Orders of the Day — National Health Service Contributions Bill

Part of the debate – in the House of Commons at 12:00 am on 15th February 1961.

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Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Willesden West 12:00 am, 15th February 1961

I follow the speeches of my hon. Friends with a good deal of diffidence for, with their differing personalities, they have presented such a complete case. We have heard three speeches which were an absolute and complete antithesis of the speech of the Financial Secretary to the Treasury. He was trying to blur over the edges and to say that there was no difference between the two sides of the House, and that we differ in degree, but not in principle. But what has happened in the debate is that the gap between the order lines, has become a huge chasm, to show quite clearly vast and fundamental differences of approach, thought and philosophy about this Bill.

We have before us one of a series of Measures designed to make vital and fundamental changes in the basis of our Health Service. I loathe and detest the lot. I am rising tonight to speak on one section of those Measures and to protest against this poll tax of 1s.—10d. for the worker—that is to be imposed.

My hon. Friends have said that it is fair that this debate should be piloted by the Treasury. This is the dead hand of the Treasury at work, and, like many of my hon. Friends, I deplore the fact that the Minister of Health, instead of fighting for his Department, seems only too willing to fall in with the idea of this imposition of £ 50 million falling mainly on working people.

Perhaps some hon. Gentlemen have been surprised at the strength of feeling on this side of the House. They would be even more surprised if they knew the strength of feeling in the country on this issue. Last Thursday, in the middle of our debate. I received a green card and then met some of my constituents with 200 signatures from workers in my area protesting against this poll tax. I understand that more are to be presented to me tomorrow.

Workers in industry are concerned about this attack on what the Financial Secretary so rightly called fringe benefits. Once one starts to impose a weekly contribution, it has an immediate effect on the pay packets of the workers and they naturally feel extremely aggrieved. There has been a complete lack of understanding by hon. Gentlemen of the way in which the ordinary worker views this kind of thing. There is nobody who is more generous than the man in the workshop. If somebody suffers some misfortune, the hat goes round within five minutes. If somebody leaves, someone goes round with a list for subscriptions. But in the midst of an affluent society the Government have come round with the begging bowl for 10d. a week, and the workers naturally resent this. Most of my hon. Friends have already expressed some measure of that resentment. There is a vital difference of principle between the two sides of the House.

The Government are trying to raise £ 50 million. One of the reasons given for raising that money is that for the first time in history a Conservative Minister has been converted to the principle of planning. He wants to institute planning in one-third of the Health Service. His hospital planning capital programme will cost an extra £ 5 million a year for the next ten years. By the Bill he will raise £ 50 million in the first year. That is enough to cover the total sum required. Will he make sure that next year some is remitted? Will he rescind this poll tax? I rather suspect that once the charge is imposed there will be only one direction in which it will move—upwards, and ever upwards.

During the speech of my hon. Friend the Member for Blackburn (Mrs. Castle), one hon. Gentleman raised a point about the incidence of this tax on different sections of the community. May I look at it from the point of view of one section of the community—the general practitioners—and consider it in relation to their incomes? Under the Bill they fall into the category of self-employed persons. They will pay seven guineas a year, which is more or less equivalent to what they pay to the British Medical Association by way of subscriptions.

It has been said that the average income in industry is £ 14 10s., but in fact the average wage is about £ 10 or £ 11, as my hon. Friend the Member for Stoke on Trent, South (Mr. Ellis Smith) pointed out. The worker has to find a sum of £ 2 3s. 4d. annually from it.

What does the general practitioner pay it from? Before the Pilkington award, the average general practitioner had a net income of £ 2,485, and the Pilkington award raises that. His gross income is about £ 3,700 or £ 3,800, because the difference between his net and gross pays for his car, for his gardener, if he wants some flowers in his waiting room, for part of his laundry—the white coat he wears—and so on. There is a vast difference in the way this poll tax falls on the one section of the community and on the other. I should be the last to belittle or deride the work of the general practitioner. I do not for a moment suggest that he does not earn every penny he receives, but why should there be this discrepancy between the man earning £ 50 a week and the man earning £ 10 a week?

Hon. Members opposite have talked a good deal about the need to extend the hospital part of the Health Service. I was interested to see the recent figures of the amount spent in the last three years. I put a Question to the Minister about it. We find that we are under-spending on our Estimates. The figures for 1958, 1959 and 1960 show that expenditure was £ 17 million, £ 19 million and £ 20 million, and yet we have heard a lot from hon. Gentlemen on the other side about £ 50 million a year for hospital planning.

I submit that the amount is out of all proportion to the tasks in hand. The Bill is being introduced not because there is an urgent or sudden need for Health Service expenditure to be reduced or for contributions to be raised. It is an ideological approach. Why is it that, when the Government or the Treasury look round for some money, the first thing that they do is to attack the Health Service?

Hon. Members opposite have spoken of their philosophy in looking forward to a society of sturdy independence. It is notable that Tory philosophy always seems to relate itself to some kind of cash nexus, and they believe for some reason or other that it makes a man far more sturdy if he has to pay an extra 1s. as a poll tax contribution. The sturdy independence falls heavily on the old. The old-age pensioners have to be sturdily independent through the whole winter while their promised extra 7s. 6d. comes just before the municipal elections next month.

I join with hon. Members opposite who urge that we should explain to our constituents that the old and people who are in need can recover expenses under the National Health Service by going to the National Assistance Board. But the pride of ordinary people on the borderline is sufficient to deter them. This is a poll tax which will lead to continual discontent. There will be a continuous campaign in industry and in areas like my own where there are many factories. I am already being subjected to a barrage of letters about it.

The hon. Member for Cheadle (Mr. Shepherd) said that, in spite of what they were doing, the Tories had a social philosophy and they did care. What it all boiled down to was that, if someone was absolutely dropping at the wayside, they, rather like the squire giving out jelly to the poor man at the gate, would step in to help. That is the approach.

When, however, as my hon. Friend the Member for Blackburn said, it comes to taking the attitude that when people in the community are suffering, are in distress, have any anxiety or are sick, those who are well should be prepared to contribute, it seems that hon. Members opposite have no perception of anything of this kind. They look forward to a grand free-for-all, to the law of the jungle, with the idea that those at the bottom end of the scale may receive charity to save them from the worst consequences of the policies that are put forward.

Throughout the debate, a great deal has been said about the inception of the Service. What a glorious adventure it was. We started out into the unknown only three years after the war without any knowledge of the results that would accrue from it and after the bitter opposition of the British Medical Association, led by its then secretary. We reached the situation when we faced the costs based on the Spens Report, which looked back to find what were the doctors' earnings in 1939. We were having a big flow-back from the Armed Forces. The whole economic situation was in a gigantic state of flux.

It was during that period that the foundation was laid for this marvellous Service. During that period, we were able to go forward with this great Service in spite of all the difficulties. The hon. Member for Cheadle gave us his concept of the health services in Mexico and France. I assure him that our Health Service, for which these increased contributions are now being asked, is second to none in the whole world,

The hon. Member for Carlisle (Dr. D. Johnson) sought to lead us into pastures new by comparing the National Health Service with the Australian and New Zealand services. The only assumption I can make is that he will oppose the Bill, because he prefers those systems. From my knowledge of the services in those countries and of general practitioners I have met who have worked there, I assure the hon. Member that no G.P. who has worked under our Health Service and under the Australian service has any doubt where the consideration for the patient is highest and where a doctor is able to give the greatest quality of clinical service and do what he calls "good medicine."

I was surprised that the hon. Member for Carlisle somehow sought to get in a side swipe at teen-agers. The teen-agers in industry will be asked, irrespective of age, to contribute according to the scale specified in the First Schedule to the Bill. They will pay their contribution as much as anybody else. The hon. Member was less than fair to these youngsters, who have an important part to play in the community.

I have said that the Minister of Health is a late convert to planning. I have been conscious of this, because in my constituency I have an important bastion of the Federation of British Industries. One powerful gentleman, Sir Hugh Beaver, who was chairman of Guinness's in my area, has recently come out strongly in favour of planning. If this form continues, I suspect that in the same way as throughout this debate hon. Members opposite have almost claimed credit for introducing a service to which they were opposed tooth and nail, in five years' time Harold Wilson's four-year plan will be claimed as a Tory invention.

To ascertain how much hon. Members on the Government appreciate the Health Service, I have looked through the record and find that since 1951 they have had 52 commissions, working parties and reports. It will surprise hon. Members to know how many times the House has condescended to discuss these reports. Since 1951, apart from Adjournment debates, there have been only sixteen debates in the House on the National Health Service, the service which hon. Members opposite claim they are anxious to sustain and improve. We have had four Supply, six Supplementary Estimate and six Ways and Means debates on the Health Service since 1951.

Is this the kind of record that gives us confidence that the Minister will only do this temporarily in order to build greater and better things? As has been demonstrated from the Front Bench opposite, this Bill has nothing to do with health or the Health Service. It is a sheer Treasury manoeuvre and a means of taxation. A good deal of the debate has concerned itself with that problem.

I remind the Financial Secretary when he gives us enormous figures and tries to frighten us with noughts that we are all grown men. That remark is not original. I take it from Professor Jewkes who made it when a Treasury official was trying to tell the Royal Commission on the Remuneration of Doctors and Dentists how we should have an economic crisis if the doctors and dentists pressed their claim. Professor Jewkes put matters in perspective, just as my hon. Friend the Member for Stoke-on-Trent, Central, did tonight with the national figures which he quoted.

We on this side of the House see this matter in perspective. We say that if it is worthwhile increasing our production and making it such that it will compete with that of the Continent and if it is worthwhile making sure that people are kept at work, it is worth having a National Health Service which is worthy of that intention. I submit that the Financial Secretary in his speech was pleading for some kind of redeployment. He said that because we were attempting to give children in rural areas the right kind of schools which would bring them up to the standards already available in towns, this should be paid for in some way by means of this Bill. I could not follow that argument.

In 1951, one of the first things done by the Tory Government was to issue Circular 301, which cut the school building programme. We see a constant erosion of the social services by Tory Governments. We feel this matter deeply. We are not exaggerating the present attack. We realise that a considerable amount of the Health Service structure will still remain, but we fear that the rats are gnawing at its foundations.