Orders of the Day — Health Services and Public Health Bill

Part of the debate – in the House of Commons at 12:00 am on 7 December 1967.

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Photo of Mrs Jill Knight Mrs Jill Knight , Birmingham, Edgbaston 12:00, 7 December 1967

I am glad to see that the Minister nods.

Clause 17(2) speaks of the provision of ophthalmic services in health centres. There is cause to suppose that the Minister seeks to impose on local authority health committees a mandatory duty to provide opththalmic services in health centres. Is it to be mandatory or permissive? This is very important as the whole structure of the ophthalmic services could be altered. I take the point that there are some areas in which such a provision would be helpful and certainly one can imagine the public being benefited if opticians were practising in health centres and certainly they must have the right to do so, but in other circumstances and other areas it could be disastrous.

The right hon. Gentleman reminded us of the position at the inception of the Health Service when it was originally envisaged that all optical services and ophthalmic examinations would in future be carried out within the hospitals. He sensibly conceded that time had shown that that was not a viable proposition. Similarly, it could be said that whereas some health centres might usefully provide ophthalmic services in future, it must not be held that the services now provided in premises in the High Streets must of necessity go, so that all such services are provided from health centres.

There are many reasons for this. One is that many people want frames rather better than those which they can get from the Service. The hon. Member for Willesden, West (Mr. Pavitt) was a little less than fair to the opticians when he suggested that they somehow hid the available Health Service frames so as to be able to sell frames to patients privately. Their ability to sell a private frame would be very much strengthened if all the Health Service frames were always prominently on view, because most people would certainly prefer a private frame. If people want such frames they will either go to the optician completely privately, or have private frames glazed with Health Service lenses. The Minister cannot complain, because the principle by which the long-suffering taxpayer pays once to do his share of financing the Health Service and a second time to be allowed his own choice of what he wishes to wear cross his face has been accepted for a long time.

Equally, it is true that this system is not in the interests of the opticians, because it tends to mean that they are not paid enough for their services as professional men and therefore have to make up a living wage through their services as frame salesmen, and I know that this is a cause for concern for many of them. But the system has the merit of permitting the public a choice, a choice which could well disappear under the rather woolly wording of some parts of the Bill.

Does the Minister really mean that in future the poor overworked local authority health committees, already labouring to deal with a vast range of responsibilities from sewers to bad food and the provision of training centres and homes for old people must—not "can", but "must"—provide health centres where people will have to go to get their eyes examined? If he means that, the choice permitted would be controlled by him, and I am sure that the public would not like that and I do not think that the health committees would.

For years there has been pressure from the profession for ophthalmic services to be termed general and not supplementary and ore warmly welcomes what the Minister has done to get these services on the right footing, but it is probably true that stemming from that very change is a deletion of the optical services committee from health executive councils. Probably this is a mistake which can be rectified in Committee.

Hon. Members who have mentioned this subject have not recognised the possible source of the mistake, which is that the optical services committees are to go, with nothing to replace them. I do not think that the Minister has decided that these committees have not been doing a good job or that they have in any way fallen down on their duties. Having served on a health executive council for 10 years, I have some little experience of these matters. But whatever the reason for the dissolution of optical services committees, I urge the Minister to make regulations to provide instead for a committee to be set up under paragraph 6(b) of Schedule 1 to deal with such ophthalmic matters which may be delegated by executive councils. That is important. Anyone who has sat on a health executive council knows that there are various technical matters that need to be relegated to such a committee.

Similarly, I am sure that by now the Minister realises that the proposal to include only one ophthalmic optician on executive councils is inadequate. I stress the point made by my hon. Friend the Member for Wembley, South (Sir R. Russell) that we must bear in mind the high proportion of work they undertake and the huge mass of the public whom they serve. I hope that the Minister realises the importance of the point and will permit it to be rectified in Committee.

I note from Clauses 5 and 8 that the Minister does not intend at present to interfere with the present teaching hospitals. But can he clarify the future position? Does he intend that beyond the experimental period the teaching hospitals and university hospitals should co-exist with equal status and similar functions, or is it his intention ultimately to standardise the designation for all hospitals with a teaching function, placing them all either under boards of governors or regional hospital boards? The explanatory memorandum tells us that the new form of designation as "university hospitals" will be … an alternative to designation as a teaching hospital under existing provisions. That seems to imply co-existence. I am encouraged in that view not only by the Minister's nod but by Clause 6, which seeks to widen the powers of the board of governors of a teaching hospital.

But it is reasonable to press the Minister about this, because there is a classic precedent for the subsequent amalgamation of teaching institutions originally designed to be of equal status although administered differently. I refer to the colleges of advanced technology and the university colleges. What happened there has passed into history, and like most history it can give us a lesson. If the Minister should be tempted to consider eventually bringing all teaching hospitals under the aegis of the regional hospital boards, I hope that he will give full weight to the recommendations of the Porritt Committee on the subject. The Committee said that in England and Wales the teaching hospitals should continue to be administered by separate boards of governors with direct access to the Minister.

Another part of the Bill which rather disturbs me is Clause 62, which says that the Minister of Health may: (a) purchase and store and, on such terms as may be agreed between him and them, supply to authorities which are local health authorities for the purposes of Part III of the National Health Service Act, 1946, any goods or materials required by them … What does that mean? They require an awful lot of goods and materials. What are the mysterious commodities that the Minister will shop for, store and supply with such busy intensity? Are they bandages, false teeth, spectacle frames, medicines, maternity supplies and surgical supports? Why does he need to give himself the task of marketing them anyway? Is there a deep malaise in the present system of supply, or does he reckon to get them cheaper from a munificent bulk supplier? All members of the medical professions will be deeply interested in the replies to that question.

Throughout the Bill we constantly meet the words found on lines 26 and 27 on page 14, … on such terms and conditions as may be determined by the Minister … Is it too much to ask for an assurance that he will reach his determinations only after consultations with the various professional bodies involved? Much as we respect the Ministry officials and admire the way in which they work, we must press for consultation to be carried out with all branches of the medical profession who are concerned—and I can think of none who are not—because they feel that there has not been sufficient consultation.

I now turn to a completely different part of the Bill, dealing with the provision of invalid vehicles. I am most anxious that the provisions of Clause 31 shall be further widened. What is to be done is welcome as far as it goes, but does the Minister think that it goes far enough? What does he intend to be the criteria for extending the provision of cars and tricycles? The Bill is not clear on that.

I feel very strongly that at present there is something rather unfeeling about the provision of transport for physically handicapped persons. It is not only a question of the provision of an invalid tricycle or car. There is also a great need for something to be done to help handicapped people who buy their own cars and subsequently convert them to hand controls. Many such people must buy a car for themselves because of their jobs or for other reasons. It is very hard that they should also have to pay for the conversion, the cost of which is rising steeply and is now, I think, between £25 and £30.

I am particularly anxious about war-disabled pensioners who face the problem. For many months I have been pressing the Minister, with a sad lack of success, about a constituent of mine who lost both legs as a result of his war service. He went to war a strong and healthy young man and returned a cripple. The sad fact is that he is within an inch of getting help for the conversion of his car to hand controls, but he will never get it. I believe that if the legs are removed one inch above the knee it is not possible to give the help, but if they are removed an inch higher it can be given. It is something like that, but the precise number of inches does not alter my point. If a man is so badly disabled as a result of his war service that the Ministry of Transport does not allow him to drive an ordinary car without having it converted to hand controls the Ministry of Health should help him meet the cost.

There is a real need for such cases to be helped, but I am sorry to say that for many months the Minister has said at some time in the golden future something will be done, and that he has the point in mind. But along comes this Bill, which includes a great deal about invalid tricycles and cars, and yet it includes not a thing that will help my constituent and those in his position.

Clause 13 makes it a statutory duty of local authorities to provide home help. I do not want to say much about that or to speak for much longer. But is the Minister aware of the great difficulties of providing home help? It is not a question of saying "Let there be light", and simply switching on. It is very difficult to get these valuable ladies, and rates of pay for such domestic help must be far higher than the normal rate paid by housewives for the help they get for a couple of hours a week. I know this very well because of my work on a local authority health committee. Most health committees have great difficulty in filling their existing vacancies.

The Minister should also be aware that other local authority departments take home helps from them—particularly the children's department, where, because of recent legislation, it has been thought wise, I think absolutely correctly, that families in danger of breaking up should be given every possible help. This frequently involves a special home help who helps to get the family over the difficult" and even teaches the wife to run her home more happily.

More and more are being used in this department. This is a most important branch of the service. It has been said that it can keep people out of hospital, and that is true. Home helps provide an extremely important service, but it is not so easy to get them as the Bill envisages and the Minister seems to imagine.

I tremble at the statutory headaches which the Minister is imposing on local authorities, such as the duty to provide laundry services. I do not argue that it is highly desirable, and we have heard how it helps elderly people, but it could be expensive and this has not been recognised. It could give a great good to a certain section if all local authorities set up a laundry as a sheltered workshop for mentally and physically handicapped. A very few have done this, as I know from having been involved with one which did. If, instead of using existing laundries, we could set up laundries for the handicapped, who do this work very well, this would be a good thing.

I hope that the Minister knows how to finance all this bountiful help. I have a good deal of information about the effect of devaluation on local authority services and most hon. Members know that the 8 per cent. Bank Rate has had a dreadful effect, since so many of these services must be financed by loans. I was surprised to see, in the first part of the Bill, a reference to financial effects which implied that it will not cost very much and I was reminded of precisely the same mistake on the inception of the Health Service, when people were told that it would cost very little yet the costs have been rocketing ever since. They could not do otherwise.

The passage in question says: Some increase of expenditure under the powers conferred on local authorities under Clause 43 to promote the welfare of the elderly may be expected, and may lead indue course to increased Exchequer support for local authority expenditure … That has too much of the flavour of the sweet by and by. This will have to be financed fairly soon and it should be done properly since it will cost a lot of money. It goes on: No significant net financial effect is expected from the other improvements to public welfare and health services. This is a sublime example of optimism. It will cost money and it is no use pretending otherwise. I do not quarrel with being asked to provide more money for these necessary services, but I plead for realism and not claims that this will cost little or nothing.

I welcome Clause 43 warmly. Perhaps by now the Minister will have recognised that many hon. Members feel that something should be done by way of a register or survey to determine the size of the problem or elderly people. This is of great importance. So far, the Minister has given only a lukewarm response to this. While many old people get to know what help is available to them through their doctors, we must remember that some never go near doctors. It is important that we should know where they are and who they are and explain clearly to them what can be done for them.

I have one word of warning. In dealing with elderly people, we need welfare workers of exceptional calibre, because so many old people far prefer to stay at home rather than enter hospital. I know that in some local authorities, an old lady or gentleman may be found in dirty surroundings, unable to cope and look after themselves. Such people may he removed much against their will and taken to hospital, where they usually die miserably soon afterwards. I hope that great stress will be laid on domiciliary services in this respect, with more help through Meals on Wheels. Until quite recently it has been difficult to get enough money for this extremely valuable voluntary help, which would keep people in their own homes and should therefore be encouraged with all our energy.

There are many points on which we hope that the Minister will give his blessing to Amendments in Committee. I welcome the spirit in which the Bill has been introduced.