I beg to move,
That an humble Address be presented to Her Majesty praying that the Welfare Foods (Great Britain) Amendment (No. 2) Order, 1957 (S.I., 1957, No. 1759), dated 9th October, 1957, a copy of which was laid before this House on 29th October, in the last Session of Parliament, be annulled.
We have a specific objection to one part of this Statutory Instrument, and that is to Article 3. We have no objection to Articles 2 and 4. It is on Article 3 specifically that I wish to speak. It states:
The expression 'young child' in the said Order of 1954 shall not include, in relation to the supply of Concentrated Orange Juice, a child who has attained the age of 2 years.
This means that the Minister is to deny this important welfare food to children after they attain their second birthday, as compared with the past, when they had this privilege until they were five years of age.
The provision of fruit juice was first introduced in the autumn of 1941. If I remember rightly, at that time little of it was orange juice. Much of it was juice of other kinds—blackcurrant juice, rose-hip juice, and so on. By 1943, we had increased supplies of orange juice available under Lend Lease and we were able then to offer it to children until the age of five.
The purpose of supplying orange juice is commonly known and understood throughout the whole country, and certainly to everyone in this House. We offered it to young children to provide through its medium an accessory food factor or vitamin, called Vitamin C, to protect the child in its most tender years against scurvy or allied disorders. If the whole amount we have been supplying were taken up by the child, properly given, every child from the age of six months until five years would receive 26 milligrammes per day of ascorbic acid or Vitamin C. The amount considered necessary to protect children had been given by the British Medical Association Committee in 1950 as 15 mg., so that in offering 26 mg. we were making assurance doubly sure. It is noted, however, that in Canada the figure was thought to be more correct at 30 mg. However, whether it were 15, 26 or 30 mg., it was a specific and important amount that was being offered.
It may be that in rebutting our arguments the Minister will tell us, amongst other things, that welfare foods have never been fully taken up by the public, and, indeed, this is true. That is a very poor argument, for the truth of it is that if the public does not fully take up an advantage offered to it, it is nearly always because people are ignorant of the benefits available, or because the distribution points are not convenient to them and, therefore, they buy it elsewhere.
We know that, in 1948, 36 per cent. of those entitled to do so took advantage of this type of food. From then until 1954 there was a slow but steady decline down to 28 per cent. In 1955, the figure was beginning to rise, and reached 30 per cent. What happened to the remaining 70 per cent.? Surveys have been conducted and, to the best of our knowledge, it appears that 44 per cent. buy for their children some proprietary remedy of this nature containing ascorbic acid or Vitamin C and pay for it rather than take that juice which is freely available and to which they have a right.
That still leaves 18 per cent. of our children completely unprotected. Those are the facts which are not in dispute and which have been brought out quite clearly in the Report of the Joint Sub-Committee on Welfare Foods which, I have no doubt, we shall all be quoting. Babies and young children must obtain their Vitamin C from some source, and I know that the Minister will agree that some they must have or they would fall sick. They get it from milk, potatoes and green vegetables or citrus fruits. When they are very young they get it entirely from milk.
It is worth noting that cow's milk is a very poor source of supply of Vitamin C as compared with human milk. There must be a reason for that. I presume that the calf does not need it. Possibly, the calf synthesises it itself. It is not available in sufficient quantities in grass as compared with the quantities which are available for the human child if it is breast fed.
In an ounce of cow's milk there would be at the maximum 0·6 mg., whereas in a well-fed woman there may be as much as 2·5 mg. per ounce when suckling her child. However, if the cow's milk is further treated by boiling, it is doubtful whether there is more than 0·1 mg. per ounce. The ascorbic acid in cow's milk must vary according to season. It is obviously available rather more when there is new grass in the spring than later in the late summer.
That is not good enough, of course, for a human child's needs. The human child needs it when it is young, and its mother provides it when it is young. It is therefore significant—and I shall draw the analogy of the needs of a child of two—that a human child can get as much as 50 mg. from its mother per day—that is in 20 ounces of milk over the twenty-four hours.
If it can get as much as 50 mg. a day when it is a newly born baby why, when it is two years of age, should we suddenly withdraw this additional amount which we know is taken up on average to the tune of about 10 to 15 mg.—because not all orange juice is taken by each and every child for whom it is provided? Why is it that we are told that at the age of two a child no longer needs to get it?
In the Report of the Sub-Committee which investigated this, there is considerable argument on this point. In the main, however, the Sub-Committee makes it clear that in its view the provision of orange juice was to prevent scurvy, and in children of two years of age in this country there is little or no scurvy at present. Therefore, it said, from the age of two there was no need to give any additional orange juice as a welfare food. The Sub-Committee did say that at the end of the first year of life there was a tendency towards scurvy, and therefore orange juice should be given until the age of two was reached.
The Sub-Committee did not say much about sub-scurvy. We do not need to be told by medical men or scientists that if, at a certain point, as a result of the denial or withdrawal of an essential food factor a situation arises in which gross disease occurs, then leading up to that stage there may be stages of the disease which are not so clearly apparent. Scurvy is a very old-fashioned disease and has been well known for a very long time. The early literature of Holland suggests that the Roman legions became addicted to scurvy when they crossed the Rhine, and the Dutch, or Friesians, showed them how they could cure themselves by using scurvy grass, which can be translated as spoon-leaf grass, which gave ascorbic acid.
In Britain our peasants and countrymen for hundreds of years made medicine in the spring in order to treat disorders of the blood and to see that loose teeth should become firm. They made it from rose hips, which we ourselves used to protect children in the war when we had no orange juice. People knew how to treat themselves when the spring came and the material became available. They used green leaves, vegetables and, later, berries and fruits. They did not know what scurvy meant, or what it was that they were treating themselves for, but they knew how to treat and cure the disease.
Potatoes contain Vitamin C, but I hope that the Minister will not ask mothers to offer children of two or three years of age their full ration of Vitamin C from potatoes alone. If they do, they will do the children a great deal of harm as well as some good. Potatoes are filling rather than fattening, and the poor infants will be grossly overfed. Citrus fruits are essential for the population, and particularly for growing children. I have not so far controverted a single argument brought forward in the report, but citrus fruits are a comparatively modern import into northern countries, such as Scandinavia, Holland, Germany and even Northern France and Britain. They were a rarity in Tudor days and were used with spices. When spices were pushed round there was an orange on the dish, and diners were allowed to handle it and smell it, and they then had to put it back. I believe that oranges were about £5 each in the early days.
When Mary Queen of Scots, who was addicted to migraine, was sick, she was always given a confection of orange with sugar and, as everybody used to whisper, "Marie est malade", the word "marmalade" came into existence. I must leave these fascinating and interesting points, however, and return to the wickedness of the Government.
In making its recommendation the Sub-Committee nonetheless notes two things that I want to point out to the Joint Parliamentary Secretary. First, it notes that 25 per cent. of children today have less Vitamin C in their diet than the British Medical Association Committee on Nutrition advises. Secondly, it points out that the consumption of oranges on a national scale has fallen in recent years. I noted, from an answer given me by the Minister of Food on 25th of last month, that our imports last year had fallen by 11,000 cases, as compared with two years ago—I am sorry, that is this year. We are 11,000 cases down on last year. Compared with two years ago, we are down by 32,000 cases. Compared with two years ago the import of oranges for the population as a whole is down by 10 per cent. Unfortunately, the price for this diminished quantity has risen by £2 million, so we see that there is a price resistance in the population because of the expense of this type of fruit. Of that there is no doubt.
The Minister suggested at Question Time that the failure of the crop in Spain this year, or this season, might be responsible for the diminished number. But that is not true for the year before, and I feel that it is the increase in the price, amounting to £2 million on a lower quantity of fruit, which has affected the public and which holds them off from buying as many oranges as before.
In spite of the fact that today fewer oranges are being imported—10 per cent. fewer than two years ago—that 25 per cent. of our children are taking less than the requirement as laid down by the British Medical Association—the requirement which I have already shown is only a fragment of what a human baby gets when it is born from a healthy mother—the Minister has accepted the majority view of this Committee and is denying this welfare food to children from the age of two. The majority view of the Sub-Committee according to the Report is that there is virtually no scurvy in children, and that is true. In children of two years there have been found very few cases. They mentioned seven cases in 1955 in one hospital in Birmingham. But still, for the country as a whole, we accept that there are very few cases, certainly as compared with the sort of thing seen in this country fifty years ago.
Secondly, the Report states that in marginal deficiency of Vitamin C—when there is not enough—wounds do not heal so well. The Report states that there is no clear evidence, apart from the fact that wounds do not heal so well, that a high intake of Vitamin C gives any benefit to health or that a low intake inhibits growth. With great respect to the Sub-Committee—I do not have to apologise to its members, because I am not criticising their view—everyone knows that we do not know a great deal about the subject. We are still learning, and it will be some years before we know much more. However, it is suspected that Vitamin C is essential if the cement which joins one cell to another is to be available in proper quantity and quality. It is also suspected that it is needed for the formation of the cells that form our bones and the dentine, or enamel, of our teeth.
A piece of evidence, which I think irrefutable, showing other sub-scurvy states without gross disease was noted in the Scandinavian countries at the beginning of the war. It was observed that always at the end of the winter all the children tended to have fragile blood capillaries, the tiny vessels coming into the skin which were easily fractured and showed bruising and bleeding. It all disappeared in summer when fruits came into season again, particularly berries. Following that observation they began to prepare sweets for children containing the juice of rose hips, the very thing that has been used in this country by our countryfolk for many hundreds of years. Today I understand they use other things, probably synthesised Vitamin C.
This evidence shows that there are conditions other than those of gross scurvy, in which we see spongy gums, swollen ankles and legs with haemorrhages into the skin, and gross bleeding, until people can no longer walk. Our sailors died in very great numbers at one time from gross forms of scurvy. It seems a strange argument which is used by the majority of the members of the Sub-Committee when they say, "If it is needed for growth, why stop giving it at the age of five? Why not continue it as long as the human being is growing?" That seems a very poor argument, not worthy of these very eminent gentlemen. As the Minister knows there were two members of the Sub-Committee who disagreed with the majority view. They were just as eminent as their colleagues. The Sub-Committee consisted of very eminent gentlemen. It does not surprise anybody that doctors do not always agree with each other. Anyone who has practised in the law courts knows that that is true.
The minority put its case very clearly. It said there were six points to be emphasised. First of all, the recommendation of the British Medical Association should be adhered to, as a fifth to a third of the children of the country were below that level. Secondly, it said that malnutrition and stunted development had been disastrous in the past, as indeed they were. It does not need people like myself to vouch for it, but I can remember the remarkable changes for the better that have taken place. Thirdly, it said that, taking second place only to Vitamin D, which protects against rickets, Vitamin C had been of the greatest practical value to the children. Fourthly, it said that from the age of two to five years growth was rapid and that deficiency could be dangerous. Fifthly, it made a point that the consumption of oranges by the population was falling. It was the poorer section of the community which was the hardest hit, the section which tended to have the largest families. Number of children as well as income makes for poverty in family units. Sixthly, it said that optimal, positive health required more of a nutritional substance than the amount to ward off gross disease, and of course they are absolutely right.
I ask the Minister what pressure has been brought to bear upon him and his right hon. Friend to take the proposed step? I understand that the cost to the nation of this welfare food is about £1¾ million per year or a little less. To deprive children from two to five years of age of their orange juice cannot save the Department any money, because the whole apparatus of administration must remain exactly the same. Expectant and nursing mothers are to receive orange juice, and babies until they are two years of age. There will be no fewer people to administer the service, and the location points will be kept up just the same. I wonder how much the Minister is going to save? We shall be very glad to hear the answer from him. I do not think it can be as much as £¼ million in real saving. That is for a year for all the children between two and five throughout this country and in Scotland. It seems to me very strange, if it is nothing more than that, to take away the insurance which has been provided against some scurvy and against the possibility at any rate of interference with their health. That is a false economy.
The Government have done this sort of thing before. It is in line with previous action they have taken. They had a Committee which recommended them to degrade our flour and they then said, "We are putting back some of the things which were taken out". The medical officers of the Ministry of Food told them not to do it, but they did not take that advice. There were editorials in the Lancet and British Medical Journal saying that this was wrong; but nevertheless they took that action.
It seems to me that the Government are concerned with standards other than those which we think suitable for the people of this country. They are concerned with minimal rather than optimal standards. As long ago as 1935, when Sir John Boyd Orr presented his report on food and health to the House, that was the excuse used not to carry out his recommendations—that the Government were concerned with minimal and not with optimal standards. We know what conditions were like in 1935.
Today, at a time when the Government are conducting a campaign asking that there should be no further wage increases and when we have seen that a need for these health foods exists, the Government have selected children aged between two and five as a group to be deprived of this vital constituent in their food.
The technique of waiting until gross disease affects people, particularly children, and then saying, "Does it matter? You can always go to the doctor and be cured and it will cost you only the 1s. prescription charge", seems to me to be the wrong technique. We feel that we are essentially divided in the House on this issue and, with a division of this type, the sooner the nation reaches a decision as to who should govern the better.
I beg to second the Motion.
I speak not as a doctor, but as a parent with practical experience of the factors involved in trying to provide a balanced diet for children. I cannot follow my hon. Friend the Member for Stoke-on. Trent, Central (Dr. Stross) into the medical realms with which he dealt so ably, but I should like to put one or two practical points to the Minister on this subject because I feel very strongly about the Order.
It is being said among members of the medical profession, and also to mothers who attend welfare centres, that children are now becoming over-vitaminised. That is a horrible expression and I do not like what I think it means. Apparently it is being suggested that these children are getting too many vitamins and that they do not need the vitamins in orange juice. That is the basis of the Order, supported, of course, by the Report to which reference has been made.
May I put a question to the Parliamentary Secretary? If this is so, why is it the practice in families who can afford a planned and adequate diet to provide their children with fresh orange juice?
Why do they do that? Why do they have it themselves? They have it because they know that these fruits are essential to full health, and that in the form of orange juice these vitamins are obtained in a pleasant, palatable and easy way. That is something that we all know from our own experience. Orange juice is recognised as being highly beneficial for full health. I stress those words "full health", because that is what I am concerned with. I am not concerned merely with the absence of disease, but with full and abundant health.
I am interested in the reference made in this Report to income groups. I cannot avoid the suspicion that in looking at the Report the Ministry—and even the distinguished sponsors of the Report itself—were influenced by the fact that a higher proportion of families in the higher income groups avail themselves of this welfare orange juice than do those in the lower income groups. It would seem that the Ministry said, "Why should we provide orange juice for families whose income is over £10 a week? They ought to be able to buy it for themselves." I do not know whether that was in the Ministry's mind, but that is how the Report appears to me.
I would ask the Parliamentary Secretary whether he is satisfied that when—and it has, of course, already been withdrawn—this orange justice is withdrawn from children over two years of age, the families that have been obtaining it from the welfare centres will be able to provide the children with fresh orange juice instead. Some of them may, but I am quite certain that they will be able to provide it only in much smaller proportions, if at all.
This morning I paid 1s. 2d. for three oranges. Three oranges do not go very far in the making of orange juice. Families, even those who have what are called higher incomes—and that is only over £10 a week, which is not a very big income when there are children to cater for as well as all the other incidentals of family life—will find it very difficult to provide fresh orange juice when oranges cost as much as that. And, of course, lemons have been 4½d. and even 5d. each in the last few months.
The prices of these fruits are really beyond the reach of ordinary families. That is borne out quite clearly by the figures already referred to, and by the Answer to a Question this afternoon that the intake of citrus fruits in this country is declining. It is obvious why—they cost too much. It is clear that whatever the slightly higher income groups may be able to achieve, the poorer families will not be able to provide this fresh fruit at all.
If there is anything at all in the argument that it is possible to have too many vitamins, it is also quite clear that the poorer families will not be getting enough, because the only time we can substantiate that argument is when, and if, the family is having a perfectly adequate balanced diet. We know that the lower the income the less balanced the diet becomes, and that the item that always suffers is the supply of citrus fruit, green vegetables, salads—all those things associated with this Vitamin C. We know that the poorest families will not be able to provide their children with sufficient of this important vitamin.
I would like to stress the difficulty of mothers in the lower income groups. Where there is more than one child, the arrangement generally is for father to have his mid-day meal out, and for the children to have their mid-day meal at school, while mother very often gets along during the day, at home, as well as she can with a sandwich, a cup of tea—just anything that is handy—without providing an adequate meal for herself. When she has at home with her a child under five years of age, and who is no longer a baby, it is a considerable expense to provide a balanced mid-day meal for that child alone, recognising that when the rest of the family come home she will have to provide an evening meal for them.
These things are very important when there is not much money to spend and there is a real danger that if the child between two and five years of age is not getting orange juice it will be deficient in this important vitamin and in a very vital factor in its health.
The Report draws attention to something which, it says, is outside its terms of reference, and that is the availability of these welfare foods. The Report suggests that the Ministry should review this matter. It is quite clear to me that this is one of the factors in the difficulty that mothers experience in obtaining this orange juice for their children. It is one of the factors which have prevented as many of them taking advantage of it as might have done.
It was the practice, when the distribution centres were more numerous, for mothers frequently to send elder children with the ration book to the distribution centre to collect the orange juice, but when the Ministry of Food offices closed and the distribution centres were more widely scattered, it often involved a bus journey for the child to go to the distribution centre, and, not unnaturally, mothers refused to send them. That is one factor which undoubtedly has led to a lower consumption of this welfare orange juice than would otherwise have been the case.
Quite clearly, if fewer people in the lower income groups are taking advantage of the orange juice, this is an argument not for withdrawing it altogether for children between two and five years of age, but for examining the reasons why they are not taking full advantage of it and for giving them the opportunity of taking greater advantage of it. It is no reason at all for this Order and for what is behind it.
Over a number of years I have been very interested to see the party opposite, both nationally and locally, dealing with some of our important social services by what seems now to be a recognised formula. The first stage is to introduce restrictions which make the service less easily available to those who want to use it. The second stage is to say, "There are fewer people using it and, therefore, we will have to restrict the service still further." The third stage is to say, "We must now withdraw the service altogether because the numbers using it are not sufficient to make the cost of it economic."
In this case, the first stage was reached in 1954 when the Ministry of Food and the distribution centres closed and difficulties were put in the way of mothers obtaining welfare foods. The second stage is being reached in this Order when restrictions of a further kind are put upon the service, and I hope that it will not come to the third stage, but I fear that it will, when welfare foods will be withdrawn altogether on the ground that it is no longer economic to provide them because there are not sufficient people to make it an economic proposition to continue. I fear that that is the logic of the line which the Ministry of Health is taking in this respect.
I come back to the point which I made at the beginning, that to me the important thing is that as far as possible every child should not only be free from disease but should enjoy that radiant, full, abundant health which our modern knowledge of diet and which we, with our wealth of civilisation, should be able to give. If this small expenditure on welfare orange juice for children between two and five years of age will promote that full health and remove any shadow of doubt that some of them might come nearer to diseases such as scurvy than they had been in the years when they enjoyed the facility, when we should continue the service.
It is completely wrong for the Ministry of Health to make this Order knowing, as the members of the Committee making the Report stated, that much of the evidence on which they based their Report was neither firm nor unequivocal and that there were many factors that they were not able to consider. They recognised the value of this welfare orange juice, and maintained that it would be of great advantage to continue it for children up to the age of two. The Ministry is being wrongly advised to withdraw it for children between two and five, who, if they lose something of value in those formative years, can never make up for it afterwards.
Like other hon. Members, I have had representations about this matter from constituents and others, and it is not surprising that many people regard this action of the Government with a great deal of suspicion. It may be that they regard it with all the greater suspicion because of the Minister who has taken it. There can be no doubt that unless the Minister can give a very clear answer to the points raised by my hon. Friends we on this side of the House will find ourselves in a very difficult position. A very clear explanation must be given of the reasons for taking this action.
I agree that there has been, as my hon. Friends have made clear, a conflict of specialist evidence. In the ordinary way, when such a thing occurs, one expects the Ministry to take a cautious line, being anxious to do nothing which would cause any future harm or difficulty. What we shall want to know, among the many other matters raised so fairly by my hon. Friends this evening, is precisely what action the Ministry proposes to take to ensure that no possible harm can result from the action we are now considering. It has already taken place as from 1st November, and orange juice for children over two years of age is now stopped.
Quite clearly, it will not be easy to detect such harm; it may well occur without our being able to know very much about it for some considerable time. It is therefore, right that we should ask the Ministry what action it has taken, since preparing this Order, to obtain fuller information than that which was available to the expert Committee which itself admitted that it was to some extent at a loss in the task which it was set. What has the Ministry done during the last few months to keep proper track of the situation and make sure that fuller information is available?
The second important point which was touched on by my hon. Friends concerns the facilities provided for distribution. That matter has been raised in the House on several occasions by my right hon. and hon. Friends and we have not yet had really satisfactory answers to the questions that have been put. It was made perfectly clear that one of the reasons for the drop in the use of orange juice and of the other welfare foods also has been the difficulty about the distribution centres. What we have a right to know from the Ministry is what action has been taken concerning that difficulty. Has the Ministry made a proper and effective survey to find out what has been stopping people from taking up the orange juice? Has the Ministry, for example, taken any particular areas as test areas in which to open additional distribution centres? That would be a reasonable thing to do.
Has the Ministry selected any towns where the evidence shows that there has been a particularly heavy drop in the use of orange juice and has it taken the initiative to open additional distribution centres to check upon the results? If the Minister has information to give us following such a check, it would be of undoubted value to hon. Members and would give us some useful information. If that has not been done, the Minister has been very careless in producing an Order like this without taking proper action to ensure that it really was necessary.
The trouble with the Government is that even when they bring in an Order that may be justified, their recent record gives every justification for arousing suspicion. We need, therefore, to know fully what further protective action the Government have taken before we can allow this issue to go.
I should end on perhaps a congratulatory note. It has been very difficult, in recent times, to get the Ministry of Health to appear in matters that have anything to do with health. There is a Bill now before Standing Committee upstairs which deals with health, and we hope to see the Parliamentary Secretary of the Minister of Health himself in the Committee before we are through with it. On this present Order, which is certainly a health matter, it is at least encouraging to see that the junior Minister of Health attends.
Like my hon. Friends who have supported the Motion moved by my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross), I cannot speak with any medical knowledge; but the decision we have to make tonight is in any case a layman's decision and the decision we are criticising is a layman's decision. The decision in the order is a decision taken by two men, the Minister of Health for England and Wales and the Secretary of State for Scotland. They had to make a decision after considering medical advice. The decision that is recommended to us nonetheless is not the decision of Lord Cohen and his Committee. I say in passing, from long personal acquaintance, that I have the greatest respect for Lord Cohen and nothing I am saying is in any way criticism of him. It is the decision of the Secretary of State for Scotland and the Minister of Health that we are criticising.
Placing myself in the position of one of those Ministers—a position which I have occupied in the past—and reading the evidence in the Report, I would find it extremely difficult to come to the decision that they have reached. Despite the fact that a majority of the Committee made the recommendation embodied in the Order, I think that any layman wishing to do his duty properly by the people would be obliged to attach extremely heavy weight to the opinions of Professor Garry and Dr. Harris, which are summarised in paragraph 83 of the Report. I quote from it:
They also point out that the consumption of fresh oranges has declined during recent years and that it is known from the National Food Survey data that the average, consumption per head falls as the number of children in the household increases and is very much smaller in the lower income groups. The fact mentioned in paragraph 81 above that the uptake of welfare orange juice is also lower in these groups is not regarded by them as justifying its discontinuance but rather as an argument for its continuance. They contend that the available evidence indicates that considerably more of a given nutrient, including vitamin C, is needed for full development and for optimal health than for mere protection against gross deficiency disease, and that the existence of intakes below the reputed requirement, as noted above, constitutes an additional argument for continuing the scheme.
That summary seems to me to be conclusive. Those who will suffer most from the action taken under this Order will be the children of the poorest of the poor and the children of the large families, the very children for whom I was pleading last Wednesday when we were discussing the National Assistance Board rates. It is not those children only who will suffer by any means, but large numbers of others in large families whose parents are above National Assistance level, but who none the less find it impossible to provide them with sufficient quantities of these foods.
It is essential that the Government should look again at this matter and take into account that this must be not a mere medical calculation but a statesman's decision and should be guided by considerations of the welfare of those portions of our population who need assistance most. I hope that we shall hear the Minister's view on this matter expressed through his Parliamentary Secretary and that he will not take shelter behind any learned report. I hope he will say, "This is the decision of my right hon. Friend who takes full responsibility for it". Even if the Parliamentary Secretary tells us that his right hon. Friend has instructed him to say that he will not reconsider this, no matter what we say here, I hope he can assure the House that he will make renewed and redoubled efforts to try to increase the proportion of welfare foods consumed by those to whom he will still give them.
The proportion of welfare foods consumed, as the hon. Member for Stoke-on-Trent, Central has already explained, are alarmingly low. There are far too many people in need of these welfare foods who are not receiving or taking them. If the Minister has decided to go on with this proposal and take the welfare foods away—orange juice, in particular—from the children between two and five years of age, this gives him unquestionably a better administrative opportunity to see that children under two years of age and expectant mothers receive the juice which they need. This gives him a chance to raise the proportion of those who now take it from 30 or 40 per cent. to 100 per cent.
The promulgation of this Order and the carrying out of the decision proposed in it will give the idea that in medical opinion the welfare foods are no longer necessary. It may give the impression to all and sundry reading a short account in a newspaper that we are all so well fed that we do not need to take, or look out for, the cod liver oil, orange juice and other welfare foods.
Reference is made in this Report to the concern which was felt in 1954 to 1955
lest the fall in consumption might be due to difficulties resulting from changes in the system of distribution.
I myself at that time asked several Questions about this, and at that time I was glad that the Minister undertook to
review the distribution, to make inquiries of the local authorities of what special arrangements they were undertaking.
I think the time has come, if this decision is to stand, to do that again. If this decision is to be adhered to, I would ask for an undertaking that a special new inquiry be made of all the local authorities in England, Wales and Scotland so that the unanimous recommendation contained in paragraph 99 of the Report may be implemented:
We feel, however, that in view of the low uptake of these foods it is important that the possibility of improving the present distribution arrangements should be kept constantly under review both by the Government Departments and the local authorities concerned.
That unanimous recommendation, I take it, is accepted by the Government. What are they going to do then to carry it out?
I suggest that the effect of the wartime propaganda, which was very successfully carried on by the Ministry of Food during the war by means of advertisements of all kinds, has now worn off. The mother of 20 years of age today was only eight years of age in 1945 when most of that propaganda was tailed off. It cannot remain in her mind as it remains in the minds of all of us, the recollection of the explanations of how important it is to have these vital welfare foods when baby is expected or when children are very young. The time has surely come to do that work again, to make special efforts.
I do not suggest hoarding advertising. I do not even go so far as to suggest advertising in the national newspapers, but I do suggest that the Minister ought now to print a new issue of special leaflets which would be distributed to mothers by the midwives who visit them or whom they visit during pregnancy, by the maternity and child welfare clinics which they visit, post-natal and ante-natal, and by the hospital management committees, so that when babies are born in hospitals or when babies are born at home or when babies are taken to the clinics their mothers can be explicitly reminded of these important facts. Every or nearly every mother in the country could be reached in this way, especially if the cooperation of the general medical practitioners were also enlisted. I do hope that special efforts will now be made, if we are to reduce the numbers, to concentrate on those who may still receive these foods, to try to acquire 100 per cent. uptake, as the ugly word is, of these welfare foods.
The Secretary of State and the Minister of Health, when they are providing these welfare foods, have to ask themselves how to obtain a supply. I want to refer to one aspect of the supply of orange juice in particular. I am grateful to the Under-Secretary of State for the Colonies for coming here tonight for the debate. I told him I was going to refer to the supply of orange juice.
It can and does come from many countries, but, in particular, some six or seven years ago special arrangements were made to obtain supplies of it from Jamaica. Under the Jamaican Agricultural Marketing Act a co-operative of small farmers was established, and this co-operative has made a special business of supplying concentrated orange juice to this country under long-term contracts.
The co-operative obtained finance, with the help of the Colonial Development Corporation and the Jamaican Government, to build a special factory for this purpose. Forty thousand Jamaicans, each farming on a very small scale, are engaged in this co-operative. Their standard of living is pitifully low, as anyone who has been in Jamaica can testify. Some of them produce very small quantities indeed, but here is an outstanding example of how we in the United Kingdom can help the poorer people in the Commonwealth countries and how at the same time they can help us. It is an example of how reciprocal and of how much mutual benefit this Commonwealth co-operation in trade can be. The poor Jamaican farmers in this way are given a long-term contract upon which they can rely, and we are given a supply of appropriately prepared orange juice suitable to our requirements, on which we also can rely.
This contract has been in force for a long time, but it ends in 1960. Just about that time those who voluntarily undertook, at the request of this country, to plant the orange trees and produce the necessary quantities of oranges for us and had them processed will find that their trees are beginning to bear larger quantities.
I understand that it takes five or six years before an orange tree bears anything at all. When it gets to fifteen years old it comes to full bearing and after that it continues for quite a number of years. The position will be very awkward for this co-operative in 1960. I hope, therefore, that when they are looking forward to their future policy in this matter the Secretary of State for the Colonies and the Minister of Health and the Secretary of State for Scotland will have special regard to the desirability of continuing to employ this source of supply.
I am not pleading for any wealthy trade interests. I should never dream of doing anything of the sort, but I plead for mutual co-operation with and help for the farmers of Jamaica. This can be of advantage to our balance of payments, obtaining this product as we would be from a sterling area, and it would be to the mutual advantage of our own people and the people of Jamaica.
Many in this country sometimes criticise the large number of immigrants who come from Jamaica. I have certainly not been one of those critics. I have done all in my power to see that these immigrants are welcomed and looked after properly when they arrive, but no one wants to see their numbers unnecessarily increasing. I hope, therefore, that the Parliamentary Secretary to the Ministry of Health will indicate that there is a firm intention on the part of the Government to continue the supply of orange juice to our young children and expectant mothers and that they fully appreciate the desirability of continuing to obtain large quantities of orange juice from Jamaican co-operative producers.
The debate has been a most useful one. I hope that hon. Members will bear with me if I go back for a moment over the inception of the scheme, the modification of which we have been discussing. Hon. Members will know that the history of orange juice distribution as welfare food started in 1941 when Lend-Lease orange juice was first provided for children up to the age of two years and that from that followed, in 1943, an extension to children up to five years of age and to expectant mothers.
The object of the operation at that time was to supplement our diet against the great deficiencies both of quantity and vitamin content which existed in those days of war. Let us be perfectly frank. The scheme succeeded magnificently. There is no doubt that the country owes a great deal to the measures taken at that time to ensure that our children were as well-nourished as they possibly could be in the circumstances of war. Orange juice was chosen for this purpose because, as the hon. Member for Stoke-on-Trent, Central (Dr. Stross) has observed, it is perhaps the best source of Vitamin C that can be easily assimilated by young children before they get to the age when they can take in more bulky foods.
I hope that hon. Members will keep in mind the object of the scheme. The decision now to restrict the distribution of orange juice to children up to the age of two only is not—I emphasise this—based on economy; it is based on the most authoritative medical advice, which, in turn, stems from a totally different food situation from the one which confronted us during the war years.
An analysis of sample inquiries carried out in 1951 into the consumption of orange juice and the actual diet of children showed that the majority of those studied between the ages of two and five were obtaining sufficient Vitamin C from their ordinary regular diet—that is to say, judged by the B.M.A. standard of 15 mg. daily—without taking any account of the welfare orange juice which they received.
But, as the hon. Gentleman pointed out, between one-third and one-fifth of those in the 2–5 age groups were found to be obtaining less than the recommended allowance from their diet, and the effect of any welfare orange juice and other vitamin preparations taken was only to reduce by about a half the proportions of children whose Vitamin C intakes were judged to be unsatisfactory by the British Medical Association standards. What I mean is that, even after making all those calculations, there was still a small but significant minority which did not measure up to those standards.
Despite this indication that a number of children were receiving inadequate supplies of Vitamin C, there was no evidence of scurvy among children under two except in rare and special circumstances, such as those of mental deficiency and coeliac diseases.
The recommended levels of vitamin intake are only approximations, and the British Medical Association itself stressed in 1950 that the basis for them was far from exact. I say that because the hon. Member for Stoke-on-Trent, Central made a point, a fair one, about what the B.M.A. considered was the right level. I wish to make it clear that the B.M.A. itself agreed that these were approximations.
Does the hon. Gentleman agree that the level of 15 mg. is half the Canadian level and half the level suggested by the League of Nations as the standard? Will he say, if he can, why Nature supplies an infant with as much as 50 mg. per day from its own mother if the mother is reasonably well fed?
Yes, I take that point, and, if the hon. Gentleman will forgive me, I will deal in greater detail with his contribution to the debate in a minute or two.
In March, 1956, the Minister of Health and the Secretary of State for Scotland decided to seek the advice of the Central and Scottish Standing Medical Advisory Committees on the need for welfare food supplements. When the Joint Sub-Committee on Welfare Foods was appointed in April, 1956, under the chairmanship of Lord Cohen, it was asked particularly to advise on the continued need for orange juice for children aged two to five.
In October and November, 1955, a further sample inquiry was undertaken by the Social Survey into the consumption of welfare foods, including orange juice. The findings, which differed little from those of an earlier inquiry, were put before the Joint Sub-Committee and are quoted in its Report. It was found that between 43 per cent. and 51 per cent. of children in the 0–5 age groups took no welfare orange juice during the week before the interview and that the proportion taking it fell with increasing age. In the preceding four months, 32 per cent. of all the families interviewed had not obtained any welfare orange juice, but about 44 per cent. of those families had bought some proprietary preparation containing Vitamin C.
Very few cases of deficiency disease have been reported in recent years, but to obtain an up-to-date picture for the Committee, the Health Departments wrote to a number of obstetricians and paediatricians and medical officers of health in May, 1956, asking what cases they had seen in the two preceding years. The total number of cases of scurvy reported as a result was very small and nearly all were about the age of one year. Almost all the cases reported among children over two were associated with mental retardation or specific disease.
I want to turn to the recommendations of the Joint Sub-Committee. In its Report, which was approved by the two parent committees, the Sub-Committee recommended that
Welfare orange juice should continue to be supplied to children under the age of two as at present"—
cases of scurvy, although rare, do still occur usually around the age of one or at the beginning of the second year.
The Sub-Committee further recommended that
there is no need to provide Welfare orange juice for children over two because scurvy is virtually non-existent after that age, even though the uptake of Welfare orange juice or other supplements is lowest in the income groups whose diets are least likely to be satisfactory.
The Sub-Committee attributed the absence of any evidence of Vitamin C deficiency among children over two to the fact that sufficient is obtained from their diet which, of course, is more varied than that of younger children.
It is true that two members of the Sub-Committee of 14, Professor Garry and Dr. Harris, dissented from the recommendation and contended that orange juice should be provided up to five years because
there may be impaired growth and development or other ill-effects associated with low vitamin C intake.
The majority of the Committee pointed out, in reply to the minority view, that
where investigations on man have been adequately controlled, no benefit to health, or enhanced resistance to various stresses has been found on high, as opposed to moderate or low…dietary intakes of Vitamin C and no differences in growth were reported in two groups of elementary school children, one with and the other without Vitamin C supplement.
Perhaps it is a coincidence, but it is certainly apt that the reference to school children is a reference to an investigation carried out in Stoke-on-Trent and Salford during 1943–44.
The Report on Welfare Foods was approved by the two parent committees and published on 30th July. The Government accepted the recommendation to limit the scope of the welfare orange juice scheme to expectant mothers and children under two and it was decided to bring the change into effect on 1st November. The Minister of Health and the Secretary of State for Scotland therefore announced the decision on 30th September and from 1st October onwards the Ministry of Pensions and National Insurance adjusted issues of new orange juice token books for use after 1st November so that they ended during the month when the child's second birthday occurred. Any orange juice tokens for use after the age of two issued before 1st October, however, remain valid, because it was found impracticable to invalidate them. Most of those are in the hands of parents of children between two and three years of age.
I want now to deal with the remarks of the hon. Member for Stoke-on-Trent, Central. I am sure that we are all indebted to him for his witty account of the origin of the word "marmalade," even though it may have no precise bearing on these matters. He was quite right when he said that paragraph 3 of the Order is the operative one. We are not very much worried about the rest, which relates to cod liver oil. We are changing the name and issuing it to expectant mothers monthly instead of at six-weekly intervals.
I do not necessarily challenge the hon. Member's figure, but I am not sure where he got his figure of 26mg. of ascorbic acid as being the requisite or appropriate intake for young children. I repeat what I said before, that the B.M.A. says that the recommended levels of vitamin intake are only approximate. I agree with the hon. Member that as between what the B.M.A., the Americans and the Canadians regard as appropriate there is a very considerable difference of opinion.
I think that the figure is in the Report. This is the amount in the ration of concentrated orange juice offered to the child from the age of six months to five years. It contains 26 milligrammes.
I am obliged to the hon. Member. As I say, there is a very considerable difference of opinion as to what the level of this vitamin intake should be, and the figures that have been put up to us vary fairly widely.
The hon. Member also asked why we thought it appropriate to discontinue the ration of orange juice after the child has reached the age of two years. He suggested that although, after that age, the child would get on to a heavier diet, it would be quite wrong to think that the child would live largely on potatoes at that time of life. That is true, but as the child gets older the filling foods, such as potatoes, green vegetables, and so forth, increasingly form the bigger part of its diet, and it is also important that the milk which it then drinks is sterilised or pasteurised, which means that its Vitamin C content is not so likely to be impaired as the kind of milk, other than its mother's, which it has had during the earlier years of its life.
The hon. Member went on to inquire whether we were right to base our confidence that this is the right thing to do simply upon the fact that there is hardly any evidence of scurvy, as such, in children after the age of two. He said that we did not actually have to have our teeth falling out, our limbs swelling and all the evidence of scurvy in order to be rather ill, and that there might be a sort of sub-scurvy, or borderline condition, which could not be called scurvy but which it was very undesirable to have.
That was a fair point. I am advised that the Committee took the view that scurvy occurred up to the age of one year, as opposed to later in life, because the only Vitamin C-containing food in the diet of such children at that age was milk, the Vitamin C content of which can be destroyed. In older children scurvy does not occur because they get potatoes and vegetables. Moreover, in the form that they receive their milk—bottled, pasteurised or sterilised—the vitamin is still present. On those and other grounds the sub-committee concluded that a margin existed. The only point of difference between the majority and the dissenting minority was as to the magnitude of that margin. Both majority and minority agreed, albeit in another context, that a considerable margin exists between such levels and that at which scurvy develops.
The other question about which the hon. Member asked me was whether the financial saving involved was considerable in relation to what was being done. In giving him the figure I would emphasise again that it is not the financial aspect of the matter but the fact that we are taking advice from what we believe to be the finest source which is leading us to act in the way that we are doing. The actual saving over a full year for England and Wales and Scotland is estimated at £800,000, and about £200,000 for the remainder of this year.
The hon. Gentleman referred to sub-scurvy and the slow healing of wounds which he took to be evidence that a deficiency of this vitamin may manifest itself in certain conditions. My information is that this was shown on experiments on volunteers previously totally deprived of Vitamin C for several months, and that volunteers who had been taking in a 10 mg. dose reacted perfectly normally.
I now pass to the hon. Member for Wood Green (Mrs. Butler). She asked why it is that apparently well-to-do families continue to take up supplies of citrus fruit—oranges and lemons, in plain language—whereas there would seem evidence that the less well-to-do are giving them up. Is not that a way of saying that there is considerable merit in the eating of oranges, and it is no use our trying to say that it does not matter very much after the age of two? Obviously, I cannot answer that with any certainty, but I should have thought the intake of orange juice by large sections of the population was not entirely unconnected with the desire to remain slim—
—and, also, it is a pleasant drink. The hon. Lady was referring to families, and if we consider the intake of these things by families, we must conclude that not only the children in the families drink orange juice.
The hon. Lady inquired about the adequacy or otherwise of distribution. I have no reason to suppose that this contributed in any way to the falling off in the take-up of these foods. There are 9,900 distribution centres in England and Wales. To make sure that we are not falling down on distribution, that it is not the weak link in the chain, my right hon. and learned Friend sent out a circular at the time the decision was announced, on 4th October, asking local authorities to see whether their distribution arrangements could be improved.
Can the hon. Gentleman say whether there has been any reply to that circular? Is there any information to suggest a need for further centres to be opened?
No, there has not been a reply up to now. I assure the hon. Gentleman that we shall watch that matter carefully.
Finally, the hon. Member for Wood Green said, in effect, that if the Government decision is a marginal decision with the rights and wrongs finely balanced, her advice was that the decision should not be taken. With respect to the hon. Lady, the decision is not a marginal one. I believe that as a very large majority. 12 out of 14, of the eminent members of the Committee gave this advice, we are right to take it.
The hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) thought that because there was a difference of opinion in the Committee the Government should err on the side of caution and keep the existing arrangements going. A majority of 12 out of 14 seems to be a fairly solid consensus of view on one side, and I believe that we were right to do as we did.
I raised another point with the hon. Gentleman. What action is the Ministry taking to keep a check on the position, particularly on the state of health of the children, to make sure that nothing goes wrong?
The hon. Gentleman did ask me that, and if he had not reminded me of it I should probably have forgotten it. The National Food Survey will show whether there has been any decline in Vitamin C intake; this is a continuous survey of samples taken at random and shows that there is nearly 100 per cent. margin.
The right hon. Member for Middlesbrough, East (Mr. Marquand) said that this was a matter for laymen, although experts might give advice. It was an executive matter for the Government. I am not attempting to shuffle our responsibility on to the experts. Having chosen the best people we could get to advise us, and having seen the quite categorical nature of their advice, I think that we were right to draw the conclusions that we have drawn.
The right hon. Gentleman made a point about the position of the citrus growers in Jamaica, who were, on the whole, small men in growers' co-operatives. He was concerned lest this action should redound to their disadvantage in the near future. The Ministry of Agriculture, Fisheries and Food have a contract with the West Indian producers to take up to 5,000 tons of orange juice concentrates a year until the season 1959–60, subject to agreement on the price, and this contract will be honoured; but up to now the amount offered annually by these producers has been very considerably less than that amount. We recognise that increasing supplies, as the trees come to maturity, might well come forward. In the current season, 1957–58, growers have been able to offer only 750 to 1,000 tons, and there is, therefore, a considerable amount of slack to be taken up before they are in the position of having over-provided for a situation in which we shall be taking up rather less concentrate than before. We should not overlook the fact that the industry cannot depend upon one source and that there are other sources which it must exploit.
This decision is a medical one, taken on medical advice, and not one taken on economic grounds. It would be very strange indeed if precautionary measures. appropriate in war-time and in the ensuing years of scarcity and rationing, however appropriate then, were equally appropriate today. I recognise that hon. Members opposite have used their time to examine this whole business very thoroughly and fairly, and I think that they have presented their arguments with great good sense and restraint. I ask them to believe that in taking this decision we have been actuated by a respect for what we believe to be the finest expert advice we could get.
Having thoroughly discussed this matter, to which they rightly attach the greatest importance, I hope that hon. Members opposite may now feel able to withdraw the Prayer.
I have no intention of detaining the House for long. In fact, I am particularly anxious for the Parliamentary Secretary to the Ministry of Agriculture, who should have an ice-block and towel to study the complexities of the Slaughterhouse Bill. I should like to join with the Parliamentary Secretary in saying what a well-informed debate this has been. In particular, I am obliged to my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross) for giving the derivation of the word "marmalade", and I thank the Parliamentary Secretary for his agreeable and well-informed manner—in fact, so well informed that I must say that his contribution has been most exceptional coming from the Front Bench opposite.
The Parliamentary Secretary probably feels that we are unduly apprehensive over this matter, but he should not blame us. Over the range of debates we have had on this subject during the past year or so we have learned well the mean, stingy attitude of Her Majesty's Government to welfare foods and have every right to feel apprehensive now. That is why, when we received this Order, we had to scrutinise it very carefully, because we are concerned about the way in which the Government have run down—and apparently intend to continue to run down—the expenditure on welfare foods.
Both sides of the House should show equal concern about this matter and seek to promote the expansion of the provision of these foods. That is why I should once again like to emphasise our concern for the children in the larger family, and in particular those children in the larger family where the wage earner is less well off. We should take what steps we can to ensure that those children are not prejudiced.
I should also emphasise the point that has already been made, that we should keep under review the methods of distribution of welfare foods, and the general acceptance of their importance. It was for that reason that I spoke with some feeling on the subject. I do not think that the Government should ask us to accept the cutting down of welfare foods merely by talking about our having more food available generally.
We are concerned specifically with the taking of the welfare foods by the families of this country. We should keep alive to this aspect, and where there are special problems like that of the larger family we should take particular steps to see that they get the welfare foods they need and, generally speaking, recognise that this is not a problem that can be solved merely by talking of our food situation having improved compared with that obtaining during the war.
We are here concerned to see that our children take the particular foods that are of especial importance to them. That is why I hope that, in spite of the Government's general attitude, which is adverse to the idea of welfare foods—shown tonight by this too-easy acceptance of the general improvement in the food situation as an excuse—we shall continue to keep this matter under close review.
I should like to say a word, too, about the position of the West Indies. I am very much obliged to the Under-Secretary of State for the Colonies for being with us throughout this debate, but I am not sure that we have yet had a satisfactory assurance. I would not associate the problem we are discussing directly with the West Indies. I would not, in other words, advocate a policy of welfare foods merely because of the difficulties that may arise in the West Indies. But these problems are related. I believe we have to keep in mind all the time the position of the Commonwealth producer. We have got to be conscious of the difficulties of the Commonwealth producer. Disregarding for the moment the question of welfare foods, we have the producers who are receiving, and very properly so, the guarantee. We are told—and there can be no question—that the guarantee will run for the full term until 1960. We would have assumed that anyway. But what is the position after 1960? That is what we want to know. I will give way to the Parliamentary Secretary if he wishes to intervene.
This is a broader question than the question of the supply of orange juice under the welfare food scheme, but I think we ought to have a statement which can further this assurance beyond 1960, because, as has been pointed out, here are growers who will reach a stage in the development which will place them in great difficulties if we are to have a further decline in the consumption of citrus fruits. I am not asking for a specific reply tonight, but I should have thought that this matter ought to have the concern of Her Majesty's Government.
To conclude by referring to the Report which is before us, I have explained why the Parliamentary Secretary may feel that we are unduly apprehensive about this Order, but when we turn to the Report itself I feel, with my hon. Friends, that the Government can very properly say that they sought expert advice, that they obtained that expert advice and that they are doing no more than implementing the advice that they received. But I think there are broader considerations than that, which are brought out in the reference to the views of the minority Report. I agree that it was a minority which comprised no more than two out of fourteen, but nonetheless the views of the minority raised points broader than the strict medical grounds upon which orange juice is given. For those reasons, I would have thought that the Government would have been reluctant to accept the advice of the Committee and would have said that there are broader grounds upon which the continuance of orange juice can be justified. The uptake is not enough, but we know that orange juice is the most popular of the welfare foods that are taken by families.
I should have thought that orange juice would be an item amongst the welfare foods which the Parliamentary Secretary would be reluctant to stop, and indeed that there are genuine grounds for continuing it. If he has taken this step on the advice of the Committee, I hope he will consider ways and means of advertising the remaining welfare foods and ensure that we get a more encouraging response to the opportunities which are made available. It is because the Government are relying upon the majority Report, upon what appeared to be the broad views of the Committee on medical grounds, that I would advise my hon. Friends not to press this Prayer to a Division but to withdraw it.
There is another technical ground which the Parliamentary Secretary pointed out. This Order increases the amount of cod liver oil available. We are often in this difficulty with regard to Prayers. We take it as a whole or not at all. We do not want to deprive the mothers of the extra cod liver oil. For that reason, and because we are in some difficulties with regard to the Report before the House, I would advise my hon. Friends, in spite of the persuasive nature of the speeches they have made, to rest hopeful that those considerations will bear upon the Parliamentary Secretary meanwhile, letting this Order go through.