I think it is appropriate that the voice of Scotland should be heard in support of this Bill before it leaves the House. This is a Great Britain Measure, agreed at every step with my right hon. Friend the Secretary of State for Scotland. There are no Scottish Clauses and there is no special Scottish implication.
Only yesterday the House completed a Scottish Bill of vital importance and interest to the Scottish people alone. I am sure that the House will agree that it was more in Scotland's interests that as Minister concerned directly in both Bills I was right to concentrate my efforts on the purely Scottish Bill and to leave this important Great Britain Measure to the expert guidance of my right hon. Friend the Minister of Health, who is best fitted to speak for Great Britain as a whole. I have read all the speeches made on both sides of the House, both in Committee of Ways and Means and on all previous stages of the Bill.
The basic issue is simple to state and not so simple to solve. The cost of this great service of which the nation is so proud has been rising steeply from its initial figure, which exceeded the original estimates of the planners upon whose plans the conception of the National Health Service was based. Since then, year by year, an ever-increasing cost has been met by the nation as taxpayers and, to some extent, by increased charges.
Should we call a halt in this steady expansion when there is still so much to be done? If not, who is to meet the increase in this unexpectedly heavy burden now carried by us all—as taxpayers to the extent of 80 per cent., as stamp payers to the extent of 5·8 per cent., and as patients who pay for making use of the service to the extent of 5·5 per cent.?
Of course, the National Health Service must be maintained. The differences of opinion between us are not about whether we should maintain and advance the Service, but how we should do so. I think we have taken the best course in bringing, as the Bill does, our share as taxpayers of this ever-increasing burden down from 80 per cent. to 74 per cent. and our share as stamp payers up from about 6 per cent. to 11½ per cent. and, therefore, more in line with the share of the total cost borne by the stamp payers in the first year of operation of the Service.
To me the reasons for supporting the policy of the Bill are overwhelming. They are, first, that the nation accepted the principle of a flat-rate contribution when the scheme was inaugurated and we are not breaking fresh ground. Secondly, the original division of the burden between taxpayer and contributor has slipped in favour of the contributor. Thirdly, there has been a substantial increase in the wages and earnings of contributors since the contributions were first fixed. Fourthly, we all accept the fact that additional money has to be found and that the alternatives to increasing the stamps could only be either the payment by the taxpayer of more than was considered his fair share, or a greater payment by the patients in the form of increased or new charges, or diminished service. We badly need a better appreciation by the public of the facts about the National Health Service, and that will to some extent be achieved by separating the contributions.
Then there is the disallowance of the health contributions as an expense for Income Tax purposes. It could have been done before and perhaps it should have been done.
In the current year we estimate that we shall be spending £690 million on the National Health Service, of which Scotland's share will be £73 million. Does that huge sum represent a continuation of the trend pointed out by the Guillebaud Committee, the trend that over the years the National Health Service was receiving an ever-diminishing slice of the national cake? Let me give the House the figures. They are compiled on the same general basis as those used by the Guillebaud Committee, but they are United Kingdom figures and not figures for England and Wales which the Guillebaud Committee used. Unlike the Guillebaud Committee they are based on calendar years.
In 1950, the cost to the public funds of the National Health Service current expenditure as a percentage of the gross national product was 3·85 per cent. By 1954, the last year touched on by the Guillebaud Committee, it was down to 3·17 per cent. In 1955 it had risen to 3·25 per cent. and in 1956 it was 3·33 per cent.; so the trend has reversed in the last two years
In spite of that, some hon. Members felt, as the hon. Member for Kilmarnock (Mr. Ross) said, on 20th May:
The fact is that, although we have been spending more money, we have had no extension of the Service in Scotland."—[OFFICIAL REPORT, 20th May, 1957; Vol. 570, c. 964.]
I am sorry the hon. Member is not present. As the hon. Member for Lanarkshire, North (Miss Herbison) knows, that is not true.
The number of hospital beds in Scotland rose from over 61,000 in 1953 to over 63,000 in 1956, an increase of almost 2,000. That compares with an increase of about 4,000 in England and Wales where the figures were over 478,000 in 1953 and over 482,000 in 1956. Again, comparing Scotland favourably with England, the number of new out-patients in Scotland rose from 1·8 million in 1953 to 2·2 million in 1956, an increase of 400,000. That compares with the figure of only 200,000 in England and Wales—6·7 million in 1953 and 6·9 million in 1956.
Finally, as an example of how increased expenditure has more than overtaken rising costs, I quote the Great Britain figures for expenditure on hospital buildings, in which Scotland has shared proportionately. Up to 1955–56 the average figure was just over £12 million; in 1956–57 the figure was just over £15½ million; but for 1957–58 the estimate is nearly £21 million. These last figures obviously show a real increase in the amount of work being done.
This Bill enables the nation to carry forward its plans for the expansion and improvement of the National Health Service without adding yet another tax burden to the heaviest taxed people in the world. It is a wise Measure, and I commend it to the House.