I beg to move,
That this House deplores the statement made by the Minister of Health on 1st February which clearly indicates the determination of Her Majesty's Government to undermine the National Health Service and to place heavy burdens on those least able to bear them.
In speaking to this Motion, I shall inevitably be dealing to a large extent with arguments about money and economics. I want to put the Minister's own case under the light and under the glass. To do that I must to some extent deal in his currency.
At the very beginning, I should like the House to recall, as I am sure it does, that the debate is really about people and how they live. Shall the citizens of tomorrow be helped to get off to a good start today with welfare foods made so easily available that every encouragement to use them exists? Shall the sick—all of them—be treated to one standard, the best available? Shall their treatment, cure and general care be a charge on all of us who are healthy? We should remember that we are all liable to be sick or old or both; unless we are especially lucky or especially unlucky, we shall all at some time be in one or other of those classes.
Lastly, the debate is about whether the cost of doing this shall be borne by each of us according to our general ability to pay, just as our receipt of care when we need it shall be assessed by our general needs at that time.
That is what the debate is about. As I shall hope to show, there is a great, fundamental and deep gulf between right hon. and hon. Gentlemen opposite and my hon. Friends and I on this issue. Speaking without too much emotion, I hope and without what I am sometimes accused of, namely, too much vigour at this Box, I believe that the policy we seek to censure today is indeed a monstrous one. It is a monstrous policy which has offended many far beyond the ranks of those who normally support my party. Hardly a newspaper, however sycophantic, however willing normally to find a case for the Tory Party, has been ready to support this policy fully.
The Sunday Times, on 5th February, contained a leader which I want to quote. I select this from the many possible leaders I could quote. It started with friendly words to the Minister and ended, as one would expect, with friendly words to the Minister. It also contained the words:
But Conservatives should beware of thinking that a principle has been affirmed to which modern Toryism can nail its colours; for no new principle has been introduced. A permanent principle cannot be manufactured out of a moving percentage, and in so far as the reforms are to be judged in terms of principle they are far from invulnerable.
That goes a long way for the Sunday Times.
The leader continues:
If the problem is looked at purely as one of raising the £850 million cost of the Health Service, and the different sources as taxation or pseudo-taxation under various guises, it is not good in principle to off-load from a graduated Income Tax, or from duties on consumption goods, to a poll tax on the gainfully occupied … or to a levy on the sick (as the extra charge for prescriptions can be made out to be).
In addition to what the newspapers have had to say about it, we have all been inundated with letters from all kinds of people. We have had thousands. I have had a larger post bag on this than on anything since Suez. Of all the letters I could quote—I could quote many; they are all here—I wish to quote one which came not to me but to my right hon. Friend the Leader of the Opposition. It is a two-page letter. The Minister may have it to look at. Whoever is to wind up tonight may have it for his winding-up speech. I will read only the first and last paragraphs:
Dear Mr. Gaitskell,
Increased charges for medicines in the State service. My background is a doctor of 68, practised medicine for 43 years, chiefly as a panel doctor, but the last three years as a consultant. I am a lifelong Conservative. I am horrified and amazed by my Party's proposal to prostitute the whole principle of a State service and to render that service a hardship to poor people who need it most of all.
He goes on for two pages explaining why he feels that, and winds up—a life-long Conservative and all his adult fife a doctor:
After a lifetime of helping others and healing the sick, my considered opinion is that anybody supporting the increased charges is a wicked old"—
Here, I am afraid, I am in some difficulty. I think that the word he meant to type was "beggar", but that is not, in fact, the word that he has typed. I was happy to see that the doctor also wrote a letter to the Daily Telegraph; not in quite the same terms, but saying the same thing.
That letter is similar to many that we have had from pharmacists as well as from doctors, from patients and from the dependants and supporters of patients. If the Minister is not moved, as we must be moved by some of these letters, he must be a very hard man, indeed.
The real trouble is, if I may use some terminology that comes easily to me from old Ministry of Works days and, further back, to building days—that we have here a noble edifice that requires a great and imaginative architect for its improvement and for its continuation. Instead of a great and imaginative architect, we have a quantity surveyor. That is our trouble. We have descended from the real problems to fiddling about and messing about with quantities and bills of costs.
Let me on behalf of this side nail up our colours. We believe that a comprehensive medical service, free to the patient at the point of need and with one standard for all the sick, was good and is good, was attainable and is attainable, and we remain for it. The Tories never were for it. If the Minister has one advantage to commend him over his colleagues it is that he has never failed publicly to act as they believed. When the Service was introduced, and when the Bill was going through this House they opposed it at every single stage. I believe that it was the only great social service of the Welfare State that they opposed on Third Reading.
I recall the issue of the document called One Nation, of which the Minister, together with that modern progressive, the Colonial Secretary, together with the Lord Privy Seal, together with the Leader of the House, were the great authors. I have re-read it for this debate. I have never in my life read such loving nostalgia for everything to do with charity and the Poor Law for the wretched in our country. They recite the lot. They go back to Edward's Statute of Labourers, they come up through the Elizabethan Poor Law, they extol the virtues of giving alms to the poor and, of course, they end with the declaration, from which the Minister has never departed, that, when they had the power, charges would be imposed.
Indeed, One Nation went further—and it may be that this is the next move that hon. Members opposite will be asked supinely to support. It called for charges" for board in hospitals. In April 1958, and in November, 1959, the Minister himself canvassed the abolition of all subsidies on social services, and particularly the subsidies on housing. I hardly need to read quotations—I do not think that the Minister will dispute them. On housing, he made a declaration that
The council house system today is morally and socially damaging"—
For the moment, I am dealing with what hon. Members on both sides—[HON. MEMBERS: "Answer."] The jackals bay when there is nothing better they can do. The issue at this moment is that the Government, the party in power, should answer for their declarations.
The Minister said:
The council house system today is morally and socially damaging, and I think we might do something about this nuisance during the life of this Parliament.
Let us have it on the record for April—
The right hon. Gentleman surely knows my views on this. I made it quite clear that I considered that this was something that should be dealt with by the House, and I blame his party in various parts of the country for not doing something themselves.
That is a really good dodge, but the hon. Gentleman will notice that the Minister does not do that. That is what I said about the right hon. Gentleman—that is the sort of dodge the Minister does not use. He does believe that that system is morally and socially damaging. He does believe that it is a nuisance. He does believe that we should abolish the council house subsidy—
I am glad that the hon. Gentleman says that, but I do not think that his belief adds much to the debate.
Further, the Minister really does believe that
Given that redistribution is a characteristic of the social services, the general presumption must be that they will be rendered only on evidence of need….
The question that therefore poses itself is not whether a means test should be applied to social services, but whether any social services should be provided without a test of need.
That is the fundamental difference between us. What I want to get clearly accepted is that the Tory conception of social services in general, of our duty, as a community, to each other, is wholly different from ours. They will provide an ambulance service for the wretched—we do not dispute that. The Minister will provide that, but it will be an ambulance that will not be too comfortable and not too easy to get lest the chap who gets it might be lazy and might thumb a ride when he should walk. That is the real point. The service will be there for the absolutely wretched—for the fellow who really falls right through—but it will not be there just because we ought to take care of the men and the women who have need and whom we ought to help.
We, on the contrary, applaud the element of redistribution involved by this and other social service schemes. We believe in a society in which we would be members, one of another, whose duty it was to share each other's burdens. We did and we do mean a comprehensive National Health Service to be a permanent feature of our life.
What is the Minister's case? On what grounds does he claim that it is right to do this? There were two statements, and I will take, first of all, the one made recently when these charges were introduced. He said three things, and I will come back to an earlier one later on. The first is that the cost of the Service is getting too high and that we cannot afford it as a nation. The second is that, unless it is cut, desirable developments in the Service—in particular, new hospitals and such—cannot proceed. The third is that there is waste in the Service which the charges will help to avoid. Those are the three legs on which he stood, and I will deal with each in turn.
Firstly, I will deal with two arguments which are not really relevant but which have been very heavily overworked by the party opposite. The first was overworked by the present Minister in 1957 when as a junior Treasury Minister he introduced the separate health contribution and doubled the existing figure. I answer it now because he may have intended to make the same case again. The burden of his case then was an inherent conception from the beginning that 25 per cent. of the cost should be found from contributions. He worked that very hard over many pages in here. The second of these irrelevant but hardworked arguments is that Labour did something like this in 1950–51. I have no doubt that we shall hear a good deal of that argument again today.
I will deal, therefore, with both of those arguments before I deal with the main one. The 25 per cent. conception of the Minister rests on the fact that during the war the Actuary's memorandum attached to the Beveridge Report included the figure of 10d. as the contribution which was assumed to be available for the health provisions. That 10d. was assumed to bring in £40 million, and the total cost of the Service was estimated to be £170 million. The figure of £40 million is roughly a quarter of £170 million, and so, Q.E.D., it was an inherent conception, the Minister said in 1957, which was embodied in the Bill, that a quarter of the cost should be covered by contributions. I have read everything carefully once again, and there is absolutely no foundation for that at all. The 10d. arose quite arbitrarily. It arose only in the Actuary's memorandum The only reference to it is that it is the sum available for health. It is not that it is the sum chosen for health, and not the sum we have to have in order to get that proportion for contributions. The only reference to it in paragraph 34, and again later on, is to the effect that that is the sum available.
In any case, the actual cost of the scheme was so wildly different from the Actuary's guess that in any case the 25 per cent. notional relationship or coincidental relationship was completely destroyed at the very beginning. Nobody ever proposed that the 10d. should be doubled, trebled or quadrupled to get back to the notional relationship of 25 per cent. That argument, on which he rested his whole speech in 1957—perhaps he is hoping to use it again today—is just an alibi, a rationale thought up after the event. It has no historical validity at all. In it we see the politician in the right hon. Gentleman and not the teacher.
Turning to the second argument, every time Health Service or prescription charges come up in the House reference is made to Labour's action in 1950 and 1951. The allegations are that we imposed a ceiling and we imposed charges. As a matter of detail, we did not impose charges. We introduced an enabling Bill under which the Tory Minister imposed charges. I do not make a lot of that. [Laughter.] There is a certain usefulness in getting the facts right, is there not? I imagine that if the Tories are to defend an issue such as this, probably one thing they will not wants to do is to get the facts right.
I do not rest my case on that. I want the House to be clear about the times in which we were then living. I will let the House into a personal secret. When I sat on this Bench today I felt it very deeply, when I heard my hon. Friend the Member for Nelson and Colne (Mr. S. Silverman) and other hon. Friends saying things about defence policy with which I disagree and on which I took a position near to the Minister of Defence, and I felt bound in all honesty to show that I disagreed. I did not think it would be honest not to. As I was doing that I suddenly thought, "Gracious, in a minute we shall argue about the Health Service charges. We had to do some things in 1950, because of the Korean war, on which the party opposite supported us. Will they be so honest today as to say that we were then under financial strain and not use the consequences against us for political advantages?" I restrained myself from getting up, as I was tempted to do, to support the Minister, but I knew jolly well that ever since the Korean war, on which they said they supported the Minister of Defence and the Prime Minister, they have never ceased to use the consequences for mean political advantage. I doubt very much whether they will have the guts to do it today.
I go further. The ceiling that we sought to impose in those difficult times—a ceiling which was never held, to get the facts right again—was a higher proportion of the Exchequer expenditure, and a higher proportion of the national income, than they are spending now. It was clearly established in the Budget speech of my right hon. Friend that it was to be regarded as a temporary position relating to circumstances then prevailing and not be regarded as a desirable or permanent thing. The fact that they use what we did, rightly or wrongly, in 1950 at the time of the Korean war as a justification for what they are doing today, is a fearful commentary on the situation where they claim we have never had it so good. We have never had it so good that they make it worse for the sick and needy than we had to make it in 1950.
I turn now to their major case. The first argument is that the cost is too great to be borne. At around £860 million the Minister says that if it goes any higher we would have to stop having desirable things and the figure itself is too high. It is only a little over half what the nation spends on defence. While I defend what has to be spent on defence, I am bound to say that the society we are proposing to defend is an important consideration also.
The total figure or a sum of money by itself is no guide. It has to be looked at as a proportion of the national income. A fixed sum is relevant only by reference to the total from which it comes. As a percentage of the national income, our expenditure on the Health Service rests almost exactly where it was in 1950. For everything that has happened since, for all the things the Government have taken credit for, for all the expansion that they claim to have done, for all the improvements, for all the "never had it so good" wonders of Conservative administration, they are spending no more on health than we were spending in 1950. Indeed, they are spending a little less. In 1950, the percentage of the national income which went on health was 4· 5. Today, taking current and capital expenditure together, it is about 4· 2, a little less after ten years of alleged Tory progress.
Taking it as a percentage of total Exchequer expenditure, of what the Government spend on our behalf, it has remained steady. It was 10· 6 per cent. in 1950. It was 10· 4 per cent. in the Civil Estimates for this year. It has, in fact, gone to 11· 7 per cent. in the corrected Estimates, but the extra is to pay for the doctors' and dentists' pay and includes a very large non-recurring item on account of back pay. It is, in fact, something less than 11· 7 per cent., and I do not think I am far wrong when I say that it has remained just about the same as a percentage of Exchequer expenditure. The claim, of course, is that it is too high, although it is no higher than it was ten years ago.
I take it next as a percentage of what we find for the social services. It has fallen from first priority to third. It has fallen from 28· 5 per cent. of the social security budget to 23· 1 per cent. On 1st February this year, in the passage to which I have already referred, the Minister, in introducing the charges and referring to the total cost of the Service said that it could not be allowed
to go on increasing at so high a rate".
The fact is that it is not increasing "at so high a rate". Taking 1949 levels of prices and remuneration if we refer to Table 27 on page 57 of the Minister of Health's own report on the costs, in this case, of the National Health Service—we find much the same answer for the rest of the services as the Ministry gave for the Health Service—we find that in real terms the advance in expenditure on this Service over eleven years has been 22 per cent. That is 2 per cent. a year. According to the Minister, we cannot let it go on rising at that rate.
What are we telling our people—that we cannot put 2 per cent. extra a year into the Health Service? Is that too much for us? Is that disaster? If the Minister and his supporters really mean that, they had better go and talk in real terms to their constituents.
Will my hon. Friend allow me to tell him that there are so many points I could take up that I should be here for the rest of the day? I had better leave a few for him and for others to raise.
When the Minister says that the cost of the Service cannot be
allowed to go on increasing at so high a rate",
what he really means is that we cannot manage 2 per cent. a year for the Health Service. [Interruption.] We may still disagree in the end, but I ask hon. Members opposite to take this seriously. For very many people there is no more important and no more moving subject than what we are now discussing.
They may think that I am wholly wrong, and I may bore hon. and right hon. Members, but I ask them at least to try to listen to the argument. I will do my best not to trespass.
We are spending about 4 per cent. of our national income on health. A revealing comparison can be made in the figures shown in the I.L.O. Report entitled "The Cost of Medical Care", issued in 1959. Unfortunately, the figures relate to 1953, but I shall have a word to say about that in a moment. In 1953, there were only two countries among all those referred to which spent less than we did out of their national income on the care of people who need a Health Service. I am talking about public and private expenditure, the whole lot. The Report produces all the figures and sets them out. Only two, Holland and Denmark, provided less out of their national income than we did.
The matter is worse than that, of course, because we happen to know our figure for 1959. It is still about 4 per cent. Those of us who know the Continent of Europe know very well that the continental countries have moved forward enormously in their social services between 1953 and 1959 and, when the comparison for today comes out, it will look even worse than that table for 1953 revealed. The case the Minister made seems to me to be a silly collection of unsupported allegations and assertions. There are no facts to back up the assertions he has made.
The issue today is as it was in 1946, as it was on the Second Reading of the National Health Service Bill and on the Third Reading of the Bill—not whether we can have a comprehensive medical service free to the patient at the point of need, but whether we want to have such a comprehensive social service. That question is answered by us "Yes". It is answered by the Minister now, as it was then, "No". The issue is as simple as that.
The Minister's second argument was that we must make the cut and that, if we did not, we could not go on with the development of the hospital service, building new hospitals and so forth. I welcome the new hospital programme. We have called for it often enough and, heaven knows, the Government's record during the ten years they have been in power has been a fairly grim one in hospital building. It is not this Minister's fault. Others here can answer for that.
What does the hospital building programme provide? It provides for an increase of £5 million a year from now until 1965–66. That is what it comes to. The Minister proposes to take back through his charges and contributions £65 million a year. He is not just taking back £5 million for the hospitals. He is taking a cumulative increase, £65 million on top of £65 million every year.
As regards the £5 million for the hospital programme, is it seriously argued by the Minister, who ought to know, that the gross national product will not rise at all in the next five years? Shall we stagnate economically as badly as all that? If so, it is a jolly good job he did not make a speech in the debate yesterday or the day before. However, let us assume for a moment that he is right and that we cannot provide the hospitals if we do not take charges from the other part of the Service. What is the next step?
In one of the Conservative Party documents, we are told that we cannot build the extra universities and provide the extra university places unless fees are charged for secondary grammar school education. Is this the next move? It is an extension of the same principle. If we cannot build hospitals unless we increase charges for prescriptions, for welfare foods and so on, the same argument can be made for charging for education so that we may provide the extra university places.
The whole thing is childish, dangerously childish. It shows what can happen to a great concept, to a great and extremely important part of life, when, as the late Aneurin Bevan once said, little men do silly little sums. These are the consequences of having a former junior Treasury Minister where an imaginative senior Minister ought to be. This is the problem.
The right hon. Gentleman's third argument is that these proposals are needed to prevent waste. But how will that be achieved? Presumably the waste to which he refers is the drug bill, and that is why he is increasing the prescription charges. In this, past experience and, as far as I can find, all advice are against him. The Hinchliffe Committee, the Lancet, economists who made an investigation and even the men who helped to invent the original prescription charges scheme were all against him. They found that the effect of the previous scheme was not to prevent waste but to encourage it because people tried to help each other out and doctors tried to help poor patients by prescribing for them things which they should not have prescribed.
When the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith) was Minister, he was strongly pressed about the Hinchliffe Report on 15th July, 1959. In paragraph 301 of the Report, it was said that it was hoped that this would lead to the abolition of the charge and not an increase in it. The right hon. and learned Gentleman said:
If such a scheme proves successful in controlling expenditure on drugs, we would, naturally, consider whether the saving justified the abolition of the prescription charge at the end of the two-year period as suggested … "—[OFFICIAL REPORT, 15th July, 1959; Vol. 609, c. 440.]
We are not yet at the end of the two-year prescribing period, yet the Minister is putting prescriptions up. The right hon. and learned Member for Hertfordshire, East, knew that this was the way not to cut but to increase waste. The Minister is going against all advice. Indeed, the whole weight of opinion, both medical and lay, is against him on this.
What is the waste? We must be careful about this. It is not necessarily in the number of people to whom drugs are supplied or in the number of prescriptions for drugs. There has been a great advance in new and expensive drugs, specially in antibiotics, in recent years. These drugs do save lives. Killer diseases are coming under control. People are getting back on their feet and back to work very much more quickly. Of course, these drugs cost money. I will come in a moment to where I think the waste is, but do not let us get into a state of mind where the fact that more expensive drugs are being prescribed by doctors for sick patients is in itself a bad thing. If we do, we shall end by believing that the invention of penicillin was a disaster for the world when, of course, the contrary is the case. Let us applaud it, not nag about it.
Let us put it at is worst. We still lose 75 times as many work days because of medical incapacity as we lose by industrial conflict. In 1957–58 we lost 300 million days. Even if it is put at is worst, it is still a good and useful expenditure of money to avoid that to say nothing about the human aspect. I should like to paraphrase a poster which we used to see on the hoardings before Tommy Trinder became chairman of Fulham Football Club, which, speaking as a supporter of West Ham United, is a fate almost worse than death. The poster said, in effect, "If it is waste you are after, do not go to the patient". It is not the patient who is wasting the money. He has had the misfortune to become sick. I say that if it is waste the Government are after they should go for the manufacturers and for the industry. There is no doubt that it is the state of the pharmaceutical industry at which we ought to look.
May I give some reasons for saying that? There is a fearful waste in sales promotion and sales pressure. I shall be very surprised if doctors and chemists have sent me letters but not to anyone else about this. I have the most incredible collection of evidence here which has been sent to me by people I have never met and who, I am sure, have never voted Labour about the free gifts which pour through the doors of doctors from pharmaceutical firms. A torrent of unsolicited stuff is poured through doctors' letter boxes. I have estimates of the cost of this. They are enormous. No one believes that these firms are giving away the full value of what they are making and selling. I have much evidence about dubious sales methods. Incidentally, the Minister could "have a go" himself if he would get at the hospital management committees about the degree of by-passing of their central arrangement which is going on through pressure being put by salesmen on matrons and other hospital officials to get them to buy things. In this way they by-pass the central purchasing arrangements of the hospital management committees.
The right hon. Gentleman might have a look at the maintenance of prices and the ring arrangements in the industry. Again, I am speaking about what he can do himself if he wants to tackle the problem of waste and not take it out of the patients. Why does he refuse to allow the hospital management committees to take advantage of the patent law restrictions which are available to all other Crown services? Why does he not insist that they should be available to them as well, since he himself said that they were legally entitled to do them in answer to a Question the other day? Why does not he look into—or get someone to look into it for him—the reason for the maintenance of the higher proportion of sales of proprietary drugs against a generic alternative when a generic alternative exists? I have examples of enormous differences in price, four, five, eight and nine times the difference, between the proprietary article and the other.
The Minister might also look at the absolutely indefensible rise in profits in this industry. I have seen examples of the rising profits of various firms of anything from 80 to 400 per cent. over the last eight years. American subsidiary firms have been making profits of more than 100 per cent. per year on the total capital involved. All kinds of bodies and public servants, including the Comptroller and Auditor General and the Public Accounts Committee, and I do not know who else, have reported on this matter.
I am bound to ask what it is that the Minister is afraid of, like all his predecessors. This perhaps will sound offensive, but I deliberately mean what I say. The Minister finds it easier to take it out of mothers, their children and the sick than to take on this vast great industry. Let us have a full inquiry into the cost of drugs and into the state of the pharmaceutical industry. Let us look, without any commitments to begin with, at this dragon of uncontrolled private enterprise waxing fat at the public expense and be prepared to take State action, whatever it involves, and not be afraid for doctrinaire reasons.
The hon. Member for Torrington (Mr. P. Browne) has declared himself on this matter. He is wide awake, alert and alive to what is involved. He said that the time has come to consider the nationalisation of the drug firms, many of which are American-owned. I am, of course, not so committed. All I ask is that there should be an inquiry. Let us get at the facts. The hon. Member for Torrington may turn out to be right after we have had the inquiry. If the Government do not do that, if they will not get at the facts, for heaven's sake let the Minister and his hon. Friends stop making indignant noises about the depredations of the burglar and then quieting their conscience by taking it out of the victim's sick children and the victim's sick parents.
Incidentally, I address this specific question to the Minister in the light of what he is proposing to do. Will he give us a pledge today about the question of drugs for private patients outside the Health Service? A hundred or so of his hon. Friends do not seem nearly as concerned about the cost or about the waste as the Minister says he is. They are prepared to widen it much further by introducing a second tier, a new stage. It could easily be the next move. Will the Minister give us this pledge? I ask him for it. We are entitled to have it.
In my summing up, in which I hope I have carried the House with me, there is absolutely nothing in the case that the Minister has made for the actions he proposes to take. The excuses he has given could not be flimsier. He does this because he believes in it. He does not do it reluctantly because things are in trouble. He does it because it is part of his basic philosophy. Those who vote with him tonight accept and vote for his basic philosophy. They cannot then make speeches in their constituencies saying that they are also for the Welfare State and for the National Health Service.
I am sure that, whatever Welfare State the hon. Member spoke for, he would be heavily qualified about it. I am quite prepared to go into any of the constituencies of hon. Members opposite, with any one of them, and discuss this issue with their constituents. Hon. Members opposite raised the charges. They imposed the higher contributions for one reason only. They want to redistribute wealth to the greater advantage of the better off at the expense of the poor people and those in trouble.
Let me show evidence for that. I cannot take into account what the Chancellor proposes to do in April, although I could make a fairly good guess about what he will do. Let me show some evidence by looking backwards. Let us consider, if hon. Members opposite will, the miserable £16 million which the Minister is taking out of the welfare foods and all the other charges which he is imposing on the people who are in need—otherwise they would not be asking for these services—and compare that with the recipients of past largesse from Chancellors of the Exchequer on the benches opposite.
The party opposite always, does this outside the Budget, and this is why. We now have two Budgets every year. We have one in which the Government tax the poor and the sick, as they are doing now, and we have another one in April, when they give the proceeds away to their pals and to the better-off. Take the dearer welfare foods, the extra cost of orange juice and cod liver oil, and compare that with the cheaper alcohol drinks that the Government arranged last year and years before. Under a Tory Government, it is cheaper to drink wine but more expensive for the children to drink orange juice—£4 million tax relief on wines and £1½ million tax increase on orange juice and cod liver oil. Compare the charges on spectacles and teeth—about another £1½ million, I should think—with the give-away on gifts inter vivos from death duties and the give-away on directors' remuneration and persuade anybody which of those claimants is the more entitled. Above all, compare them all with the tax-free capital gains that the Government never touch.
Let us look at this in a little greater detail. Let us go back to welfare foods. Think of the proud boast we have until now been able to make about the condition of British children. Their condition owes a great deal to the welfare food scheme and attention to their health. We could say that we maintained it in war. We maintained it in the difficult conditions after the war. The only conditions in which we cannot maintain it are those of Tory affluence. It is no use the hon. and learned Member for Surrey, East (Mr. Doughty) laughing. It is so. We did it during the war and after the war. The only time when we cannot permit children to have orange juice and cod liver oil as a welfare food without charging them the economic price is when, according to the Tories, we have never had it so good.
This is preventive medicine. The Minister makes so much about waste. If he wants to avoid waste, a sensible way is to have some preventive medicine so that people do not get rickets and so that kids do not grow up spindly and so that they grow up strong and healthy. Now. we are taking these things out of their reach. Previous Ministers disturbed the arrangements and the centres from which the welfare food was obtained and the result is that the proportion of people taking it already has fallen catastrophically. The Government now put a charge of 1s. 6d. where formerly there was 5d., and 6d. where there was no charge, and they are discouraging people still further. The Minister knows it, and he means it. This is what he likes to do.
No comment about that. Is it Brighton? [Interruption.] I am sorry. I got my Johnsons mixed up. I was thinking of the Johnsons whom the Conservative Party heaved out. I am sorry, I got the wrong Johnson. However, I will be in Carlisle just the same. [Interruption.] It is extraordinarily interesting and significant how much fun hon. Members opposite have to get out of the smallest thing that is quite irrelevant to the argument. They must be in trouble.
Let me now turn to the prescription charges, at the raising, the doubling, of prescription charges. This is providing a positive deterrent to those seeking treatment. This will deter people from going to the doctor. This will encourage them to try self medication. The intention is to get them to go to the chemist and buy something for themselves rather than go to the doctor and get a prescription from him. It also helps another collection of pals: it helps all those chaps on television who night after night are coming forward with their specious advertisements for the very things the Minister says are causing waste. It is a penalty on those who are chemically sick.
I shall listen with interest to as much as I can of the debate, but I have other commitments to go to. [Interruption.] This is ridiculous, this laughter. One does what one can. It is ridiculous that when one makes an excuse sincerely meant it gets that kind of silly laughter. I shall be in the House as long as I can be here; but in case I should miss anybody's speech I was apologising in advance. It will be only at the time of another commitment I have elsewhere That is all. That is all I meant. Surely it is nothing to cause people to laugh like that.
Have hon. Members opposite received the kind of letters which we have receivef—[HON. MEMBERS: "No."]—from diabetics? The hon. Gentleman who is putting his hand to his ear, does he think it wasteful—
I will give way in a minute. Let me finish and then I will give way. Has the hon. Gentleman had any letter from a diabetic who has to attend a doctor regularly and have a whole series of prescriptions? Has he had any letters from rheumatic patients who have to see a doctor regularly and have a whole series of prescriptions? Has he had any letter from anybody like a member of my family with a skin disease which needs three or four prescriptions every time she goes to the doctor? She will now be paying 10s. every other week under this new freedom. Has he had any letters like that?
To be perfectly honest, I have not had any such letters at all. [HON. MEMBERS: "Oh."] It is absolutely true. It may be that we have a much healthier climate in the Nantwich constituency. But, quite apart from that, Mr. Deputy-Speaker, is it in order for the right hon. Gentleman to speak to an hon. Member in the tones and the manner that he did?
If the hon. Gentleman has not had any letters, I am surprised, for pretty well all of us have had them. But let us see, since people on the Conservative side are shaking their heads on the point. Perhaps the explanation is in one of the letters I have here, from a chap who says, "It is no use writing to my Member. He is a Conservative."
This is a penalty on everybody with a family. In a family of two or three children, one of them or all of them may be sick and need a prescription. Of course, up goes the bill and that deters a man from getting a prescription. This is a penalty on all small incomes, those for whom the N.A.B. may not be available whose incomes are still very small. This means 2s. an item. We are not talking about a bob or two bob. We are talking about 6s., 8s. or 10s. a prescription. We are talking about people who go every week, certainly every other week, to the doctor. This has become a major attempt to dismantle the comprehensive Health Service.
Let me turn now for a minute to the question of contributions. This is a straight transfer of taxation, away from the principle of ability to pay, towards a £50 million poll tax imposed regardless of financial position. The Minister can check my figures. For the employed person, this doubling of the charge means a 260 per cent. increase in ten years. In that time wages increased by 74 per cent. The insurance contribution which the insured worker pays at present—for heaven's sake let us get this understood—will go up—with wage claims in six months' time. I am glad that the Chancellor of the Exchequer is listening. For the insured worker it means an increase of 6 per cent. at £9 per week and 58 per cent. at £15 per week over what he presently pays, and since the Ministry of Labour tells us that the average earnings are something over £14 a week, it means for the great majority of employed workers in this country that they are faced with more than a 50 per cent. increase in stamp contributions which they now have to pay.
We hear a lot about the way the Government have relieved people from Income Tax in ten years. Let us just look at this. Let us take a man with £10. There are lots of him. There are far more of him than we are apt to hear about. In 1951 he was still paying Income Tax. With his Income Tax and National Health stamp combined he paid 10s. 1d. a week. Under the Tories, it is true, he has been relieved of Income Tax. They take a lot of credit for this. In consequence of this increase, he is now going to pay 10s. 7d. a week on stamp alone. So he is out of Income Tax and pays 6d. more per week than he did on the combined ticket. But a man with £5,000 a year is more than £700 a year better off than he was ten years ago. Sixpence a week worse off on £10; £700 a year better off on £5.000 a year.
Put it another way. Yield from taxation which comes by way of stamps is up in real terms by 90 per cent. in the ten years. Taxation which comes by way of Income Tax, Surtax and Profits Tax is up in the same period by only 12 per cent.
This is real regression. This is transferring the burden with a real vengeance. This a real demonstration of Tory philosophy. I think it adds up to two things. The scheme is not only no longer free at the point of need; it is now, or will be when the Minister has done his work, a real in-built deterrent. Secondly, it is no longer financed on the basis of ability to pay. It now carries a whacking great poll tax, and the contribution of the Exchequer is down from 80 per cent. where it was when it began to 70 per cent. which is where it will be in 1961–62.
My last words to the House are these. It is no use pretending that we are not bitter about this. We are. I shall not go over my background again—but for any of us who grew up in circumstances where reliance upon a public health provision was essential, the old infirmary and panel doctor system burned itself into our hearts in letters of fire which really moved and shook us. We cherished and meant the ideal of replacing the old infirmary approach and the old panel doctor approach. Sometimes, on other issues, as I said earlier, I have come to similar conclusions on the facts presented as the Government. Some people, whose political thought is superficial, have sometimes said and written that this meant that the issues between the two parties were narrowing or disappearing. I never believed that. This Minister, supported by the whole Cabinet, as he at the moment is, supported by the whole Tory Party, as tonight, I imagine, he will be, proves that that is not so. Our fundamental philosophies are poles apart.
I could never be associated with an outlook such as he discloses in these proposals. I hope he will not mind my saying that to do so one has to be capable of writing things like the couplet which the Daily Mail quoted on 6th October last year from his own "First Poems: 50 short lyrics". The couplet was:
I hate the ugly: hate the old.
I hate the lame and weak.
I am proud to move this censure Motion.
Before I reply to the Motion which the right hon. Member for Belper (Mr. G. Brown) has moved, perhaps I might be allowed to congratulate the hon. Member for St. Pancras, North (Mr. K. Robinson) on his accession to his shadow office. He will, I know, be a very agreeable sparring partner, not least because of his very real interest and concern in the National Health Service and—if I may say so on a personal note—the fact that he shares with me a special concern for the mental side of the Service.
The Motion conveys two charges against the Government. The first is a reference—and I quote from it—to
… the determination of Her Majesty's Government to undermine the National Health Service …
It will, therefore, be necessary for me to trouble the House with something about the recent development and the future prospects of the National Health Service. Opportunities of talking about the National Health Service do not come so thick and fast in this House that any
Minister of Health can be expected to avoid the chance of taking them.
May I first begin this review with the hospital service? It is not only by far the largest single element in the National Health Service but is, in a sense, the key to the whole, in that the development and integration of the whole crystallises round the development of the hospital service.
I want to refer first to the most essential part of the hospital service, as indeed of any medical service—the human element. The last few years have seen a steady and, in some respects, a quite dramatic increase in the staffing of the hospital service. Hospital doctors in post have increased in the last five years by some 10 per cent., full-time nurses by some 13 per cent., and part-time nurses by 35 per cent.
It is, no doubt, due to this large strengthening in the staffing of the hospital service that we have been able to achieve in it the striking increases in treatment given, to which I referred in the House last week: an increase in inpatient treatment of 10 per cent., in out-patient treatment of 5 per cent., and in domiciliary consultations of over one-third.
We have, in fact, been able, because of this steady strengthening of the personnel element of the hospital service, to make a more intensive use of the physical facilities which were available. Much still remains to be done. We need a considerable strengthening, particularly, of the medical auxiliaries—and here it is very encouraging to notice the large increase in the number of students in medical specialities which will, inevitably, in a few year's time, enable us to make good many of the existing deficiencies.
The Working Party under Sir Robert Platt, which has been studying the medical staffing of the hospital service, has just presented a very important report. This will be published next month, and my right hon. Friend the Secretary of State for Scotland and I will immediately engage in consultations with the professions upon the recommendations of that report.
I should also like to refer, while I am on the matter of personnel in the hospital service, to the strength of the midwifery element. This is at present severely undermanned—perhaps I should say "underwomanned". I have just asked the hospital authorities to take a number of specific steps, and, if possible to take them urgently, which will render midwifery more attractive and which will enable them to retain or attract back into the service the women whom we need. These are directions in which we want to go, and go faster, in strengthening the staffing of the hospital service.
The reference to midwifery leads me to another aspect of the hospital service which, I believe, has been unduly neglected while other sides have been developed. This is the human side, the relationship between hospital and patient; the attitude of the hospital service to the individual man and woman in its care as a human being and not merely as a case.
I believe that in this respect some parts, at any rate, of the hospital service have been out of step with its general development. The Central Health Services Council—[Interruption.] I am sorry if Members opposite, who have put down a Motion of censure do not want to hear about the National Health Service and its development—
The Central Health Services Council has just made three remarkable reports on three aspects of this human side of the hospital service. One is on the care of women in childbirth, another is on the in-patient's day, and the third is on noise in hospitals. On all these matters, and on the whole approach of the hospital service to the patients, I believe that progress needs to be made, and I should like to see 1961 as a year in which there is a marked change and progress in this respect.
All these things on which I have been speaking can be, and to a very large extent have been, achieved in the existing buildings of the hospital service, but there can be no dispute about our need to modernise the buildings, and, indeed, to modernise the whole pattern of the hospitals in this country.
In recent years, capital outlay upon the hospitals has been rising rapidly from under £10 million a year, five years ago, to £25 million in the current year and, with increases intended, to £31 million and £36 million in the two coming financial years. But this year we opened a new phase in the history of the hospital service by asking hospital authorities throughout the country for the first time to take a ten-year view of commencements and a fifteen-year view of building work which they wish to see carried out.
For the first time the hospital service in this country is being asked and is being enabled to plan ahead on a rational basis, with the full view of ten or fifteen years' work. For the middle of the decade the basis has been taken of some £50 million annual expenditure upon capital account, but beyond the middle of the decade the Government have placed no financial limitation on the plans which they expect the hospital authorities to put forward. They are being asked to set out what they believe would be the practicable and desirable development of the hospital services in their regions over the next ten to fifteen years.
Here is the truest economy, for by these means we shall be able to ensure that the temporary work, the work on improvement, the work on expansion which we do, is logically built into a long-term plan. We shall be able to see that the short-term planning is of the right amount in the light of what we intend to do about the longer term, and by means of this long-term plan we shall achieve the utmost return from the capital expenditure which we incur year by year.
But it will be not only on capital account that we shall by this means achieve true economy. The hospital authorities are to reflect their capital plans in terms of running costs, and so for the first time we shall be able to see how the modernisation of the hospital service should reflect itself in genuine economy in the running costs of the hospitals, which are the main element in the cost of the National Health Service.
In this immense operation the cooperation will be needed not only of the hospital authorities, but of the public at large and of Parliament. We are facing a period in which the pattern of the hospital service in this country, if it is to be modernised, will in some respects have to be radically altered. That radical alteration and modernisation will mean the giving up of many old habits, the loss of many old associations, and the Government will need the support of Parliament and the public in carrying through this wholesale alteration and modernisation of the pattern over the coming decade and decade and a half which is undoubtedly necessary.
But this prospect of being able with security and with sureness to look forward to development in terms of decades has already in my experience revolutionised the morale of the hospital service. There is already an immense surge of confidence and a forward-looking attitude. [HON. MEMBERS: "Where?"] I advise hon. Members to ask any hospital management committee, or any hospital board, which is concerned in this work whether this is not the most inspiring task upon which it has been engaged since the hospital service began.
The modernisation of the hospital service will not and cannot stand alone. We cannot have a modern hospital service unless the local health services are also expanded and modernised. One of the ways in which the new hospital plan will be an instrument of progress is that it is bound to spell out the directions in which the local health and welfare services must be expanded in order to support the hospital service.
We must have local health and welfare services which will ensure that we use the hospitals for the purposes for which they are suitable, that we can use them intensively, that we can use them properly and that we can give care outside the hospitals and in the community in all the various situations which are appropriate to those who do not need hospital care.
I often think that the local authority element of the National Health Service is unduly overlooked and disregarded. In present terms of magnitude it is by no means negligible. This year, the current expenditure of these authorities amounts to another £100 million on top of the £860 million or £870 million of the National Health Service in the narrower sense. If the local authority services are to expand and be modernised along with the expansion and modernisation of the hospital service, two great elements will be necessary. The first will be in capital and the second will be in personnel.
There has been more capital development here in recent years than is sometimes realised. The number of places in old people's homes in the last five years has gone up by 20 per cent. The number of places in training centres for the mentally sub-normal has gone up by 50 per cent. Those rates are still rapidly rising. Capital expenditure has trebled in the last five years and this year is nearly £13 million, or approximately half the capital expenditure in the hospital service itself, and I expect that loan sanctions in the coming financial year will amount to £20 million.
Local health and welfare authorities are being asked to regard this as the level at which their capital investment should continue.
This capital investment, the building and creation of the institutions which the local health and welfare authorities will need, is an integral part of the growth of the local health services by the side of the hospital service; but even more so is the development of the right numbers and the right kind of personnel in the local authority services.
In my contacts with the local authority services I have been immensely impressed by the work which has been done and the calibre of the people doing it in the domiciliary services. It is a tremendous experience to realise how much can be done for the family and for an invalid still living in his own home, by the domiciliary officers of a local authority. This is a side of the services which calls for expansion and strengthening in personnel.
The debate is about the National Health Service. The debate is about a Service which the Motion says Her Majesty's Government are determined to undermine.
The Government have already announced their acceptance of the main recommendations of the Younghusband Report. One of the most important of those is the establishment of linked national councils for the training of health visitors and social workers. The person who is to be chairman of these linked councils will be a key figure in the development of the local health services, and I am delighted to be able to tell the House that Sir John Wolfenden has agreed to take up that post.
Can the right hon. Gentleman say upon what date the necessary legislation will be introduced to establish the national councils, as recommended in the Younghusband Report?
These national councils and the lines on which they are set up will determine the future of these professions for years to come. It is overwhelmingly important that they should be established on the right lines.
It would be quite incorrect to refer to the local authority health services as if they could be divorced from the general practitioner service, for it is a platitude, and perhaps too much of a platitude, to say that the general practitioner is the leader of a team most of whose members belong to the local health service. The general practitioner service has been substantially strengthened in the last few years. In the last five years there has been an increase of 5 per cent. in the number of general practitioners, and the improved distribution of family doctors is reflected by the fact that since 1952 the population in areas which are under-doctored has fallen from 21 million to 9 million. My right hon. Friend the Secretary of State and I are having re-examined the data and calculations which underlie the estimate of the future of the size of the profession in the Willink Report.
Finally, I should like to refer to the general dental service. [HON. MEMBERS: "Oh."] It is of some importance and I should have thought it would have been a source of gratification to the whole House to know that in the last five years we have had a 10 per cent. increase in the number of dentists working in the general dental service, and the treatments given have increased more than in proportion, in fact by 25 per cent.
And very germane to the immediate subject of charge is the fact that treatments not involving dentures but treatments involving preservation of the teeth have doubled since 1951 when the charges for appliances were introduced.
Before my right hon. Friend leaves the general topic of personnel, may I ask whether he would like to refer to the long hours worked by and the low pay of dental nurses, district nurses and ordinary nurses in our hospitals and the need to increase that pay?
I quite agree with my hon. Friend that the hours which are worked by nurses and the pay are a material factor in the staffing of this aspect of the Service, and with him I would entirely dissociate myself from the point of view of the right hon. Member for Belper who seemed to think that an element of cost which arose out of the pay of those working in the Service was something which could be disregarded—something which is not integral. On the contrary, if there is expenditure that is more important than any other, it is expenditure upon the human element of the National Health Service.
The Minister charged that my point of view was that this element of cost could be disregarded. I never said that or anything like it. I said that it should not be put on the patients by way of a direct charge, and so far the right hon. Gentleman has spoken for half an hour and has not mentioned either of the things that are involved in the Bill.
But what I have been talking about is that National Health Service which the Opposition charges the Government with the determination to undermine, and I am content to leave it to the House and to the country to decide whether a Service which has that record behind it and which has those prospects and plans for future development is one which the Government are determined to undermine.
But these developments which I have been describing are inevitably and necessarily reflected in the cost of the Service, in its gross cost, in its cost as a proportion of the national income and in its cost to the Exchequer. The gross cost of this Service last year rose by 6 per cent. It rose this year by 7 per cent. and next year it will rise by nearly 10 per cent. My figures, I think, are on a slightly different basis from those of the right hon. Member for Belper, but the general effect of the curve is not substantially different. The proportion of the gross national income which the Service absorbs has increased over the last five years from 3· 2 per cent. to 3· 8 per cent., which is equal to the highest point at which it has ever stood, and it seems clear that the proportion which will be taken next year must be higher still.
These increases which reflect the development of the Service are in turn reflected in the net cost of the Service to the Exchequer which, as I told the House last week, had increased by 6+ per cent. last year and by 8½ per cent. this year and, but for the Government's proposals, would increase next year by 11 per cent. Even after the proposed changes are made, the net cost of the Service to the Exchequer will have increased over three years by about 20 per cent.
All hon. Members, in whatever part of the House they sit, are perfectly well aware that a rate of increase in the cost to the Exchequer of that order cannot continue without one of two things happening—either the development of the Service being limited, or an adjustment being made in the financing of the Service. [HON. MEMBERS: "NO."] This was what hon. Members opposite themselves discovered. The right hon. Member for Belper referred to the Korean War, but the point is that the party opposite also came to the conclusion that there was a point beyond which the increasing cost of the Service could not be put upon general taxation.
Hon. and right hon. Members opposite are not a party which has any aversion to high rates of taxation, but they came to the conclusion that there was a point beyond which the increased net cost could not be borne upon general taxation. [An HON. MEMBER: "Party politics."] This is not a party point. It goes much deeper. That is the lesson of the experience of the party opposite in the year in which the proportion of the national income which the Service was taking was the same as that which has again been reached. What is done when in this situation the decision is taken not to curtail the development of the Service but to adjust the financing 1s not that the service is undermined; it is that the Service is under-pinned.
It is quite untrue to say that the percentage borne by the Exchequer now is no lower than it was when the Labour Government were in power, but we will deal with that later. I want to ask the right hon. Gentleman a question. He said that, after the changes that he has announced, the increase in the net cost to the Exchequer over three years will be 20 per cent. He gave us the previous increases annually. Will he tell us what next year's increase will be after the changes?
I apologise to the hon. Gentleman. He is quite correct. The increase over the three years is 6½ per cent. plus 8½ per cent. plus 3 per cent. cumulative.
The second point to which the Motion asks us to direct attention is whether this adjustment of the finances of the Service places heavy burdens on those least able to bear them. There are three classes of measure which the Government propose, and I want to consider them separately.
The first is the increase in the National Health Service contribution. It is said—and, broadly, it is rightly said—that this contribution, like the flat-rate National Insurance contribution, is of the nature of a poll tax. It falls irrespective of the earnings of the person by whom it is paid. But in deciding whether such a tax is fair or not we have to consider whether it is in the right relationship to the earnings of those who will pay it and in the right relationship to other sources of finance.
There can be no absolute, no mathematical, standard of what is right and fair in such relationships, but I appeal to the decisions and the views in this matter which this House has taken over the last fifteen years. In 1946 this House, with a slightly different composition, set up the National Insurance Scheme and the National Health Service, and, in doing so, established the flat rate or poll tax from which there was to be an element specifically allocated which would be carried to the credit of the National Health Service.
I think it is a fair test to see how the flat-rate contribution today, after these changes, will compare with the flat-rate contribution which was thought right by Parliament when it was setting up the National Insurance Scheme and the National Health Service. If we look at the situation in 1946 when the total stamp, including the National Health Service element, was fixed at 4s. 11d., we find that the average male earnings at the time were 114s. 1d. per week, or a ratio of 4· 3 per cent. If we take as the fairest comparison the stamp which will be paid by a flat-rate contributor—that is, a contracted-out contributor—in future and compare that amount with current earnings, we find that the ratio is just over 4 per cent. So, in fact, the ratio which the flat-rate contribution for all purposes bears to average earnings today is less than that which was thought right by Parliament when the National Health Service and the National Insurance Scheme were established.
Those who say that this bears unfairly and unevenly—I am appealing to the verdict of this House when it established these Services—on the lower-paid workers must address themselves to the task of proving that the relationship between the lowest earnings and the average earnings is more unfavourable today than it was in 1946; and I should like to see them make a start on that.
Is the right hon. Gentleman really trying to suggest that we cannot afford a better situation now, fifteen years after the war, than we were able to one year after the war in this respect? Also, since he is arguing that this is the right relationship between the contribution on the one hand and taxation on the other, will he now give a pledge on behalf of the Government that the next time the Chancellor has any hand-outs to give he will remit these changes before he remits the taxation of well-to-do taxpayers?
I am arguing that this is a relationship which this House itself has thought quite right, and that if it was fair in the circumstances of a wage of 114s. a week, it is fair on a wage of 300s. a week, which is the average today.
The other test which falls to be applied to a flat-rate tax is whether the right proportion is being maintained between the financing of the Service from the flat-rate element and from the other sources. The right hon. Gentleman mistakes the nature of this argument. Here, again, one as looking at what this House, when it established the National Health Service, believed in the light of the facts of those times was the right proportion to be borne by the contributory element—the credit from the National Insurance stamp—towards the whole cost of the Service. What we are looking for is the standard which was then considered—indeed, by all parties—to be fair.
If we make that comparison we find that the decision in 1946 was that it would be fair for 21 or 22 per cent. of the cost of the Service to be borne by the contribution. Today, after the contribution is increased, only 16· 7 per cent. of the cost of the Service will be borne by the contribution, and even if one throws in all the charges for good measure, the figure is still approximately the same as was considered to be right in 1946—when the national income, the earning capacity, and the level of earnings were substantially lower than they are today Now I come to the second element in these proposals—the proposal to charge cost price for the vitamin supplements. I would remind the House, as the right hon. Gentleman did in part, of the history of these vitamin supplements. They were a siege measure which was introduced when this country was in a state of siege during the war, when it was difficult to obtain sufficient normal food for the population. Therefore, the decision was rightly and wisely taken to safeguard the vitamin requirements of the children and the mothers.
But it is also pertinent to remind the House that it was thought quite right in those dark days when we were under siege to charge for these vitamin supplements—5d. for the orange juice, 10d. for the cod liver oil and 10d. for the vitamin tablets. It was only in 1946 that the indiscriminate subsidy was introduced by the party opposite. Hon. Member's opposite really are living in an unreal world if they imagine that in the 1960's the vast majority of the mothers who take their children to the local authority clinics are not both able and willing to purchase the vitamin supplements which their children require, just like every other element of family requirements in the condition of the high standard of living of the 1960's.
An indiscriminate subsidy for this purpose is no longer necessary. What we need, of course, is something which will get at the families which are in real need and in real risk of being neglected. [Interruption.] I understand, of course, that hon. Members opposite would like to subsidise everything; but that is not the keynote of the society of the 1960's.
The way in which we can get at the families who are in real need of these vitamin supplements, the families who do not come to the local authority clinics, is through the local authority health visitor. It is through the local authority health service that we can get at the families who need this supplementation and who need advice and help in getting it.
So far as there is any barrier by way of means, that is then completely dealt with, because not only do all recipients in families where there is a regular National Assistance grant receive the welfare goods free—and that scheme will be extended to cover all the vitamin supplements in future—but the National Assistance Board will make these available free of charge to families which are above the National Assistance Board standard on the same basis as I shall explain presently, when dealing with charges. To the charges I accordingly now come.
We are told that the charges which are being increased for dentures and spectacles, and the prescription charge, represent a charging of the sick. This can hardly be said to apply to the increased charges for dentures and spectacles, which increases in any case are not only exactly in proportion to the increased cost of supplying the articles but are tiny and negligible in comparison with the increase in all kinds of benefits and earnings since those charges were fixed.
I come now to the prescription charge. I emphasise that this is not an alternative to other measures directed to limiting the cost of the pharmaceutical services. The new voluntary price regulation scheme has opened the means of very effective negotiation with the pharmaceutical industry, which is being vigorously pursued, and a number of other measures will be taken in coming months which will assist in economical prescribing in the general medical service within the full professional discretion of the medical profession.
On this pharmaceutical point, the right hon. Gentleman will remember that when, for example, in the 'forties we had price control of consumer goods with no Government money involved, the Board of Trade and other Departments had full access to the costs of the manufacturers concerned before deciding what a fair price should be. The right hon. Gentleman's Department has so far not obtained any cost figures from any of the pharmaceutical manufacturers either for production or for advertising expenditure, which we know is very costly. Therefore, as the right hon. Gentleman says that it is going to be vigorously pursued, will he tell us whether the Ministry of Health will insist on getting full costing from firms which are taking so much of the taxpayers' money? Will he also insist that they limit their advertising expenditure and open up their patents to the Crown?
The negotiations to which I referred will involve discussions on, and disclosure of, costs. I assure the right hon. Gentleman that the Government will not overlook any genuine possibility of securing a true economic price for the drugs supplied through the pharmaceutical services.
Coming to the prescription charge, even of this charge it is not true to say, as a whole, that it is a charged placed on the sick, because, of course, this charge in many cases will be paid by those who are earning where the prescriptions are made out to dependants. It is not true to say that over a great part of the field the cost of this charge will be borne by those who are sick.
I ask the House to consider the movement of benefits of all kinds, earnings, and of capacity to pay since this House thought that it was right to legislate to impose the 1s. prescription charge. As the right hon. Gentleman quite candidly said, that was in 1949. It was in 1949 that it was thought that to supplement other forms of taxable capacity it was right to make this charge. It was not thought that other forms of taxation should be used instead. That is the point.
Since then benefits have more than doubled. Wages have far more than doubled. Even if one takes 1952, the point of time at which the 1s. charge was imposed, both benefits and wages have practically doubled. It is the most ludicrous exaggeration to say that, by and large, the 2s. prescription charge is any more unfair and any more a burden than the 1s. charge in 1949.
I come now to the qualifications to that. I recognise that there are a number of special cases where provision needs to be made. For example, where prescriptions are regularly required by those who are chronically sick, doctors are not only able but are advised to prescribe for two or three months' requirements so that the increase in cost in those cases is negligible. I know that in many cases of chronic sickness it is not practicable to make a prescription for as long a period as that, and I had worked out, as an example, a diabetic patient's prescription which had to be renewed every four to six weeks. That worked out as a net increase on the average over the year at 8d. a week.
What I want to place on record here are the arrangements which exist, where there is the possibility of these charges causing genuine hardship, for their being refunded or for the money to pay for them being obtainable. First, all charges are recoverable in respect of recognised war disabilities. There is no question, as there never has been in the past, of any of these charges falling on the war disabled in respect of their war disabilities.
Secondly, all those who are in regular receipt of payments from the National Assistance Board can obtain across the counter at any post office a refund of any of the charges, and where those people are unable to go to a post office by reason of sickness or infirmity, arrangements exist for them to be collected by a third party.
But it is not only those who are in regular receipt of National Assistance who are entitled to refunds. The National Assistance Board will refund also to people who are above its normal standards of need, including people who are in employment. I think that the House will be interested in the higher allowances, disregards and standards which the National Assistance Board applies for the purpose of refund of charges.
For this purpose the Board allows expenses in connection with employment, such as fares to and from work, superannuation contributions, and trade union subscriptions. In addition, items such as mortgage repayments, hire-purchase and insurance premiums are taken into account and up to 40s. of net earnings are disregarded. In the case of the prescription charge a higher basic standard, by 2s. or 3s., is applied after all these additional allowances and disregards have been made. It is in the public interest that those arrangements should be as widely known as possible. They make it clear that for a great many people who may be involved, by these charges, in some degree of hardship, but who are not within the normal limits of the National Assistance Board standards, repayment of the charge can be obtained. The more widely that is known the better.
I should also add that in cases where there is a cash difficulty the Board will make arrangements for the refund, so to speak, to be made in advance and the payment to be made before the chemist has to be paid.
I am sorry; I have not the figure. I hope that what I have said will result in any person who thinks he may be within the limits of those arrangements obtaining a refund under them.
This afternoon I renew the pledge made by my predecessor that he would examine any case of potential hardship under these arrangements which was brought to his attention.
On a point of order. The Minister is dealing with a most important matter, which affects many people. [HON. MEMBERS: "Point of order!"] This is a matter of the greatest importance to many people, and it seems to me that on the occasions when I have tried to intervene the Minister has not given way because he knows quite well that I have his own statement of 1951 in my own hand.
Does not my right hon. Friend think that these low figures may be due to the fact that even the present arrangements have not been given sufficient publicity? Will he ensure that the statement that he has made today is circulated to citizens' advice bureaux, to doctors, to chemists, to local authorities and to all those voluntary organisations who come into contact with the people in whom he is interested?
Although it is not a point of order, I will answer it. I gave way to my hon. Friend the Member for Tynemouth (Dame Irene Ward) because she had a good point. I will do the best I can to give the widest publicity to the arrangements that I have announced.
In replying to the Motion, which refers to the undermining of the National Health Service, I will not close with these matters which, important though they are, are of comparatively minor dimensions in relation to the Service as a whole. I would refer the House again to the background against which the debate is taking place. It is a background of the steady development, year by year, of this Service, which both sides of the House have created—[HON. MEMBERS: "Oh"]—and whose future hon. Members on both sides wish to be safeguarded. All, if they are honest with themselves, must recognise that that future would be jeopardised if measures such as the Government are proposing were not taken at this stage.
What I have shown is that this can be done without departing from lines which have been laid down in the past and thought to be fair and reasonable by Parliament, and without imposing hardship or an unreasonable burden upon anybody. I ask the House to reject the Motion.
Seldom have we heard a worse defence of a bad case—I think that in those words one might sum up all that one could say. First, we were treated to a policy of planning for the future with regard to hospitals, plans which we know from past experience will "go west" at the first financial crisis, because if there is a financial crisis the first thing to go will be the money for hospitals. That will happen in the same way as it has happened on other occasions in respect of money designed for schools. We are under no illusions about what the Tories mean by these things.
The fact that these charges items are being dealt with at this stage would seem to make this the first instalment of what we may expect for the future. The Minister talked about the expansion of the Health Service. This is a rather late conversion but it is a conversion which has come since the introduction of the block grant. If the Service had been expanded under the old system the Exchequer would have been responsible for 50 per cent. of the cost. While for a short period the Exchequer contribution must be maintained at a certain percentage, there is no guarantee under the block grant system that the percentage will be maintained, and so the usual thing will happen that we are accustomed to get from Tory Ministers. There will be pressure to extend services the cost of which falls more heavily on the ratepayer and less heavily on the Exchequer.
I am interested to learn that authorities are being requested to speed up their requests for capital expenditure. My experience has been the opposite, and that we have had to beg in the past for something to be done. On occasions we have been successful, but that does not alter the fact that had there not been pressure upon the Minister nothing would have been done. There has been no pressure from the Minister; the pressure has been the other way. We have bad to plead to be allowed to get on with many of the schemes to which the Minister is now giving lip-service. That is the background.
We accept the need for the modernisation of hospitals. That has been accepted for many years and the programme has been long delayed. I can only hope that it will proceed as well as the Minister anticipates and will not be interrupted. We have this much to think about. It was not for nothing that a kite was flown regarding the imposition of a charge for the food supplied in hospitals. It is the usual practice to fly a kite about a proposal and play it down, and then later it is introduced. I have an idea that before very long some Minister—not perhaps the present Minister, because I do not think his showing today has enhanced his status—will say, "We have all these fine plans for the hospitals and we are going to improve them, and all the things will be done that will humanise the Service. But the cost is going up, and in order to keep it properly in balance between the various sections, we shall have to make a charge." It is obvious that the charge will be in respect of the provision of meals in hospitals. At any rate, even if it be denied now it will be interesting to see whether that will happen in the near future.
I am wondering why, when he was dealing with the question of orange juice, vitamins and such things, the Minister did not say anything about welfare milk. This is another thing about which a kite is being flown in some quarters. The Minister would be under considerable pressure from the Milk Marketing Board if he did anything to stop the consumption of milk. The problem today is to maintain the consumption of milk and any Government action to reduce it would create difficulties in other directions. So perhaps we can understand why these proposals are limited to orange juice, to ood liver oil, vitamins and things of that kind. But we are still suspicious and we anticipate that this is only the first instalment of what the Minister and the Cabinet intend to do.
The right hon. Gentleman made no answer to the case put by my right hon. Friend the Member for Belper (Mr. G. Brown). He brushed aside the specific questions which were put to him, but they still remain pertinent questions which will have to be answered. There is a fundamental difference between the approach to this matter by hon. Members on this side of the House and by hon. Members opposite. In 1945 our intention was to have a free Health Service. It is true that a modification was made at the beginning of the Korean War to meet the situation existing at that time. But a promise was made that this was intended to be a temporary modification. Hon. Members opposite have carefully ignored the fact that it was the intention of the Labour Government to make the modifications temporary because we were committed to a free Health Service which would be available to rich and poor alike. There was to be no question of any difference between one person and another.
We recognise, of course, that from a snob point of view some people choose not to use the Service or to use only a part of it which is expensive, they want free drugs or drugs which will cost them only a few shillings. It will probably be a useful argument for the Minister, who will be able to say to his back bench colleagues, "Now I am putting up the charges it is no use asking that private patients should be treated in the same way as Health Service patients regarding drugs. It would not do at the present time, so please pipe down."
What is meant by this question of a 2s. charge? There are many items which will appear on prescriptions which will not cost 2s. and many will cost only just about 2s. What is a doctor to do about such items? Will he put them on the prescription if they cost less than 2s. and say nothing to the patient, who will thus be getting something of a lesser value than he has paid for? Or will the doctor say, "All right, I only wanted to prescribe a certain amount, but if I prescribe double the amount that will justify the payment"? Alternatively, will the chemist have to administer this? Will the chemist have to say, "I am sorry about this, you had better buy this item over the counter and it will cost you less"? I do not know whether a chemist is entitled to cross an item off the prescription—[HON. MEMBERS: "He is not."]—or what is he to do?
My hon. Friend asks whether a chemist can strike an item off a prescription. I think that the Minister is saying, "Yes". I am surprised and I am sure that my hon. Friend will appreciate the information which I can give him. The Scottish Executive Council called attention to this when I raised the matter and insisted that not only was this a bad practice by the chemist but something to which doctors objected. I am sure that my hon. Friend will agree that it is wrong that a chemist should have to answer questions which the patient may ask, such as, "Which medicine shall I take, this one or that one?"
I am grateful to my hon. Friend for the information he has given which pinpoints an important part of the case I am endeavouring to make.
What is the chemist to do? If he cannot take the item off the prescription, is he to say to the patient, "If you buy this over the counter it will cost you 1s. If I prescribe it, it will cost you 2s."? Is he to leave the item on the prescription and make a note that this item has not been prescribed? One can imagine the amount of administrative work involved in matters of this kind. It could be quite fantastic. I hope that the Minister will not think that these are small issues. They are very important administrative issues, quite apart from the health point of view, and I consider them matters to which attention should be given.
I could understand if the Minister said that they were in difficulties about the question of making a charge for each item on a prescription and, therefore, they would impose an overall prescription charge, or something of that kind. That was the intention of the Labour Government, to have a prescription charge and not to itemise the charge. But the Tory Government made it an itemised charge. Why not examine the problem which is thus created to see whether some other solution may be found? But I may as well make it clear that no solution will be satisfactory to hon. Members on this side of the House except the complete abolition of these charges.
I wish now to deal with another matter, the provision of bifocal lenses. If a doctor prescribes certain drugs which are more expensive than others, it is not a question of making an additional charge, the charge is the same. But if an ophthalmic surgeon or an optician prescribes bifocal lenses because they are necessary, the argument is that they are more expensive and therefore the patient must pay more for them. That does not seem to me a good argument.
The argument may hold good that a person requires something and, therefore, there has to be a prescription charge, whatever it may be, but the person who requires bifocal lenses should not be at a disadvantage compared with one who does not. As I am getting older, I happen to know that bifocal lenses are a great advantage as one gets older. It is people who are getting older who, therefore, have a greater need and they will have to pay the most. I think it has been established and that it is accepted by some opticians that some people have bifocal lenses instead of single lenses prescribed because that may off-set the oncoming of certain types of eye diseases. That is a secondary point. The main point is that, if the need is there and a charge has to be made, it ought not to be a discriminatory charge.
I should like to hear the answer of the Minister to that, but I think that the answer is that the Government find it necessary to scrape the barrel in order to get all they can to provide for tax reductions which the Chancellor of the Exchequer will hand out in other directions. Our main charge is that this is another deliberate attempt to depart from the principles of a free Health Service.
I was in the House at the time and I recollect that the Tory Party voted against the Third Reading of the National Health Service Bill. There is no question about that. It is no use hon. Members opposite saying that they were in favour of it. They may say, "We did not like this part or that part", but the fact remains that they voted against the Bill and it is on record that they voted against it. Despite that, the public has come to accept the Welfare State as a fact and as something desirable, so hon. Members opposite have changed their tune. In due course they will change it again if they find that they are becoming too unpopular.
Much has been made of the cost of drugs. We have had very little evidence about what the Government have done on this question. We have heard about the importation of continental drugs, which may or may not be of the same standard as those produced here. I do not know, but one thing which may be said for English drugs is that the standard is generally high. That would be admitted on all sides. It may be higher than that of some of the continental drugs which are brought in as alternatives. That is not the answer. Our charge is that, because the cost of drugs is too high, the Minister, rather than dealing with that aspect of the problem because it would hit his friends, says. "The cost of drugs is high, so the charge has to be higher to the sick and needy"
The right hon. Gentleman made a wonderfully impressive statement about allowances for mortgage repayments and hire purchase and so on, that was all in order to justify a prescription charge and, above all, in the hope that the procedure will be so complicated and will so stink of the means test that people will not use it. The more publicity he gives to that scheme and the more restrictions which surround it. the fewer people will use it. This was one of the worst aspects of the pre-war means test to which we became accustomed in the thirties. It might be argued that, because the economy is in a bad way, these things are necessary, but the two propositions do not tie up. Hon. Members opposite cannot have their cake and eat it. They cannot go about preaching, "You have never had it so good", and then saying that the cost of a few millions for the National Health Service is something which the Exchequer cannot bear.
Obviously hon. Members opposite will troop sheepishly into the Lobbies against this Motion, as they always do when these things are discussed, no matter what their real feelings may be. They will say to their somewhat irate supporters, whom they hope will vote for them again, "I did not like this, but it was a Government decision and I had to support it." Let us hope that some of them will have the courage of their convictions and will go back to the principles to which they give lip-service, so that we may have a proper Health Service on the basis of the cost being borne by those who can afford to pay. That is precisely our case, which is also that those who cannot afford to pay shall receive the health services that they need.
Frequently we are told how important health is and what a great advantage to the economy it is to have a healthy nation. Yet all the time we get this chiselling—not underpinning, but chiselling—at such a service because that fits with the Tory ideas of the economy. I should like to see this Motion carried. Although it will not be carried in this House, I am confident that it will be carried in the country.
I ask the indulgence of the House for this my first contribution to a debate. Having listened with respect to the speech of the hon. Member for Southall (Mr. Pargiter), I express my regret that it did not contain more reference to what I think many hon. Members will regard as by far the most important sentence in the statement of my right hon. Friend the Minister which gave rise to the Motion before the House. That sentence was:
The Government are determined … to carry through a long-term programme of modernising our hospitals."—[OFFICIAL REPORT. 1st February. 1961: Vol. 633, c. 988.]
My right hon. Friend has claimed that that message has given renewed hope to those responsible for hospital administration through our hospital boards. It was my fate for a number of years to be a member of a hospital group management committee, the Shrewsbury Group. I can truly say that for many years it was a frustrating experience, and I can entirely endorse what my right hon. Friend has claimed, that he has now given us a new message of hope. The right hon. Member for Belper (Mr. G. Brown) listed in his speech a number of cases of waste in the National Health Service. So far as I was able to follow him, he did not list the item which to anybody who has served on a management committee is the outstanding example of waste in this Service, the need to spend money to keep going out-dated hospitals.
In my hospital district, we have had cases in which we have had to spend tens of thousands of pounds to preserve buildings which we knew were not worth preserving. In my constituency of Ludlow, there is a hospital which we call a hospital only by courtesy. It is thought better that in the Welfare State it should be so called, although we all know that in fact it is a workhouse. which was built in 1838. It was built of stone which is now crumbling inside and outside. It was built in the form we so well know, the form of a cross with a central structure and four courtyards. In the basement and the ground floor we have modernised the kitchen. Meals have to be carried up a narrow, winding stone stairway to patients on the first floor. Fortunately, they do not have to be carried to the second floor because that has been condemned as unfit for any use whatever.
In the central structure on the first floor, one goes straight into the world of Dickens, by entering that curious octagonal chamber which some hon. Members may have experienced, where four doors lead into the four arms of the building and four windows overlook the four courtyards. From one of the windows one has a view of the stone-breaking cells where casual visitors were put in former days, and one can see the metal grille through which at the end of the day they had to throw the broken stones.
I visited this hospital a few days ago. The feature of this hospital, which I am afraid is typical of many of our old hospitals, is that in essentials it does not change but in inessentials it changes all the time. Such essentials as lifts, X-ray departments and an operating theatre, of course we do not have. But on nonessentials there is poured forth a never-ending stream of public money. We paint the walls. If the stone will take the plaster, we plaster the walls. We re-arrange the rooms and put up partitions. We pull up the stone flags and put down new floors. We try to improve the lighting. We have even converted the stone-breaking cells into stores.
We do all these things in the sure and certain knowledge that we are wasting and throwing away public money on a building which ought not to exist. We do so because we know that unless we do this, it will not be possible to keep that hospital in operation at all. Hon. Members will understand when I say that it has been a frustrating experience to be a member of a group hospital management committee.
Hon. Members are no doubt aware, but is the country aware, of the state of the capital investment in our hospitals? An investigation was carried out some six years ago by the Institute of Economic and Social Research. The Institute estimated that in the 1930's, before the hospitals were nationalised—and taking account of differences in wages and prices—about £30 million a year was being spent on the capital reconstruction or building of hospitals. In the years which followed the institution of our National Health Service, the comparable figure, as the Minister has told us, was £9 million—£10 million—£11 million. It has risen, if I am right, to £25 million in the present year and will rise next year to £31 million. Under the programme which the Minister has announced it will rise to £50 million. The figures which I have given are an indication of the degree to which we have fallen behind even in the bare business of maintaining our standards. It was estimated by the secretary of the regional board under which I served that at the rate of progress achieved in the first seven years of our National Health Service, it would take 250 years to rebuild all the hospitals in that region.
It is one of the great tragedies that when this scheme was launched in 1948 the public was left with the impression that we were unlocking a Garden of Eden into which they had only to enter to find everything perfect. As we know from these figures—and surely in cold print these figures are no less incredible than the Ludlow Hospital in cold fact—the National Health Service, financially speaking, has been living on the past. We have not even been paying for the present. Under the proposals which the Minister has put before us we shall not only be paying for the present but we shall begin to pay for the future.
I suggest that the time is long overdue for the public to be shocked into an awareness of the situation. We are now being asked to pay for our present hospital service and to pay for the future. As one who has served in the service, I am glad that we are being asked to pay for it within the ambit of the service itself. I admire the Minister's courage, and I am sure that the vast majority of those who are engaged in the service will give him their fullest support.
No one doubts or denies that this expenditure must involve a new and heavy liability on our community, but I believe that if the present proposals are courageously carried through, at whatever the cost to our own generation, we shall be doing something which will ensure that future generations will look back upon this as the starting point of a new and happier era of our National Health Service.
I have great pleasure in complimenting and congratulating the hon. Member for Ludlow (Mr. More) on his maiden speech. When one listens to a maiden speech, it is pleasant to know that the hon. Member is speaking from experience and from deep conviction. Running through the whole of the hon. Member's speech were both knowledge and conviction. I am sure that we all hope to have the benefit of his experience in future health debates and other debates, particularly when we consider the problem of giving the country the hospitals which he realises it so desperately needs.
I turn to the subject of the debate. I consider that we had a most brilliant speech from my right hon. Friend the Member for Belper (Mr. G. Brown), who put these charges in the proper perspective. He made it clear, not only to the House but to the country, why these charges were being imposed at present and on whom they would fall most heavily.
We then listened to the Minister of Health. The more I listen to him the more I believe that he is not a Minister of Health at all; he is a Minister of the Treasury with the name of Minister of Health attached. It is not very long ago that he resigned as a junior Treasury Minister. Why? Because his Government at that time were not willing to make a cut of £50 million in the social services. It is not that his Government did not want to do these things. His Government decided that it was most inopportune at the time to effect these cuts; it was too near an election. Because it was too near an election, the hon. Member and his right hon. Friend the Member for Monmouth (Mr. Thorneycroft) were sacrificed by the Government.
The Government won that election, but not only on matters of health but on many other matters, they won it on a false prospectus. Every month that the Government remain in office proves more and more how false that prospectus was. The present Minister of Health was appointed not to ensure that we had a better health service but to ensure that there was a Minister in that position who would gladly—and I say "gladly" advisedly—operate the cuts. As far back as 1st May, 1952, the present Minister said this, as a back bencher:
I also believe it is generally recognised that, if we are to have expansion in those branches of the Service where it is most urgent … then that money has got to be found by other means within the Service."—[OFFICIAL REPORT, 1st May, 1952; Vol. 499, c. 1780.]
The Minister used almost exactly the same words when he announced the cuts last week. He need not smile, because my case is that he was appointed specifically to administer the cuts, because it was well known that he would administer them.
As I come to the House every day, I see huge posters on almost every hoarding. They concern the council elections. On the posters in large lettering are the words, "Conservatives Care". The Conservatives do not care for the old people. The Conservatives do not care for the chronic sick. The Conservatives do not care for those living on small fixed incomes. The Conservatives do not care for the lowest paid wage earners and their families. The Government have proved themselves to be a totally class Government. We have often been accused of fighting the class war.
The Government fight it in a debate like this debate today and, as my hon. Friend says, practise it continually. Of course the Conservatives care for some people. They care for the Surtax payers particularly. They have great tenderness for those people. They have great tenderness for many people who could carry quite easily, without any hardship, a greater burden than the Government are willing to put on their shoulders.
The Minister of Health has a rigid one-track mind. He proved it as a back bencher. He has undoubtedly proved it as a front bencher. Today he posed again, just as he posed them in 1952, what he considers to be the only two alternatives in the Health Service. According to him, with his one-track mind, the two alternatives are—impose these charges or limit the Service, that is, limit expansion.
I will not denigrate the undoubted intelligence of the Minister. He was so intelligent this afternoon that he would not give way when he knew that I could pin what he was saying today as something which he just did not believe. However, I shall not denigrate his intelligence by suggesting that in 1952 or last week he was unaware or is unaware today that there is at least a third alternative which would not bear heavily on the poorest section but which would give us the kind of Health Service and the hospital buildings which all of us want to see.
The Minister made a very great deal out of the proposed capital investment in hospitals. He almost based the whole of his case on that. Today he purposely devoted a great part of his speech, not to dealing with the indictment of our Motion of censure, but again to saying
what the Government would do in the future. I can remember the Guillebaud Report. [HON. MEMBERS: "Hear, hear."] I am glad that hon. Gentlemen opposite remember it. I can remember the words of a previous Tory Minister of Health when speaking in the debate on the Guillebaud Report. These are his words:
Those are the recommendations regarding £30 million a year being a desirable rate of capital expenditure for the hospital service for Great Britain at which to aim over the seven years succeeding 1957–58."—(OFFICIAL REPORT, 7th May, 1956; Vol. 552, c. 858.]
We are now in 1961 and the Minister tells us that five years ago—that was after almost five years of Tory Government—we were spending under £10 million on capital investment in hospitals. He said that this year we are spending £25 million. As with so many Tory promises, it is to go up in future. They have lagged far behind what the Guillebaud Committee asked them to do. Now when they realise how desperate the hospital service is they are to take credit for what they propose to do, and they will place the burden on the poorest.
I was interested to read the editorial in The Guardian the morning after the Minister made his announcement. It said this:
But this growth in the health bill needs to be seen in its proper perspective.
This is not a Socialist publication. It continues:
To begin with, as the Treasury admitted in a recent ' Bulletin for Industry', expenditure on the Health Service has lagged behind that on other social services in recent years. This has meant that some branches of the service have been starved of badly needed funds..
Starved by whom? They have been starved by a Tory Government that all those years were telling us that we never had it so good. According to the Treasury's own statement, we have been starved of funds for the hospital service.
The editorial continues:
as Mr. Powell himself recognised earlier this month when announcing long overdue plans for modernising the hospitals.
The Minister is quite wrong now. because of the misdeeds of the Tories in the last few years in regard to hospital building and starving it of funds, to say that the only way we can get better hospitals now is by taking in charges and insurance contributions £50 million
this year, much of it from the poorest, and £65 million in a full year, according to his own statement.
The right hon. Gentleman has managed to win his point. When he was at the Treasury he wanted a £50 million cut from all the social services. As Minister of Health he is getting £65 million in one year from the National Health Service alone. People all over the country—not only those who support my hon. Friends and me, but all decent-minded people—oppose very strongly the charges that the Minister intends to make.
Talking about the charges, the right hon. Gentleman today outlined the three different categories which could all obtain help from the National Assistance Board. In other words, if there was any real hardship it would be dissipated completely by the National Assistance Board. His 1952 statement, his statement last week and his statement today on limitation of charges were all of a piece, but his statement today on the National Assistance Board and his speech on 24th April, 1951, were very different. I intend to put his speech on that occasion on record. He said:
Now from the point of view of the potential recipient, the people who are not going to be helped, who are not going to pass this means test, are precisely, in many cases, the most deserving. They are the people, the old-age pensioners, people just on a living wage, who are going to say, ' This is a pretty stiff sum I have got to pay, but I will be dashed if I am going to the National Assistance Board to argue the case about it.'
He went on to say:
Those are the people who are going to suffer most from these charges, if we leave this method of assessment in the Bill … we should envisage a wholly new approach, separate from the National Assistance Board, in the determination and administration of the means test".—' [OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 314.]
How different that statement from the one he made today—and one, I felt, that he made with such pleasure today. When I compare the Minister's speech when he was a back bencher with his speech today, I can only say that that part of today's speech was just sheer humbug. I do not believe for one moment that he believes it, but he had to make some case to try to ensure that people will believe that there will be no real hardship whatever in these cases.
On the very day after the Minister's announcement, a woman called at my home. She was in great distress about these charges. She was told that I would not be at home until the Friday of that week, and she came again on the Friday night. Again, I was out—I had another engagement. She came back on the Saturday. She came to my home three times because of her worry. She is a diabetic and has a heart condition.
With the present charge of 1s. per item on a prescription she pays 5s. a fortnight. That will go up to 10s. a fortnight—£1 a month. Once a month she has to go from our village to a clinic, and that costs her 2s. in bus fares. That brings it to £1 2s. a month. Her heart pills, which usually last a week, cost 2s., so the total is £1 4s. a month. Her husband is an oncost worker, and they have two children. That woman is worried almost to death about what is to happen to her, but I would wager that if she now went to the National Assistance Board she would be told that, even according to the scales described by the Minister, the household income is too high to allow her to be reimbursed. The extra money that she will be asked to pay because she is a sick woman will come very largely from money that her family really need.
The present Secretary of State for the Colonies realised this, although he himself had many things to say about the National Health Service. On 27th March, 1952, he said:
The last conclusion I wish to leave in the mind of my right hon. Friend is that I think I am right in believing that, particularly with the poorer people, health expenditure is a marginal expenditure and one of the first things which goes by the board if anything has to be paid for.
I am quite certain that that is why, immediately after the Minister's announcement, the British Medical Association declared itself opposed to these increased charges.
The Colonial Secretary went on in the same speech to say:
Surely then it follows that, if there is a much greater deterrent charge—and I hope that the Ministers will look at this—it may be that they will be able to come to the House and, by Order in Council, achieve what we are trying to achieve in this Bill with a much smaller charge."—[OFFICIAL REPORT. 27th March, 1952; Vol. 498, c. 964.]
That was in 1952, and the right hon. Gentleman was afraid even then that the charge—then 1s. per prescription—would prove to be too high for the
poorest people, and would be detrimental. Since then, a Tory Government has made it 1s. per item on a prescription and under this "Minister of the Treasury of Health" it will be 2s. per item.
One of the reasons he gave was the increase in the drug bill—in the price of the prescription. He gave us the exact figure; it has risen from 5s. l½ d. to 7s. 4d. That represents an average increase on each item of 43 per cent. from 1956, when the last increases were made. It means that this wonderful Minister of Health says to himself, "I will make an increased charge, but I will not increase it by 43 per cent. or by 50 per cent. I will raise it by 100 per cent."
Even his own case, therefore, does not stand up. He not only wants to cover what he thinks is a loss but wants to make a profit for the Treasury. It is a most scandalous thing to do. He is not afraid to harm the poorest of our people, he is not afraid to harm the chronic sick, but he is dead scared of doing anything against those who are making huge profits out of the pharmaceutical industry.
All doctors will tell of the advertisements they get, of how beautifully those advertisements are got up and how expensive they must be. That expenditure goes into the cost of the item that has increased by 43 per cent. Every doctor will say that his place is littered with free samples of what might be used—but not a word comes from this Minister of Health about what he would do about that matter. That is too difficult, and it does not suit the philosophy of the Tory Party. But it suits the Tory Party's philosophy beautifully—and particularly the philosophy of the Minister of Health—to attack those who can least afford to be attacked.
Another woman called at my home with a letter. Strangely enough, she, too, was a diabetic with a heart condition. Her husband must be too poor to pay Income Tax, but the Tories told him at the General Election, as they told all those earning under £9 a week, that their contribution was to be reduced. They were all told that when the new scheme came in in April their weekly contribution would be less. They were told that it would come down from 9s. 9d. to 8s. 7d.
As I say, that was at the time of the General Election. It now transpires that men earning less than £9 a week will, as a result of an increased charge imposed by a previous Measure and the charge to be imposed by the Bill that we are to debate tomorrow, have to pay 10s. 7d. a week. I know, because I have worked it out, that there are many thousands of men earning only up to £9 a week. What they will pay from 1st April will represent almost 6 per cent. of their incomes. What a shockingly progressive poll tax on the poorest in the country. When these people are off ill they will be worried to death about how they will meet this 2s. per item on the prescriptions.
The Minister has spoken about the need for better hospitals. At present, over half the hospital beds in the country are for the mentally sick. From what I saw of that woman who came to my home worried to death, it seems to me that there will be far more mental illness caused by the Minister of Health and these shocking charges that he is putting on. [An HON. MEMBER: "And the Secretary of State for Scotland."] Of course, the Secretary of State is just a poor fish. He follows what the Minister of Health gets his Cabinet to do. My indictment is against the Minister of Health because his whole history in this House has been to aim at cuts in the National Health Service.
There are many more points I wanted to raise tonight, but I know that a great many of my hon. Friends wish to speak in this debate.
Finally, on this third alternative, my hon. Friends in the debate yesterday showed the Government where they could get the money—a Government which, by their own actions, bring about the crises we have from time to time, a Government who are at the bottom of the league among many countries in exports and increased industrial production. They take advantage of that situation—I say "advantage" advisedly—to do what the Minister of Health and many Tories have always wanted to do. This is a matter of principle with the Minister—a matter of his deep Tory philosophy—that there should be these charges. If this Government had only had the increase in industrial production and had maintained the same place in exports as we had under the Labour Government, the money would have been there for our hospital expansion.
I have already said they are doing it because they want to do it, but I want to show where they can get the money to do what should be done. In the two-day debate which we had, the Government clearly showed that they did not have a clue how to solve the economic difficulties. However, we did make it clear how they could have done it.
There is no doubt in our minds that there will be tax concessions in the Budget for the very best off people in the country. I believe in helping those who desperately need help. I believe that the majority of people in this country accept that. I say to the Minister that he should consider many of the points that will undoubtedly be put forward in this debate and that he should try to get away from his hidebound ideas and really be a Minister of Health, a Minister who is out to prevent ill health and who is out to cure ill health as speedily as possible.
This is a debate on controversial proposals and no doubt I shall become involved in the controversy. Before I do so, I should like to congratulate—and I feel sure this is entirely non-controversial—my hon. Friend the Member for Ludlow (Mr. More) on a truly admirable maiden speech. He spoke from a personal knowledge of the hospital service and I feel I can say on behalf of the whole House that his speech was of a kind that will be welcome and that we wish to hear on many occasions in future.
There are many hon. Members on this side of the House who are glad to see Her Majesty's Opposition united once again. [HON. MEMBERS: "Oh."] I say that even though they are united in what, I recognise, is a kind of ritual dance along well-worn tracks of party politics. I would have preferred to have started by congratulating the right hon. Member for Belper (Mr. G. Brown) on his introduction and the way in which he has led this ritual dance. I am afraid I cannot do so. Instead, I feel that I should commiserate with him that, on this occasion, he is not being partnered by the Leader of the Opposition. We fully understand the historical reasons which make it difficult for the Leader of the Opposition to take part in a debate on health.
I had the privilege in a previous health debate of following the noble Lord when he made a most knowledgeable speech. Will he return to his previous form and get on with the subject?
We all fully understand the reasons the Leader of the Opposition is not taking part in this debate and why he has decided to sit this one out.
Hon. Members opposite accuse us in our Motion of undermining the Health Service. I feel that they will forgive us if, for a moment in face of this accusation, they allow us to look back to the condition in which the Health Service was when we took office. We took office in 1951 when the Leader of the Opposition introduced his one and only Budget. That was the year in which the National Health Service charges went up and the right hon. Member for Huyton (Mr. H. Wilson) went out.
Hon. Members opposite also accuse us in their Motion of placing a heavy burden on those who are least able to bear it. [HON. MEMBERS: "Hear, hear."] If they applaud that sentiment they will allow us to look back for a moment to their last year of office, because it was in that year that the Trades Union Congress bitterly complained that the rising cost of living was imposing an increasing burden on the lower-income groups. If hon. Gentlemen will not take my word for it, perhaps I should quote the words of the Trades Union Congress. They accused hon. Members opposite of reducing the standard of living for the lower-income groups "below tolerable limits".
In their last year of office hon. Members opposite, as a kind of final firework display before the funeral they were soon to undergo, clamped down a totally arbitrary ceiling of £400 million on the Health Service. In doing so, they struck a blow at the Health Service without equal since the war.
The hon. Gentleman cannot get away with that, because we heard his right hon. Friend say categorically this afternoon that in that particular year, as a percentage of the gross national income, that was the highest amount of money spent until this very year when, at last, we are reaching back to it.
There is a total difference between the proposals of my right hon. Friend and the action of the hon. Gentlemen opposite in which they imposed a limit on the expansion of the Health Service. The whole theme of my right hon. Friend's proposals is to emphasise the expansion of the Health Service. In their last year of office, right hon. and hon. Members opposite imposed a ceiling of £400 million on the Health Service. Today, expenditure on the Health Service is £867 million.
I used to live in a part of the country where the overwhelming majority of the population were coal miners. Very few coal miners would find any real meaning in the word "undermining" in the Motion which the Opposition have put down. Indeed, by every yardstick I can think of, the Health Service today is immeasurably better than it was when we took over responsibility for the health of the nation.
The hospital building programme of right hon. and hon. Members opposite began and continued at the exhilarating rate of £10 million a year. Now, the hospital building programme is running at £500 million over the next ten years. An annual rate of £50 million a year for the hospital building programme hardly indicates that we intend to prune that part of the Service out of existence.
If the undermining is not taking place in the hospital building programme, is it taking place on the human side? Perhaps we are undermining the recruitment of doctors, nurses and consultants to the Health Service. The number of full-time nurses has risen by 23 per cent. in the last ten years. The number of part-time nurses has risen by 79 per cent. As every hon. Member knows, there has been a steady increase in the numbers of doctors, consultants and other persons in the Health Service.
Will the noble Lord say how large a proportion of the total he has referred to was the result of introducing nursing auxiliaries, State-enrolled assistant nurses and other untrained or semi-trained nursing staff because the Government could not attract qualified nursing staff?
I regret that I cannot differentiate, because I have not the figures with me, but I can say that the increase of 23 per cent. in the number of full-time nurses and of 79 per cent. in the number of part-time nurses is nothing of which we on these benches need to be ashamed. It is a move in the right direction, surely, which hon. Members should not carp at.
If the undermining is not taking place in hospital building or in recruitment of staff to the Health Service, perhaps it is the patients who are, so hon. Members opposite feel, getting a rotten deal from my right hon. Friend. One can only say that the number of in-patients cared for by the hospital service has increased during only the last five years by 10 per cent. The number of out-patients cared for by the hospital service has increased in the last five years by five per cent. More important, perhaps, in the hospital service is the fact that the number of domiciliary consultations during the last five years has increased by 30 per cent. One can hardly say that there is an undermining of the service for the patients.
Will the noble Lord agree that the fact that hospitals have to take in more patients indicates that there is probably not enough preventive work, and that the 2s. prescription charge will mean that more people will now want hospital treatment?
I should have thought that the statistics I gave, particularly the increase of 30 per cent. in domiciliary consultations, were a complete answer to the question the hon. Lady has asked.
Perhaps I can speak for Scotland, in that case.
Our determination to improve the National Health Service and our determination to fulfil our ambition to diminish ill-health in this country and to remove suffering as much as possible has cost the country an immense sum of money. In terms which take account of the change in the value of money, there has, during the past ten years, been an increase in expenditure on the Health Service of one-quarter.
We are absolutely determined on these benches that we shall continue a high rate of investment in the essentials of the Health Service. There is—it would be foolish to fail to recognise it—a real danger that the very foundations of the Health Service will be imperilled by the rising cost to the taxpayer. If we ignored this danger, if we allowed the cost to the Exchequer to continue to soar, the inevitable result would be a reaction and a retrenchment as damaging to the Health Service as that undertaken by the late Sir Stafford Cripps which, as I have said, was a retrenchment very gravely resented by those who had dedicated their lives to the Service and damaging in a way which cannot possibly be compared with anything suggested since.
Hon. Members opposite are, of course, perfectly entitled to say that the rising cost of the Health Service should be borne by the Exchequer. They are perfectly entitled to say that the rising cost of the Service should be met out of increased taxation. All I can say about that is that it was not so very long ago that hon. Members opposite were involved in a General Election campaign and they were prancing round the country hawking the promise that, instead of increasing taxation, they would reduce direct taxation. I find it impossible to square the attitude of mind which the Opposition are adopting now with the promises with which they tried to delude the electorate at the last General Election.
The noble Lord, apparently, disapproves of the idea of any increase in the cost of the Health Service being carried by the taxpayer. What are the Government doing now when they put 1s. on the stamp? Is not that a tax?
I meant direct taxation. I will come now to the point which the hon. Gentleman makes.
Faced with the increasing cost of the Health Service, we have, in my judgment, three clear alternatives. First, we could hold back, as the Opposition did, the expansion of the Health Service. We could put a ceiling on its costs. We could say, "Thus far and no farther". That was the course of action which right hon. and hon. Members opposite took in 1951. Were we to emulate them, were my right hon. Friend to take that course now, I should regard it as a gross betrayal of the real interests of the Heath Service. I should regard it as a betrayal of the interests of those who have dedicated their lives to the Service and a betrayal of the interests of the patients and the beneficiaries.
The need today in the Health Service is not to halt its expansion. The need is that it should continue its expansion unchecked, and nothing is more damaging to it than to place an arbitrary limit on it postponing planned progress and upsetting planned expansion.
I agree entirely with the hon. Gentleman that we need to expand the Health Service, but will he tell us how many new hospitals his Government have built in the last nine years?
I have mentioned that. I said that when we came to office the annual expenditure on hospital building was £10 million. The annual expenditure on hospital building under my right hon. Friend's proposals is £50 million. It seems to me that an increase of that nature is something for which we can take credit.
I am glad that in his proposals my right hon. Friend, faced with a difficult problem, has emphasised the need for the expansion and not the restriction of the Health Service.
The second course which faced us was that the whole of the increased cost of the Health Service could be borne by the taxpayer. It is claimed by hon. Members opposite that we are undermining the Health Service. But, surely, if anything would undermine the Health Service it is higher taxation, because that would strike at the very roots on which the Heath Service depends. A demand for higher taxation would strike at the economic prosperity of the nation. The Health Service is built on the energy, earnings and productivity of the nation and, even at this moment, with the present level of taxation, those earnings, energy and productivity are being sapped. The Health Service is carried by the nation's earnings, and, with the present level of taxation, we are in danger of killing the goose which lays the egg.
Unless we are to halt the expansion of the Health Service and imperil the foundations on which it depends, we must adopt a third course. What we have to do, without reducing the hospital, family doctor and consultant service standards below the essential level, is to find some other source of revenue. Those words are not mine but those of the Leader of the Opposition in 1951. Therefore, my right hon. Friend has taken the course of increasing the contribution and the charges.
I completely support my right hon. Friend in this action. Equally, I appreciate the concern of hon. Members opposite on this subject. I fully appreciate—surely every one of us appreciates it—that to pay an increased contribution or an increased charge is not pleasant for anyone. Also, there is a certain validity in the charge that this is a regressive tax. Every flat-rate contribution is a regressive tax, and we must be cautious in shifting the burden from a graduated income tax to a flat-rate contribution. What we are proposing is no more a poll tax in the normal usage of the word than it was when it was introduced by hon. Members opposite. The contribution next July, when related to average earnings, will be almost identical with the contribution related to average earnings when it was introduced by hon. Members opposite in 1949. There is only a slight difference. In 1949 it was 3· 45 per cent. Next July, not taking into account any increase in earnings which might take place between now and July, it will be 3· 65 per cent. If this is an outrageous and insufferable poll tax today, why was it not an outrageous and insufferable poll tax when hon. Members opposite introduced it in 1949?
My right hon. Friend has taken steps which will sustain the finances of the Health Service and ensure that it will be possible for us to continue its expansion. I sometimes wonder whether members of the public, particularly hon. Members opposite, have any idea how vitally and desperately necessary it is that there should be expansion and an increase of expenditure in the essential and critical parts of the Health Service.
Hon. Members opposite clamour about our proposals to deal with cod liver oil, which is free and of which only 9 per cent. of a possible uptake is used. They clamour about vitamin pills, which are free and of which only 30 per cent. of a possible uptake is used. Many years ago, when Florence Nightingale was nursing, the hospital beds were so close together that the lice used to pass from the bedboards of one bed to another. The beds were so close together that the nurses could not even change the bed linen.
Recently, I had the opportunity to visit a number of mental hospitals. Many of them were built more than a hundred years ago. Architecturally, they looked more like cavalry barracks than hospitals. Today, in the sixties, in one of them the beds were still so close together through overcrowding that there was not even room for a locker for the personal belongings of the patients. It did not really matter, because even if there had been room for lockers the hospital could not have afforded to buy them. In this hospital there was a female nurse establishment of 251. In fact, there were 120 female nurses in the hospital. There was a male nurse establishment of 190. In fact, there were only 102 male nurses. This hospital could not even advertise for more nurses, because it could not afford to build the accommodation for them.
It seems to me that it is these facets of the Health Service—the mental hospitals, staffing and new building—that we should emphasise, and we should not disperse our energies and resources on things which are less essential.
I have given way enough.
My right hon. Friend has embarked on a hospital building programme infinitely larger than anything which hon. Members opposite even dreamt of, and, far from placing his plans in jeopardy, as the proposals of hon. Members opposite would do, they should support him for his courage, his humanity and his wisdom.
We have listened to the hon. Member for Hertford (Lord Balniel) speak with great feeling about the conditions and hardships in hospitals in the days of Florence Nightingale. It would be interesting for us to know what the hon. Gentleman's forebears were doing about it at that time. If his family were following the true traditions of the Tory Party they would be taking very good care not to be dealing with contemporary hardships, although willing to indulge in historical reminiscences, about times when other people were working for improvements.
I will answer both those interjections. I suspected that the hon. Member for Hertford was a throw-back. I am sorry to hear that he slipped even from the Liberal Party to the Tory Party. As for the intervention by the hon. Member for Nottingham, West (Mr. Tapsell), I have a great respect for Lord Shaftesbury. Every party throws up members with a vision ahead of their time and who are seldom appreciated by their contemporaries. The reason why Lord Shaftesbury's name is honoured is that he had compassion for the poor and he had the energy to follow up his sympathy. This marked him as different from the general run of his party. We on this side always honour brave men of vision. Lord Shaftesbury, therefore, can be claimed by us rather than by hon. Members opposite.
There has been considerable feeling in this debate and there will be more feeling before the night is over. The feeling that has been renewed today will continue during the remainder of the week, and after this week it will go on in broader, deeper and more passionate form. It is not as easy for hon. Members on this side as for hon. Members of the party opposite to get the true facts of any situation made widely known. We do not command the same publicity resources. Therefore, we have to fight very bard indeed when we set out to demolish the mountains of lies and half-truths with which they surround so many public issues.
I do not for one moment 'believe that if the people of this country understood the true facts about the Health Service more than a contemptible minority would support what the Minister of Health, with the backing of the Tory Cabinet, is proposing to do. It is our job, as always, to deal with a monumental barrage of lies and half truths, and to find our way to understanding as best we can.
During his speech, the Minister of Health said quite a few extraordinary things. But perhaps the most extraordinary of all was when he claimed that he and his party had been architects of the Health Service. I sent a note to the right hon. Member for Luton (Dr. Hill) and he has received it, but I can understand that it may not be possible for him to be present. I informed him that I intended to refer to him in the debate. If hon. Members wish to refresh their memories as to the manner and extent to which the party opposite co-operated in establishing the Health Service, they do not need even to fatigue themselves by reading the newspapers of those days. It would be enough if they looked at the accompanying cartoons.
It was almost impossible for what we on this side were trying to do to become known to the public because of the hysterical shouting and abuse that went on. We were told by the right hon. Member for Luton, who is now Chancellor of the Duchy of Lancaster and who at that time was doing a discreditable job in trying to prevent doctors from knowing the true facts about the Labour Government's proposals instead of assisting them, that if the Health Service was established there would be improper interference between patient and doctor, that there would be bureaucratic control and that the wonderful work of the great army of voluntary workers in hospital administration, an army drawn from all parties and all classes, would no longer be wanted or at the least would be denigrated.
I am not complaining that in the newspapers of that time there was day after day both political and personal abuse. That is how the Tories fight. The Minister of Health is a man with a definite philosophy. He believes in his Toryism. It is to the good of the House of Commons if Members say plainly what they mean. I hope that before this battle is over, we on this side will show that we have an equally definite philosophy.
Do hon. Members remember what was said in those days by the British Medical Association? Today, even they are warning that if we continue to have prescription charges we are interfering improperly in the relations between doctor and patient. Does any hon. Member on the Government side deny that that is the contemporary opinion of British doctors? Doctors have now had experience of the Health Service. Again and again, they are put in an impossible position. Not only does the prescription charge mean that sometimes they have to prescribe much more medicine than is used. It means that they know that patients who would otherwise come to them sometimes stay away. It may be difficult for hon. Members opposite to realise the truth of this, but it is true. I have many other aspects on which I wish to speak and I will accordingly leave my hon. Friends to give further illustrations.
I am concerned with another improper interference in the relations between doctors and patients. It is intolerable when a doctor is dealing with a patient and the patient insists upon having a form of medicine which the doctor knows is two, three, four or five times more expensive than is needed, simply because it is a widely advertised proprietary brand. I do not think that the Minister or hon. Members opposite would deny this. Again and again, doctors are badgered by patients and by the relatives of patients. Especially when people read in the venal commercial Press that those they love can be saved or that suffering can be reduced if only their doctor will prescribe these widely advertised drugs they press desperately to have them. We all know that that is true. Doctors not only deserve but need the protection of the House of Commons. The present situation should not be allowed to continue.
At the same time, doctors are badgered by the commercial advertisers. But it is the badgering by the patient which is much more difficult for the doctor to resist. Today we have been given illustration after illustration of the cruel commercialism, leading to inflated profits in the drug trade.
I now turn to my colleagues on these benches and I ask, what is the answer? The Minister of Health knows his Tory philosophy, but have we not a Socialist answer to this? Is it necessary that we should continue to allow the sale of medicine to be a lush field of commercial exploitation? Is it not time, particularly in face of what we have heard today, that we caught up with the needs of the time? Even enlightened Conservatives know what has to be done. A Tory doctor, writing in the Tory Daily Telegraph, has said that against all these pressures of commercial medicine, the only thing to do if we are to rescue patient, doctor and taxpayer is to have our medicines manufactured and distributed under proper conditions of public ownership and control.
I am not given to betting, but I am willing to predict that what I have now indicated will be the official policy of the Labour Party before long. And I hope that when I say so nobody will accuse me of trying to split my party. Everything we have to say in this debate today must be said in order to fulfil the great ideal of the Health Service, not to destroy it. And it can be fulfilled only by a powerful and united Labour movement. It will not be done by hon. Members opposite.
This House of Commons is a place of many changing moods. Its social urbanities do not change the fact that here great social battles are fought. I do not think that anyone, irrespective of party, would fail to help and sympathise with a fellow Member on a purely personal issue. But that does not alter the fact that the British House of Commons is a battlefield: it is not a playpen, though hon. Members opposite would like to treat it as such. It is our privilege to be able to discuss and to settle great questions by Parliamentary methods that in less fortunate parts of the world have often to be settled by bloody murder, dictatorship and repression and social horrors of every kind such as I hope will never darken our fair country. But the alternative to violence is that we in this House of Commons should do our job effectively.
Hon. Members opposite often make seductive speeches. I have heard their tactics described as the iron fist in the velvet glove. I would be more inclined to describe it as a knuckleduster masquerading as costume jewellery. But you are not afraid to use the knuckleduster. You prefer the iron fist to have a velvet glove over it, but, nevertheless, you are willing to say to the people of this country in the year 1961 that you cannot come to the rescue of doctor, patient and taxpayer although you admit—
In the situation we have now reached I do not see any solution to what is now happening in this field of medicine but to rescue it from the commercial interests that are behaving so shockingly at the present time.
Now I go on to a matter which my right hon. Friend the Member for Belper (Mr. G. Brown) dealt with extremely well in his speech. He anticipated the Minister of Health. He explained to the Minister of Health, in what I thought was extremely clear and cogent language, that because about 25 per cent. of the cost of the Health Service had been paid for other than by direct taxation when the Health Service was introduced, this was not a figure laid down for all eternity. I do not know whether the Minister has any need of an aural aid or not, but certainly he had the point explained to him well and fully; all the same, he stuck to his notes, and came back again and again to the point that the percentage of the cost of the Service which was borne by insurance was right when it was started and was right at the present time. I do not so underestimate the intelligence of the Minister as to imagine that he cannot see the flaw in his own logic. Would he like to tell us that the rumour that the Government are going to rush to rescue 'the Surtax payers when the Budget is introduced has no foundation at all because the Surtax payers have to be kept at the point at which they were in the years 1949 and 1950 and 1951? Where is the logic of the Minister's brain?
I tell him further that he must not think that the impositon of this poll tax, the carrying of the cost of the Health Service on the insurance stamp, is part of the permanent philosophy of the Labour movement. It most certainly is not. We, like you, Sir, have deep roots. We, like you, Sir, have a philosophy. Our philosophy, Mr. Speaker, is that the way to deal with such issues is from each according to his means, and to each according to his needs. I hope that hon. Members opposite will not think that this is old-fashioned language, because the only people who can effectively deal with the future are the old-fashioned ones, that is, those with roots deep in the past. It is a very basic part of the philosophy of our movement that we should give according to our means and receive according to our needs.
Instead of being badgered about with all this nonsensical talk about what percentage of the cost of the scheme should be borne by the insurance stamp, lest us make the conflict between the two sides of the House, clear to the whole world outside, particularly the industrial population. Let us join issue as the battle develops, and say quite clearly that the whole of the cost of the Health Service must be paid for by the Chancellor of the Exchequer.
I hope that when we reach that point—because I am certain we shall reach it—we shall at the same time make it quite clear that we do not have a free Health Service. We can no more have a free Health Service than we can have a free Defence Service—but nobody would think of paying for the Defence Services of Great Britain by adding to the poll tax taken out of the wage packet of the ordinary worker.
We have got to raise our banners higher than they were in the past. Times move on. We have got to be careful that we do not become infected by the political disease of hon. Members opposite, Conservatism. We have to be looking ahead, and I say that the way to get out of this continual, frittering argument is to lay down the clear lines of division between the two sides of the House. It is nonsense for a country like Great Britain to pretend that it cannot meet the whole cost of the Health Service without resorting to charges on spectacles, teeth, surgical instruments, prescription charges and insurance impositions.
The Minister of Health has his head in his hands. Maybe he is counting. I have been counting, too, and I know perfectly well that the Service is costing us about 4 per cent. of the national income. There has been some small difference in the figures quoted. Some of us got them today from the Library, some of us got them elsewhere. When I say that the whole cost has to be paid for in that way I know it would be a substantial increase, but I also know that there are means by which we can not only increase national expenditure but can make very considerable national savings.
There has always been a dual morality in public life. We have one standard when dealing with expenditure on social services and another when dealing with expenditure on armaments. I am no pacifist, and I am the last person in this House who would resort to what I would consider the most unfair demagogy of pitting defence against the National Health Service. Two of the supreme responsibilities of any Government are fairly to defend our country and fairly to see that they sustain, at the highest possible level, the health of our people. But I fail to make sense of one investigation after another into charges on our Defence Services.
The Estimates Committee was meeting quite recently. I believe it was considering the Sea Slug—I am open to correction about details. That is not my line of country. But the essential consideration that emerges—and this concerns every taxpayer—is that again and again we are told that Ministers have made estimates for military equipment fantastically wide of the mark. The Sea Slug was to cost £1 million. Yet before we know where we are we find that it costs £70.
Then there is the kind of inhibition which the Government have when dealing with the subject of equipping and provisioning the Defence Services. I hold the view that we on this side of the House should become as tough businessmen and women as Members opposite claim to be. We should realise to the full the advantages we have in buying for Government Departments. Whether we are buying for the Defence Services or for the National Health Service we are customers with a very large order. Whether we are bidding for beds, for hospital equipment, for medical instruments, or for anything else, we should exact, in a way that we have not even begun to do, all the advantages of our position. Sometimes we could save money by astute buying, by mass purchases. Sometimes we could do it by insisting that the particular product must be nationally owned and produced.
I give one example only from the early days of the National Health Service. Aneurin Bevan was very proud indeed—and remember that he was the Minister responsible for housing as well as for health—when, on top of all his other duties, he could come to the rescue of thousands of deaf people in this country.
The wonderful way in which he did so was by reducing the cost of all aural aids to almost one-tenth of what they had been before. The reduction was spectacular. The duty of Ministers who have followed him is to keep on improving the type of aural aid and, at the same time, to keep on exacting the maximum advantages which they have because they are such great customers.
I do not want to see the provisions for the National Health Service and for the defence services in conflict with one another. We have to resolve the question of priorities. Some of us hold that the language of priorities is the religion of Socialism. Hon. Members opposite may not yet know what that means. I hope that in time we shall teach them what it means. It means that there are always things which a nation cannot afford, but that the test of civilisation of that nation lies in how it decides its priorities—what it can afford and what it cannot afford.
It is a disgrace to all of us, when we look round our country in the last year or so—and particularly when we look round the West Ends of our great cities—and see the blatant expenditure which tells us, by the naked eye, that there are some in our community who are taking full advantage of Tory Government to extract not coppers from the Exchequer, not small sums, but millions and tens of millions, and even hundreds of millions of pounds for their own consumption.
It is time for me to end my speech, but I want to mention one thing more—and it is something which cuts very deep with me. I am not given, as the Press knows, to discussing private matters. I consider that private life is private and public life is public. I consider that people in public life who are willing to be exhibitionists as far as their families and private firesides are concerned, are two-dimensional types. If they cannot protect their own homes they are not going to be much good in protecting others. That is the philosophy which I follow. Some hon. Members on both sides of the House will agree with it. and others will disagree with it.
When I beard the Minister of Health boast, in the introductory passages of his speech, about what he was going to do to increase hospital accommodation in the next ten years, I was almost physically sick. My dismay was because, instead of boasting about what he has not yet done, he should have been apologising to the House for what he and his predecessors have failed to do in the last ten years.
It is a very poor defence indeed, having allowed our hospitals to go unrenovated and under-staffed, with their nurses underpaid, and having failed to provide new hospitals that should have been begun a decade ago, to tell us what he is going to do in the future.
I had a dilemma to face which many citizens of this country are also facing. My mother is 82 years of age. She was fortunate enough to have a cataract cut from one eye, which made a great difference to her life. She had the operation as a National Health Service patient, and it was done with superb skill and kindness in every way Then she became obsessional about the other eye, which still has a cataract on it. She felt that the bad eye was affecting her good eye. She was not able to read. I was faced with the problem of what to do about it. I have a wonderful doctor, and he did everything in his power to get her back into hospital to have the second cataract cut. He used the perfectly fair argument that this was now a nervous condition as well as a physical one. He did everything in his power. We raked the local hospitals which would have been capable of doing the operation. At the end of the day I was told that my mother, after all the agony she had gone through, had to face the winter as she was. My doctor was not able to tell me when she could have her sight restored.
I have all the documents. If they had told me that it would be a week, a month, two months, I would have waited. But at Moorfields Hospital—a superb hospital—the waiting list at that time was 1,700. We raked all the hospitals in our area. It was the same story wherever we went. I could not be given a date, and so I had to face the problem of what to do.
I made the decision of which I am now going to tell the House. There was only one thing to be done: she must have that second cataract cut. She had had as much punishment as any wonderful mother ought to be asked to take. She had the cataract cut in the same hospital where she had had the first cataract cut. Once again a superb job was done, but she had it cut because I was able to sign a cheque for a certain sum of money.
It is disgraceful that any daughter in this land should be put in such a position. I do not for a moment imagine that I am the only one with a profound love for her mother. Aneurin Bevan would have pulled down the heavens rather than have her suffer. I wonder how the hon. Member for Hertford would have dealt with a situation like that. I wonder if he would have cared, as I care deeply, that any other daughter should have that dilemma facing her, that she be expected to watch unnecessary suffering at the heart of her home because she cannot afford to sign a cheque for £50 or £100.
Since I have embarked on the story, if the House will forgive me, I had better give the rest. As a private patient, my mother was in a little room on her own. I explained that it would be much better if she went into a general ward. She wanted to be in a general ward. Her memory fails her and I thought that she would have been less frightened in a general ward. I suggested that even though I would pay, someone in the general ward, with a different temperament and badly wanting privacy, should change over with my mother, so that my mother would go to the general ward which suited her temperament so much better. It could not be done. I am not blaming anybody. Doctors in hospitals have to work to regulations and I hope that not a single word of mine will be taken to reflect on nurses or doctors or anyone else in hospitals, because they could not be more skilled or kinder.
The next thing that happened was that I was told that my mother had got up in the middle of the night and would now have to have a special night nurse. In the private wing of that hospital there were only two night sisters, so there could not be one always available for one patient. Could there be a greater waste of our resources? If my mother had been in the public ward she would not have needed a special sister. I resented that waste. But supposing that I had just managed and no more to scrape up enough to get my mother into the hospital as a private patient and had then found that I had to pay other bills for special night nursing! That is a dilemma which faces many people. Of course, I said that whatever was necessary for her safety and protection was to be supplied.
I hope that hon. Members opposite will not under-estimate how deeply these issues affect hon. Members on this side of the House. It must be remembered that the National Health Service was started against monumental opposition. To get it started required great courage, great compassion, an iron will and very great administrative ability. With all those qualities, to get it started at all inevitably meant that compromises had to be made. But compromises which were forced on us by the circumstances of the immediate post-war years are intolerable in the circumstances of 1961.
I hope that my hon. Friends on these benches will not be afraid to hold high the banners behind which we march. Hon. Members opposite can twist the figures any way they like, but the fact is that we might at this moment have the pleasure of perfecting our Health Service. Instead, we are engaged in this squalid debate about raising prescription charges from 1s. to 2s., and so on, and about who was responsible in 1950 and 1951. I could tell hon. Members the whole of that story. I can relate its every nuance, but I am interested in rallying not only my own colleagues, whom I know to be entirely at one with me on this issue, but the common sense and the common kindness of the people of this country, in particular the great army of voluntary health workers who make it possible for the administrative cost of the Service to be little more than 2 per cent. There is an immense amount of good will for the Service.
Do not let us appeal to the lowest in our people. We can no longer give world leadership in terms of wealth or size. But some of us hold firmly to the belief that we can still give another leadership because of a quality of tenderness and mercy in our people. This we can do if there is true family feeling among us and provided we are willing to work and live by civilised priorities.
I will not attempt to follow the arguments of the hon. Lady the Member for Cannock (Miss Lee), but I know that I speak for both sides of the House in expressing sympathy for the difficult time which she has had in dealing with her mother and in getting her into a hospital.
However, the accusations which she made against my right hon. Friend were not fair. There are several hospitals in my constituency, and I have seen the work which is being done to modernise them. As a result, some of them are now extremely good, and also there are great schemes for building new hospitals. Since the war, much work has been done to convert some of our older hospitals into better places for the treatment of patients.
With one proviso, I welcome my right hon. Friend's proposals and congratulate him on his courage in bringing them forward. Hon. Members opposite keep condemning us for undermining the National Health Service, but far from undermining we are strengthening it by the action we are taking. It was hon. Members opposite who attempted to undermine the Service when they put on the £400 million ceiling. I am glad that the Leader of the Opposition, who is not here this evening, sometimes shows a little more sense of reality than do his colleagues. He proposed prescription charges and, had the Labour Party returned to power, would have brought them in.
The hon. Lady the Member for Cannock said that the Health Service was not free. How right she was. The Service costs are well above £800 million a year, but some hon. Members opposite have a different philosophy, which I fail to understand, that if anything is free it must be good, while if it has to be paid for it is automatically bad. Obviously, the sum of £800 million has to be paid; we differ in our methods about its payment.
I now come to the proviso which I have mentioned. There may be a certain section of the public who will be penalised or even suffer hardship because of these additional charges. I am referring to the borderline cases who are not actually receiving National Assistance. I know that it is extremely difficult to get a formula to help these people, but I sincerely hope that my right hon. Friend, in consultation with the Chancellor of the Exchequer, will attempt to find some formula to solve this problem.
Under a Tory Chancellor, under the 1957 Finance Bill, the principle of making a concession was introduced. In 1958—and I have the actual Memorandum which was sent out—the allowance was raised. Those who had incomes not exceeding £275 were exempt, provided they were 65, and for a married man it went up to about £440. I do not say that that is the solution, but this bracket group might possibly be the basis for some formula.
I feel that in the whole realm of National Health Insurance we are apt to forget the operative word "insurance". What is insurance? It is a system whereby many contribute some money to a fund, and when one falls on hard times one can draw from it.
If I may digress, how did insurance start? A man named Lloyd had a coffee house in the City to which sea captains and owners of ships used to come and discuss their problems. On one occasion, one of these owners lost three ships rather rapidly, and the others clubbed together to help him out of a difficulty. They then said: "This might happen to us all. Why do not we all contribute and make a payment in case a disaster comes upon one of us?" That is how insurance started.
I do not believe that it is right to think on the lines on which I am afraid so many people do, not only for Health Insurance but all insurance. The present trend is to say, "If I pay in £10 a year I am getting a bad bargain if I do not take out £11". A lot of people believe that. The real truth of the matter is that we all subscribe and we do not want to take out little fiddling amounts. What we want to do is to ensure against real disaster and trouble.
I was recently in Canada and I was told the story of a young girl who worked in a bank. She absconded with 10 thousand dollars. She was brought back for trial and was asked: "Where is the money? What did you do with it?" She produced receipted bills for 11 thousand dollars for medical treatment for her mother. That is a large sum of money. Thank God, that sort of thing cannot happen here. Thank God, we have this Health Service.
Anybody who is seriously ill can get the finest treatment the country can provide. There is no question about that.
I believe that there is much waste in our Health Service. I know of many cases where people who go in for regular treatment, it may be for their eyes or for their hands, or for something like that, who could quite easily travel by ordinary transport and, if necessary, have their bus fares refunded. I know of ambulances—I am not now referring to large ambulances for stretcher cases but to ambulances for sitting cases—travelling fifteen or twenty miles to bring people in for treatment. Not only is this a waste of money, but the time the patients spend away from home or away from their jobs is a waste. I believe that that should be looked into.
There is another side, and I am referring now to prescriptions. Far from condemning all doctors, I believe that there are quite a few doctors who are a little lax in the way in which they prescribe. I know of an American who stayed at the Dorchester. He cannot have been broke to have stayed there. He was going back to America on the "Queen Mary" the following day. He cannot have been hard up to have done that. He suffered from asthma. He wanted a drug—I think it was called antihistamine. He went to a chemist and asked for two or three tablets. The chemist said, "I am sorry but this is on prescription in this country, although I know that you can get it without a prescription in America". The American asked what he should do and was told by the chemist, "The only thing I can do is to give you the address of a doctor who will give you the prescription". The American went to the doctor and then returned to the chemist twenty minutes later with a prescription for one hundred tablets, yet he needed only two or three, or perhaps four. The cost of that prescription was 42s.
I will give way in a moment.
I know of another case of a woman who had a thorn in her finger. She received treatment in the out-patient department and was told to keep the finger clean and wrapped up. She was given a prescription for twelve one-inch bandages. Surely that is wrong.
As regards the first story about the American who stayed at the Dorchester and had to see a doctor and was given a prescription for antihistamine, did the American pay the doctor a fee before he consulted him, and what sort of prescription was it? Was it on Form E.G.10, or on a private piece of paper with a prescription for which the American paid?
I do not know whether it was Form E.C.10 or Form E.C.11, but it was not on a private piece of paper and it counted against the National Health Service. He did not pay one penny for it. He was not a resident here; he was merely passing through.
Finally, there was the case of the man who went to a doctor and was given a prescription for one hundred tablets of terramycin. I gather that this is an antibiotic. He took it to a chemist who gave him his tablets. He was surprised at the quantity because I understand that this is a form of shock treatment which produces effects in two or three days. The chemist thought that this large quantity was unnecessary.
Some days later the patient went back to the chemist and said that as he was feeling rotten he had given up taking the tablets. He asked whether the chemist could recommend a good tonic, and on the chemist's recommendation he bought one. Later he went back to the doctor who said, "You are looking very well now. You had better have another hundred terramycin tablets". He received in all two hundred tablets. Only two days ago I checked the cost of those tablets and found that it was 174s. 2d. per hundred.
I have referred to those cases because I consider that they are glaring examples of what can happen, but if cases like that occur there may be many others. I feel that some instruction might be given to doctors to be a little more careful in how they prescribe. Let me add that I am not accusing all doctors of prescribing indiscriminately.
I believe that we have the finest Health Service in the world. It is the envy of the world. Not only have we now an excellent Health Service, but I believe that the measures put forward by my right hon. Friend will see that we maintain that Health Service not only now but also in the forseeable future.
I understand that it is not the intention to call the Amendment in the names of my hon. Friend the Member for Orkney and Shetland (Mr. Grimond), other hon.
Friends of mine and myself, to leave out from "indicates" to the end and to add:
the failure of Her Majesty's Government to put forward any new proposals for the financing of the National Health Service which would be equitable, would ensure economy and would allow for the proper development of the service".
But I do not think that my remarks will be in any way out of order, although they are largely directed to the points made in the Amendment—because the debate has ranged very widely.
As compared with what went before it, and even compared with what people had in mind when it started, the National Health Service is undoubtedly a very fine one. But there is a great deal still to be done, as was indicated by the story told by the hon. Member for Cannock (Miss Lee). We must avoid this Service becoming a kind of sacred cow, so that when a Member criticises any aspect of it, or the way in which it is run or financed, he is immediately accused of being opposed to the idea of a National Health Service which is freely available, in the sense that any person who needs it can take advantage of it without let or hindrance.
The fact that it is going so well considering how it started—and the hon. Member for Ludlow (Mr. More) and the hon. Member for Hertford (Lord Balniel) had something to say about the way in which it started—makes it all the more necessary to view it with a critical eye and ensure that it develops properly, as circumstances require. It is not a free service; it never has been. It has to be paid for, and the real argument arises as to how it shall be paid for. I have yet to hear a convincing argument to prove that the Service can truly serve the needs of all the people only if no charges are made upon a person when he wishes to take advantage of any part of it. I am not against charges; the question is what should those charges be, and what will their effect be on the general purpose and usefulness of the Service. I am opposed to charges whose sole purpose is to ensure not the better use of limited resources—and some are still very limited—dut the finding of some way of raising more money for the Exchequer.
I find it difficult to differentiate between a charge borne by the Exchequer, which is regarded as being paid by the taxpayers, and a charge which is suddenly imposed, for example, by an increase in the price of the prescription stamp. That is also a tax, in another form, and I do not see how the Minister has achieved any miraculous saving of the taxpayer's money by suddenly putting 1s. extra on the stamp. Perhaps the Parliamentary Secretary will enlarge on that point. The person who pays the contribution for the stamp is a taxpayer, and all that has happened is a movement of the kind one might expect in a Budger—which might be right or wrong—from a tax on the generality of taxpayers, in a progressive fashion, to a poll tax. As I see it, the services should be available to all, and no one should be prevented or even discouraged from making a proper use of them simply owing to lack of means. Such financial disciplines or checks as are desirable should encourage preventive medicine in particular and the best use of resources in general.
I want to examine some of the increases against that background. I agree that it seems difficulty to understand why the increases have been put on welfare foods, especially on orange juice, which has been increasingly used in recent years, but there is not a very wide use of the three welfare foods, taken together. The probable truth is that it is not so much that parents are neglecting to use them as that they are buying other proprietary forms. A case can probably be made out that it is no longer a proper use of our economic resources to continue this subsidy in respect of foods which are not being widely used, especially in the case of cod liver oil.
The correctness of the provision with regard to amenity beds has been questioned for a long time. Even with the increased charge of 24s. this is still an uncovenanted benefit to those who make use of it. In view of the existing pressure on beds I would have thought there was a good case for charging either their full cost, or alternatively, adding them to the rest of the beds for general use in the hospitals. In that case the lady referred to by the hon. Member for Cannock could have made use of the amenity bed.
If a charge is made on spectacles it tends to ensure care in their use, and their preservation, but I would have thought that the present charge was sufficient for that purpose. I do not see what extra benefit is to be derived from the increased charge, apart from the fact that it will bring in more money to the Chancellor. The same can be said of the increased charge for dentures.
The case for a charge on prescriptions has never successfully been made out. It was not successfully made when the charge was first imposed, and I have heard nothing in the last few days to convince me that the case is any better now. Whatever provision may be made, the Minister knows that there are many people who will not take advantage of these arrangements because they are either too proud to apply for National Assistance or they do not know about it or understand it. The arrangements are too complicated and people in the lower-income groups are often the people who least understand them, although they are often made for the good of those very people.
Doctors have assured me that quite a number of their patients will suffer hardship as a result of this increase. The sympathetic doctor will prescribe larger quantities of medicines than perhaps would otherwise be the case. That will defeat the Minister's purpose, because in that way he will lose prescription charges and it will increase waste and, therefore, the total charge for the drug bill which the Chancellor of the Exchequer will have to find. It will certainly add to the burdens and debts of country doctors, as did the original charge.
So far as I can see, all that will be achieved by this charge is that money will be brought into the Exchequer. It does not achieve what I should like to see, a true economy in the Health Service. If economy is the aim—that is an important aim at any time—while avoiding hardship, I suggest that there are two alternatives which, at least, are worth considering. The first is that drugs should be free to low-income groups to a greater extent than was indicated by the Minister, and that for the remainder, those people who would not come within the ambit of the groups, there should be not a flat charge of 2s. but a percentage charge. This would ensure that a person paying 2s., 3s., 4s., 5s. or 6s. for a drug would see that the prescription was not made out for a larger quantity than he required. A percentage charge would go some way to achieving this, whereas a flat-rate charge would not. I should not recommend a minimum limit for such a charge, but there could be a maximum of 10s.
I agree that that would be a complex matter.
The Minister has already indicated his own proposals about the raising of the limit to those who are in a higher group than the National Assistance limit, and I do not see why arrangements cannot be made for a much higher level. I wish to get right away from the possibility of anyone suffering hardship in this matter. The handling of prescriptions and the payment would not present any difficulty.
The prescriptions could be priced and the amount marked on the prescription when it was paid so that there would not be any possibility of a "fiddle" by the chemist.
The whole point of my argument is that I feel it important that we should get out of the entrenched positions in which apparently no suggestion about alterations will be acceptable, at any rate by the Labour Party, and nothing can be considered which is in any way a charge when medicine is purchased or at the time of sickness. That is a perfectly reasonable point of view to be adopted by people who believe it to be absolutely essential that no such charge be made. I do not believe it is. I consider that, in the years to come, such a system will not provide us with the best Health Service for the country as a whole, including the poorest of our people. Therefore, I think we should have a free discussion of different forms of charge which we could consider imposing.
The other alternative I wish to suggest is that the vast majority of prescriptions could be made from the British National Formulary and such prescriptions should be free. I am told by doctors that there would be no difficulty about this. The Formulary is brought up-to-date every year. There might be a comparatively small number of drugs that a doctor might want to use which might not be included in the Formulary but special provision could be made for that. The drugs from the British National Formulary should be free and there should be a full charge for proprietary brands if patients decided that they would sooner have some branded product instead. One could give an example of this by quoting the case of aspirin. The standard soluble aspirin which I think is called acetyl-salicylic acid costs 8s. 1d. for 500 tablets whereas "Solprin", which is frequently prescribed, costs 12s. 6d. for 500 tablets, that is 50 per cent. more than the standard aspirin, and I am assured that it does no one any more good.
If the British National Formulary were used as a basis, and the prescriptions were free, and if anyone wanted a proprietary brand they would have to pay the full price, that would seem to me to introduce a real element of economy in the use of drugs. It would cope with all the kind of nonsense with which doctors are inundated every day. I am told that articles such as I have in my hand are put through their letter boxes at the rate of 10 or 12 a day. This one is a long-playing gramophone record all about diabetes. I asked the doctor who received it if he knew about diabetes and he said he did. A tremendous lot of money is being wasted on this sort of thing and, by this means, great pressure is brought on doctors. Not only are they the recipients of this kind of glamorous and interesting literature but they also receive invitations to lunch or to see film extracts. It is only natural that sometimes they should feel an obligation to the people who entertain them so well.
My complaint against the Minister is that he has not given any new thought to the financial development of the National Health Service. There has been no hint, for instance, of any major tax reform coming from the Government recently.
In this connection, it is time that we thought again about a social security tax. Running the dual system of stamps and Income Tax is long out-dated. The Royal Commission went into the question of a social security tax, but did not examine all the possibilities. I should like to see more study made of a progressive form of social security tax which would cover the whole cost of all the welfare services of the State. While there has been no particular zeal in pursuing tax reform, there has been talk in other quarters about a move away from Income Tax to direct taxation.
The Minister has not shown a real inclination to study the financial disincentives to the right development of the Service in other fields. I particularly mention the domiciliary services. In his speech the right hon. Gentleman referred to the one-third increase in domiciliary consultative services and to the need to strengthen the midwifery service. He. went on to say that the new hospital building programme—I think his words were—spells out the appropriate development of the local authority health service. I take his point on this, because I have spent a great deal of time in the last few days considering this matter. It has struck me that the development of the domiciliary services appears to be an entirely logical, proper and very humane development.
I was most interested in a programme I saw on television two or three weeks ago. Other hon. Members may have seen it. I think it was about the domiciliary service in Croydon. I found it most impressive. In Bolton, my home town, expenditure on the local health services in the last ten years has more than doubled. There is a tendency, however, on the part of local authorities—which originally got a 50 per cent. grant towards local health services and now do not know what they get, because it is hidden in the block grant—whenever a suggestion for further development is made, to say, for instance of the nursing services, "We pay half this. We had better encourage people to go to hospital."
It would appear that as new hospitals are built they will concentrate more and more on very highly specialised services. The new drugs have given the general practitioner greater ability to deal effectively and quickly with many more diseases of patients at home rather than sending them to hospital. This seems entirely desirable, but it is dependent upon a further growth of the domiciliary services and good co-ordination between the general practitioner and those services, and an increase in the morale and status of the general practitioner, whose status had seemed to be going down. If we look at the financing of all this we see that everything is loaded against this development. The medical practitioner gets a per capita fee. His inclination, if he is governed only by monetary interest, would be to write out a chit and get the person to hospital as quickly as possible, and not to say, "I will visit you at home and will pay you several visits." The local authority, because it bears half the cost, has the same inclination to say, "Let the hospital service do the job."
I come to another point, which no doubt will appear slightly controversial to the Labour Party. That is the question of the cost to the patient when looked after at home, as distinct from when he is in hospital. I am not in favour of making a house charge for patients in hospitals as such, but, when we look at that proposal in connection with the development of the domiciliary services, in equity there starts to appear a very good reason why at least careful consideration should be given to whether those who can afford it should pay something towards that accommodation.
The hon. Member may say "Oh", but, if someone stays at home to be looked after by a visiting G.P., not only may he have to pay something for domestic help, but someone in the family may have to stay at home from work to help to look after him. That is a very great charge on the family and the tendency has been to say, "Go to hospital where everything is free." If we accept that the development of the domiciliary services is a desirable development within the limitations, this point is at least to be considered.
The answer one might give is that, in that case, we should increase grants for people who stay at home when they are ill. My point is that the present financial arrangements are weighted against the domiciliary services. It is greatly to the credit of all those who have been involved in those services that, in spite of this, the services have made such great headway. It is to these and kindred subjects that the Minister would do well to pay attention in future.
I am glad of the oppor- tunity to follow the hon. Member for Bolton, West (Mr. Holt) and, in particular, to refer to the last point which he made about domiciliary work. I agree that, whenever possible, people should be nursed in their homes, but I point out that it is possible to obtain adequate home help from local authority or voluntary sources. These services should be increased, but there need be no fear that they will cost the family anything. The services are available to provide the help which is needed.
The right hon. Member for Belper (Mr. G. Brown) likened my right hon. Friend to a quantity surveyor. I think that that was a great compliment, because no architect of any scheme would dream of going ahead without the views of his quantity surveyor. An architect may have many airy-fairy ideas, but it is the quantity surveyor who knows the practicalities of the job. The right hon. Gentleman could therefore have paid the Minister no greater compliment than to suggest that he is a quantity surveyor. My right hon. Friend will now get down to the job. Perhaps we should have had a quantity surveyor many years ago.
I have lived in a number of countries, and I consider that our Health Service is the most comprehensive in the world. I can prove my point by reference to the services in other countries. In Australia and New Zealand, for instance, one has to pay when one goes to a doctor. One pays for one's medicine and receives back a percentage of the payment, perhaps 80 per cent. With the exception of pensioners and those needing life-giving drugs, the people pay for the services of the doctor and for the medicine. I think hon. Members will find that in Britain we have the most comprehensive, all-over service. A number of countries rely on health insurance. America, for instance, has the Blue Cards and the Blue Shield schemes. If hon. Members go to other countries and see how the people's health is catered for, I think they will agree that the poorest people in this country have better protection than the poorest people in any other country.
A United Nations Study on Drug Costs in twelve prosperous countries, published in 1959, shows that expenditure in Britain, expressed as a percentage of the average income, is lower than in all but two of those countries, although the patients bear a far larger share of the cost in all the other countries. I think that is another proof of the value of the Health Service. I am sure we were all interested that President Kennedy referred particularly to the service in this country, and many of us were astonished that one of his first acts to relieve the poor was to increase their food parcels, things about which we have forgotten in this country for thirty years.
In my opinion, the functions of the Health Service are to keep the people fit and to continue research into those diseases which are not already conquered. The Health Service has done a tremendous amount to conquer tuberculosis and poliomyelitis. Recently, the increased assistance to mental health work in this country has meant that we lead the world in attention to mental health. We have more people employed in the country than ever before in our history, and that could not be the case unless they were fit, and physically and mentally strong. That is another way of proving that the service is working well.
I think that we have the healthiest children in the world. The children of today are much heavier and taller than those of ten years ago. When hon. Members talk about the health foods no longer being provided free, we might consider that this is not necessarily detrimental, in view of the figures which have been given during the debate of the lack of interest in these foods. I have a cutting here which some hon. Members have seen, of a letter in the Sunday Express which, referring to cod liver oil, says,
I give it to the dogs.
When hon. Members opposite talk about orange juice, perhaps I have an unsympathetic mind, but I recall that orange juice goes very well with some other types of drink, and if it is free there is a great temptation to use it in this way.
This kind of thing is not good enough. It is the kind of thing we have heard for years. If the hon. Lady cares to read the Conservative Party's latest glossy pamphlet, she will see again this suggestion that we should have a means test because some people mis-spend what they have. Let us judge on the majority and not on the isolated cases which are are quoted in letters in the Sunday Express.
I agree that we should always judge on the majority, but it is right to point out that there are abuses of certain services and that it is necessary to take them into consideration when we make these changes.
The increase in the average length of life in Britain is a great credit to the service. In India the average is only about 32 years, but the average length of life here is increasing year by year. This is partly because of the Health Service. [HON. MEMBERS: "Hear, hear."] Exactly. I am trying to show you how it is working.
I return to the question of the working of the National Health Service. It works on three prongs—through hospitals and the specialists, through local authorities, and through general practitioners. There should be much more co-operation between those three branches.
The Minister has announced the rebuilding programme for hospitals. We are all very pleased that it is beginning. In the rebuilding scheme, hospitals should be built more on the lines of present-day schools. Many hospitals built in the 1880's are still in operation. They were so strongly built that it will cost a tremendous amount of money to pull them down. In the changing pattern of the Health Service, I should prefer to see less permanent buildings so that we can keep up to date as the years go by.
Some of the hospital regions are still too large. A region in the West Country spreads from Gloucester to the Scilly Isles. I understand that a new group was recently created in Wessex. In order to have easier working of the scheme, some regions should be looked at carefully with a view to being cut down.
I realise that the hospital building programme may take a long time. I will therefore suggest some action which my right hon. Friend can take at once. I should like to see a team of surgeons, doctors and nurses formed to deal with what is called "cold surgery". I mean the type of case to which the hon. Lady the Member for Cannock (Miss Lee) referred, which is not a priority because it is not an emergency. There are a number of tuberculosis hospitals which are hardly being used. Many of them have good theatres. Where possible, as it would be in a number of districts, I should like teams to be set up to go round performing operations—cold surgery—to relieve the very long waiting lists of hernias, varicose veins, etc., which prevent people doing a full day's work. If this was done, the waiting lists would be cut down considerably.
I should like to see local authorities taking charge of all the chronic sick and the ambulant old. I should like to see hospitals used for acute cases. The division of authority at the moment makes for poor working. I quite agree that the block grant would have to be increased. I hope that there will be a gradual process of making aged patients, whether they be bedridden or ambulant, the responsibility of local authorities.
The number of out-patients has increased by 12 per cent. since 1949. We could do much to build up the status of general practitioners. One hon. Member said that it is very difficult for a doctor to refuse to give certain drugs if his patient demands them. It is equally difficult for a general practitioner to refuse to send a patient to a specialist if the patient demands it. Very often, the general practitioner is equally capable of doing the job. Doctors receive ten years' training, but they are perhaps not getting the benefit of that training in the eyes of the general public. I should like to see general practitioners given a better status in the country.
Turning to prescription charges—
I have been trying to show how good the various branches of the Health Service now are in many ways, and seeking to prove that they have not been undermined, as the Opposition's Motion alleges. I have been using these illustrations to make my point that the National Health Service has been doing its duty to the people, and that, under the propositions now put forward by my right hon. Friend, we can expect it to be even better in the future.
I want to refer to prescription charges because, as many hon. Members know, I was one of those who did not vote in favour of the last increase in them. My right hon. Friend has said that people on National Assistance—old-age pensioners and others proving hardship—can either get the money for the prescription prior to receipt of the medicine or can claim it afterwards. For the future, I should very much like to obviate this rather lengthy business. which often entails much travelling.
I suggest that a special form should be given to doctors, who would enter only the name and number of the patient who is in receipt of National Assistance. The patient would then take the form directly to the chemist and get the medicines, leaving it to the chemist to make the claim. That would save these people having to hand out the money in the first place, and I hope that that suggestion will be considered.
I should like to suggest, also, that these charges should not be increased until 1st April, instead of 1st March, as they would then coincide with the increases in pensions.
I hope that in future it will not be necessary continually to increase the National Health contributions and the prescription charges. I should like to see for the lower-paid workers a sliding scale on the same lines as we have for National Insurance. I think that it was the hon. Lady the Member for Lanarkshire, North (Miss Herbison), who said that people earning £9 a week and under would soon be paying lower contributions for their pensions but that we were now asking them to pay considerably more for their National Health Service benefits. We talk a great deal about the average wage being £14 a week, but averages do not mean much, and I know of many people who have £10 or less. That being so, the same consideration as is given in the administration of Income Tax and National Insurance should be given to those in the very low income groups.
I want to pay a tribute to the very many voluntary organisations that do such great work in our hospitals. I think of such organisations as the League of Friends, whose members not only help greatly in the way of visiting patients and the like but contribute considerable sums of money for improvements to the hospitals themselves. Such action shows that although this is now a national service, individuals still take a great deal of interest in it, and wish to add their share for the benefit of the patients.
Tribute should also be paid to the many students from overseas who nurse in our hospitals. Many hospitals would be short-staffed without them, and by the training we provide here we increase the service we can give to the newly-developing countries. In conclusion, I wish my right hon. Friend success in his new scheme, and in his term of office as Minister of Health.
I think that if the hon. Lady, the Member for Plymouth, Devonport (Miss Vickers) wanted to give a title to her speech she would probably call it "The Painful Consequences of Mr. Powell", because she, at least, has shown some compassion for those who will be hard hit by these increased charges, and has made a gesture of anguish on their behalf, which is more than we can say for the majority of hon. Members opposite.
I am sorry that the hon. Member for Carlisle (Dr. D. Johnson), who is a professional colleague of mine, is not in his place. He was the man who challenged my right hon. Friend to a debate in Carlisle. I should like to attend this debate and to see him wiped across the floor as he was wiped across the floor from 1945 to 1949 when he fought tooth and nail against the Health Service up and down the country long before he ever came to Parliament. It is true that he fought against the Health Service 100 per cent. and, even now in his own writings and, for example, in his recent book "Doctor in Parliament" he still puts on record his objection to the National Health Service in principle. He is an honest man, even though he is so dreadfully lost in the present-day political world.
May I say that the majority of my colleagues in the medical profession do not share the view of the hon. Member for Carlisle. The men in medicine today are not the same men that were there in 1948; they have changed a lot. A decade has passed; some have died, some have retired and others have taken their place. There is a new generation and an entirely different attitude to the National Health Service. Those who were not happy with it at the beginning have seen it in practice and now welcome it.
It is a remarkable fact that today, when we are debating this matter, we know that every single doctors' organisation which has met to consider it has come out against these charges. Admittedly, the Fellowship for Freedom in Medicine, the welly-known Teddy boy group of high-powered consultants, have not yet met but we know what it will say. Like the hon. Member for Carlisle, the members of that group have been dead against the service since its inception.
My objection is that this particular method of paying for the Health Service, such as suggested, is bad from the point of view of medicine. I hope to argue the case that I believe many doctors, irrespective of their political views, sincerely hold against these charges. There is no point in going over who started it all, that seems to be irrelevant. We are talking of the validity of the charge.
I am extremely glad that the Labour Party never imposed the prescription charge, as such, because it was probably against that particular mechanism that the most serious charge of bad medical practice can be made. I can see the dilemma of my Liberal friends who are trying to find ways and means of making suggestions. I believe that the hon. Member for Bolton, West (Mr. Holt) took us to the slough of despair when he suggested that we might perhaps have a 10s. charge, or something in kind, and then went on to his other, and more interesting, idea that we should free all prescription charges on drugs at present on the British Pharmacopoeia. I second that, if I am in order in doing so. The trouble is that the Minister could not possibly accept that, because it would completely undo one of his principal sources of revenue to finance the Service. The hon. Member for Devon-port at least made an attempt to find some way of getting round the awkward mechanism that the chronically sick are having to face in order to get this rebate—a rebate which my hon. Friend the Member for Lanarkshire, North (Miss Herbison) pointed out was impossible to achieve, on the word of the Minister in 1951. The hon. Lady suggested a National Assistance number. She meant very well, but I find it a very unpleasant suggestion.
If the Minister is unwilling to budge on these charges he might, perhaps, be willing to allow doctors to issue a certificate to all chronically sick persons which will exempt them from any charge whatsoever. That seems to be a reasonable idea. Give a card to everyone who, on the doctor's certification, is chronically sick. The card would be withdrawn when the doctor is of opinion that the patient is no longer in that condition. The production of the card at the chemist would mean that the charge could be waived. Each card could be numbered, and the stamping of the number on the prescription by the chemist would be sufficient, and no money need then be paid.
I do not know what the position will be among many of the patients of rural practitioners when they have to pay 2s. per item to the doctor who is also the dispenser. They may well become more annoyed than before when they have to pay the doctor 1s. I know that many doctors think that patients have a feeling that it is the doctor himself who is getting it.
One of the most galling things of all—perhaps this irritates doctors more than anything else—is that last night, on the Consolidated Fund Bill, Parliament voted a sum to meet the Pilkington recommendation for higher doctor's pay, and that sum is the very same as the amount to be raised by higher prescription charges. In other words, the doctors seem to be getting a rise because the patients will have to pay 2s. instead of 1s. per item. [An HON. MEMBER: "It is the other way round."] No. I think I am right. But whichever way it is, whether it arises from what happened last night or what we do tonight when we vote on the charges, the fact is that there is no con- nection. The Minister has never pretended that there was a connection between the Pilkington award and the increase in prescription charges. That is not his excuse. His excuse is that we have a wonderful hospital building programme to embark on.
The noble Lord the Member for Hertford (Lord Balniel), the son of the Premier Earl of Scotland, who knows very little about the lives of the people, in my opinion, or he would not make the speeches he does, seems to have stopped doing research for the Conservative Research Department. He has his facts all wrong. He talked about the present hospital building programme as £50 million a year. It is not. That is what it is to be in 1964–65, if we are lucky, and under this Government we are extremely unlucky in these affairs. At present, in fact, it is to be £31 million. We are told that the complete ten year hospital building programme might be £500 million. It "might be" that. Those are the words of the Minister of Health. On average, that would be £50 million a year, which is £25 million a year less than the British Medical Association proposed, substantially less than what the Labour Party proposes, and substantially less than what is needed, in fact, if we are to get within seeing distance of solving our hospital difficulties at all soon.
The fact is that what is proposed is not really to finance the hospital building programme. The programme is going up by £6 million next year, from £25 million to £31 million, yet the Treasury will take in £65 million net gain from these new charges. In other words, the Treasury will in one year make ten times what the increase is to be in the hospital building programme.
Even supposing that the argument were that we shall iron it out in time, the fact is that, in eight years, by these increases of charge, the Treasury will have accumulated over £500 million, and this is the total sum of the whole hospital building programme itself. The Government will have been saved any additional expenditure.
The interesting feature to note is that the Minister gave his news conference on the same day that he attended the Cabinet meeting to discuss these charges. Of course, his news conference was all about the window-dressing. His visit to the Cabinet meeting was to discuss the charges. The Secretary of State for Scotland, of course, is just as much involved as the Minister of Health. He does not have the same fanciful intelligence that the Minister of Health has in all the subtleties of argument we heard today. The Secretary of State is a simple man. When he spoke to the Tory women in Scotland on Saturday—those elderly matrons who are more interested in birching than in medical drugs—
I think it is the same all over. The female of the species is more dangerous, whether in England or in Scotland.
The Secretary of State told them outright, according to one Press report I have, that the Government's proposals are
entirely due to the fact that we must embark on this hospital programme.
The right hon. Gentleman knows how lamentable is the Scottish hospital programme. There is not a single Scottish Member who cannot stand up now and recite a list of the various extensions in his own constituency which have been pending for years. The fact is that none of us can say even now when these will take place.
It is not a plan that we have. There is no plan for the hospitals. There is no real £500 million plan at all. It does not exist. It is not in the Ministry of Health. The Department has not collected the facts yet. It has not sorted out the priorities. There is no plan. Yet we are being told tonight by the Secretary of State for Scotland and by the Minister of Health that they propose to raise these charges to bring in £65 million now in order to finance a programme which does not even exist. How long will the people take this sleight of hand? How long will they be misled?
Think of all the dreadful things which will happen consequent on these new prescription charges. We have seen the beginning of it. Anyone can see in any television programme on I.T.V. the amount of advertising—which, in my opinion, contravenes the Television Act—designed to encourage self-medication. It is quite deplorable. Yet we know that, if the two "bob" charge is insisted on, the spread of self-medication will become greater. When we think of the number of cases which come to us of people who have medicated themselves for far too long and present themselves in a state of illness, particularly in the case of cancer, which is beyond cure, it is no wonder that we get passionate about these things.
The B.M.A., in its radical days in 1909 and 1910, when it was really an organisation to be proud of and not the one just liberated from the hypnotic spell of the Chancellor of the Duchy of Lancaster, went to town with the drug companies and told the people of the danger of self-medication and its wicked consequences. These days people are driven to seeking their own remedies. The message of medical science is, "If you have a complaint see a doctor. Do not run to your granny or take notice of a silly advertisement which pretends that it can cure your complaint." One of the great fears of medicine is that we might frighten people away from receiving advice at an early stage of illness.
I now wish to deal with the argument that we have heard this afternoon about prescriptions. When the 1s. per item rule came in in 1956, I went to the Renfrewshire National Health Service Executive Council concerning a complaint that had been lodged about a chemist who, in all innocence, had been told by a patient, "I cannot afford 3s. for these three items. Which item can I do without?" The chemist said, "If that is the case, do not take this one". He was immediately challenged by the executive council, and quite rightly so. In my opinion, no chemist has the right to change the prescription of a doctor at any time under any circumstances unless he is first willing to contact the doctor and make sure that all is well. It is a most dangerous procedure.
There is one thing in which the pharmacy profession does not wish too be involved. This was something that I was told this afternoon. I was told that chemists do not wish to be responsible for having to determine which particular item a patient should take in preference to another. What a deplorable idea it is that chemists should be in a position to make such a decision. Yet the Minister sat there triumphantly nodding his head indicating that he was willing that chemists should make this decision. I hope that the doctors will challenge him on solid professional grounds. We have rules in medicine which have been observed for hundreds of years, and I disagree entirely with this innovation.
The right hon. Gentleman's head almost fell off in his emphasising. My hon. Friend the Member for Southall (Mr. Pargiter) challenged him. If it is the case, as HANSARD will show, that the right hon. Gentleman indicated assent to the point made by my hon. Friend, perhaps he will take an early opportunity to correct the mistake which he made this afternoon. Doctors do not like to sit at tables deciding how many medicines should be prescribed for a patient. They wish to be free to prescribe fairly and honestly what, in their judgment, is right for a patient. Long ago they used to sit on one side of the table and say, "To which class does this patient belong—to the class which can afford any kind of medicine, or to the class which can afford only a certain type of medicine?"
Nowadays, we are back even beyond Lloyd George's time. In his time, at least a stamp meant that a working man could get his medicine free. Now, that no longer applies. The working man pays for his stamp and, in addition, for his medicine. The doctor, therefore, has to decide how these charges will influence him and will change his practice in medicine.
As will soon be learned from medical organisations, the relation between doctor and patient—which the Tories prophesied would be jeopardised but which, in the opinion of many people, including the doctors, has been improved—will be affected by these charges if it is affected at all. The Conservatives are, therefore, introducing their own irritants into these affairs.
I deplore, like almost every other doctor, the introduction of the new prescription charges and these new taxes on the Service. They are regressive and, for whatever political reason they are imposed, they certainly will not receive the support of the medical profession. I hope that every doctor will lobby his Member of Parliament until such time as we can have these charges changed, even if we have to wait for a Labour Government.
In her eloquent speech, the hon. Lady the Member for Cannock (Miss Lee) said that the language of priorities was the religion of Socialism. While I certainly would not find that a very satisfying—[Interruption.] For the benefit of hon. Members opposite, I have been told to speak until ten minutes past nine. Therefore, they will not have to put up with me for more than about ten minutes.
The hon. Lady said that the language of priorities was the religion of Socialism. While I do not think that that would be an entirely satisfying religion, I certainly think that priorities in the social services are extremely important. That is precisely why I support the measures which my right hon. Friend the Minister of Health announced in the House last week and which he defended so ably this afternoon. Those measures are based, as has been generally agreed in the debate, not merely on administrative convenience but on sound political principles, and on political principles strongly felt. I share that feeling.
I realise that hon. Members opposite disagree passionately and sincerely with that principle. The right hon. Member for Belper (Mr. G. Brown), in opening the debate, was quite right in saying that there was a fundamental division between the two sides of the House on this issue. As I understand it, the party opposite believes that universal subsidies should be paid to everyone irrespective of need. It is around this point that many of the major political controversies of recent years have centred. One thinks of the arguments about food subsidies, the general housing subsidy and, indeed, the Rent Act. They all centred around this same argument.
Hon. Members opposite affect to believe, and some of them may still believe, that we on this side are hard-faced men who have done well out of the war and want to grind the faces of the poor. I assure hon. Members opposite that I care just as much for the social services as any hon. Member in this House. I would never support policies advocated by a Government which I thought were aimed at damaging those social services. I believe, however, that our social services can be made more effective and more humane when Exchequer expenditure is made selective and is concentrated either on cases of individual need or on providing those services which, by their nature, the individual cannot provide for himself. Even the Beveridge Report never intended or implied that social services should be made indiscriminate with everybody, however poor, subsidising everybody else, however rich. In the affluent society that would be the economics of the madhouse.
The approach which many hon. Members opposite have to these problems is, I believe, inspired by pre-war memories instead of post-war experience. I think, judging by discussions which I have had with people who share their views, that two pre-war memories in particular which govern their thinking are the widespread unemployment between the wars and the way in which the household means test was operated between the wars. Those conditions, fortunately, are gone, and to the people of my generation—and I would say that the people of my generation, the younger, now form about one-third of the nation and will soon form one-half—the conditions prewar are almost as remote as Victorian England. What we are concerned with is today and tomorrow.
What, I am sure, the Government are rightly doing is to move away from combating a widespread pauperism which no longer exists and is now confined to special and easily identifiable groups and towards providing proper amenities and services for a fully employed and highly paid society. My right hon. Friend's proposals, with their shift of emphasis away from current expenditure in the Health Service towards capital expenditure and away from spending money on parts of the Health Service where the individual can reasonably be expected to make some provision himself towards parts where he cannot do so, are very much to be welcomed. I hope that this tendency will be carried further, not just in the National Health Service but in the welfare services as a whole.
It is not part of my argument that we as a country should spend less on the social services. On the contrary, I hope and believe that as the years go by and as our national income increases we shall spend more and more on the social services, but I want to see that expenditure going where it is really needed, on building new hospitals, prisons—[Laughter.]—roads and all the other many things which we require. If the hon. Member over there laughs at the idea of building new prisons, I would ask him to come with me to some of the prisons which I visited in the past year and see the conditions people live in. If he does not think that that would be a valuable form of social expenditure I shall be very surprised.
I would say to hon. Members opposite that we in the Conservative Party profoundly believe in the social services. We want more money spent on them as the country can afford it, but we want to ensure that the money is spent where that money will do the most good and not on providing broadcast benefits for people many of whom do not need them and would rather make provision themselves for their own needs.
I should first like to thank the Minister for the very kind words which he used in relation to the new responsibilities which have just fallen on my shoulders. We shall, no doubt, be facing each other with some frequency in the next few weeks, but if the duel is a prolonged one, at least I look forward to it.
I should also like to add my congratulations from this side of the House to the hon. Member for Ludlow (Mr. More) on a most admirable maiden speech. He and I share the experience of hospital administration in a voluntary capacity, he on a management committee, I on a regional board, and I only hope that he will find that experience as valuable in this House as I have done.
I have found this an extremely interesting debate. I must say that I thought it was a little surprising that we did not hear from either of the right hon. Gentleman's two predecessors who are on the back benches. The right hon. and learned Gentleman the Member for Hertfordshire, East (Sir D. Walker-Smith) was here part of the time but he did not see fit to intervene. There has been singularly little attempt throughout this debate on the part of hon. Members opposite to counter the arguments of my hon. Friends.
Indeed, I think that our case has been made so cogently, first of all by my right hon. Friend the Deputy Leader of the Opposition, and later by others of my hon. Friends, that there really is very little left for me to do—very little beyond, perhaps, summarising the case and answering one or two points made by the Minister. Before doing so, I should like to deal with one matter raised by the noble Lord the Member for Hertford (Lord Balniel).
He is a good debater and usually a fair one, but he was falling a little below his form when he talked with mock indignation about the Budget of my right hon. Friend the Leader of the Opposition and about the ceiling on the Health Service without bothering to remind the House that this was essentially a temporary ceiling, that any charges that were imposed then lapsed automatically after three years, that we were in the Korean War, that we were facing vastly expanded defence costs—and that it was at a time six years and not 16 years after the Second World War.
The Minister made a very curious speech in reply to my right hon. Friend the Member for Belper (Mr. G. Brown). The first two-thirds seemed much more like a speech introducing Health Estimates than a reply to a Motion of censure. In the course of these passages, he gave us, I agree, some very interesting information, and on this I will be very glad to comment on some future occasion.
I want to say only this one thing about that part of the speech tonight, and that is to congratulate him on securing Sir John Wolfenden as chairman of the National Councils for the Training of Health Visitors and Social Workers. It is an excellent choice, although in the light of the Government's treatment of him as chairman of another body to which they appointed him I am a little surprised at his accepting this invitation.
The Minister's case for these increases in charges and contributions has one virtue: it is a simple and straightforward case. He told us last week, and again today, that the Health Estimates are continuing to rise and would have been up by 11 per cent. next year, that the Service is costing the Exchequer more than we can afford and, therefore, economies have to be found. He claims that he is faced with two alternatives. The first is that of curtailing the Service, of cutting back development—perhaps development already planned—and the second is finding more money from patients and contributors. He says that faced with these alternatives he chose the latter.
In our opinion, this dilemma which he has described is a wholly false one. As some of my hon. Friends have done, I want to challenge his basic assumptions. It is a curious thing that whenever Conservative Governments get into economic difficulties their first instinct—one might almost call it a Pavlovian reflex—is to cut the social services. In this kind of surgery—perhaps mutilation is a better word—the National Health Service is always the first one to suffer. The cry put by the Government and from the benches opposite is that the Service is costing more than the nation can afford—as if health is a thing one can afford or not at choice.
We have heard this cry before. We heard it from the present Secretary of State for the Colonies when he became Minister of Health in 1952. I think it was in the following year that he set up a Committee the main purpose of which was to investigate the Service, which had then only been going for five years, and to recommend how a rising charge to the Exchequer could be avoided. When that Committee reported, in 1956—it was, of course, the Guillebaud Committee—it told the Minister that, far from rising, the cost of the Health Service had been steadily falling in relative terms, that is, expressed as a percentage of the national income. That decline continued for one or two more years, and then steadied and flattened out and very slowly began to creep up again. The increases in recent years in the financial cost of the Service—I am not now talking about its relative cost—have been mainly due to increased wages and salaries.
We can all agree that five years ago, a little more or a little less, salaries in the Service were disgracefully low, and I am very glad that some of them have undergone improvement and that some of the anomalies vis-à -vis other comparable occupations have been recognised. Certainly wages and salaries have been responsible for most of the increases, but, even so, there is no indication of any significant rise in costs in recent years.
The Minister gave a Written Answer today bringing up to date the Guillebaud tables, the operative tables showing the percentage of the national income devoted to the Service. They confirm that even today in this so-called affluent Tory society we are not spending so much of the national income on the Health Service as we were in 1950.
What is this panic bleat about the increasing burden? By the only honest yardstick, that is, as a proportion of the national income, we are getting our Health Service more cheaply than we were ten years ago. On almost any statistical basis—and these are very complex calculations, as the Minister knows—on gross costs, net costs, Exchequer expenditure, public authority expenditure, one arrives at much the same result every time, and not one of those calculations supports the Minister's plea that the costs of the Service are getting out of hand.
My right hon. Friend the Member for Belper quoted the Treasury Bulletin for Industry, but there was one figure which he did not mention. In the last ten years, the actual net expenditure on the Health Service, that is, in money terms, has risen by about 80 per cent. but that on education in the same period has risen by 160 per cent. or rather more. That suggests that the Health Service has not been getting out of hand. The Exchequer itself has been getting off still more lightly.
The Minister suggested that the Exchequer contribution which will result from these changes will be no lower than it was under the Labour Government or at the beginning of the Service, but the Treasury has announced, I understand in an official statement, that the new changes will mean a fall in the Exchequer contribution to 71 per cent. next year which is the lowest proportion since the Service began—71 per cent. next year while in 1956 it was 83 per cent.
Those are arid, statistical calculations. Does the right hon. Gentleman never stop to consider the dividends of the Health Service? I do not mean even in terms of human happiness, but in straight economic terms, in keeping people at work and getting them back to work after they have been sick. The whole trend of successive Conservative Administrations has been to shift the financial burden of this Service progressively from the Exchequer to the patient himself, at the time of greatest need, and to the public at large on a poll tax basis.
The result of this is that the patients, who paid in all a mere £2 million or £3 million for pay-beds in 1950, will now be forking out more than £50 million in direct charges. As regards the contributor, he was paying 8½ d. per week in 1950. He is soon to pay 2s. 8½ d., an increase of nearly 300 per cent.
We can deal in more detail with contributions under the Ways and Means Resolution and the subsequent stages of the Bill. I want to say a word about the effect of these increased charges on the patient himself. First, I want to consider the prescription charge. Here, quite naturally, the heaviest burden will fall on the chronic sick. I happened to see yesterday the analysis of a random list from a London teaching hospital of regular out-patients needing prescriptions. These were regular weekly attenders. They had broken up this list into those who wanted prescriptions with one, two, three or four items. Several of these, I think it was at least five out about 50 or 60, had five item prescriptions—10s. under the right hon. Gentleman's proposals. There were many more with three or four items.
The Minister says that he will encourage doctors to prescribe for long periods, but that is not possible in many of these cases. Does he not remember when we last had the prescription charge increased, when I think it went from per form to per item, the then Minister of Health gave all sorts of promises about the packs he would arrange and about the block prescriptions, but in the end it boiled down to practically nothing? There were either technical difficulties, administrative difficulties or medical difficulties, but very little was done.
The right hon. Gentleman said today that he would arrange a pack for diabetics.
There is some kind of pack for diabetics at the moment. It has been mentioned many times. It does not cover insulin, which is what the diabetic needs most urgently. It does not cover it because of the difficulties of storage and keeping it fresh.
The fact is that one cannot effectively minimise the burden of these charges on the chronic sick. These charges have once again been roundly condemned by the medical profession, as my hon. Friend the Member for Greenock (Dr. Dickson Mabon) reminded the House. They have always been condemned by the doctors. They were described as a tax on illness. They were condemned by the Hinchliffe Committee. Indeed, I think it is only the Government who are in favour of the prescription charge, and there is no doubt that this 2s. per item will deter quite a large number of people from visiting their doctors.
The Minister brushes this aside and says that, after all, it is a charge of comparatively minor dimensions. I should like to take one hypothetical case. It is quite a common sort of case. A small child has an earache, a complaint which is often trivial and transitory. The mother is poor, not particularly intelligent, and has not heard about arrangements for hardship refund and how to get that to which she is entitled. She remembers that the last time the child had an earache she took him to the doctor and got a prescription for perhaps ear drops, an antibiotic, and a tonic—three items which will now cost 6s. The family is particularly hard up that week and so she takes a chance. The child is not taken to the surgery although, in fact, it probably has bad middle ear infection or even an incipient mastoid or something that could lead to deafness. The child goes without treatment simply because the woman has been deterrd by that charge. One may say that she is irresponsible, but the fact is that the prescription charge encourages just such irresponsibility. If we double the charge we double the encouragement. It is little better than imposing a charge for visiting the doctor—and I have no doubt that that is what many hon. Members opposite would like to see.
Unless we distribute the costs fairly the benefits of the Service will not be fairly distributed. If we compromise on one principle we shall compromise on another. It is not good enough for the Minister to fall back on the National Assistance Board arrangements, saying that in cases of hardship refunds can be obtained. I will not read again the figures that I gave him in an intervention, showing the miserably small number of special hardship cases which are refunded by the Board, but if we take the whole of its refunds we find that eleven out of twelve people have to pay their prescriptions in full. Only one person in twelve gets a refund—including those with regular weekly National Assistance payments. The system of refunds at best is a very cumbersome one. The offices of the Board may be nowhere near the chemist's, and it may involve a bus journey both ways in order to claim a refund. At best that is inconvenient because it may involve fares, and for some people it is ignominious because it involves a means test.
We can deal in greater detail with the other charges, on teeth and spectacles, in tomorrow's debate. I want to turn to the effect of those charges upon the right hon. Gentleman's estimates. He has told us that he expects to double the revenue from the doubled prescription charge, which sounds logical enough in all conscience. There will be some saving in the drug bill through people not seeking the treatment which they need, but it will be a saving at the cost of their health. But any savings which there may be under this head will be more than offset by increased over-prescribing, especially by the kindlier and more considerate doctors. They will tend to prescribe quantities for two weeks ahead instead of one. It is no good the Minister circularising general practitioners about the wickedness of over-prescribing if, at the same time, he sets up a conflict between the doctor's humane instinct and duty to protect the patient, on the one hand, and his somewhat remoter duty to the Chancellor on the other.
So the drug bill will continue to rise, and who will be happier to see half-full bottles of medicine going down the sink than the drug manufacturers? I predict that the 2s. charge will produce a far more lucurative revenue for the drug manufacturers than for the right hon. Gentleman's estimates. If he really felt compelled to make economies, why, instead of milking the patient and the contributor, did he not turn his attention with equal ruthlessness to drug prices, especially those of the American manufacturers which he knows, which the Public Accounts Committee knows, which the Press knows and which everybody knows to be grossly inflated? He has announced that he is taking some steps, and we shall wait to see how determined those steps are.
I now turn to a matter with which we can deal when we debate the prescription charges Order, but I should like to ask the Financial Secretary—since the Minister did not answer my right hon. Friend—about free drugs for private patients. Can we now have a categorical assurance that this proposal is out, indefinitely? It would be absolutely monstrous and intolerable if, in doubling the prescription charge to the ordinary poor people, any change were made in providing free drugs to private patients who can afford to buy them.
There is one item in respect of which the estimated saving of the right hon. Gentleman will be precisely achieved, namely, on the welfare foods. What he is going to do is to eliminate the entire subsidy—the indiscriminate subsidy, as he called it—which places these supplements within the reach of every mother. It means that orange juice will now cost about four times as much as before, that cod liver oil and tablets will cost 1s. a bottle and 6d. a packet. This time it is the children who will suffer. Clearly this supplement must have been a positive contribution to the health of children. Equally clearly, far fewer mothers and children who now have them will get them in future—and this to save the right hon. Gentleman a paltry £1,500,000. I say "paltry" but I must not forget the two concessions, which he announced in his statement, to nursing and expectant mothers and children of free dentures and spectacle allowances for children over ten at a total cost of £270,000, which was hardly worth mentioning in a statement which increases charges by £65 million.
The point has been made time and again about the disparity between the figures involved in the much trumpeted capital expenditure on the hospital service of £5 million a year as against £65 million a year which the Minister is clawing back from the patient public. I will not labour the point any further. But, of course, as more than one of my hon. Friends has said, the biggest increase in cost in the last year in the Health Service was the Pilkington award to doctors. How are the Government to meet this bill? By putting the burden on to the patient at his time of need. I do not think that doctors will be particularly happy to think that their increases in salary are coming from the pockets of the sick in the form of prescription charges.
We have said that these new impositions represent not only the most serious attack yet made on the National Health Service but a new and significant inroad into the whole principle of the Welfare State. It is part of the familiar Tory pattern, to the design of which the right hon. Gentleman has made a considerable contribution in the course of his political life. To me and to my right hon. and hon. Friends the whole justification of the Welfare State lies in its contributions to human happiness, something rather more than the mere elimination of avoidable misery. This idea was quite well put in an extract from a speech which I read some weeks ago and which stated:
In any given state of society and medical knowledge there is an ideal application of the available resources which will yield the greatest harvest in terms of health, well-being, comfort, reassurance—in short, of happiness. We shall never quite attain this ideal, but we ought to be tending towards it.
That brings me to the Minister himself, for it was he who uttered those brave words—so out of character—in his first major speech as Minister of Health at Llandudno last October. The words ring a little hollow today. But at the time they impressed the leader-writer of The Times newspaper sufficiently to write that
fears that the Minister would be over-zealous about finding economies do him less than justice.
Presumably that impression was shortlived because the same newspaper began its editorial last Thursday with this sentence:
That Mr. Powell should take his Ministerial axe to the Health Estimates is no surprise.
Those who were shocked and surprised should have known better. When the right hon. Gentleman, with his notorious
passion for cutting Government expenditure, was appointed to a great spending Department a mere two and a half years after those "little local difficulties," it was his axemanship that was needed. Whether he was the initiator of these cuts or merely the willing agent, he has dealt his Service a grievous blow and it is unlikely to be the last. As The Times said last Thursday:
It is worth wondering, for example, how long it will be before further increases in charges will be made on the basis of budgeting inconvenience.
The Minister, in his ten years in this House, has gathered an unusual fund of respect from both sides for his courage, his integrity and his intellectual capacity. They are all qualities which were very manifest in the speech he made in the debate on the Hola massacre last April, a speech which many who heard it—certainly I—will long remember. But there is another side to his political character. He seems to display a curiously bleak and blinkered attitude to people, as if he regards people as statistical entities and consumers of Exchequer funds. Austerity fits him like a hair shirt. His Ministerial record has been referred to in the debate, and I shall not weary the House with it any more, but it must be very convenient to a Government to have at its disposal a Minister who seeks mass unpopularity with the single-mindedness of the right hon. Gentleman.
His proposals have been almost universally condemned, which doubtless serves to convince him all the more of the rectitude of his policy. He reminds me of that other enigmatic gentleman, the Akhond of Swat, of whom Edward Lear wrote:
Does he study the needs of his own dominion
Or doesn't he care for public opinion
The Akhond of Swat?
Not caring a jot for public opinion is perhaps the only self-indulgence the Minister permits himself. No doubt when he comes to write his autobiography he will proudly entitle it, "No Love for Enoch."
These qualities have their place—of course they have—in government as elsewhere, but one is bound to ask if this particular combination of qualities is quite what is needed to administer a great human service like the National Health Service. The Observer newspaper told us last Sunday that the right hon. Gentleman knows twelve languages. There is one of which he knows nothing. It was mentioned, oddly enough, by the hon. Member for Nottingham, West (Mr. Tapsell), but it was first mentioned in one of the most memorable and moving speeches I ever heard Aneurin Bevan make—" The language of priorities". That used to be the very essence of the National Health Service as Nye Bevan and the Labour Government created it.
I wish to correct the Minister. This, incidentally, was not a Service which both sides of the House did their best to create. It was a Service which hon. Members opposite did their best to abort. These proposals are going to cause suffering and hardship—how much no one can say—suffering inflicted on people in their time of greatest need when they are ill and specially vulnerable. The more ill they are the more they will pay. The same is true of the contributions, the poorer people are the more they will pay in proportion to income.
Labour remains firmly pledged to the principle of a Health Service free to the patient. The right hon. Gentleman has taken a step which widens immeasurably the breaches already made in the basic principle that health and care in time of sickness is a right of our people. He said last week that he would have been betraying his trust had he agreed to an increase in the budgetary cost of the Service. It is because in our view he has betrayed his trust that we have tabled this Motion of censure and I ask the House to support it.
The hon. Member for St. Pancras, North (Mr. K. Robinson) has delivered an interesting speech on the subject of my right hon. Friend the Minister of Health. I should have preferred to hear him or some other hon. Member answer some of the arguments which my right hon. Friend used this afternoon. I have listened to nearly all the debate and none of my right hon. Friend's points have been met.
Before I turn to more controversial matters, I shall carry the whole House with me if I join in the congratulations to my hon. Friend the Member for Ludlow (Mr. More) on his very thoughtful and interesting speech based, as he showed us clearly, on personal experience of the hospital service.
This has been a serious and interesting debate, and there is one simple reason for that: in Britain the ordinary man in industry knows well that he need no longer feel anxious for himself or for his family if he is ill and cannot work, as so many people felt anxious years ago. We are just as glad about this as are right hon. and hon. Members opposite. Secondly, this state of affairs will in no way be altered by the charges which we are discussing on the Motion of censure. We can argue at Budget time—no doubt we shall argue a good deal when we reach it—about the distribution of the national income, but nothing can alter the fact that the 1950s in Britain were the best decade ever for the ordinary industrial workers. They were marked by a rapid increase in the standard of living, unexampled in our national history and a rapid increase in our social standards, too. It is nonsense for the Labour Party to talk as though they alone were identified with the ordinary workers in this country. That claim flies in the face of three General Elections and a great deal of evidence published since the last election.
One curious feature of the earlier debate was the very surly reception of the good news which my right hon. Friend the Minister of Health gave the House, equalled only by the extraordinary reception of the remark by my hon. Friend the Member for Nottingham, West (Mr. Tapsell) about the importance of the prison service. My right hon. Friend the Minister of Health gave the House extremely good news about the increase in the number of hospital doctors and nurses, the sharp increase in treatments and the very important news about the hospital building programme.
Right hon. and hon. Gentleman opposite asked for the details of the schemes which have been approved. Let me give them. Over 190 major schemes have already been announced for 1955–60, of which 31 have been com- pleted, 27 are in progress on the site and 140 are in various stages of planning. These include 36 new hospitals, of which 10 are partly built, 7 are building and 19 are in the course of planning. The programme also includes 7 new dental hospitals in the course of planning and building. Furthermore, on 25th January, a new list of major hospital schemes was announced, and this contains no fewer than 29 schemes, of which 6 are new hospitals and 23 are projects of development and modernisation.
The point which I wish to emphasise is that there is to be a continuous rise in the hospital building programme from: £24 million-£25 million this year to a total of £50 million by 1965–66. Hon. Members opposite say that we should have made more rapid progress earlier in the hospital building programme, but, in that case, since they believe that the language of priorities is the religion of Socialism, I must ask them what part of the public investment programme they would have put further back in the queue. Would they rather have had fewer schools or fewer roads?
I am talking here about the public sector. There has never been any dispute in the House that we must have some scheme of priorities in the public sector. I ask hon. Gentlemen opposite to what they would have accorded a lower priority if hospital building was to have had a higher priority.
I come on now to a point I was asked by the hon. Member for Southall (Mr. Pargiter), who suggested that under the general grant system there was no guarantee that local health services would receive the Exchequer proportion of relevant expenditure. I assure the hon. Gentleman that the history of the two general grant settlements with the local authority associations shows that there is no truth in that accusation. In both cases local health services have attracted the full Exchequer grant at the rate of over 50 per cent. of approved relevant expenditure, and on the last occasion the increase in the cost to local health services was considerable and attracted Exchequer grant at the same rate as other general grant services.
There is every reason to suppose that when future general grants are settled this pattern will be followed, except that by then the proportion of local health to total relevant expenditure for general grant will very likely have risen. [An HON. MEMBER: "What is the hon. Gentleman talking about?"] If the hon. Gentleman had listened he would have realised that I was answering a question asked by the hon. Member for Southall during the debate.
I propose to say now, if the House will permit, a few words on the subject of public expenditure, because one must view these charges and the proposed increase in contributions against the background of rising public expenditure as a whole. It is fully recognised on both sides of the House that, on the one hand, we must provide the public services which the community needs but, on the other hand, that if the Government pre-empt for their own public services too high a proportion of the resources we produce we shall find it difficult to find resources for other forms of economic activity which, by general understanding, are just as important and valuable to the community.
No, I will not give way. I have been interrupted a good deal in the course of my speech. I intend to say a few words on this subject now without further interruption. In 1952 public expenditure when we first took office was running at the proportion of 45½ per cent. of the gross national product. It then fell steadily to about 40 per cent. in 1957. Since 1957 the proportion of public expenditure to gross national product has been rising again. In virtually every part of the public sector today there is a strong expansion in expenditure. In the course of a decade, (he cost of education has increased from about 3 per cent. of the gross national product to over 4 per cent.
The hon. Gentleman asked about health expenditure. Those figures have already been given in this debate. Expenditure on health has increased from about 3· 4 per cent. of the gross national product in 1957 to just about 4 per cent. at the present time—[HON. MEMBERS: "What about 1950?"] In 1950 it was also 4 per cent., but education—[Interruption.]—in 1950 was a good deal lower. Obviously, if other services expand, it is extremely difficult for any particular service to maintain its proportion, and I think that the Government have nothing whatever to be ashamed of in the proportions that social expenditure has taken of the national product during the last ten years.
At the same time, no responsible Government can possibly ignore rising trends in public expenditure. As the House is very well aware, the original Estimates presented last year showed an increase of some £342 million. I can tell hon. Members that next week, when the Vote on Account is published, they will find that the Estimates for the forthcoming financial year would again have shown an increase of well over £300 million but for the steps we are now discussing.
I maintain that in those circumstancs, the action of the Government is perfectly reasonable and only responsible. After all, we are here dealing with a problem that has faced all Governments in their turn. In this debate, hon. Members have frequently shown that they do not want to be reminded of what they did in 1950 and 1951, but let us not forget that in his 1950 Budget—[HON. MEMBERS: "Korea."]—this was before the Korean War; this was in April, 1950, nearly three months before the Korean War—Sir Stafford Cripps said of the Health Service:
Any expansion in one part of the Service must in future be met by economies or. if necessary, by contraction in others."—[OFFICIAL REPORT, 18th April, 1950; Vol. 474. c. 59.]
I believe that, as my right hon. Friend said, that statement was much more damaging to the National Health Service than are the Government's present proposals.
There is another point about Government expenditure which we should remember. In the early years of the 'fifties the reduction in the defence programme was there to make room for expanding social service programmes, but if one now looks ahead and indulges in what hon. Members opposite approve of, namely, a little forward planning in the sphere of Government expenditure, one discovers no big contracting programmes. The problem of any Government must be to contain this growth of expenditure and keep it within reasonable bounds. Faced with the figures before us today, I feel that the Government have taken only a reasonable and responsible course, in view of the Estimates coming before the House, in making these increases in charges and contributions.
A further point that one should not forget is that not only in relation to hospital building but right across all Government capital expenditure we are seeing an increase. The hon. Member for St. Pancras, North (Mr. K. Robinson) said that a capital expenditure of £50 million over a period of some years seemed to him small compared with the total cost of the Service, but we should not forget the programme of increased capital expenditure in the social services as a whole. Both the education service and the Health Service depend for their progress on increased capital expenditure, and increased efficiency as well—
What I said was that an increase in the capital programme at the rate of £5 million a year was chicken feed compared with the £65 million a year saved by these proposals.
I return to the point—[HON. MEMBERS: "Answer."] I will answer the hon. Gentleman's point. The increase of £5 million a year in capital expenditure will be of infinitely greater benefit to the National Health Service than the charges we are now considering can possibly prove of damage to it, so I have no doubt whatever that we are right, in our social service policy, in giving priority to capital expenditure but not failing, when necessary, to take unpopular decisions in regard to current expenditure. Whatever may have been said in this debate, and whatever may be said in the House, I believe that there is a wide measure of agreement in the country—[An HON. MEMBER: "What country?"]—this country—on the desirability of assuring good standards for those who are poorest in the community. I believe there is no dispute that those in need should have the best possible hospital treatment. This has been one of a pattern of debates that we have at regular intervals in the House and with which we are extremely familiar. The truth is that it is not an attack on Government policy but on Government
policy as the Opposition would like it to be. When one considers the whole economic and social history of Britain in the 1950s and considers the rise in living standards and in social standards and the better distribution of incomes in the country—[HON. MEMBERS: "Oh."]—if hon. Members disagree with that let them look at the article written by their own hon. Friend the Member for Grimsby (Mr. Crosland) in this month's Encounter. He makes that point as compared with 1949. I believe it to be perfectly true.
I wanted to ask the hon. Gentleman a courteous question. The hon. Member continually referred to public expenditure. I think that he means Government expenditure. If the public spend more as a result of the prescription charges and the Government save on expenditure, how is that a saving in the national economy, public expenditure or Government expenditure? The public are likely to spend more.
|Division No. 40.]||AYES||[10.0 p.m.|
|Abse, Leo||Allaun, Frank (Salford, E.)||Bacon, Miss Alice|
|Ainsley, William||Allen, scholefield (Crewe)||Baird, John|
|Albu, Austen||Awbery, Stan||Baxter, William (Stirlingshire, W.)|
|Beaney, Alan||Hill, J. (Midlothian)||Plummer, Sir Leslie|
|Bellenger, Rt. Hon. F. J.||Hilton, A. V.||Prentice, R. E.|
|Bence, Cyril (Dunbartonshire, E.)||Holman, Percy||Price, J. T. (Westhoughton)|
|Blackburn, F.||Holt, Arthur||Probert, Arthur|
|Blyton, William||Houghton, Douglas||Proctor, W. T.|
|Boardman, H.||Howell, Charles A.||Pursey, Cmdr. Harry|
|Bowen, Roderic (Cardigan)||Hoy, James H.||Rankin, John|
|Bowles, Frank||Hughes, Cledwyn (Anglesey)||Redhead, E. C.|
|Braddock, Mrs. E. M.||Hughes, Emrys (S. Ayrshire)||Reid, William|
|Brockway, A. Fenner||Hughes, Hector (Aberdeen, N.)||Reynolds, G. W.|
|Broughton, Dr. A. D. D.||Hunter, A. E.||Roberts, Albert (Normanton)|
|Brown, Alan (Tottenham)||Hynd, H. (Accrington)||Roberts, Goronwy (Caernarvon)|
|Brown, Rt. Hon. George (Belper)||Hynd, John (Attercliffe)||Robinson, Kenneth (St. Pancras, N.)|
|Butler, Herbert (Hackney, C.)||Irvine, A. J. (Edge Hill)||Ross, William|
|Butler, Mrs. Joyce (Wood Green)||Irving, Sydney (Dartford)||Royle, Charles (Salford, West)|
|Callaghan, James||Janner, Sir Barnett||Shinwell, Rt. Hon. E.|
|Castle, Mrs. Barbara||Jay, Rt. Hon. Douglas||Short, Edward|
|Chetwynd, George||Jeger, George||Silverman, Julius (Aston)|
|Cliffe, Michael||Jenkins, Roy (Stechford)||Silverman, Sydney (Nelson)|
|Collick, Percy||Johnson, Carol (Lewisham, S.)||Skeffington, Arthur|
|Corbet, Mrs. Freda||Jones, Rt. Hn. A. Creech (Wakefield)||Slater, Mrs. Harriet (Stoke, N.)|
|Craddock, George (Bradford, S.)||Jones, Dan (Burnley)||Slater, Joseph (Sedgefield)|
|Cronin, John||Jones, Jack (Rotherham)||Small, William|
|Crosland, Anthony||Jones, J. Idwal (Wrexham)||Smith, Ellis (Stoke, S.)|
|Crossman, R. H. S.||Jones, T. W. (Merioneth)||Snow, Julian|
|Cullen, Mrs. Alice||Kelley, Richard||Sorensen, R. W.|
|Darling, George||Kenyon, Clifford||Soskice, Rt. Hon. Sir Frank|
|Davies, G. Elfed (Rhondda, E.)||Key, Rt. Hon. C. W.||Spriggs, Leslie|
|Davies, Harold (Leek)||King, Dr. Horace||Steele, Thomas|
|Davies, Ifor (Gower)||Lawson, George||Stewart, Michael (Fulham)|
|Davies, S. O. (Merthyr)||Ledger, Ron||Stonehouse, John|
|Deer, George||Lee, Frederick (Newton)||Stones, William|
|de Freitas, Geoffrey||Lee, Miss Jennie (Cannock)||Strachey, Rt. Hon. John|
|Delargy, Hugh||Lever, Harold (Cheetham)||Strauss, Rt. Hn. G. R. (Vauxhall)|
|Dempsey, James||Lever, L. M. (Ardwick)||Stross, Dr.Barnett (Stoke-on-Trent,C.)|
|Diamond, John||Lewis, Arthur (West Ham, N.)||Swain, Thomas|
|Dodds, Norman||Lipton, Marcus||Swingler, Stephen|
|Donnelly, Desmond||Loughlin, Charles||Sylvester, George|
|Driberg, Tom||Mabon, Dr. J. Dickson||Symonds, J. B.|
|Ede, Rt. Hon. C.||McCann, John||Taylor, Bernard (Mansfield)|
|Edelman, Maurice||MacColl, James||Thomas, George (Cardiff, W.)|
|Edwards, Rt. Hon. Ness (Caerphilly)||McInnes, James||Thomas, Leslie (Canterbury)|
|Edwards, Robert (Bilston)||McKay, John (Wallsend)||Thompson, Dr. Alan (Dunfermline)|
|Edwards, Walter (Stepney)||Mackie, John||Thomson, G. M. (Dundee, E.)|
|Evans, Albert||McLeavy, Frank||Thornton, Ernest|
|Fernyhough, E.||MacMillan, Malcolm (Western Isles)||Thorpe, Jeremy|
|Finch, Harold||Mallalieu, E. L. (Brigg)||Timmons, John|
|Fitch, Alan||Mallalieu, J.P.W. (Huddersfield,E.)||Tomney, Frank|
|Fletcher, Eric||Manuel, A. C.||Ungoed-Thomas, Sir Lynn|
|Foot, Dingle (Ipswich)||Mapp, Charles||Wade, Donald|
|Foot, Michael (Ebbw Vale)||Marquand, Rt. Hon. H. A.||Wainwright, Edwin|
|Forman, J. C.||Marsh, Richard||Warbey, William|
|Fraser, Thomas (Hamilton)||Mason, Roy||Watkins, Tudor|
|Galtskell, Rt. Hon. Hugh||Mayhew, Christopher||Wells, Percy (Faversham)|
|Galpern, Sir Myer||Mellish, R. J.||Wells, William (Walsall, N.)|
|George, LadyMeganLloyd (C'rm'rth'n)||Mendelson, J. J.||White, Mrs. Eirene|
|Ginsburg, David||Millan, Bruce||Whitlock, William|
|Gooch, E. G.||Milne, Edward J.||Wigg, George|
|Gordon Walker, Rt. Hon. P. C.||Mitchison, G. R.||Wilcock, Group Capt. C. A. B.|
|Gourlay, Harry||Monslow, Walter||Wilkins, W. A.|
|Greenwood, Anthony||Morris, John||Willey, Frederick|
|Grey, Charles||Mulley, Frederick||Williams, D. J. (Neath)|
|Griffiths, Rt. Hon. James (Llanelly)||Neal, Harold||Williams, Ll. (Abertillery)|
|Griffiths, W. (Exchange)||Noel-Baker,Rt.Hn.Philip (Derby, S.)||Williams, W. R. (Openshaw)|
|Gunter, Ray||Oram, A. E.||Willis, E. G. (Edinburgh, E.)|
|Hale, Leslie (Oldham, W.)||Oswald, Thomas||Wilson, Rt. Hon. Harold (Huyton)|
|Hall, Rt. Hon. Glenvil (Colne Valley)||Owen, Will||Winterbottom, R. E.|
|Hamilton, William (West Fife)||Padley, W. E.||Woodburn, Rt. Hon. A.|
|Hannan, William||Pannell, Charles (Leeds, W.)||Woof, Robert|
|Hart, Mrs. Judith||Pargiter, G. A.||Wyatt, Woodrow|
|Hayman, F. H.||Parker, John (Dagenham)||Yates, Victor (Ladywood)|
|Healey, Denis||Parkin, B. T. (Paddington, N.)||Zilliacus, K.|
|Henderson, Rt.Hn.Arthur (Rwly Regis)||Pavitt, Laurence||TELLERS FOR THE AYES:|
|Herbison, Miss Margaret||Pearson, Arthur (Pontypridd)||Mr. Bowden and Mr. Rogers.|
|Hewitson, Capt. M.||Peart, Frederick|
|Agnew, Sir Peter||Barlow, Sir John||Berkeley, Humphry|
|Allan, Robert (Paddington, S.)||Barter, John||Bevins, Rt. Hon. Reginald (Toxteth)|
|Amery, Rt. Hon. Julian (Preston, N.)||Batsford, Brian||Bidgood, John C.|
|Arbuthnot, John||Baxter, Sir Beverley (Southgate)||Biggs-Davison, John|
|Ashton, Sir Hubert||Beamish, Col. Sir Tufton||Bingham, R. M.|
|Atkins, Humphrey||Bell, Ronald||Birch, Rt. Hon. Nigel|
|Balniel, Lord||Bennett, F. M. (Torquay)||Bishop, F. P.|
|Barber. Anthony||Bennett, Dr. Reginald (Cos & Fhm)||Black, Sir Cyril|
|Bossom, Clive||Grosvenor, Lt.-Col. R. G.||Maitland, Sir John|
|Bourne-Arton, A.||Gurden, Harold||Manningham-Buller, Rt. Hn. Sir R.|
|Box, Donald||Hall, John (Wycombe)||Markham, Major Sir Frank|
|Boyd-Carpenter, Rt. Hon. John||Hamilton, Michael (Wellingborough)||Marlowe, Anthony|
|Boyle, Sir Edward||Hare, Rt. Hon. John||Marples, Rt. Hon. Ernest|
|Braine, Bernard||Harris, Frederic (Croydon, N.W.)||Marshall, Douglas|
|Brewis, John||Harris, Reader (Heston)||Marten, Neil|
|Bromley-Davenport,Lt.-Col.SirWalter||Harrison, Brian (Maldon)||Mathew, Robert (Honiton)|
|Brooke, Rt. Hon, Henry||Harvey, Sir Arthur Vere (Macclesf'd)||Matthews, Gordon (Meriden)|
|Brooman-White, R.||Harvey, John (Walthamstow, E.)||Maudling, Rt. Hon. Reginald|
|Browne, Percy (Torrington)||Harvie Anderson, Miss||Mawby, Ray|
|Bryan, Paul||Hastings, Stephen||Maxwell-Hyslop, R. J.|
|Bullard, Denys||Hay, John||Maydon, Lt.-Cmdr. S. L. C.|
|Bullus, Wing Commander Eric||Heald, Rt. Hon. Sir Lionel||Mills, Stratton|
|Burden, F. A.||Heath, Rt. Hon. Edward||Montgomery, Fergus|
|Butcher, Sir Herbert||Henderson, John (Cathcart)||More, Jasper (Ludlow)|
|Butler,Rt.Hn.R.A. (Saffron Walden)||Henderson-Stewart, Sir James||Mott-Radclyffe, Sir Charles|
|Campbell, Sir David (Belfast, S.)||Hendry, Forbes||Nabarro, Gerald|
|Campbell, Gordon (Moray & Nairn)||Hicks Beach, Maj, W.||Neave, Airey|
|Carr, Compton (Barons Court)||Hiley, Joseph||Nicholls, Sir Harmar|
|Channon, H. P. G.||Hill, Dr. Rt. Hon. Charles (Luton)||Nicholson, Sir Godfrey|
|Chataway, Christopher||Hill, Mrs. Eveline (Wythenshawe)||Noble, Michael|
|Chichester-Clark, R.||Hill, J. E. B. (S. Norfolk)||Nugent, Sir Richard|
|Clark, Henry (Antrim, N.)||Hinchingbrooke, Viscount||Oakshott, Sir Hendrie|
|Clark, William (Nottingham, S.)||Hirst, Geoffrey||Ormsby Gore, Rt. Hon. D.|
|Clarke, Brig. Terence (Portsmth, W.)||Hobson, John||Orr-Ewing, C. Ian|
|Cleaver, Leonard||Hocking, Philip N.||Osborn, John (Hallam)|
|Cole, Norman||Holland, Philip||Osborne, Cyril (Louth)|
|Cooper, A. E.||Hollingworth, John||Page, John (Harrow, West)|
|Cordeaux, Lt.-Col. J. K.||Hope, Rt. Hon. Lord John||Pannell, Norman (Kirkdale)|
|Cordle, John||Hopkins, Alan||Partridge, E.|
|Corfield, F. V.||Hornby, R. P.||Pearson, Frank (Clitheroe)|
|Costain, A. P.||Hornsby-Smith, Rt. Hon. Patricia||Peel, John|
|Coulson, J. M.||Howard, Hon. G. R. (St. Ives)||Percival, Ian|
|Courtney, Cdr. Anthony||Howard, John (Southampton, Test)||Peyton, John|
|Craddock, Sir Beresford||Hughes Hallett, Vice-Admiral John||Pickthorn, Sir Kenneth|
|Critchley, Julian||Hughes-Young, Michael||Pike, Miss Mervyn|
|Crosthwaite-Eyre, Col. O. E.||Hurd, Sir Anthony||Pilkington, Sir Richard|
|Crowder, F. P.||Hutchison, Michael Clark||Pitman, I. J.|
|Cunningham, Knox||Iremonger, T. L.||Pitt, Miss Edith|
|Curran, Charles||Irvine, Bryant Godman (Rye)||Pott, Percivall|
|Currie, G. B. H.||Jackson, John||Powell, Rt. Hon. J. Enoch|
|Dalkeith, Earl of||James, David||Price, David (Eastleigh)|
|Dance, James||Jenkins, Robert (Dulwich)||Price, H. A. (Lewisham, W.)|
|d'Avigdor-Goldsmid, Sir Henry||Jennings, J. C.||Prior, J. M. L.|
|Deedes, W. F.||Johnson, Dr. Donald (Carlisle)||Prior-Palmer, Brig. Sir Otho|
|de Ferranti, Basil||Johnson, Eric (Blackley)||Profumo, Rt. Hon. John|
|Digby, Simon Wingfield||Johnson Smith, Geoffrey||Proudfoot, Wilfred|
|Donaldson, Cmdr. C. E. M.||Jones, Rt. Hn. Aubrey (Hall Green)||Quennell, Miss J. M.|
|Doughty, Charles||Joseph, Sir Keith||Ramsden, James|
|Drayson, G. B.||Kaberry, Sir Donald||Rawlinson, Peter|
|du Cann, Edward||Kerby, Capt. Henry||Redmayne, Rt. Hon. Martin|
|Duncan, Sir James||Kerr, Sir Hamilton||Rees, Hugh|
|Duthie, Sir William||Kershaw, Anthony||Rees-Davies, W. R.|
|Eden, John||Kimball, Marcus||Renton, David|
|Elliot, Capt. Walter (Carshalton)||Kirk, Peter||Ridley, Hon. Nicholas|
|Elliott,R.W. (N'wc'stle-upon-Tyne,N.)||Kitson, Timothy||Ridsdale, Julian|
|Emery, Peter||Lagden, Godfrey||Rippon, Geoffrey|
|Emmet, Hon. Mrs. Evelyn||Lambton, Viscount||Roberts, Sir peter (Heeley)|
|Errington, Sir Eric||Lancaster, Col. C. G.||Robertson, Sir David|
|Erroll, Rt. Hon. F. J.||Langford-Holt, J.||Robson Brown, Sir William|
|Farey-Jones, F. W.||Leather, E. H. C.||Roots, William|
|Farr, John||Leavey, J. A.||Ropner, Col. Sir Leonard|
|Fell, Anthony||Lewis, Kenneth (Rutland)||Royle, Anthony (Richmond, Surrey)|
|Finlay, Graeme||Lilley, F. J. P.||Sandys, Rt. Hon. Duncan|
|Fisher, Nigel||Lindsay, Martin||Scott-Hopkins, James|
|Fletcher-Cooke, Charles||Linstead, Sir Hugh||Sharples, Richard|
|Foster, John||Litchfield, Capt. John||Shaw, M.|
|Fraser, Ian (Plymouth, Sutton)||Lloyd. Rt. Hon. Selwyn (Wirral)||Shepherd, William|
|Freeth, Denzil||Longbottom, Charles||Simon, Rt. Hon. Sir Jocelyn|
|Galbraith, Hon. T. G. D.||Longden, Gilbert||Skeet, T. H. H.|
|Gardner, Edward||Loveys, Walter H.||Smithers, Peter|
|George, J. C. (Pollok)||Low, Rt. Hon. Sir Toby||Smyth, Brig, Sir John (Norwood)|
|Gibson-Watt, David||Lucas-Tooth, Sir Hugh||Soames, Rt. Hon. Christopher|
|Glover, Sir Douglas||McAdden, Stephen||Spearman, Sir Alexander|
|Glyn, Dr. Alan (Clapham)||MacArthur, Ian||Speir, Rupert|
|Glyn, Sir Richard (Dorset, N.)||McLaren, Martin||Stanley, Hon. Richard|
|Godber, J. B.||McLaughlin, Mrs. Patricia||Stevens, Geoffrey|
|Goodhart, Philip||Maclay, Rt. Hon. John||Steward, Harold (Stockport, S.)|
|Goodhew, Victor||Maclean,SirFitzroy (Bute&N.Ayrs.)||Stodart, J. A.|
|Gower, Raymond||Macleod, Rt. Hn. lain (Enfield, W.)||Stoddart-Scott, Col. Sir Malcolm|
|Grant, Rt. Hon. William||MacLeod, John (Ross & Cromarty)||Studholme, Sir Henry|
|Grant-Ferris, Wg Cdr. R.||McMaster, Stanley R.||Summers, Sir Spencer (Aylesbury)|
|Green, Alan||Macmillan,Rt.Hn.Harold (Bromley)||Sumner, Donald (Orpington)|
|Gresham Cooke, R,||Macmillan, Maurice (Halifax)||Talbot, John E.|
|Grimston, Sir Robert||Macpherson, Niall (Dumfries)||Tapsell, Peter|
|Taylor, sir Charles (Eastbourne)||Vane, W. M. F.||Williams, Dudley (Exeter)|
|Taylor, Edwin (Bolton, E.)||Vaughan-Morgan, Sir John||Williams, Paul (Sunderland, S.)|
|Taylor, W. J. (Bradford, N.)||Vickers, Miss Joan||Wills, Sir Gerald (Bridgwater)|
|Teeling, William||Vosper, Rt. Hon. Dennis||Wilson, Geoffrey (Truro)|
|Temple, John M.||Wakefield, Sir Wavell (St. M'lebone)||Wise, A. R.|
|Thatcher, Mrs. Margare'||Walker-Smith, Rt. Hon Sir Derek||Wolrige-Gordon, Patriok|
|Thomas, Peter (Conway)||Wall, Patrick||Woodhouse, C. M.|
|Thompson, Richard (Croydon, S.)||Ward, Dame Irene||Woodnutt, Mark|
|Thornton-Kemsley, Sir Colin||Watkinson, Rt. Hon. Harold||Woollam, John|
|Tiley, Arthur (Bradford, W.)||Watts, James||Worsley, Marcus|
|Tilney, John (Wavertree)||Webster, David||TELLERS FOR THE NOES:|
|Turner, Colin||Wells, John (Maidstone)||Mr. Edward Wakefield and|
|Tweedsmuir, Lady||Whitelaw, William||Colonel J. H. Harrison.|
|van Straubenzee, W. R.|