rt. Hon. Harold (Huyton)|
|Ledger, R. J.||Rankin, John||Winterbottom, Richard|
|Lee, Frederick (Newton)||Redhead, E. C||Woodburn, Rt. Hon. A.|
|Lee, Miss Jennie (Cannock)||Reeves, J.||woof, R. E-|
|Lever, Harold (Cheatham)||Reid, William||Yates, V. (Ladywood)|
|Lever, Leslie (Ardwick)||Rhodes, H.||Zilliacus, K.|
|Lewis, Arthur||Robens, Rt. Hon. A.|
|Lindgren, G. S.||Roberts, Albert (Normanton)||TELLERS FOR THE NOES:|
|Lipton, Marcus||Roberts, Goronwy (Caernarvon)||Mr. Pearson and Mr. Simmons.|
|Logan, D. G.||Robinson, Kenneth (St. Pancras, N.)|