Vote 11. National Health Service, Scotland

Orders of the Day — Supply – in the House of Commons at 12:00 am on 12th March 1959.

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Motion made, and Question proposed,That a Supplementary sum, not exceeding £2,376.500, be granted to Her Majesty to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1959, for the provision of a comprehensive health service for Scotland and other services connected therewith, including medical services for pensioners, etc., disabled as a result of war, or of service in the Armed Forces after the 2nd day of September, 1939, certain training arrangements, the purchase of appliances, equipment, stores, etc, necessary for the services, certain expenses in connection with civil defence, and sundry other services.

7.33 p.m.

Photo of Mr Niall Macpherson Mr Niall Macpherson , Dumfriesshire

In introducing the Supplementary Estimate, I wish, first, to express my regret that my right hon. Friend the Secretary of State and my hon. Friend the Joint Under-Secretary, the hon. Member for Craigton (Mr. J. N. Browne), who are responsible for the Health Service in Scotland, are at resent in the care of the Health Service in, England, and cannot be present. I am, therefore, in this connection making a somewhat reluctant debut at this Dispatch Box to introduce this Supplementary Estimate.

I wish first to explain the reason why the Supplementary Estimate had to be put down. This Estimate seeks additional provision mainly for four services. First, the hospital, specialist and ancillary service, for which just under £700,000 is required for the acceleration of the programme of works, and about £300,000 for additional running costs; secondly, for the pharmaceutical service, with £641,000 more; thirdly, the remuneration of general medical practitioners, with a further £220,000, and, fourthly, the local authority health services, with an extra £185,000 net. There are smaller increases under seven other heads, amounting in all to £325,100, and there is an unexpected deficiency of £68,800 for appropriations in aid. Relatively small savings under three other heads offset this increase by £57,400, making a net additional sum asked for of £2,376,500.

The largest item in the Supplementary Estimate is the additional sum of just under £700,000 for the accelerated programme of hospital works. As my right hon. Friend announced on Tuesday, in answer to a question from my hon. Friend the Member for South Angus (Sir J. Duncan) a sum of £1,150,000 was made available by the Government to Scottish hospital authorities in the late summer and autumn of last year with the object of relieving unemployment by accelerating the programme of minor capital works, building maintenance and the replacement of equipment. The amount of this sum falling in the current financial year is the £700,000 or thereabouts which I have mentioned.

The regional hospital boards are giving, so far as possible, special consideration to the needs of hospitals in the unemployment black spot areas including Western Clydeside, North Lanarkshire, Aberdeen and Dundee. They have been asked to use the money to carry out necessary works and to purchase equipment, particularly for hospital laundries, which will improve the efficiency of the Service or lead to economies in future running costs. The provision is included in the appropriate capital and revenue subheads of the Estimate: £394,000 in advances to regional hospital boards on capital account and £273.000 on revenue account, the balance being in the subheads for equipment and the ambulance service. The additional sum of approximately £300,000 for the running costs of the hospital service is required mainly to meet the cost of salary and wage awards made after the original estimates were framed.

The second largest item in the Supplementary Estimate is £641,000 for the pharmaceutical service. While the number of prescriptions dispensed by chemists is expected to be about 1 million fewer than estimated, the average cost of ingredient continues to rise. The main reason for this is the greater use by family doctors of the more expensive drugs such as the antibiotics and corticosteroids about which my hon. Friend the Parliamentary Secretary to the Ministry of Health has been speaking.

There are two reasons for the extra amount of £220,000 for general practitioners' remuneration. The first is that an advance payment is being made earlier than expected on account of the balance on the central remuneration pool for 1957–58. The other reason is the interim award of 4 per cent. from 1st January, 1959, made pending receipt of the Report of the Royal Commission on Doctors' and Dentists' Remuneration, offset by a saving on recalculation of the 1956–57 central pool balance.

The additional £185,000 needed for tile local authority services is mainly attributable to expenditure on clinic and home help services as well as to salary and wage increases. In some respects, therefore, for the reasons I have given, the original calculations on which the Estimates are based have had to be revised.

That is a brief description of what ate Supplementary Estimates are for, but before I conclude, I should like to mention two other points. The first is in connection with the hospital service, which is the biggest single item in the National Health Service Vote and makes the largest call on the Exchequer. The Supplementary Estimate arises because the greater part of the expenditure is on salaries and wages. There have been increases, as I have said, in line with the trends elsewhere, for which we have to make provision.

Apart from this, we have this year achieved a remarkable result. A year ago, when the £ was under pressure and expenditure had to be severely restricted as part of the Government's measures to protect the £, we set the hospitals in Scotland the task of saving about £400,000 on their annual expenditure. That was to be their contribution towards stability. That saving has been very largely achieved by careful economy, as the result of reductions in demand and appropriate action, notably in tuberculosis treatment in hospital.

Within the total provided, it has still been possible to staff and to bring into service the new buildings that were completed during the year, and other improvements have been made as well. Naturally, my right hon. Friend and the hospital authorities were sorry that they had to restrict expenditure in this way, but it was necessary. Now that these financial difficulties are behind us we look forward in the next financial year to improvements and extensions of the Service on a much greater scale than has been possible hitherto. It is still sometimes said that there is too much waste in the hospitals and no proper financial control. The measures taken this year show that there is control. My right hon. Friend and I are grateful to the hospital authori- ties for their excellent co-operation with us.

The other topic I would touch on briefly is the pharmaceutical service. Once more we have to make provision for in creased expenditure on what is commonly known as the drug bill. The important factor giving rise to the Supplementary Estimate is that the increase in the cost of prescriptions has exceeded our expectation. Expenditure on the pharmaceutical service is a complex matter. There is the prescribing practice of the doctor, the cost at which drugs are bought from manufacturers and the payments to be made to the chemists. During the year we have agreed on changes, as my hon. Friend the Parliamentary Secretary to the Ministry of Health has already announced, which will reduce the burden on the Exchequer of the cost of drugs and the payments to the chemists.

There is a general feeling that more attention should be given to the actual prescriptions the doctors write, both in hospitals and in general practice. Does the doctor make the right choice and prescribe the right amounts? Does he know enough about drugs and about the cost of them? These and other aspects of prescribing practice were referred by my right hon. Friend to a Departmental Committee under the Chairmanship of Sir James Douglas and consisting, properly, mostly of doctors. It included some of the most distinguished doctors in Scotland, both in the hospital service and in general practice.

The Departmental Committee has just submitted its Report, and my right hon. Friend is arranging to publish it as soon as possible. It made a whole series of recommendations which we shall have to study and to discuss with the medical profession and others concerned. It has not hesitated to criticise, and if I may put it in this way, same people may find the medicine it prescribes rather unpalatable. We wanted a full report on this difficult subject from a committee composed mainly of doctors and we are very glad to have it. I think the Committee would want to know that, and we shall all study the Report carefully. I will take this opportunity, on behalf of my right hon. Friend and of my hon. Friend the Member for Glasgow, Craigton to thank Sir James Douglas and his committee for their labours and for producing with no delay this valuable Report.

With this explanation I hope that the Committee will be prepared to approve this Supplementary Estimate.

7.45 p.m.

Photo of Miss Peggy Herbison Miss Peggy Herbison , Lanarkshire North

I must first of all thank the Joint Under-Secretary of State for his explanation of this Estimate For both the Scottish Ministers who are in charge of the Health Services to be off ill is very much like the Minister of Health and his Parliamentary Secretary being ill and asking the Minister of Education to come to present the Supplementary Estimate We are all grateful to the Joint Under-Secretary of State for doing his very best to give an explanation of this Supplementary Estimate.

We are being asked to vote a sum of more than £2¼ million. The Joint Under-Secretary of State has said that the hospital service is the biggest single item, that is, if we take in with the hospital service the ambulance service and the other ancillary services. If we take this single item, the biggest is the pharmaceutical service at £641,000. My right hon. Friend the Member for Warrington (Dr. Summerskill) dealt with this subject very fully on the English Supplementary Estimate and I propose to say very little indeed on the matter, not because I do not think it is of the greatest importance that we should have savings wherever we can and not because I do not think that many people would feel that savings can be made, but because my right hon. Friend dealt so fully with the subject. Some of my hon. Friends may want to deal further with this Scottish point.

I want to make only one point. The Minister said that prescriptions had been fewer than had been estimated for, but the cost of the ingredients had been very much higher. Would he tell us when he replies to the debate—I understand that the Joint Under-Secretary of State is also to reply—what is now the cost of the prescriptions?

I want to deal with the Supplementary Estimate for the pharmaceutical service, which shows a saving. Had it not been for this saving we should be voting more than £673,500. We are told that the saving, in dispensing fees and rota payments, was £83,000. I want to get information on this subject, if possible.

In Scotland we have had experience of this rota system being stopped by executive committees in some areas. The Joint Under-Secretary will know about one of the cases that I took up at Newmilns in my own area. When the rota system is stopped, no chemist's shop is open at any time on Sunday in the area. When there is illness in the home on Sunday and a doctor has to be called in—which usually means some serious illness—a member of the family has to travel a fairly long distance to get the medicine that is on the prescription. That causes very great inconvenience in a home that is already suffering from the illness.

The Government first made the prescription cost 1s. and then made the prescription cost 1s. per item. This bears very heavily when sickness comes. It is a tax on the sick man or the sick woman. By taking away the rota system in some areas it means that not only have people to pay these extra shillings for the prescription, but they have to pay extra money for travelling from the village, in sonic instances long distances, to get the medicine from the chemist.

I ask the Joint Under-Secretary to have a word with the members of his Department and with the Secretary of State to see if the right hon. Gentleman will ensure that where an executive council has stopped the rota system—it seems that quite a number have—there is no great hardship, as there was in my constituency until, after investigation by the Secretary of State, the rota system was started again.

I want to deal with the ambulance service, which comes under Subhead D.7. There we are asked to vote £69,000, of which £17,000 is for the purchase of vehicles and equipment. The Joint Under-Secretary told us that, because of the financial difficulties of the Government, the hospital services were asked to save as much as they could and there was a saving of £400,000. I wonder it some of that was a real saving. That is why in this instance I want to examine the matter. My hon. Friend the Member for Motherwell (Mr. Lawson), put a Question to the Secretary of State on 23rd February. He asked about ambulances that had been ordered on behalf of the St. Andrews and Red Cross Scottish Ambulance Service in 1958. This was the Answer given by the Secretary of State: The Joint Central Committee for the Scottish Ambulance Service advised me that it was urgently necessary to provide additional vehicles to avoid a breakdown of the Service during the winter."—[OFFICIAL REPORT, 23rd February, 1959; Vol. 600, c. 119.] That was a very serious position for our ambulance service to get into. It had urgently to order new ambulances—I take it that this £17,000 is to pay for some of them—because there might be a breakdown in the service. Would that breakdown have been due to these economies which were imposed on the hospital service by the Government?

There is another point to which we on this side of the Committee must refer. When it was discovered that there would be a breakdown of the ambulance service what did we find? Instead of the order being placed with a Scottish firm, although we are always complaining of the very high rate of unemployment in Scotland compared with that in England, the order went to an English firm. Scottish firms were not even allowed to tender, but the order went to an English firm without any tendering at all. We criticise the Government, first, that when they insisted on savings in this instance they were not real savings, and that they might have been a grave danger to our hospital service and to the lives of the patients. Because they are insisting on this saving the Secretary of State had to say, "We had not time to put this out to tender and we just gave the orders to an English firm." On all these complaints, the Secretary of State deserves very great criticism.

I come to Subhead K.1. and the grants to local health authorities. We are asked for an extra £45,000. We are told that this is: Additional provision required mainly because of extension of clinic services. If the Joint Under-Secretary can give me the information, I should like to know exactly where these extensions were. If the hon. Gentleman cannot give the information now I shall understand and perhaps he will give it later in writing. In my area the population is scattered and the villages are some distance from the towns. For a considerable time we have been trying to get adequate clinic facilities in some of the villages. Adequate clinic services cover a very wide field and make a great difference to the health and to the spirits of people in some villages.

Another point I wish to raise is the Supplementary Estimate for which we are asked for the midwifery service, amounting to £8,000. We are told that this is to meet the cost of additional staff. The Joint Under-Secretary may be aware of a debate held in the House on this matter. I ask him if by the spending of this £8,000 he feels that we shall have an adequate midwifery service in every part of Scotland. My information is that that is not so. There are complaints about salaries and complaints about promotion. When the Parliamentary Secretary to the Ministry of Health dealt with this question, he showed that, although many trained, they did not actually work as midwives. That may be due to the amount of salary, to blocked promotion and general conditions. I hope we shall have an answer on that question.

I want to deal now with what I feel is one of the most serious weaknesses of the National Health Service in Scotland at present. That is the inadequate supply of maternity beds. This comes under Subhead A—"Advances to Regional Hospital Boards: Capital Account", and the figure is £394,000. The details we are given say that this is Additional provision required for the acceleration of the programme of works. What are these works? Do they cover a greater provision of beds for maternity hospitals? That is very important.

This morning I had a visitor who came to see me when I was in Committee upstairs. She was from Fort William, where she is a bailee. She is a member of the W.V.S. and yesterday she was entertained by the Queen at Buckingham Palace. I was telling her about the debate we were to have this evening, and I asked about the adequacy or inadequacy of the provision of maternity beds in her area. She told me that when it is decided by the doctor or the hospital authorities that an expectant mother ought to go to hospital to have her baby the woman has to travel to the nearest hospital, which is 65 miles away. Mallaig, in her district, is 100 miles away from the hospital. That is a very long distance for women to travel to find accommodation in a maternity hospital.

Recently a Report was published by a Committee appointed by the Scottish Health Services Council of the Department of Health for Scotland entitled "Maternity Services in Scotland." I want to quote from paragraph 81, on page 38, to show how serious is the position in Scotland. It reads: We turned next to the distribution of the 70 per cent. institutional confinements. This was 70 per cent. for Scotland as a whole.

A breakdown of the figures for 1957 —these were the latest figures which this high-powered Committee was able to get— into local health authority areas showed variations from 96·4 per cent. to 50·4 per cent., with 21 areas over 80 per cent., 12 between 70 per cent. and 80 per cent., and 22 below 70 per cent., all but six of these last being among the 27 areas in the Western Region, which covers about half the population of Scotland. This variation between 96·4 per cent. and 50·4 per cent. of the women having their babies in hospital is a very big variation. I would also point out that the Western Region covers the big industrial area of Scotland. It is very serious indeed that the worse provision should be found in the western area.

The Report continues: On a regional basis the same discrepancy between the Western Region and the other four regions appears perhaps even more clearly. Only the Western Region, at 65·0 per cent., is below the national figure of 70 per cent. (Glasgow as low as 57·6 per cent. if only National Health Service accommodation is counted); the three smaller regions are all above 74 per cent. and the South-Eastern Region is 76·3 per cent. That presents a very serious picture. The figures for the Western Region and particularly for Glasgow show that my hon. Friend the Member for Coatbridge and Airdrie (Mrs. Mann) has been absolutely right when she has been pressing the Secretary of State about the maternity hospital at Bellshill. The figures show that Lanarkshire, too, in the Western Region is not adequately served by the provision of maternity beds.

Paragraph 82 reads: As to overcrowding and length of stay in hospital, the average length of stay in obstetric units in the Western Region is again markedly shorter than in the other Regions. That must mean that where in other regions it is felt that women ought to be kept in hospital for a certain period, in the Western Region they are not being kept in hospital sufficiently long. The Report continues: and it is obvious that there is very little margin for the occasional emergencies, great or small, which are hound to rise in maternity units, from the closing of an entire unit because of infection, to the closing of one ward while it is painted. That is a very serious matter. In the whole of this Western Region, covering half the population of Scotland, if any crisis arises, great or small, there is very little possibility of dealing adequately with it.

In Appendix VI we find the areas with a high hospital confinement rate and the areas with a local hospital confinement rate. Port Glasgow Burgh is the lowest with 52·4 per cent. of hospital confinements, Sutherland County is next with 53·2 per cent., Airdrie Burgh is next with 55·6 per cent., and the next lowest is Lanark County, which had over 6,500 births in 1956 and the percentage for which is only 56·3. For Dumbarton Burgh it was 57·2 per cent. and for Orkney County 58·1 per cent. All of these figures are well below the national average of 70 per cent., and if one reads the Report one is inclined to believe that even the national average of 70 per cent. is too low.

I will not quote too many figures but I will turn to Appendix VIII and to the figures of vital statistics for 1957. The still-birth rate per thousand live and stillbirths was 24·0 for the whole of Scotland. The figure for those who died when less than four weeks old was 20·0 out of every thousand and the figure for those who died under one year of age was another 29 out of every thousand. It is very difficult to obtain comparative figures—perhaps some of my hon. Friends have them—but we see that the figure was 29 for the whole of Scotland, and we know that in some areas it was very much worse. Indeed, all these figures are much worse in some areas. Nevertheless, we can compare the figure of 29 for the whole of Scotland with a figure of only 22 for London, which has a big, and a very mixed population. That shows a great difference.

Photo of Mrs Jean Mann Mrs Jean Mann , Coatbridge and Airdrie

London deplores its figure of 22. If a survey is made not only of London but of the Scandinavian countries and of other European countries it will be found the Western Scotland area is the worst in Europe.

Photo of Miss Peggy Herbison Miss Peggy Herbison , Lanarkshire North

I know that it is worse than anywhere else in the British Isles, and that some of the other European countries, particularly the Scandinavian countries, return figures much better than some of the best figures in the British Isles.

How much of the saving of £400,000 in the hospital services, if any, was saved by not providing the maternity beds which were so desperately needed? If any of that saving were made by not providing these maternity beds, it is a great scandal, when we think of the mothers and the babies who lost their lives in Scotland last year.

Like the Minister, I want to pay a tribute to all in Scotland who are working in the National Health Service. I feel that they have done a wonderful job. I refer in our hospitals to the domestic staff, the nurses, the doctors, the consultants, and in our villages and our towns to the general practitioners, the district nurses and the midwives. They do a wonderful job.

It seems very clear from the speech of the Joint Under-Secretary of State and from the speeches of the English Ministers that they now accept the National Health Service. Although we feel that there are areas where savings can and ought to be made, particularly in the pharmaceutical service, in other services—and I cannot stress strongly enough in the maternity service and the provision of maternity beds—the Government ought to be providing far more. Is any coverage made in these Estimates for further provision?

8.11 p.m.

Photo of Sir James Henderson-Stewart Sir James Henderson-Stewart , Fife East

I should like to join the hon. Lady the Member for Lanarkshire, North (Miss Herbison) in congratulating my hon. Friend the Joint Under-Secretary of State upon the speech he delivered at short notice on a subject which is a little off his normal beat. He did it exceptionally well and I am happy that he did it in accordance with the traditions of the office.

The hon. Member for Lanarkshire, North has also given an example to the Committee of an admirable and temperate speech. We are obviously dealing with a matter on which we are entitled to express our views without being tied to any party line. On this matter we should try to state the point of view that represents the human needs of our country and the hon. Lady did that with great skill, great knowledge and experience.

Listening to the two speeches which have been made, I came to the conclusion that probably the essence of what we are discussing tonight is the responsibility of the hospital boards. It is what the hospital boards are doing in their hopsitals that matters so much. In that connection, I was very interested to read the Report of the Acton Society Trust which we recently received. The Report is called "Creative Leadership in a State Service", meaning a State health service. It is a very interesting report on the various activities of the National Health Service.

The Report is addressed almost entirely to the English service. There are just a few words, but not any more, addressed to the Scottish service. Since there is a great deal of criticism in the Report, I should like very much to know from my hon. Friend whether the Report covers Scotland, whether, in the course of its examination, the Committee looked into Scottish affairs, and to what extent their criticisms apply to Scotland. It would be very interesting to know that.

The reason I press for that is that I want to know what measures my right hon. Friend the Secretary of State for Scotland is taking to give guidance to hospital boards on future policy. We have come to the end of roughly ten years of the National Health Service. As the hon. Lady said, it has done remarkable work. I agree with that. I agree with her, too, in paying tribute to the labours of the people concerned with the Service during those ten years. We have learned a great deal. There has been a tremendous development in spheres, many of which we had not thought of before.

Where do we go from here? Is it not fair to assume that the next ten years will be very different again? Things have been happening recently—the hon. Lady spoke about the maternity service; I could quote other examples—that are not to everybody's satisfaction, where some changes or developments are needed. At this time, when we might say that we are consolidating or about to consolidate ten years' service, we should be thinking and Planning ahead.

I give another example of changes that have come about which nobody expected. The other day my right hon. Friend the Secretary of State for Scotland told us—I was very surprised to hear it—about the redundancy in the beds used for tuberculosis. He said that 1,000 beds had become redundant at the end of last year.Iremember—and I am sure that the hon. Lady remembers—many a debate in the past in the days when tuberculosis was a very serious thing and gave us cause for great anxiety. Fortunately, thanks to the efforts of the medical service and others, that period has apparently passed and we have reached the miraculous situation of having too many beds now. It is extraordinary.

Were we ready for the change? Were all the beds that were made redundant in that way used? Is there some other big need growing that we ought to know about? In other words, is the Scottish Health Department not only thinking forward, but advising hospital boards on the lines of their thought?

There is a need for assurance from my hon. Friend that the Secretary of State is both aware of the change in the nature of the problem and is taking proper steps to ensure that hospital boards are planning forward. We all know quite well that hospital boards and their staffs are mostly overwhelmed with work and worries. As the hon. Lady said, conditions change from area to area. A board of governors in a hospital is generally very busy on a large variety of small details; they are very important, but the tendency is to become overwhelmed with detail. The time has now come when we ought to be giving a clear directive to hospital boards to look ahead.

8.18 p.m

Photo of Mrs Mary McAlister Mrs Mary McAlister , Glasgow Kelvingrove

I should like to return again to the question of maternity beds, a question which I have raised in the House more than once during the past year and which is rapidly becoming tragic in Glasgow.

The Medical Officer of Health for Glasgow stated quite emphatically in his 1957–58 Report that practically no progress had been made in this matter.

He repeated practically the same words to the Glasgow Herald as late as 12th February last. He further stated that Glasgow was at a considerable disadvantage in this respect, even in relation to other Scottish towns.

Figures have been given by my hon. Friend the Member for Lanarkshire, North (Miss Herbison). Fifty per cent. of Glasgow mothers can go to hospital to have their babies, as against 70 per cent. in Dundee and Edinburgh and approximately 90 per cent. in Aberdeen. I do not want to sound parochial, but I sometimes wonder whether the Minister realises the depth of the social problem which we have to face in the City of Glasgow. When the Second World War broke out, Scotland had the highest infantile mortality rate in the English-speaking world. With two exceptions, it was the highest of any country in Western Europe. Glasgow contributed in large measure to that very distressing record.

It is against that background, and in the face of housing conditions that, in some cases, can only be described as appalling, that the local authorities, medical and lay, as well as many tireless voluntary workers, have been striving to reduce the figures. Despite all their efforts, the figures remain substantially above the general level for the country as a whole.

We have heard many figures quoted tonight and I do not want to weary the Committee with many more, but I must point out that while there were 528 more births in Glasgow in 1957 than in 1956 there were 774 infant deaths in 1957; and that was the highest record since 1951. The 1958 figures have not yet been issued but I am told on good authority that they do not show a decrease. That is very serious indeed.

Is it any wonder that the people in Glasgow who are responsible for the maternity services feel frustrated? There are differences of opinion as to the desirability of all mothers having their babies in hospital—I even have some opinion on that myself—but could there be any difference of opinion as to where a mother should have her baby when she lives in a house which the medical officer of health admits he would condemn tomorrow if he had anywhere to put the tenants?

A recent Report of the Scottish Health Services Council on Maternity Services in Scotland—and my hon. Friend the Member for Greenock (Dr. Dickson Mahon) reminds me that I gave evidence, though I had forgotten—states that it is thought very undesirable that mothers should leave hospital before the end of ten days. It is undesirable, primarily, for two reasons: first, because the mother is not strong enough to take up the domestic reins as she should; and, secondly, because of the difficulty in getting domiciliary midwives.

The Report states that it is quite common for a mother to leave hospital after seven or eight days, or even fewer. A great deal of inconvenience is then caused to those responsible for taking care of her, but how much more inconvenience is caused if she is in a house that is due to be condemned, or is even actually condemned? I could tell quite a number of harrowing stories about the conditions in which some young mothers are living in my constituency, but I have never used that type of propaganda and I do not propose to start tonight. I will repeat only one, and then only because there is a slight touch of humour in it.

A young mother complained to me about rats in the house. She was a very decent person, who kept a very clean house, and she did not want to appear to be too much of a grumbler. She said, "I am not saying that they went near the weans, as they did to the woman upstairs, but they nearly bit the e'en out of my kitten." That is a true story. I leave it to the consciences of right hon. and hon. Members opposite whether they consider such a domicile a suitable place in which to have a baby. I implore the Joint Under-Secretary to press on his right hon. Friend the need to do something about the provision of maternity beds in Scotland.

8.26 p.m.

Photo of Mr Douglas Spencer-Nairn Mr Douglas Spencer-Nairn , Central Ayrshire

I should like to support, with all the feeling I have, the speeches of the hon. Ladies the Members for Lanarkshire, North (Miss Herbison) and Glasgow, Kelvingrove (Mrs. McAlister). I will not follow them in a discussion of the maternity service, but my view is that it is the one thing that is not yet adequately catered for in the National Health Service.

I join my hon. Friend the Member for Fife, East (Sir J. Henderson-Stewart) in saying how well the first ten years of the Service have gone. Broadly speaking, we can say that at the end of ten years the medical and hospital facilities are adequate to look after all who are ill and for as long as they remain ill. We have a service under which every child who is born able to grow up healthy is almost a guarantee that it will grow into a healthy adult.

That story is satisfactory as far as it goes, but we have three distinct problems to face—the prevention of sickness and disease, the rehabilitation of patients when released from hospital, and the care of the old so that, when we do go out, we do not have to go out after a long period of suffering from the ailments of senescence. Prevention of sickness and disease can be helped to a large extent by propaganda, and we see under Subhead K10 that Adtional provision required mainly to meet increased expenditure on health propaganda" is £8,000. It is true that our hospitals, technical institutes of all sorts—and, particularly, outstanding individuals—have produced all sorts of cures for those struck down by disease. It is equally true, and it has been emphasised over and over again during the last few years, that of all European countries we still have far and away the largest number of serious chest complaints—and, I believe, that the same is true of any country where statistics are kept.

Speaking the other day in Edinburgh, the Minister of State said that in the 17 main cities of Scotland, deaths were twice as high between mid-January and mid-February, 1959, as they were in the same period of last year. There were 468 deaths in Glasgow in 1959 as against 197 in 1958. I am no expert on these things but it is quite clear to me that that is not due to the climate of Scotland. It can be due only to one thing, and that is the pollution of our atmosphere. I do not know whether my right hon. Friend the Secretary of State has seen a pamphlet sent out, not by the Department of Health, but by the Ministry of Housing and Local Government which says "Smoke is Your Enemy." I am quite sure that the more we can do to make people realise what a terrible menace smoke is—I am speaking of smoke in the atmosphere, not tobacco smoking—the more quickly shall we reduce the very high proportion of chest complaints.

No one motoring towards Glasgow can fail to notice, even on a sunny day, that one suddenly sees a black cloud in front of one and then arrives in a city Which might be under the ground altogether, while all round about there is sunshine. We have the Clean Air Act. The most important thing today is for the Scottish Office to ensure that local authorities are made to make full use of it. People in their homes, also, must be made to realise the added dangers which they put into the atmosphere unless they install new and modern forms of heating appliances.

Turning to the rehabilitation of patients after discharge from hospital, I want to ask my hon. Friend whether any steps have been taken or are being taken to implement that part of the Piercy Report which recommended the setting up of resettlement clinics to help people who are left with some disability after they come out of hospital. If a person cannot find a job after he comes out of hospital, and if he still has some disability, deterioration sets in fairly rapidly. I hope that we shall have news of something being done to establish such clinics.

I should be out of order if I went on to discuss the position of old people, but I hope that it will be appreciated more and more that if people are not to suffer from the ills of senescence in later life they must be kept at work, or they must be given opportunities to take up hobbies or be encouraged to take up voluntary work. We all look forward to the time when people can live happily and, so far as they are able, actively, until they die and not have to suffer a long period of ill-health or neurosis.

8.31 p.m.

Photo of Mrs Jean Mann Mrs Jean Mann , Coatbridge and Airdrie

I wish briefly to comment upon certain items in the Estimates and make some suggestions. I shall not make a long speech, because I want to go to have something to eat as soon as possible. I raised last year a great many of the points which have been raised about maternity and midwifery services in Scotland, when I spoke on the Estimates. The services could be streamlined. Where there is difficulty in providing enough beds, care ought to be exercised so that the beds which are available go to the right people.

There are many women, whose housing conditions are perfect, who have a second or third safe confinement in hospital. I never had a confinement in hospital, and I have had six. To me, the birth of a child was a very happy thing. It took place in my own home. My husband loved the idea of my being at home, because it gave him a grand excuse for entertaining all his friends and "wetting the baby's head". When I came to my third, fourth, fifth and sixth confinements, my children were exceedingly glad that their mother was not packing up and leaving them to go away somewhere—they never could understand exactly where. I was always at home.

There must be many women who could well have their confinements at home. Indeed, it is a very joyous event, the most joyous event in a young couple's life. Having one's baby in hospital, with doctors and nurses in attendance, good people though they are, and leaving one's children behind at home, is a horrible idea to most mothers.

We know that it is always wise for the first confinement to take place in hospital. There are specialists who deplore the idea of having the fourth, fifth or later confinements at home, and it is thought that mothers entering von these later confinements should go to hospital. Is it possible to devise a system whereby priority would be given to women having their first confinement or their fourth or further confinement, and to women whose home circumstances are such that it is not advisable for the baby to born there?

There is this further difficulty. Although we have had a free home midwifery service in Scotland for almost twenty-two years, we have never had agreement on how we should operate it. I was in Glasgow at that time and our doctor would not allow a Glasgow doctor to undertake a confinement unless he had had at least seven years' experience of bringing babies into the world. England has a very wise system. Here no doctor is allowed to undertake midwifery unless he has served a six months' post-graduate course. I think that this is halfway towards the recognised diploma of the Royal College of Obstetricians and Gym-ecologists. If a doctor has this qualification, he then knows how to meet complications which may arise in the course of a confinement. Some of the things which I have mentioned have been recommended in the Report by the Maternity Services Review Committee in Scotland. I hope that they will be carried out.

I have a complaint to make about the ambulance service. In this respect, some areas are over-serviced. There are patients who travel in an ambulance when they could quite well walk. Some patients insist on being driven home when they could quite well walk. I know that some specialists have told patients to walk and have received the reply that the patient's doctor insists on an ambulance, and if he dared to refuse the patient would threaten to take his medical cards to another doctor. There is far too much bullying of doctors by patients who threaten to take their medical cards to another doctor who, for the sake of getting a few extra fees, will take on anybody.

There have been complaints throughout my constituency of an ambulance arriving with only one man. How is it possible for one man to manipulate an invalid on to a stretcher? In such cases, extra help has to be sought. I have had complaints from men who have had to take time off from work because they knew that an ambulance with only one man was coming for their wives. We should have value for the money which we are spending. People should use the Health Service and not abuse it. They should walk if they are able to do so and should allow the ambulance to be used by others who most need it and for whom it is absolutely essential.

I agree with what has been said about the ten-year vision of the future. There should be a bit of automation in the Health Service. Let me consider, first, the rate of growth in the care of mothers and young children by home nursing and domestic help. There is a great appreciation of the home helps and many complaints that we have not enough of them. Why do we always insist that home helps should be women? Has nobody heard of men cooks, batmen, or retired male nurses?

Why not recruit men as domestic helps? I know quite a lot of crotchety old bachelors who insist on going into hospital rather than "have a woman mucking around my apartment", but they would not mind if it were a man—say, an ex-Army man or one who had been a male nurse. I suggest that we turn our attention to the fact that there are men who are good cooks, men who can tidy up a kitchen, make beds and see another man comfortable, and who can give the kind of domestic help that is given mostly by women.

I think that the home nursing, domestic help and care of mothers and young children services could be streamlined. I know many lady doctors who, on an afternoon, have let it be known far and wide that that is the afternoon when they run their clinic for women and children. I know that these are very popular clinics. Again, it is an idea borrowed from England. The mothers come along with their babies and it is probably their own lady doctor to whom they are coming.

If we operated the same geriatric treatment as is given in some of the English hospitals, particularly in London, where elderly people are taken inside for a period—perhaps it is six weeks in hospital followed by six weeks at home—we might put these old people back on their feet. We might manage to eliminate a good deal of the nursing and also of the home help service. If we streamlined, we could pare down a good deal of the inconveniences and the expense of one or two of these services.

I should like to pay a compliment to the Department and particularly to the Joint Under-Secretary of State, the hon. Member for Craigton (Mr. J. N. Browne), for the extremely good work he has done in Scotland in the prevention of illness and the prevention of home accidents, which account for more deaths than polio or any other infectious disease. The memorandum introduced by the hon. Gentleman, showing local authorities how they could get the money for setting up committees, has been of great service and gave a lead to England, because we managed to get the English Minister to follow his example.

Now, the hon. Gentleman's "Designing for Safety" booklet, which is going out to every local authority in Scotland, is one of the best things that we have had in Britain for preventing home accidents. Again, the English Minister has promised at Question Time that he will follow Scotland's example and distribute this book to all the English authorities.

Finally, the Joint Under-Secretary has introduced a grant for Scotland that has never been given before by any party. 142 is giving for Scotland as much as has been given for the whole United Kingdom in the way of accident prevention. I am pleased to pay this tribute—

Photo of Sir Henry Legge-Bourke Sir Henry Legge-Bourke , Isle of Ely

The hon. Lady must not pursue this topic any further. It is not carried on this Vote.

Photo of Mrs Jean Mann Mrs Jean Mann , Coatbridge and Airdrie

Thank you, Major Legge-Bourke. That is all I had to say.

8.45 p.m.

Photo of Mr George Lawson Mr George Lawson , Motherwell

I should like to turn again to this question of the additional £17,000 provided for the purchase of ambulances and ambulance equipment.

When I put a Question to the Secretary of State for Scotland on 23rd February, asking— which English and which Scottish firms were invited to tender for contracts for new ambulance service vehicles"— I expected information about the firms which had been asked to tender. I did not expect that I should be given a reason for there being no invitation to tender at all to the Scottish firms. Indeed, I was rather surprised to find such a strong statement—a damning statement, I would say—made in answer to my Question. My hon. Friend the Member for Lanarkshire, North (Miss Herbison) has already read the statement, but I feel that it would do no harm to repeat it. The Secretary of State said: The Joint Central Committee for the Scottish Ambulance Service advised me that it was urgently necessary to provide additional vehicles to avoid a breakdown of the Service during the winter."—[OFFICTAL REPORT, 23rd February, 1959; Vol. 600, c. 119.] Because of the great urgency, there was no time at all to invite the Scottish firm which has for years been supplying these vehicles to tender.

It is rather astonishing that we should be told that the Scottish ambulance service was apparently on the verge of breakdown during the winter—a damning statement indeed—and in order to try to understand how this came to be, I have looked back over the Estimates since 1951–52. I find that there appears to have been a more or less regular Estimate for this kind of work—the provi- Sion of ambulances and the equipment for the vehicles—and that a regular £70.000 was provided each year.

In fact, in 1952–53 the Estimate was £85,000, but—and it is rather significant, and may throw some light on why this position was allowed to arise—I notice that whereas the Estimate was £85,000, apparently, in that year only £35,000 was spent. That was a year in which there were efforts to reduce expenditure, but the result of that reduction in expenditure in 1952–53 was to push up the expenditure in the following year to £140,000. Since that time—and this seems, to my mind, to be the beginning of the explanation of the present position—in 1956–57, the expenditure was reduced from £70.000 to £50,000, and in 1957–58 the estimated expenditure was down to £8,000.

From what I can judge, only £5,000 was spent in that year. It seems to me that what 'has happened here is that there has been an almost complete cessation of the ordering of ambulances. That seems to be what has happened over the past few years. If we take it that in 1957–58 only £5,000 was spent on ambulances and equipment, as compared with what seems to have been a regular figure of £70,000, it would appear that nothing at all was spent on the actual purchase of vehicles in that year.

The Estimate for 1958–59 was again very much down on what seems to have been the normal Estimate. It was, in fact, only £39,000. It is the supplementation of that £39,000 by an additional £17.000 with which we are concerned tonight. It seems to me, looking at this matter as I think we are bound to look at it, that there has been an effort so to reduce expenditure on the purchase of ambulances and ambulance equipment that we have been pushed into a position in which in this winter the condition of the fleet was such that, to avoid a breakdown, there had to be this hurried, or what seems to have been a very hurried, ordering of these vehicles. It is very serious and most reprehensible that such an important part of the Service should have been allowed to run down over two years in this way.

There are one or two related questions which I should also like to put to the Joint Under-Secretary of State for Scotland. I appreciate that this is not his department but I know that he will make an effort to reply. If I am wrong, I am sure that the hon. Gentleman will correct me, but I was lead to believe that the placing of these orders in 1958, in respect of which the supplementation of £17,000 is partly to be paid, was not by the Scottish Office but by the Ministry of Supply.

I understand that a Ministry of Supply official visited Scotland, inspected the ambulance fleet and apparently made models or copies of certain Scottish ambulance vehicles. The Scottish ambulance vehicle differs from the English because in Scotland there are high tenement buildings with spiral stairways, with the result that the type of stretcher used has to be such as can be much more easily manoeuvred than the type used in England. I understand that it follows that because of the shape of the stretcher the shape of the typical Scottish ambulance is different from that of the English ambulance.

I am told that the Ministry of Supply official who made drawings or prepared models of the Scottish ambulance took his drawings to an English firm which provided the ambulances in 1958. We are told that the position was so urgent that there was no time to do otherwise than ask an English firm to supply these ambulances. That is absolutely disputed by the Scottish firms which in the past have provided these ambulances. They say that they could have met the demand for the main bodies more quickly than it was in fact met.

Is it true that the orders for these ambulances were not placed by the Scottish Office? I should have thought that the Scottish Office normally placed these orders. It is said that the orders were placed by the Ministry of Supply official with an English firm or firms without the Scottish firms being asked to tender. That is certainly true.

I do not wish to appear nationalistic and I do not argue that everything used in Scotland should be made in Scotland. Far from it, for Scotland exports as well as imports. But in a matter of this kind, when there has been a regular meeting of Scottish needs on the basis of what is a small industry, it is very unfortunate if a Ministry of Supply official apparently has the power to bypass the Scottish Office and place orders almost on the basis of his own judgment in this way. This is a bad thing. I hope that the Joint Under-Secretary will tell me if I am not correct, but if the facts are as I have described them, I hope he will assure me that this will not happen in the future.

We are being asked to grant an additional £8,000 for the provision of the midwifery service, mainly to meet the cost of additional staff. Recently I received a deputation of midwives from my constituency. I had not known that they were as much concerned as they are. I thought midwives seemed to think more of service than of themselves and were happy in their job. Apparently, however, there is a strong feeling of grievance among midwives, certainly among those who came to see me.

As a result of their visit I read the report of the Adjournment debate on 23rd January which was initiated by my hon. Friend the Member for Southampton, Itchen (Dr. King). I was surprised to learn that, although there were more than enough women coming forward for training as midwives, and although there were more than enough who qualified, the service could not grow because of the numbers who left it. Apparently this was due to the conditions under which they work. For example, the midwife is highly qualified and her job must be one of the most vital in this country, since she is engaged in delivering children and looking after the mothers. I was surprised to find that the pay ranges from £10 a week to a maximum of £12 4s., which is below the national average.

I know that it is not in order here to argue about increases in wages, but I should like to know whether the conditions described by my hon. Friend the Member for Itchen, when speaking of midwives in England and Wales, also exist in Scotland. If they do, how far does the Joint Under-Secretary think that £8,000 will go towards remedying the deficiencies?

Photo of Mr Simon Mahon Mr Simon Mahon , Bootle

Dr. J. Dickson Mahon (Greenock) rose

8.59 p.m.

Photo of Mr Niall Macpherson Mr Niall Macpherson , Dumfriesshire

I apologise to the hon. Gentleman the Member for Greenock (Dr. Dickson Mabon) for rising, but I promised to sit down at a quarter past nine to give time for a further debate.

Photo of Mr Simon Mahon Mr Simon Mahon , Bootle

On a point of order, Sir Charles. Is it possible for me to protest at the fact that I have attended the whole of this debate and that the Minister has now been called?

Photo of Mr William Morrison Mr William Morrison , Cirencester and Tewkesbury

That is not a point of order. If a member of the Front Bench rises, I call him. It is not in my hands. There is still half an hour to go and I hope that the Minister will not speak for half an hour.

Photo of Mr Thomas Fraser Mr Thomas Fraser , Hamilton

The Minister has said that he has promised to sit down at a quarter-past nine. Is there any reason why he should not finish at half-past nine?

Photo of Mr Niall Macpherson Mr Niall Macpherson , Dumfriesshire

There is another Estimate to come after this one and it is expected that there will be a short time in which to present that Estimate at the end. I apologise to the hon. Member for Greenock, but I hope that he will allow me to continue my speech.

Photo of Mr Simon Mahon Mr Simon Mahon , Bootle

No. I think that it is a very grave discourtesy, considering all the time I have been here.

Photo of Mr Niall Macpherson Mr Niall Macpherson , Dumfriesshire

I regret that, but I am afraid that time is against us. It is unfortunate that we should have ended on this particular note, because this has been a very even tempered and extremely useful debate.

I should like to thank all those who have spoken for the way in which they have approached this debate and, in particular, for the tributes that have been paid by the hon. Lady the Member for Coatbridge and Airdrie (Mrs. Mann) and others to my hon. Friend the Member for Craigton (Mr. J. N. Browne) for his work for the Health Service.

The hon. Lady the Member for Lanarkshire, North (Miss Herbison) dealt, first, with the pharmaceutical service and I should like to deal with her question. She asked what were the costs of the services in Scotland. The average cost per prescription in Scotland is 7s. 6½d. This is 1s. 1d. higher than the average cost per prescription for England and Wales. Without going into details, I would say that, despite the high average cost per prescription, the cost of the pharmaceutical service in Scotland per patient on doctor's lists is almost exactly the same as in England and Wales.

The reason is that there are more pharmacists in Scotland in proportion to the population. There is one for every 3.000 persons in Scotland compared with one for every 3,400 persons in England and Wales and proportionately fewer prescriptions, 3·9 per head annually compared with 4·5 in England and Wales.

Each pharmacy has to employ a qualified dispenser and assistants, as does an English pharmacy, and the cost has to he covered by the fees for proportionately fewer prescriptions. That means there is a difference here, as well as the difference in prescribing practice in Scotland, as compared with England and Wales. The hon. Lady also asked about the rota system. If I may I shall ask my lion. Friend to write to her on that point.

On the ambulance service, a good deal was said by the hon. Member for Mother-well (Mr. Lawson) and the hon. Lady for Lanarkshire, North. I should like to say to the hon. Lady the Member for Lanarkshire, North that any need for an urgent order was not due to any holding back by the Government owing to economic difficulties. I think that the hon. Member for Mother-well has already made that case tonight. I should only like to add that the points which the hon. Member for Mother-well have made will be very carefully looked into. As he knows, an answer has been given to him on this point and on the special procedure for single tender which has been touched upon by him. I do not wish to go into further details. I can only assure him that the points which have been made will be carefully looked into.

Photo of Miss Peggy Herbison Miss Peggy Herbison , Lanarkshire North

The Minister suggested that my hon. Friend had made the case that it was not because of economy. I listened carefully to what my hon. Friend said about what has been spent over the years. Whether one calls it economy, or not spending the money, it still means that we are in this position because the money was not spent.

Photo of Mr Niall Macpherson Mr Niall Macpherson , Dumfriesshire

I understood the hon. Member for Lanarkshire, North to be asking whether the need for this order being urgent arose out of the economies imposed by the Government this year. I think that she was attaching it to the figure of £400,000. I am saying that it was not related to that. The fact that there is £39,000 included in the Estimate this year which, as the hon. Gentleman has said, is a good deal more than the previous year, indicates that any economy was in the previous year and not in this year.

Photo of Mr George Lawson Mr George Lawson , Motherwell

The hon. Gentleman is misrepresenting me, although he may not be doing so deliberately. If, in fact, there was £70,000 expenditure which fell to £5,000 and then, in the following year, the figure was only £39,000, that would suggest that the problem facing us now is due to that heavy reduction in expenditure.

Photo of Mr Niall Macpherson Mr Niall Macpherson , Dumfriesshire

The hon. Gentleman will realise that the ambulance service had to be built up to start with. No doubt an estimate was made of the time the vehicles would run and some vehicles did not last that long, hence the need for the urgent order. That is what I suppose to be the case, but I assure the hon. Gentleman that what he has said will be carefully looked at.

The hon. Lady asked about midwifery staffing and whether there was an adequate service in every part of Scotland today. She may like to know that, on average, there are about 48 confinements per midwife per year and the Working Party on Midwives which reported in 1949 regarded a case load of 55 a year as reasonable. The case load for midwives in hospitals has been maintained at 35 per midwife per year. It was at that figure in 1950 and the figure was still the same in 1957.

The main point made by the hon. Lady related to the question of maternity beds. It is accepted by all concerned that additional maternity beds are required in Glasgow which has the lowest proportion of institutional confinements in the four cities. The figure which I have does not quite accord with that of the hon. Lady. It is 62·4 per cent. compared with 70·2 per cent. for Scotland, but, in any case, we are agreed that it is low.

On the basis recommended by the Maternity Services Review Committee—the Montgomery Committee—about 850 maternity and ante-natal beds would be needed for Glasgow. At present, there are 693 beds. Work is expected to begin in the spring of next year on the 112-bed Yorkhill Maternity Hospital, the plans for which are now in final form. Twenty additional beds will shortly be available at the maternity unit at Robroyston Hospital through the conversion of existing accommodation there. Plans for a 53-bed unit at the Belvidere Hospital have recently been submitted by the regional board to the Department of Health, and are receiving urgent consideration.

In Lanarkshire, work is in progress on a new 120-bed maternity unit at Bellshill which it is expected to complete in 1961. Thirty additional beds have already been brought into use as a temporary measure in accommodation vacated by nurses, and 14 other additional beds will come into use shortly at Hamilton and Lanark. In Renfrewshire, Thornhill Maternity Hospital has recently been extended to replace the out-moded maternity unit at Barshaw, which is now being converted for geriatrics. In Dunbartonshire and Dumfries, also, there are improvements under way.

We appreciated the speech of the hon. Lady the Member for Glasgow, Kelvin-grove (Mrs. McAlister). We are attaching the greatest importance to this in Glasgow. It could be said that the regional hospital board puts the first priority on maternity hospitals and the care of old age.

Photo of Mrs Mary McAlister Mrs Mary McAlister , Glasgow Kelvingrove

Can the hon. Gentleman tell us when the work at Yorkhill will be completed?

Photo of Mr Niall Macpherson Mr Niall Macpherson , Dumfriesshire

I cannot tell the hon. Lady that, because I have not the information available.

Photo of Miss Peggy Herbison Miss Peggy Herbison , Lanarkshire North

The Minister is suggesting that work at Yorkhill will begin in the spring of 1960, but he also said that the plans were almost ready. If the Scottish Office is seized of the importance of providing better maternity accommodation in Glasgow, surely the summer months of this year could be utilised to begin the work rather than that it should wait until the spring of next year.

Photo of Mr Niall Macpherson Mr Niall Macpherson , Dumfriesshire

I am sure that my right hon. Friend will take note of what the hon. Lady has said. I cannot tell her whether it is possible or not.

On infant mortality, I have not the latest figures for Glasgow, but I have stated what the hospital authorities are doing to increase the number of maternity and antenatal hospitals and so to provide the better service we all desire. In Scotland as a whole the Registrar-General's provisional figure for 1958 shows that infant mortality was the lowest yet recorded. For every 1,000 live births there were 28 deaths of infants under one year, compared with 29 in 1957 and 47·3 in 1946–50. My right hon. Friend is concerned to make sure that that figure should be lowered further as fast as possible. I can give that assurance to the hon. Lady.

My hon. Friend the Member for Fife, East (Sir J. Henderson-Stewart) asked about the recent Acton Society Trust Report, and whether it covered Scotland. While much of what is said in this Report, and in previous Acton Society Trust Reports, has been written primarily with reference to conditions in England and Wales, the Trust has, of course, covered Scotland in its inquiries. My right hon. Friend and his Department have taken careful note of the views of the Trust.

On the question of leadership, which is perhaps the Trusts' main criticism, I suggest it is necessary to strike a balance. The hospital service in 1948 was a series of disconnected units when it was taken over. It must be allowed to grow gradually into one coherent organisation. It relies very largely on voluntary effort in the hospital boards and has derived great benefit from the efforts of those individuals. All this would be lost by anything resembling regimentation. My right hon. Friend believes, as I think his predecessors have done, that in some respects it is possible from St. Andrew's House to guide and to lead, but that it would be quite wrong to command and direct, save in the last resort. The military parallel drawn by the Acton Society does not seem to me to be a good one.

Perhaps I might mention one or two examples of the ways in which we have tried to do some of the things which the Acton Society has in mind. We have just sent to the hospital authorities a memorandum on some of the major questions of policy and organisation to which my right hon. Friend thinks they may wish to give more attention than has been possible in the difficult conditions of the first years of the Service. We have begun a series of discussions round the table with each regional board in turn, about the direction in which it should seek to develop the Service over the next few years. I can assure the Committee that there is no question of not looking forward and planning ahead.

Within the Department we have set up special machinery to study the trends of medicine, morbidity, and so on, to try to assess their impact on the hospital service. We are also strengthening the technical staff to cope with the architectural and other problems arising from new hospital building. On the building programme itself, we have provisionally agreed with the hospital authorities a list of the major projects which we and they would like to put in hand up to 1965, subject, of course, to resources being available when the time comes and to later adjustment for changing conditions. We had also begun to study with them farther distant projects which will take us up to 1970.

Perhaps I may turn to more immediate problems. We arranged a highly successful conference last year to examine, with the hospital authorities, the application of work study to the hospital service. The Department is setting up a special branch to deal with this and allied subjects, and the officer who is to take immediate charge of it is at present on detached duty studying the subject further with I.C.I. These are examples of what we are doing. While we welcome consiructive criticism of the kind made by the Society, and, indeed, of the kind that has been made in the Committee tonight. I suggest that my right hon. Friend and the Department are not quite so lacking in leadership as the Society's Report would suggest.

Although I have not been able to deal with all the points raised, I shall take note of the points made by the hon. Lady the Member for Coatbridge and Airdrie, with all her usual rugged vigour, and the point made by my hon. Friend the Member for Central Ayrshire (Mr. Nairn). What I have said will, I hope, be sufficient to show that these Supplementary Estimates represent a step forward as well as covering the higher cost of salaries, and so forth; and, as my right hon. Friend said before, they are in no way an indication of extravagance.

Question put and agreed to.

Resolved,That a Supplementary sum, not exceeding £2,376,500, be granted to Her Majesty to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1959, for the provision of a comprehensive health service for Scotland and other services connected therewith, including medical services for pensioners, &c., disabled as a result of war, or of service in the Armed Forces after the 2nd day of September, 1939, certain training arrangements, the purchase of appliances, equipment, stores, &c., necessary for the services, certain expenses in connection with civil defence, and sundry other services.