There are many hon. Members who want to speak, so I will be brief. I will not follow on what the hon. Member for Maldon (Mr. Brian Harrison) has been speaking about, although I find the subject that he has raised of some interest.
I would like to pick up one or two of the points that the Minister made in introducing this Bill. First, I pay tribute to him for the very significant revival of morale in the National Health Service. Those of us who have been closely connected with the Service for many years past realise that over the last two or three years there has been a significant revival in morale, which had got woefully low. I am not suggesting that all our problems are solved—far from it—but I think that we are justified in adopting an attitude of perhaps cautious optimism.
I particularly endorse what the Minister said about health centres. It is encouraging to see this increasing development in health centres, although one must underline how very far we have to go before health centre practice becomes the normal type of general practice in this country. I look forward to that day.
The hon. Member for Farnham (Mr. Maurice Macmillan) welcomed the non-doctrinaire approach, as he put it, of the Minister on a number of issues. I welcome the non-doctrinaire approach on health centres that we have had from the Conservative Party. All the old political bogeys and the extreme doctrinaire attitude of some of our political opponents has, fortunately, been forgotten. Health centres will help to a certain extent in solving the difficult problem of shortage of doctors, because one advantage of this form of general practice is that it makes more efficient use of the skills of a limited number of doctors.
Another important thing that we have to do is to increase the opportunity for training at medical schools. Whether it be in health centres, group practices, or even partnerships—I do not want to get involved in an almost theological distinction on the borderline between these three types of family medicine—team work is essential. The family doctor especially will increasingly be the leader of the team. Many doctors appreciate and welcome this sort of practice, but some do not realise how important it is to cooperate, not only with their own professional colleagues, but with other medical workers such as health visitors, social workers, district nurses, midwives, and so on.
I also welcome the Minister's announcement that we are to spend £100 million on new hospital building, and particularly his emphasis on the increasing concentration of geriatric and psychiatric work in this sphere.
My right hon. Friend also mentioned productivity. Productivity is perhaps not the sort of word one would normally use when talking about medical practice and hospital work, but I think that it is justified. Productivity has improved enormously in the Health Service as a result of medical advances, new drugs, techniques, and improved organisation. There is still a great deal more that we could do. For example, I am convinced that there are thousands of patients who are unnecessarily admitted into hospitals, or, if they have to be admitted, are perhaps admitted too early and languish for one, two or three days before their operation takes place. If one adds up these unnecessary days in hospital by thousands of patients all over the country, one realises that here at least is one factor that is aggravating the waiting list.
There are many patients who could be discharged from hospital much earlier than they are at the moment. It always strikes me as extraordinary, as a family doctor who also worked within the hospital service, but under the supervision of a consultant, that I would be looking after patients in my own general practice work who were very much worse in health and in much more need of care and attention than some of the patients who were remaining in hospital because of arbitrary rules that had been accepted by the hospital and by the consultant. For example, that somebody who has an appendicectomy shall not go home for eight days, or whatever is the arbitrary length of time. Because these rules have been adopted we find patients in hospital who are often not as ill as those being looked after outside. This is a direction in which we could look towards improving productivity.
Concerning out-patients, a very large number of people attend unnecessarily—cases which could be looked after by their family doctors if only we were prepared to give to the family doctors in all parts of the country the tools of their trade: the ancillary help and the right to send patients for investigation that the doctors in the more fortunate parts of Britain, by and large, have.
The Bill is no startling major step forward, but it is a valuable step. As was said earlier, no changes in administration are proposed. It is a pity that we have not begin to tackle the problem, because the need for unification of our tripartite service is becoming increasingly obvious as the years go by.
Some attention has been given to the section on pay-beds. I want to spend a moment or two discussing this. I am opposed to private medical practice. I always have been. I was when I was a medical student and my attitude was reinforced when I become a doctor in hospital, and it was still further reinforced when I started in general practice. I think that private medical practice is morally indefensible and, medically, exceedingly inefficient. But we are not today arguing about the rights and wrongs of it; we are discussing the points put forward in the Bill.
I welcome the Minister's assurance that he will not use his powers to extend private practice in any way, but will make a more rational use of beds in our hospital service. I hope that this will mean that not only certain private patients will be treated in beds which have previously been exclusively reserved for Health Service patients, but we will go much further along the road towards using the empty private beds that are in existence at this moment in nearly every large hospital in the country. Bed occu- pancy rates in private wards and private rooms very often fall far below the bed occupancy rates in the Health Service section of a hospital. This is a dreadful waste of desperately short hospital accommodation comparable to the waste which I think private practice makes of the desperately short skills of the medical profession.
I am interested in the new designation of university hospitals. I do not share the fears which have been expressed in the House today that some sort of precedent might be created, and that the time might come when there will be some change in the way in which we deal with our teaching hospitals in England and Wales. It is interesting to note that this is applied only to England and Wales. The Scots have been more intelligent than we have been in this respect. From the early days teaching hospitals there have been an integral part of the regional hospital board set-up. My experience of Scottish teaching hospitals convinces me that there are strong arguments in favour of their system, as opposed to ours which tends to isolate the teaching hospital from the ordinary run-of-the-garden hospitals, and therefore tends to isolate hospitals not only administratively, but professionally as well.
I am particularly interested, too, in the proposals for the midwifery service, namely, that we should enable midwives employed by local authorities to work within hospitals as well as in the district and the community. This is particularly important in those rural areas which are largely dependent on small maternity units, often staffed by family doctors, because these units have been facing serious problems in recent years. One of the problems has been to staff them, largely because it is difficult to obtain midwives.
Working in this sort of area, I have often felt that this problem could be solved, if, instead of having a divided midwifery service where there are hospital and district midwives in the sparsely populated areas, there was a midwifery service which provided care for those who needed it, whether they be in hospital, or outside it. This would have the advantage, not only of solving some of the staffing difficulties, but would get over a real and justified professional objection by midwives to the early discharge of patients from hospital.
The early discharge of midwifery cases from hospital is increasingly happening, quite rightly from the medical point of view, but, understandably, a trained and qualified midwife gets a little fed up when virtually all the cases which she has been looking after in the district are delivered by somebody else in hospital, and are discharged two or three days after the delivery. If we have a system whereby the midwife follows the patient around, so that the patient has continuity of care, and the midwife has continuity from the professional point of view, we shall be taking a real step forward.
The other Clauses of the Bill which I particularly welcome are those which help the old folk. I am referring to the insistence that the provision of a home help service shall be a statutory duty on local authorities. I regret, as one hon. Gentleman opposite did, that the provision of a laundry service is not to be statutory, too, because the problem of soiled bed linen is probably the most common single factor which results in old folk having to be unnecessarily admitted to hospital.
It is not just the economic cost, although this has been mentioned by some hon. Members. It is the cost in terms of human suffering. It is difficult to explain, unless one has had to deal with a large number of old folk, just how much it means to many of them to be removed from the home in which they have lived for perhaps 40 years and be put into the extremely strange environment of a hospital ward. When this is done only because there are not the means in ordinary people's homes to do all the washing that is necessary two or three times a day, it seems very wrong indeed.
As I say, I welcome all the Clauses which promote the welfare of the old folk, and I was pleased that when my right hon. Friend introduced the Bill he mentioned loneliness, because in old age this is one of the biggest problems which has to be faced.
I welcome the fact that more attention is to be paid to post-graduate medical education, because there is a great need for this. When talking about medical education, we sometimes concentrate too much on undergraduate education, and forget that the average doctor today will, during his working life, see a complete transformation in the medical scene. The fact is that 30 to 40 years means a complete transformation in medicine. The medicine that we are practising today is totally different from that in the late thirties, and the need for regular refresher courses is becoming increasingly great as time goes on.
I welcome the Clause which deals with invalid cars, because I consider an invalid tricycle to be virtually a sardine tin on wheels. It is wrong to expect disabled people to drive around in these abysmal vehicles. We ought to be thinking more about changing to mini cars of one sort or another.
The hon. Member for Farnham (Mr. Maurice Macmillan) mentioned the possibility of a Specialist Committee to look into health and welfare matters. This ought to be considered seriously. I have had the pleasure, the honour if one likes, of serving for the last eight or nine months on one of the two new Specialist Committees, that on agriculture. All the time that we were holding our meetings I felt that it was the sort of technique which could be usefully applied in Health Service politics, because, as we all understand, many of these issues are probably better discussed in a Specialist Committee. They do not involve party conflicts, which are better dealt with here.
I welcome the Bill. It represents a real, if not a very large, step forward. It is in some ways typical of the legislation that we have seen on this subject over the last two or three years. I think that we perhaps forget the real and significant progress which has been made since Labour came to power in 1964. We have retained the basic principle of the Service, that it should be free to all those who are in need.
I particularly welcome the fact that we are discussing the Bill so soon after devaluation. This is one of the first Measures to come before the House since then. I think that it will particularly help those sections of the community who may have to pay some of the economic prices resulting from the economic crisis which we have faced in recent months.