Dear Mr. Manuel,
I enclose a copy of a letter which the County Council have sent to the Secretary of State protesting at the effect of the new prices of welfare foods have had on the uptake of the foods in the County Council's area, as illustrated by the figures contained in the letter. The County Council have also agreed to refer this matter to the Association of County Councils in Scotland asking that the Association take the matter up with the Secretary of State.
We have clear proof that the county council is concerned. From the Questions which have been asked by many of my hon. Friends we have proof that this decrease in consumption is not confined to Ayrshire but is apparent throughout England and Scotland. The figure in England is about 75 per cent. and in Scotland about 80 per cent.
Arising from my Question on 31st January, the Joint Under-Secretary said that he was neither worried, shocked nor ashamed about the decrease. The hon. Gentleman will not be allowed to forget those words. I hope that he has had a change of heart from that flint-like, unthinking attitude. His hon. Friend the Parliamentary Secretary to the Ministry of Health does not take that view. In fact, she has given a pledge that these prices would be reviewed if there were an appreciable decrease. In a debate on these price increases, my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) said:
The hon. Lady has paid a tribute to the value of these welfare foods. She says that the Government intend that the distribution shall continue at the present level. If we are right and the Government are wrong and the take-up falls, will the Government reintroduce the free service?
The hon. Lady replied:
I do not expect to see any change. If in fact there were such a change one would certainly wish to consider it, but I shall be very surprised indeed if there is any."—[OFFICIAL REPORT. 19th April, 1961; Vol. 638, c. 1339.]
The Government are naturally concerned about the decrease. They wanted to unhold the opinion of the hon. Lady the Parliamentary Secretary. They have been conducting a great publicity campaign throughout the country by articles in women's journals, in the Press generally, in Ministry of Labour offices and on the B.B.C. and I.T.V. Despite the fact that that has been going on since 1st June, the decrease has continued and the downward trend is now unmistakable.
I quote from HANSARD of the debate on 19th April, 1961. With reference to the publicity the Government are trying to put over to the country, the Parliamentary Secretary said:
One other way in which we intend to press for concentration on the hard core is education to encourage mothers to take advantage of these foods. In this connection the National Health Service leaflet on maternity
care is being revised. This leaflet is sent by National Insurance offices to all expectant mothers, along with milk tokens It is also available in maternity and child welfare clinics. It is available to general practitioners and to hospitals in their maternity and children's departments. The revised leaflet will not be sent out until June, but early next month a special one-page leaflet on the changes and the values of the food and on the National Assistance Board arrangements will be issued with the existing leaflet and widely distributed to those people who already have the present leaflet. We propose also to enlist the aid of the women's journals and the Press, the B.B.C. and the I.T.A. Our public relations division will give information on the changes and on the supplies available."—[OFFICIAL REPORT, 19th April, 1961 Vol. 638, c. 1338.]
All that is going on. Every publicity media they could gather to their aid has been asked to propagate the value of these foods, yet still we have this very steep decrease in consumption. I quote from an editorial on this matter which appeared in the Guardian on 27th December, 1961. It said:
The Minister of Health in one of his Parliamentary replies on this issue"—
That is the welfare foods—
said there were many ways in which the nutrition of the population could be watched. No doubt, but almost all improvements and deteriorations in public health are the result of barely perceptible changes taking place over a long period and a miscalculation on the scale of Miss Pitt's does not inspire confidence in the Government's sensitivity to these changes and its willingness to act upon them. At least the £1·5 million a year saved by the abolition of the welfare food subsidies should enable the Ministry to concentrate research and assistance on those families whose children are known to be poorly nourished.
This is all to save £1·5 million. Having made the cut, the Government are trying to recover the position. In view of the ministerial promise when the question of these foods was debated, that if in the unlikely event of a falling off in demand the matter would be reconsidered, can we now have a promise from the Government Front Bench that the promise will be honoured? This matter of the health of our children and of nursing mothers is of far too great moment—it includes handicapped children—to brook any delay in waiting until the facts are clearly demonstrated by illness and disease occurring in these sections of the population.
This is indeed a strange and regrettable contrast. Yesterday we discussed the effect of subsidies amounting to £344 million. Tonight we are considering the consequences of the withdrawal of a subsidy of just over £1 million. Yesterday a supporter of what was being done by the Government, claiming the importance of agriculture, said that it amounted to one penny per meal for every member of the population. If that is true, what we are considering is the effect of a saving of one three hundred and forty-fourth part of a penny per meal.
It is incontrovertible that there has been a fall in the uptake of these foods since 1st June last when the Government started to make this saving. From 23,000 bottles of orange juice in the twelve weeks from 4th July, 1960, it has fallen in Ayrshire—I take these facts from figures supplied by the Government—to just over 5,000 in the twelve weeks from 4th September, 1961. The take-up of cod liver oil has fallen from nearly 4,000 bottles to just over 1,000 bottles for the same period.
The fall is not controvertible. The value of the foods and the service being given are equally incontrovertible. In many cases it cannot be replaced. What we are discussing tonight—cod liver oil, orange juice, and vitamin tablets—are irreplaceable for expectant and nursing mothers, babies under 2 and children under school age, and handicapped children.
The Ministry issued a leaflet containing the heading,
Why you should buy vitamin supplements",
which states that orange juice, which is concentrated vitamin C, cannot be obtained in any other way. It has a very high content of vitamin C.
A bottle contains about as much vitamin C as seven average oranges and costs much less…orange drinks at present sold in the shops contain little vitamin C and are therefore not an adequate substitute.
This is the point. It is said that people can get this from oranges, green vegetables and potatoes, but can children under 2 have a diet like that? This is the proper way to give this vital vitamin to babies. If it is not being taken up, the babies are suffering. This is the point the Government must face.
Vitamins A and D, which are concentrated in cod liver oil, help the growth of the child and its resistance to diseases
of the ear, throat and chest. My hon. Friend the Member for Central Ayrshire is right. In the face of these facts, it is incredible that the Under-Secretary should say:
I am neither worried, shocked nor ashamed…"[OFFICIAL REPORT, 31st January, 1962; Vol. 652, c. 1080.]
I intend to read on. I do not think that this is hard or cruel. I think it is utterly silly. It is a tragedy that we should have in the Scottish Office Ministers who are prepared to make such statements. The hon. Gentleman went on to say that there was no evidence that health was affected. Of course there is no evidence that the health is affected, but when will this tell on the children—not tomorrow, not next year. It will tell in their eventual inabilty to resist disease. Is it worth doing this in order to save £1½ million?
I sincerely hope that the Under-Secretary will redeem himself tonight, and will ensure that immediate steps are taken to provide these things free, as they were, or at a reduced rate, because—let us face it—if we are here seeing the loss of the mothers' habit of going to the clinics to take up these foods we can before long say "goodbye" to an increase in the take-up, in spite of all the advertisements. The Government did a terrible thing, there was no justification for it, and I think that their meanness will be paid for very dearly in the future health of our people in Scotland.
I ask the Minister to take a different view from that which he expressed the other day at Question Time. As one who represents him in the House, and as a citizen of Ayrshire, I ask him to think of the effects of this particularly mean little act of economy on the people amongst whom he lives. It has been said that he will reply that there are not likely to be any ill-effects. How does he know? Can he brush aside the opinion of the medical officer of health of Ayrshire and the opinion of the health committee there? I served for many years on the health committee of the Ayrshire County Council, and I know that its members take their duties very seriously. They are concerned, as is the hon. Gentleman, and as the Government are concerned, to curtail any unnecessary public expenditure, but they believe that this is a necessary public expenditure and wish the Minister to change his view of it.
This is something which bears very heavily on the people with the lowest incomes. A very large number of people in our villages have very low incomes indeed. At the same time, they are having to pay extra rent, and the housewives have to work on a very low margin. The medical officer of health and the health committee of the Ayrshire County Council would not have taken the trouble to have urged hon. Members representing Ayrshire divisions to raise this subject had they not first given it very serious consideration, and had they not believed that to do so was in the interests of the people they represent. I urge the Minister to give a more sympathetic reply this evening than the one he gave at Question Time the other day.
When the hon. Member for Central Ayrshire (Mr. Manuel) raised this matter at Question Time almost a fortnight ago we had some rather heated exchanges. That was, perhaps, inevitable, because the subject of these welfare food vitamin supplements is one about which there is a lot of feeling. I hope, however, to be able to show tonight that that feeling is misplaced and comes from what is perhaps a misunderstanding of what the Government are trying to do. For that reason, I welcome the debate, and I hope that in clearing up various misunderstandings it may serve a useful purpose, not only in this House but in the country.
To get the matter into proper perspective it is necessary to go back some way and to consider when this scheme for the provision of orange juice, cod-liver oil and vitamin A and D tablets began, and why it was introduced. As the House probably knows, the scheme was started early in the war when there was rationing and a shortage of foods containing these vitamins. The object of the scheme was to protect the health of expectant mothers, nursing mothers and young children by making available in concentrated form the vitamins which they needed and were otherwise difficult to obtain.
One interesting feature about the scheme which may have been forgotten by hon. Gentlemen opposite is that it was not at that time free. A bottle of orange juice cost 5d. while a bottle of cod-liver oil cost 10d.—much dearer in real terms than the present prices; packets of vitamins A and D, which cost 10d. each, were much dearer in real terms than the present price of 6d. a packet. So until July, 1946—when the party opposite made cod-liver oil and vitamin tablets available free of charge—we had in operation an orange juice, cod-liver oil and vitamins scheme at costs not out of line, taking into account the fall in the value of money, with those that obtain today. In view of all that has been said about costs this is an important point to remember.
I turn now—because this is a point on which there is considerable misunderstanding—to the health aspect and the contribution which welfare vitamin supplements have made to nutrition. The interesting thing is that the consumption of these supplements in peacetime has always been about one-third of the entitlement. That is to say, two-thirds have not been taken up. This is true even of the immediate post-war years when supplies of other sources of vitamins were much scarcer than they are today. What happened since then is that other sources of vitamins gradually became more plentiful, families became better off and the consumption of welfare foods fell even below the normal low level. In Scotland, in the last six months of 1960, the take-up of orange juice was just over 29 per cent., of vitamins A and D about 19 per cent. and of cod-liver oil about 9 per cent. The figures for Ayrshire—with which all the hon. Gentlemen who have spoken have been concerned—show that in the same period a somewhat similar trend to that of the rest of Scotland prevailed there. About 30 per cent. took their orange juice, 18 per cent. took vitamins A and D and 10 per cent. took their cod-liver oil.
It may be argued that although only a minority took these welfare foods, the food was going to those who needed it the most.
But hon. Gentlemen opposite do not seem to appreciate that surveys which have been carried out show that the consumption of welfare foods was the lowest among the social classes four and five. They are the very people who, it might be thought, would need these welfare foods the most. Yet they were, in fact, taking them the least. These facts show plainly that the beneficiaries have not had to rely on welfare foods alone as their source of vitamins. A great many people, particularly among those who are worst off, have relied instead on natural foods and, perhaps, also on the various proprietary preparations that are available in the shops and sometimes at clinics.
Throughout the period 1950–1960, when only about one-third of the welfare food vitamins available were being taken up—and when the poorer classes were taking up even less than this—what was happening to the health of the mothers and young children? This is the crucial aspect of this question, because the actual consumption does not really matter. What matters is the health of those for whom the vitamins are being made available. I am glad to be able to say that the story of health is very good indeed. In Scotland, the infant mortality rate per 1,000 live births, which was only 38·6 in 1950 had dropped to 26·4 in 1960. The maternal mortality rate per 10,000 births fell from 10 to 3 in the same period. Meanwhile scurvy and rickets had become very rare diseases.
Nevertheless, this is an encouraging picture. The point which I want to stress is that this improvement has been achieved despite the small up-take of these welfare foods.
Reference has been made to the remarks of my hon. Friend. The best answer I can give is to refer the House to what the Minister of Health said when he was asked about the same point. He then said that the problem was one of individual and particular families and that it did not require a general subsidy. That is the view of the Government, and it has been borne out by our experience.
The House will be aware that the Cohen Committee was concerned with the supply of welfare vitamin supplement for those people who had an inadequate diet. Let us consider how far our new scheme meets this requirement. The basic plank of the scheme is that those worst off—that is, those at or about the National Assistance level—will continue to get free of charge what they need. Up to date there have been some encouraging results. From mid-June to mid-September, 1961, free issues of orange juice were over 38,000, compared with a figure of less than 7,000 for the same period in 1960. This is not due to the fact that more people were receiving National Assistance; in fact, it is the other way round. There are fewer people on National Assistance now than there were in the period immediately preceding the change in prices. The reasons for the increase in up-take seem to be partly the simplified procedure and partly the good publicity given about the availability of these foods for those living at or about the National Assistance level.
For those above it, vitamin foods are available more cheaply than they are available elsewhere. To take an extreme example, the case of an expectant mother with three children under five years, it will cost only about 2s. 6d. a week for her to buy all the vitamin supplement to which she is entitled; which is less than 2s. more than she would have had to pay before. But it is, of course, up to the mother to decide whether she will buy our welfare foods or the proprietary pro ducts; or she can have the natural sources of vitamin which are now in abundant supply.
The important thing is to notice that while the total up-take of these foods has declined it never was more than about one-third. One of the beneficial results of the changes made last year is the increase in the up-take by the poorer people.
To sum up, welfare foods originally supplied at cost in wartime, have not in peace time been a main source of vitamin. In the 1950s beneficiaries used less than one-third of the quantity to which they were entitled and yet health and nutrition improved. Consequently, the fall in up-take since June is not in itself a reason for any alarm.
The group whom it is important to provide with welfare foods is that which may be in danger of not getting enough vitamins because they cannot afford to buy enough of the proprietary preparations. This group is protected under the new scheme and is taking up more welfare foods than before. For the rest, welfare foods are available as part of the local health authority services for mothers and young children at prices which are cheap and are good value for money. As I stated at Question Time a fortnight ago, the Government will continue to keep a watch on the—