National Health Service

– in the House of Commons at 12:00 am on 21st November 1975.

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11.9 a.m.

Photo of Mrs Barbara Castle Mrs Barbara Castle , Blackburn

It is appropriate that the debate on that part of the Queen's Speech dealing with health and social security should be taking place in the week when 12 million people will receive another £1,060 million in the second uprating this year of pensions and other benefits. The pension for a married couple moves up this week to £21·20 and that for a single person to £13·30—an increase of almost 15 per cent.

It means that since we took office only 15 months ago, we have increased the pension rate by more than 70 per cent. from the level introduced by a Conservative Government in October 1973, and this compares with an increase in pensions of 47 per cent. between October 1973 and October 1975, the latest figure available. It also compares with the increase in average gross earnings of nearly 50 per cent. between October 1973 and August 1975. The Government, as promised, have improved the living standards of the most vulnerable section of our community.

This week also sees the introduction of the new non-contributory invalidity pension for those too disabled to qualify for the national insurance invalidity pension. The rate of benefit will be £7·90 a week.

Again, in keeping with our policy for all our upratings, supplementary benefits have been increased accordingly, and important steps have also been taken to humanise the administration of supplementary benefits through increases in disregards, and these increases also come into effect this week. The first £1,200 of capital is now disregarded, compared with the former band of £300 to £800, and the earnings disregards, which were previously £1 or £2, are doubled. The changes mean, for example, that a single parent may now earn up to £4 a week and have capital of £1,200 without benefit being affected. This is the first time that the disregards have been increased since the introduction of the supplementary benefit scheme in 1966.

I think that this is an important starting point of our discussions today, because this is an area in which we have refused to listen to the clamour of Conservative Members for slashing cuts in public expenditure, and the Gracious Speech makes it clear that, whatever the economic difficulties of this country, we shall continue to safeguard the standard of life of the most vulnerable sections of the community.

The big sum of money involved for the latest uprating partly reflects the inflationary situation in which we live. As I have said, the increases that we have given during our period of office have been substantial, real increases but, none the less, inflation is greatly enlarging the cost of protecting those whom we are pledged to protect. This brings us to the heart of one of the subjects that I am sure the House will wish to discuss this morning, and that is the threat now facing the National Health Service from the junior hospital doctors dispute, because this is very much linked to the whole battle against inflation in which the Government are engaged.

I particularly welcome the chance that this debate gives me to report to the House in detail on the junior doctors dispute. I say "in detail" advisedly because last weekend the Hospital Junior Staffs Committee, the juniors' negotiating committee in the BMA, overthrew its leaders, who had put the Government's latest offer to a ballot, and called on the BMA Council to back industrial action by the juniors not later than the end of next week. As this would involve junior doctors taking industrial action in the form of a 40-hour week "worked flexibly" as they describe it, and dealing with emergencies only, the House does not need me to spell out what could be the consequences for patients and the NHS. I am sure that the House will wish to know in detail how this situation has arisen and what its implications are for the Government's anti-inflation policy.

When I last reported to the House, on 27th October, I explained that I was about to meet the juniors' representatives again to discuss how we could get their new contract into operation without anyone losing money—the "no detriment" principle—while at the same time not breaching the Government's pay policy Perhaps I should remind the House that last April junior doctors received pay increases ranging from nearly £13 a week to £30, so it is clear that under the 12-months' rule of the pay policy they cannot receive any additional money until April of next year.

That is why the only way in which we could bring the new contract into operation this year—under which the new pay supplements would start at 44 hours, instead of the present 80 hours—would be by redistributing among everyone the £12 million now paid in extra duty allowances to those working more than 80 hours a week. That is obviously very difficult to reconcile with the "no detriment" principle, and that has been at the heart of some of our earlier difficulties.

When I reported to the House on this impasse I had been giving a lot of thought to how we could reconcile the two apparently irreconcilables, and at my meeting with them on 30th October I put a new offer to the juniors' representatives. This proposed that the new contract should be phased in as the juniors changed jobs, which meant that everyone would stay on his existing contract, with his existing earnings, until he did so. We estimated that about one-third of juniors would be on the new contract by April of next year when extra money would be available under the pay policy which could be used to give everyone the option of switching to the new contract or continuing on his old one—full implementation plus "no detriment".

The juniors' representatives were sufficiently impressed to agree to put this new offer to a ballot of their members, together with a series of safeguards on the operation of the new contract which we had worked out together at their request, including a joint examination of the long hours worked by juniors. A copy of the BMA's statement on the proposals, which described them as a "significant change", has been placed in the Library.

Despite the fact that a ballot was taking place, industrial action by juniors has continued in some parts of the country. In the North-West, in particular, the disruption of NHS services has been considerable. I myself last week met members of the North-West Regional Executive Committee of the BMA, as well as a number of my constituents who are junior doctors in Blackburn, from which it was clear that their demands have now widened considerably, far beyond the principle of "no detriment". I was now faced with the simple demand for the juniors' basic salary to be linked to a 40-hour week with every hour worked above that being paid for at the sort of premium overtime rates that are paid in industry. And this, it was claimed, was perfectly compatible with pay policy

Others, junior doctors, such as members of the Junior Hospital Doctors Association, have argued that the £12 million which we say is available for redistribution is a "guess" or an underestimate. They have variously claimed that a much higher figure is available under pay policy. Some say £17 million; others say £25 million; others hint at much more still. The JHDA stated in advance that it would not be bound by the outcome of the BMA ballot.

The confusion has, if anything, been made worse by the result of that ballot. Of the 14,000 voting out of about 20,000 junior doctors who were sent ballot forms, 12,000 accept the principles of the new contract, about 7,000 have voted for industrial action to exact more money from the Government, and about 5,000 have rejected industrial action. At the meeting of the Hospital Junior Staffs Committee of the BMA on Monday, the leaders were overthrown, new demands were put forward to the Government, and the Committee called on the BMA Council to back industrial action to secure these demands. It is interesting to note that Dr. Bell, the former Chairman of the Hospital Junior Staffs Com mittee, has said publicly that he will not take part in any industrial action which may be authorised, while Dr. Ford, the former Chairman of the HJSC's negotiating sub-committee has dismissed as "fatuous" the claim that we and the Review Body have got our figures wrong.

It was against this background that the Secretary of State for Employment and I invited the juniors' new representatives to the meeting held yesterday. Our purpose was to explain how the pay policy applied to the juniors' case and to try to convince them that the Government are treating them in exactly the same way as they are treating everyone else under that policy. Our starting point was the new demands now made by the juniors' committee. These are, as I have said, that the basic salary should be linked to a 40-hour week, with extra payments for all hours over 40, which they say should be priced "within the pay policy", except that any time worked over 80 hours should be paid for at existing clinical assistant sessional rates.

There are two major difficulties about these proposals. The first, of course, is that the Review Body, their own independent pay body, has fixed 44 hours as the appropriate starting point for the payment of the new supplements. It is obviously wrong and incompatible with pay policy for the Government to alter the Review Body's findings unilaterally, as we are being pressed, under threat of industrial action, to do.

Secondly, the argument of the juniors was that the pay policy did not apply to overtime rates. Time and again the Secretary of State for Employment had to point out to them that they had completely misunderstood the White Paper on counter-inflation policy. The annex to Command 6151 points out that the £6 limit applies as a straightforward supplement to earnings, not to basic rates. It must be, says the annex, …the total increase over the year, however the earnings are determined. So, although extra earnings for extra work are permissible, extra earnings for the same overtime count against the £6 limit, and the juniors have already had much more than £6 this year. My right hon. Friend assured them that this argument had been applied rigorously to everyone else.

As the discussion continued, a new argument was deployed by the juniors—namely, that our arithmetic in calculating the £12 million available for redistribution was at fault. Since this argument is being used increasingly and no doubt will be used in the discussions over the next few days, perhaps I should explain to the House how this figure was calculated.

It was based on returns made to us by the health authorities of the amount of the extra duty allowances actually paid during the period last year for which figures were available, uprated to take account of the increase in the rate of extra duty allowances last April and adjusted on an annual basis. We informed the Review Body of our estimate of the total sum, and it was on this basis that the Review Body worked out its distribution of the money among the new pay supplements.

Incidentally, when we sent our calculations to the Review Body, copies were sent to the BMA so that its statistician could examine them. But they were not queried by the BMA or by any of the juniors at that time.

The figure is therefore based on the information supplied to us by health authorities. Of course, we are only too anxious that the juniors should be satisfied that the information that we received is accurate. Yesterday, therefore, we offered them an independent audit of the claim forms so that they could be satisfied that there had been no kind of "rigging" of the figure but that we had proceeded on the objective facts of the situation as put to us.

They refused that offer of an independent audit and said that they accepted that the arithmetical calculation of the claims for extra duty allowances was accurate. None the less, they continued to insist that extra money was available. One of their arguments was that, for various reasons, some doctors who were entitled to claim the extra duty allowances last year had not claimed them. This is not denied. Indeed, the Review Body, in paragraph 12 of its supplementary report, points out this fact. But it adds: We have thought it right to make due allowance for these factors in our considerations". So the Review Body was aware of a discrepancy between entitlement and claims, and this has already been taken into account in its findings.

But there is another point. If inflation is to be curbed, what matters is that we should not exceed what was actually being paid out under the old system, taking account, of course, of the April increases. To start paying now for last year's hypothetical unclaimed entitlements would clearly be inflationary. However, we told the juniors yesterday that if they felt that there were certain factors which the Review Body had not taken into account and which were permissible under pay policy, they should send them quickly to us in writing and we would examine them. But any reconsideration of those factors would clearly be for the Review Body.

As the House will see, the picture is complex. There is one ray of hope. The juniors' representatives assured us yesterday that they were not seeking to breach the pay policy. I hope that the whole House will agree that it would be intolerable if the Government were to allow that to happen. So far, they have not produced any evidence which would justify the provision of extra money under the pay policy. I know that that seems hard to many of them, but then the Government have had to be firm with other workers as well, 2 million of whom have, however reluctantly, already accepted settlements under the pay policy. Some workers have actually had to renegotiate reductions in firm-priced pay settlements to bring them into line with the policy.

At one point yesterday we were asked whether there had been any breaches of the pay policy. The answer was that there had been a few. But every one of them has, under pressure, been renegotiated. Standard Telephones is a recent example that we all have in mind. The miners are the latest to announce their acceptance of the £6 limit. What kind of response would we get from them if we were now to say that the juniors were a special case?

This does not mean that we do not have immense sympathy with the juniors. Of course we have. This is why a Labour Government first introduced extra duty allowances. That is why we have negotiated the principles of the new contract, which they welcomed overwhelmingly and on which they can build in the future. That is why we have offered an urgent joint examination of their long hours of work.

Yesterday, I suggested that we should immediately set up a joint working party to plan the reduction and eventual elimination of their excessive hours. I do not pretend that it will be easy, but that is the right way forward [Interruption.] I do not know whether the hon Member for Sutton Coldfield (Mr. Fowler) wishes to attack a case that he has not even had the courtesy to listen to, but I suggest that this is perhaps the most crucial issue that we can discuss today. I would therefore ask the House to pay me the courtesy of trying to follow the argument.

As I have said, the right way forward is for us to try to reduce and eventually eliminate these excessive hours. The wrong way, for the juniors, the country and the National Health Service, would be to fuel inflation by breaching the pay policy. As the British Medical Journal says in its current issue: The views the negotiators are supposed to represent are seldom either clear or coherent. I hope that the House will give the juniors a clear lead today and tell them and the rest of the country, "You cannot will the end of beating inflation unless you also will the means, however tough."

I hope that the House will give a clear lead to those consultants who are talking of taking industrial action against our pay beds policy. The proposals in the Queen's Speech on this will be a matter for party controversy and I have no doubt that the legislation that we propose will be fiercely contested in the House. However, that is where the policy must be fought out. The Government's intention to separate private practice from NHS hospitals has always been made clear, but we have also made it clear that the decision would be for Parliament. That is why I have not used my power of authorisation, as I could have done, to whittle away pay beds by administrative means. I prefer, and the Government intend, to submit the issue to the judgment of this House. In its turn, the medical profession must be ready to accept the will of Parliament.

It is in this House that we must decide these great matters of principle. That is what we are elected for. To Labour Members the right to free and equal medical care for everyone through the NHS is a cardinal principle. Let us have a great national debate on it. Indeed, that debate has already begun. As a correspondent said in The Guardian a short while ago, Sir, I am the headmaster of a maintained primary school. I wonder how many members of the medical profession, who advocate paybeds in NHS hospitals, would agree that for me to admit paying pupils earlier than others, and give them preferential treatment in the school (to my benefit salary-wise), would not only be illegal but morally wrong? Others have taken up this theme. Brian Inglis of the Evening Standard recently described pay beds as "an absurd anomaly". Patients, too, have their rights. The medical profession might be surprised at the letters of support that I received from all kinds of quarters on this matter. I quote one which I received from Bromsgrove the other day: I write as a member of the public who wishes to urge you to stand firm in the face of the doctors' attempts to force you to modify your proposals.I, too, have used the pay beds loophole to jump the queue and to obtain immediate treatment. I have handed over various sums of money to consultants. Rarely have I been given a receipt. Even when taking advantage of my use of the system, I hoped for abolition of the pay beds scheme. These are the views that have a right to be heard in our democracy. Of course, those who work in the NHS have a right to be heard, too. I have consulted and listened to them, but they are deeply divided. A great internal debate is taking place among workers in the NHS at all levels on this issue. The medical profession has indicated its total opposition to the proposals. The nursing organisations, although not opposing the principle of phasing out, want agreement to be reached with all the parties concerned. That is a difficult remit. The TUC not only supports the proposals, but it and the trade unions active in the NHS—not only NUPE which represents 200,000 ancillary workers and nurses, but CoHSE which represents 95,000 nurses and 70,000 other workers and NALGO which represents 70,000 administrators, clerical and special grades—have all said that we should go further than we propose.

Therefore, there is no clear guidance from those quarters. The Government must reach their own judgment. As the Queen's Speech has indicated, we stand by our election commitment and will implement it. The right hon. Lady the Leader of the Opposition in the Queen's Speech debate on education in 1970 said: I could not be influenced to go back on an election promise."—[Official Report, 8th July 1970; Vol. 803, c. 678.] I agree with her. Nor can this Government.

The Government are convinced that real benefits will flow from the separation of private practice from the NHS. We should not have embarked on this course if we believed otherwise Resources, of staff and facilities, equivalent to those required for four district general hospitals, will be released for the benefit of NHS patients. Above all, the NHS will become a better and happier Service because all working within it will be able to treat patients on a common basis, that of medical priority alone.

There is one thing the Opposition and the medical profession must bring themselves to understand. The issue of pay beds is, above all, one internal to the Health Service. The existence of pay beds, with the opportunity it gives to a few senior doctors to make private gain and the opportunity it gives to patients with money to jump the queue, is seen as a bitter affront to those thousands of other staff who are dedicated to the principle of a free Health Service. However, let me make certain things clear once again. We are not proposing to abolish private practice outside the NHS. On the contrary, we propose to reaffirm in the legislation the rights of consultants and doctors generally to practise privately.

We are not robbing people of the right to privacy. That is already available on medical grounds within the NHS without charge. As I made crystal clear in the House on 5th May and as is also made clear in our Consultative Document, we shall not only preserve the system of amenity beds by which an NHS patient can, for a small fee, obtain a single room, but extend that system as more single wards become available after phasing out. We are committed to providing more privacy, not less. Of course, amenity beds involve no compromise with the principles of separating private medicine from the NHS, for these are for NHS patients, not private patients, and no queue-jumping is involved.

I am anxious to continue my consultations with the medical profession on the timing of the phasing out and on how we deal with the situation which will arise when separation has taken place. As a good trade unionist, I recognise that all who serve the NHS have the right to have their essential interests safeguarded. Therefore, the phasing out proposals must be reasonable and we must do everything in our power to ensure that those who wish to practise privately can continue to do so. That is, indeed, the purpose of my licensing proposals. As I said in our last debate, I am very ready to discuss whether the method by which I propose to achieve this end is the right one. Some of my hon. Friends disagree with my aim on this.

Photo of Mr Norman Fowler Mr Norman Fowler , Sutton Coldfield

Is the right hon. Lady totally committed to having licensing according not only to quality but to quantity? Will she deal with that point in her speech?

Photo of Mrs Barbara Castle Mrs Barbara Castle , Blackburn

No, I do not propose to go any further than what I have already said. This is a matter for consultation. The Queen's Speech makes it clear that consultations on how we deal with the situation that will arise when pay beds are phased out and when separation has taken place are continuing. Therefore, I repeat that the intention of my licensing proposals is, among other things, to help to ensure that the opportunity to practise privately still remains for those who want it, while, in addition, ensuring that the development of private practice does not threaten the survival of the Health Service in any areas. However, this is a matter on which consultations are continuing.

As I said, some of my hon. Friends disagree with my aim of helping to safeguard the right to practise privately because they want me to go further and abolish private practice. However, this policy of separation and not abolition is the one on which we fought the General Election and it is the policy indicated in the Queen's Speech.

I have already had discussions with the BMA on the proposals in the Consultative Document and I have told it that I am anxious to resume those discussions now that the Queen's Speech has been made known. I hope that we shall be meeting again soon.

Finally, I turn to the nurses, for whom this Government have done so much. I hope that the House will never forget the vital rôle that they play in patient care. That is why the first thing that the Government did when they were elected in February 1974 was to discuss with the nurses' representatives their accumulated grievances, not only over pay, but over their training and rôle—all the issues raised in the Briggs Report. So we not only gave them the first fully independent review of their pay and conditions they had ever had—and the biggest pay increase in the history of the NHS—but we accepted the recommendations of the Briggs Report and set out to plan how we could implement them.

Ironically in one sense we have become the victims of the success of our own policy. I see that the Press is now full of the familiar scare reports about nurses being unable to get jobs in the hospitals where they have trained. Nurses face sack if they pass exams said our old friend The Daily Telegraph the other day, and other newspapers followed suit. If we are not to demoralise NHS workers still more—and unnecessarily—it is essential to get the facts straight.

It has never been the case that all nursing students could be guaranteed posts where they have trained. But today, thanks to the Halsbury Report and higher pay, this is truer than ever because there is a lower turnover of staff and a lower wastage of students than there used to be, so more newly qualified nurses will have to look to other hospitals for jobs. But this does not mean that they are "sacked", as some newspapers have suggested. The NHS still needs them.

My policy for the NHS has been to put people before buildings—in other words, to safeguard the level of services even if we have to restrain the capital building programme, and that will continue to be our policy, as I and my hon. Friend the Minister of State have made clear time and again.

Some regions, including the South-West where this problem has recently been high-lighted, have set up bureaux so that vacancies in the region can be notified. Where it is not easy for nurses to move, perhaps because of domestic difficulties, I hope some of them will take further training so that they can work in less well staffed sections of the Service, such as psychiatric nursing or the primary care services. I repeat that they will be needed.

Of course I would have liked the Queen's Speech we are discussing today to include a Bill to implement the recommendations of the Briggs Report, but I want to assure the nursing profession that this does not mean that we have forgotten it or reneged on it. I would hope that it will be included in the legislative programme for the next Session. Of course there is a problem of finance. Full implementation of the recommendations would cost about £27 million a year, and we all know that money is desperately tight. But any policy which puts people before buildings cannot ignore the vital importance of the Briggs recommendations, and we remain pledged to them. As an earnest of this we intend to build up the number of nurse tutors in preparation for the full implementation of the Briggs recommendations.

While I am on the subject of nurses I would just add that the hon. Gentleman's alarm about the phasing out of agency nurses has proved unfounded. My latest reports show that the process is going smoothly. The dependence of the NHS on agency nurses is being steadily reduced without any disruption of services. So we can dismiss the manufactured alarms of Opposition Members.

Clearly, the National Health Service is going through a testing time as those who serve it work out new relationships between themselves and towards society generally, and as the medical profession tries to think out its rôle and what sort of rewards it wants—professional or industrial. However, I believe that at the end of all this turmoil the National Health Service will come out stronger, more realistic, more democratic and better equipped to serve the people of this country for whom it was created.

11.44 a.m.

Photo of Mr Norman Fowler Mr Norman Fowler , Sutton Coldfield

That, I think, was a disappointing speech at the beginning of a national debate, which is how the right hon. Lady sees it, but it was in one respect an improvement on her last speech. It was a deal less strident than her comments on the last occasion we debated this matter.

There is one point that I should like the House to consider calmly. It is an issue which, although not part of the Government's legislative proposals, is of obvious and vital importance, and it is a question to which the right hon. Lady referred—the junior doctors dispute. Let us be clear about one point straight away: the public have every reason to be grateful to the junior doctors. When we hear of hospital doctors on duty or on call for 80, 90 or even over 100 hours a week, we realise how great is our debt to them and our reliance upon them. I can think of few groups in our society that are more deserving of our support.

The greatest challenge that the country faces today is inflation. I repeat what I have said in the House and outside—the Conservative Party will not support attempts from any quarter to break the present Government's counter-inflation policy. I make that quite clear. Had only the leaders of the Labour Party, including the right hon. Lady, said the same thing only a few months ago, when we were the Government, this country would not be in the economic mess that it is in now. Therefore, what the Opposition urgently wish is that even now, with only a few days to go before action is due to begin, a new effort at conciliation will be made.

I say that not only because it is clear that it is in the interests of the public but because there is no doubt about the present anger among junior doctors. They feel that the negotiations have been mishandled. In particular, they feel strongly about the three lost months in the negotiations, which brought them within the pay policy.

As the House will know, agreement on the form of the new contract was reached verbally in September 1974. But, to the surprise of the junior doctors, the departmental minutes of the verbal agreement made no mention of the 1st July 1975 starting date, but simply referred to "a forward date". The BMA, I am told, wrote to the Department on no fewer than eight occasions to get clarification but received little more than an acknowledgment. That is no way to treat a professional group. Finally, in January 1975 the Secretary of State conceded the doctors' case and said that there had been a "genuine misunderstanding".

The Secretary of State also said, however, that it was now, for administrative reasons, impossible to introduce the contract from 1st July but that it would have to be postponed to 1st October. The Secretary of State added one further point, however, and I quote from the Financial Times of 9th January: She also repeated assurances that there would be no freeze, no statutory control. The impression was then clearly given that no controls were in sight. The doctors, therefore, honourably agreed to 1st October and not 1st July—and found themselves in the middle of the pay policy.

The history of this dispute is sad. It is a story of departmental delay and assurances—honestly given but, as it turns out, mistakenly given. So we have reached impasse. Clearly, what is now needed is a new start. The question we must ask, therefore, is whether this emergency is unavoidable. We must "de-escalate confrontation". I hope that the right hon. Lady recognises those words, because they were her own in January 1974 during the debate on the miners' dispute.

Let us see, therefore, how we can de-escalate the confrontation. There are points that we can discuss. The junior doctors want to test the basis of the calculation of the £12 million. Where there is a good prospect of conciliation is in a possible guarantee about future treatment, that is, a guarantee or a pledge from the Government of future action as soon as is practicable within the terms of whatever the current pay policy might be, also including the right hon. Lady's point about the examination of long hours.

The question is how conciliation should take place. Some have suggested that the Advisory, Conciliation and Arbitration Service should be brought into play. I do not think that that is the right course. We are dealing with a service of vital national importance, a service for which the Government are directly responsible. Indeed, they have a statutory responsibility to maintain it. This is a situation that cannot be shuffled off to an outside body. It is a situation in which I would now urge that the Prime Minister himself should intervene, as he has intervened in various disputes in the past, such as the railway dispute, the seamen's dispute and the Liverpool dock strike. Therefore, I trust that this suggestion will now be considered, and considered urgently, and that the Minister of State can give us an indication in his summing up of whether the Government will agree to it.

Photo of Mrs Barbara Castle Mrs Barbara Castle , Blackburn

This is a serious situation and we have to try to find a way out of it. I leave aside the history. I could counter that argument but I do not want to do so, because I want to avoid this confrontation.

We have offered all the ways that we can think of in the pay policy. If the Prime Minister were to see those concerned, clearly he would stand by the Government's interpretation of the pay policy. At what point does the hon. Gentleman think the Prime Minister could concede?

Photo of Mr Norman Fowler Mr Norman Fowler , Sutton Coldfield

I seek to make this point as gently as possible. The right hon. Lady must understand that we need a new atmosphere in which the negotiations and discussions can take place. There is now an atmosphere of deep mistrust. I have had talks with the junior doctors, as has the right hon. Lady. We are dealing with a group which wants to observe the Government's pay policy. It seems to me that the Prime Minister has an opportunity to make a new start at conciliation. I know what the Prime Minister's view is on this matter. His published view is that he should intervene only as a last resort. It is my view that this is the last resort and I urge him to intervene. I do not ask for a snap reaction from the Secretary of State now, but I hope that when the Minister of State sums up, he will consider this constructive suggestion as a basis for action by the Government.

The background to this debate is one of strife. The first question we should ask is why non-militant men have turned to consider industrial action. Here the Government bear a massive responsibility. Their double standards are obvious to the whole country. The doctors, and indeed the public, remember the Labour Party in opposition and how it conspired to break the last Government's counter-inflation policy. They watch with some amazement those politicians calling for sacrifices that only a few months earlier they scorned. The doctors and the public remember how the Government stepped aside and allowed the militants at Charing Cross and Westminster Hospitals to triumph, while keeping the Government powder dry for an all-out verbal attack on the junior doctors. That is notable for the fact that it was the only attack of that kind mounted by the Government.

Let me reply directly to the right hon. Lady when she asks what our attitude would be to the prospect of action outside this House on her policy on pay beds. We do not support it and we urge that it should not take place. We shall fight that policy in Parliament with every legitimate weapon at our disposal.

When the right hon. Lady tells the Press that it is unique for a Government to be threatened about a piece of legislation before Parliament has even discussed it, what does she think the action by NUPE at Charing Cross and Westminster Hospitals was about? The Secretary of State takes the public for fools, but the public remember those disputes and her reactions to them. They remember how she dived for cover and how she briefly emerged to make the following ringing defence of parliamentary rights: I can understand the feelings of the staff. I cannot condone the action they are taking. That is as far as the right hon. Lady dared go.

In the last debate we told the Government how to handle this position. We said that it was an issue that should be remitted to a Royal Commission, and indeed that it was ludicrous to set up a Royal Commission but not allow it to consider the problem causing most trouble in the Health Service. It is tragic that that opportunity was not taken and that suggestion was not heeded.

The position today is that, at a time when the whole Service needs a period of peace and consolidation, the right hon. Lady pushes ahead with plans that lead her into confrontation with the medical profession. Has it never occurred to the right hon. Lady that we are seeing a period of strife unparalleled in the history of the Health Service? Has it not occurred to her that she bears massive responsibility for that development? As matters stand, the right hon. Lady will go down in history as Calamity Castle, the Minister who wrecked the National Health Service. [Interruption.] If the right hon. Lady finds that funny, that is a matter for her.

At the centre of the disputes of the past months is a common fact. It goes far deeper than pay and overtime rates. It is a concern about the future of the Health Service and of the medical profession. In 1970 the right hon. Lady treated us to her revised views on industrial relations legislation. It may be evident from our debates that there are a number of issues on which the right hon. Lady and I do not exactly see eye to eye, but she said something of relevance to this debate when she specifically mentioned the medical profession. At that time she said: We on this side want to move away from a situation in which workers, or doctors or consultants come to that, feel that the use of the strike weapon is appropriate to the morality of the society in which we live—and the prime responsibility for creating the moral tone of a society rests with Government"—[Official Report, 14th December 1970; Vol. 808, c. 1003.] Therefore, there arises the question of what tone, what atmosphere, the right hon. Lady has created in the Health Service.

She is right about one matter. The Government have responsibility for determining the terms of the debate. To put the question another way—what are the issues the House should be discussing in a debate on the Health Service? I have no doubt about that. We are talking about a Health Service currently costing over £4,000 million to run. The chances of additional real resources in the next month are zero. We should be frank. This will mean that badly needed improvements cannot take place and that economies will have to be made. It is no part of the Opposition's case to gloss over the reality of that position. Indeed, I would go further. There still seems to be an assumption that, after a short period of economic stringency, the Health Service will emerge into bright sunshine and that the dark months of rationing will be left safely and conclusively behind.

But it was the right hon. Member for Down, South (Mr. Powell) who almost a decade ago demolished the assumption that at any one time there is a definable amount of medical care which is needed and that if only that need is met, all will be well. The fact is that, as the right hon. Gentleman said, demand is unlimited. Every advance in medical science creates new demands. Therefore, we have a position of unlimited need but of restricted resources. What is more, we have a service depending predominantly on general taxation but with further increases in taxation becoming practically impossible to contemplate. So we are talking of a continuing position in which our prime aim must be to make the most effective use of available resources. From that position several areas of policy discussion define themselves.

We should be talking about whether it is possible to place more emphasis on community care. We face a situation where more and more elderly people are occupying hospital beds. As Rudolf Klein put it, women over 75 make up 3 per cent. of the population but occupy nearly 20 per cent. of the beds. The tragedy is that many need not, and prefer not to be treated in hospital.

We should review the previous shift in policy from hospital to the community, notably in the area of mental health. We should look at preventive medicine and at possible economies. We should consider whether new resources can be brought in, including private medicine and health insurance schemes. Those are only some of the issues that we should discuss.

How have the Government set the tone of the debate? Alone among the problems and issues of the National Health Service, the Government have chosen to press ahead with legislation to abolish pay beds. That is the issue that they have isolated from all the problems surrounding the Service. It is possible for those who support the Government's long-term aim to be appalled by the timing of this proposal. The consultants relied on the assurance given by Aneurin Bevan, and included in the original National Health Service legislation, that the paybeds compromise would be continued.

The Government are now changing the terms of service of the profession. The right hon. Lady is to all intents and purposes abolishing in some parts of the country the right to private practice, for that is what the pay beds mean. At a time when we are already concerned with the low morale of the National Health Service, when we are already concerned about the number of doctors leaving or considering leaving this country, the Government are acting in a way that will further lower morale, encourage emigration and at the same time provoke a fresh confrontation.

Of course, timing arises in another way. At a time when the Service needs every penny it can get, when indeed it has just increased dental charges by £16 million—an announcement made in a Written Answer yesterday—the Government throw away the actual income from the pay beds which alone amounts, on the right hon. Lady's admission, to £26 million a year, they turn their backs on the potential income, and take on the cost of making up the salaries of the consultants who are deprived of private practice, a point which the Government have so far studiously avoided.

In defence, the right hon. Lady says that it is a good bargain, that it is the equivalent of providing four district general hospitals. What nonsense that is, for the 2,500 beds are provided predominantly in the areas where they are least needed and hardly at all in the areas which, according to her own departmental report, are most in need.

But there is a far more fundamental point than that. There are already several thousand beds not used because of staff shortages, not used because we have not got the money to employ the nurses and other staff. So it is some bargain—we are provided with extra beds in parts of the country where they are least needed and in a situation where we have not got the money to staff them in any event. The right hon. Lady should watch it if she goes on producing bargains like that under this Government, she will be made Secretary of State for Trade.

Let us ask the Government this question again: are they able now to guarantee that they will make up the salaries of consultants who are deprived of their private practice because of the abolition of pay beds? Are they taking on that obligation? I hope that the Minister of State will give us a straight answer to that question.

If the Government are doing that, how do they justify their priorities? If they left the pay beds, they would not take on that obligation, but they could provide that same money to make some contri bution to the problem of nurses who finish their training and cannot be employed in the same hospital.

So the pay beds policy is both wrong and damaging and it has been almost universally recognised to be such. The Minister of State takes some comfort from the fact that, according to his figures, it is opposed by only 75 per cent. of the medical profession, although beyond doubt it is opposed by rather more than that. The Minister of State is a great one for taking comfort from the most barren situations. During our last debate he quoted The Times, which, he said, dismissed the theory that the National Health Service was on the verge of collapse. He picked out a few quotations from the leading article.

I was rather surprised, because it seemed to me that the nearest The Times had got to praising the Government's health policy was its leading article headed Even more foolish than Barbara Castle", which was a description of the Labour Party's policy approved at its last conference.

I therefore looked up the leading article to which the Minister of State referred. I found that as an endorsement of Government policy it was rather less than total. For what was the message of that leader? The Times said: In giving way to political pressures from non-medical staff it turned the whole economic and administrative crisis of the service to a political one. It is unlikely that the causes of the crisis, which demand good will in their solution more than any conceivable injection of public money, can be seriously grappled with so long as the question of private practice continues to breed mistrust between doctors and Government It is a great commentary upon the Government that they take support from newspaper leaders which attack their policy. It is an extraordinary Alice-in-Wonderland situation where the Ministers in the Department read only what they want to read. Doubtless the Minister of State will soon find a way of showing that the Daily Telegraph has all the time been secretly on the Government's side and that the Daily Express thinks that the Secretary of State should be promoted.

However, such an avid reader of The Times as the Minister of State might note yesterday's leader. In case it has slipped his attention, I shall read him the relevant lines from it. Referring to the right hon. Lady's policy The Times says: This is obviously a piece of class legislation. It will damage the Health Service; it will deprive people who, like ministers, are willing to pay for privacy of an important convenience and it will accelerate the emigration of doctors. The Alice-in-Wonderland situation is all too evident in the detailed proposals which the Government are putting forward. Who but the Mad Hatter could devise a plan whereby the paying principle was retained for those beds called "amenity beds" which raise little money for the Health Service but abolished for those beds called "pay beds" which raise most money? Who but the Mad Hatter could devise a plan whereby the only people who can pay for treatment privately in National Health Service hospitals are those who live abroad? Who but the Mad Hatter could devise a plan whereby the private sector is allowed but only on condition that it does not develop, flourish, or show any other signs of success?

Let us take the last point, for it is of fundamental importance—licensing not only according to quality but also according to quantity. Let us take the reaction, not of the British Medical Association or of the British United Provident Association, but of the Royal College of Nursing, which says: The Royal College of Nursing sees no justification for the second aim in that it believes that the private sector should be accepted as complementary to the National Health Service and as providing a choice for the individual citizen and for the professional practitioner to which the Royal College of Nursing has already made clear that it attaches great importance. Of course, the Royal College of Nursing is absolutely right. The right hon. Lady wants the private sector to remain a cottage industry, but by what right do she and the Government seek to limit choice and seek also to limit the freedom of the citizen to spend his money in the way he wants? Licensing by quantity is a sop to those who would go even further and abolish choice altogether and outlaw the private sector. Nor are those an extreme minority; that is the officially endorsed policy of the Labour Party conference.

If one listens carefully, one will hear that the right hon. Lady disagrees with this policy, but I wonder how determined that opposition to the decision of the Labour Party conference will be. Will she "fight and fight again" for the preservation of the private sector? I wonder.

What the Minister of State can tell us clearly in his winding-up speech is that he and the Government renounce the policy of the Labour Party conference. Let them take the opportunity of this debate to tell the Labour Party that that policy option is closed, not only for now, but for the future, and to say clearly that they will not tolerate attempts to black private hospital building or political decision-making in planning applications. We shall wait to hear those assurances and we shall judge how brightly burns the red flame of the Government's courage.

The proposals put forward by the Government are damaging to the interests of the patient and the Health Service. They will provoke fresh conflict with the medical profession when the aim of any Government worthy of that name should be to seek reconciliation.

We shall fight those proposals all the way in Parliament. If the legislation gets through, let no one inside or outside the House be under any doubt that following the next General Election we shall repeal it.

12.8 p.m.

Photo of Mr Stephen Ross Mr Stephen Ross , Isle of Wight

I shall restrict my main remarks to the Government's decision to legislate to phase out private practice in National Health Service hospitals. It is well known that ordinarily I do not speak in debates relating to the Health Service.

At the outset I congratulate the Government on their regular uprating of pensions. They deserve credit for this.

I particularly welcome the statement which the Secretary of State has passed on to us from the junior hospital doctors that they are not seeking to break the pay policy. If the junior hospital doctors were to seek to break that policy, the Liberal Party would deplore it. However, that having been said, the history of the negotiations that have taken place between the junior hospital doctors and the right hon. Lady's Department leaves a great deal to be desired and one can only express understanding of the frustrations of the junior hospital doctors. I have no magic formula to suggest, but I beg them to reconsider the offer of the independent audit which, apparently, the right hon. Lady offered them yesterday and which they turned down. The offer does seem to have some merit.

The Liberal view about pay beds was clearly stated by my hon. Friend the Member for Truro (Mr. Penhaligon) in our debate on the National Health Service less than a month ago, and before that by Dr. Michael Winstanley, whose wise counsels in this House we greatly miss. I subscribe to their views. I am not a member of BUPA. When I have been in hospital, I have always been in a public ward. That does not go for quite a number of hon Members opposite, but I defend their right to have their operations in a private ward if they so wish.

I have every reason to be grateful to the National Health Service and deeply regret the unrest which besets it and the general feeling of dissatisfaction among those who work in it. But the situation can only be worsened by the commitment to legislate for the abolition of pay beds.

I support the hon. Member for Sutton Coldfield (Mr. Fowler) in saying that if ever there were a time for courage and diplomacy, this is it. Why not honestly admit that finances just do not allow for this policy to be implemented at present? For the Government deliberately to seek confrontation with the consultants over some 1 per cent. of all beds in NHS hospitals, when resources are so scarce and they already have more than enough trouble on their hands, strikes me as foolhardy. Moreover, I question whether it is really in the best interests of the patients. As I see it, it cannot possibly be so and I am certain that it is not the case in my constituency, and that is a matter of grave concern now to me because I represent an island.

I am told that in the Isle of Wight, distributed amongst some four hospitals, we have a total of 12 pay beds with none for acute cases. We have no private hospitals. Recently a planning consent was granted for one to be built, after quite a lot of bitterness had been aroused, but I understand that it is now not likely to be built because the financial situation just will not allow it. It would not pay its way. We have one or two private nursing homes but with very limited facilities, so the end of pay beds on the island must mean the end of private practice there for consultants.

This will have a quite disastrous effect on new recruitment. I ask the right hon. Lady to think about this seriously. I am told that in the Isle of Wight we have some 24 resident consultants, 11 of whom work part-time in the NHS and the remainder full-time. Two children's consultants have recently emigrated to Canada, and our very hard-worked gynaecologist has taken a two-year appointment in Newfoundland, and one suspects that he will not come back. No fewer than seven other consultants reach retirement age over the next three years, and without any private practice facilities we shall find it extremely difficult to replace them. Already, vacancies are not attracting replies.

This sort of situation must apply in some of the other more remote and difficult parts of the country. A joint meeting attended by the local branches of the BMA, general practitioners, hospital staffs and consultants and junior hospital doctors recently was unanimous in criticising the Government for their policy, and passed four resolutions, which I shall not now repeat but which the right hon. Lady must have read many times.

I emphasise that these are not the views of diehards. These people include many with what I would call progressive attitudes towards medical practice. There are some fine surgeons among them whom we can ill afford to lose. The right hon. Lady quoted a letter from someone in Bromsgrove. I shall quote a letter from one of my constituents. He writes: I have recently received treatment as a private patient in the Royal Isle of Wight County Hospital, Ryde, where I received skilled and kindly attention. I am retired and have only a small income but through thrift in my working life have made the best provision I could for my care, should the need for hospital treatment arise. It seems a great pity that the private treatment facilities available under the NHS to many ordinary people like myself should be withdrawn and I would ask you to use every endeavour to defeat the proposed measure which, in my view, strikes at the heart of democracy in this country. That comes from an ordinary working-class person. I am sure that the Government's policy, if relentlessly pursued without thought to the consequences, will ruin the NHS.

According to The Observer of 12th October, one prognosis has it that the necessary parliamentary time may not be found for this legislation. If that is the scenario, the Government should drop the measure now before the inevitable battle gets out of hand, the results of which can only do great harm to all concerned. A more sensible way ahead is to concentrate on improving the service, of which I am a 100 per cent. supporter. If the right hon. Lady will not include the pay beds issue in the reference to the Royal Commission, why not allow them to take care of themselves and stand or fall by the demand made for them?

12.17 p.m.

Photo of Mr Julian Ridsdale Mr Julian Ridsdale , Harwich

I hope the lack of support for the right hon. Lady from hon. Members opposite in this debate will make her realise how much possibly they and the country do not support the policy which she has been advocating. I congratulate my hon. Friend the Member for Sutton Coldfield (Mr. Fowler) on stating so clearly that we do not wish to make party political capital by fuelling breaches in the counter-inflation policy. I hope that our attitude will be far more responsible than that of the Labour Party when it was in Opposition.

In the Gracious Speech, the Government show little regard for the fact that they are a minority Government. If they did, they would not bring in many of the kind of measures we now face. On Thursday, The Times headed its leader, "A dreadful Queen's Speech". A better headline would have been, "The tyranny of a minority". The Government seem to be the Government of a minority for a minority by a minority. If only they had realised their position and tried to reach some consensus in the country, many of the disputes, such as those with the hospital doctors, would not have arisen.

The Government's dogma that everything in the Labour Party manifesto must be carried out is causing a great deal of trouble. I wish the Government would realise that they are a minority, that the majority of the people do not want all this legislation, and that first priority should be given to the creation of more wealth which, in the end, would be of much more help to the National Health Service.

Instead of that, we have further nationalisation measures, the development land tax, discrimination against quality in education, the extension of the dock labour scheme, which I should like to speak more about as Member for Harwich, and the pay beds Bill. All these measures will add extra burdens to the taxpayer.

The right hon. Lady said that die Government had helped retirement pensioners, and I welcome the fact that they have done so. Nevertheless, with the inflation rate we have been having, it is not a question of helping retirement pensioners in one way but of helping them in others as well. There is nothing in the Gracious Speech that will help the hard-hit and over-burdened ratepayers, whether they be householders, shopkeepers or industrialists. We need reform of local government finance, but it is being pushed aside, much to the detriment of many retirement pensioners as well.

There is nothing in the Gracious Speech to help the poor retirement pensioners over rural transport fares. Some form of co-ordinated policy in this sphere in respect of concessionary fares is surely possible so that the richer rateable areas able to afford concessionary fares can help those areas that cannot. In my constituency there are 14,000 ratepayers drawing rate rebate.

This morning we are concerned with the pay beds dispute. As an emergency patient in a public ward in the Westminster Hospital last September suffering from the effects of a perforated duodenal ulcer, I wish to pay tribute to those who work so hard and well in the National Health Service. I could not have had better treatment and when I was able to eat food, I am sure that it was just as good as the food served to patients in private beds.

However, for 20 years I have been one of the 2,334,000 people who subscribe to a private patients plan. When the Secretary of State speaks as though this scheme involves a small minority, she should pay attention to that figure—representing people who wish to have freedom of choice and to be given the opportunity to insure against a rainy day. I and many other people want to be able to continue to do so. Indeed a secretary wrote to me on this subject some time ago and said that she would rather give up one evening out a month just to save against a rainy day.

There is more to the subject than the aspect of freedom. The Government once again wish to be the godfather and godmother to everybody, without encouraging personal initiative and the wish to help ourselves—the only attitude that will lead us to survive as a country.

Speaking from the experience of having just been in hospital, I appreciate that Westminster is one of the best teaching and research hospitals in the country, but I know that my view is shared by many of those who work in the hospitals, including doctors, nurses and administrative staff. This is especially true of the hospitals that require money for research and where staff do not want to spend all their time filling in forms to send to Government Departments in order to justify expenditure. They want to be as independent as possible. That is why they want their private beds to remain in existence. They do not wish to make this a class dispute.

I thought that the right hon. Lady made a number of cheap party political points in her speech. I shall not quote all her comments in that vein, but I wish that she would leave the party political issue and try to act in a much more statesmanlike way. The present scheme saves the British taxpayer a great deal of money and is also a source of foreign exchange for our hard-pressed coffers.

When I was in hospital, I wrote to the Secretary of State about this problem, calling for more money for research but, alas, she never replies to letters but passes them to other Ministers. I wanted to know how much money will have to be found to cover research in the teaching hospitals. My hon. Friend the Member for Sutton Coldfield spoke of £26 million as the cost of phasing out pay beds. Is that in addition to money to be found for research in hospitals with pay beds?

I ask this question because of the present situation of hospital building in North-East Essex—a subject that has been raised by me and also by my hon. and learned Friend the Member for Colchester (Mr. Buck). We are most concerned at the present deterioration in the situation locally because we have possibly a greater number of retirement pensioners in our area than in almost any other. We appreciate the kind of treatment given to geriatric cases. Time and again we have been given promises by the Government that more help will be given, but some geriatric patients still have to travel 30 miles to a hospital for treatment and nobody is able to visit those elderly people when they are in hospital.

More money is needed to alleviate the present situation. We appreciate that the Government face problems in finding that money because of the country's difficult economic situation, but is this a time at which to cut back on pay beds, involving a loss of £26 million—money so badly needed in my area? I press the Government to try to give all the help they can to the people in my area. We wish to see freedom of choice rather than dictates from the Government. I believe that we in this country are all in danger of becoming psychiatric cases under Socialism. We are unable to cope with our situation because we are so undisciplined. We are unable to compete with other freer States because in such conditions we are not given the freedom to run our own lives.

Despite the minority Government, I know that the majority of people want freedom of choice that a liberalised State can give. Only in such conditions can we make the wealth that is needed to carry out so many of the necessary improvements in the National Health Service and to maintain other welfare services.

For these reasons I ask the right hon. Lady to think again before pursuing, from the minority position in which they find themselves, the Government's doctrinaire policy of trying to abolish pay beds.

12.28 p.m.

Mr. Alan Lee Williams:

Ever since the inception of the National Health Service a minority of doctors have opposed the concept of the scheme. Therefore, it is not surprising that a minority are now expressing a voice on this issue of pay beds. I shall return to that matter a little later in my remarks.

I wish first to say to my right hon. Friend the Secretary of State for Social Services that the absence of Labour Members behind her is no indication of any lack of support. It has always been the tradition that if there is concern over an issue, there are plenty of hon. Members who are willing to speak from below the Gangway. The fact is that on this issue our position has been clearly understood, and indeed it was set out in terms in the two General Elections in 1974. I do not think there is any doubt about that at all.

I know that in my correspondence there has been no avalanche of letters on this issue. I have spoken to a number of general practitioners in my constituency who fully support my right hon. Friend. It would be remiss of the House if today, because of partisan reasons, we failed to take the opportunity—or if we were to follow the reasoning of the hon. Member for Harwich (Mr. Ridsdale), who made a very good speech that would have gone down well at a local Conservative meeting—to condemn the way in which a minority of doctors have behaved throughout this dispute. What is not in doubt—and I am sure that my right hon. Friend will confirm this—is not the future of private practice but the issue of pay beds. This has been made clear on a number of occasions and there is not much ground for misunderstanding on that score.

I believe that a minority of doctors have managed to get themselves into strong positions by being elected to the various national committees—and, by any definition, those doctors are extremists. Their actions are inflicting grave damage on the reputation of the medical profession, and it is disturbing that the British Medical Association apparently supports this minority approach.

There has been an infiltration at various levels by people one can only describe as extremists, whether to the Left or to the Right—people who certainly take an extreme view rather than a balanced one. This is a reprehensible state of affairs and should be roundly condemned by the House. That minority are damaging the medical profession but, more important, they are possibly getting themselves into a position from which they will damage the interest of patients. They should show restraint. The message that should go out from this House is that those elements should try to understand my right hon. Friend's difficulties on this issue. My right hon. Friend can be certain of the full support of her back benchers. It is fully appreciated that the situation which she inherited when she became Secretary of State was not the most desirable because there was a long history of cash flow problems and neglect of the National Health Service. She is doing the best she can and in those circumstances one asks for restraint from the doctors so that they do not continue to behave in this highly damaging and irresponsible maner.

12.31 p.m.

Photo of Mrs Lynda Chalker Mrs Lynda Chalker , Wallasey

I should not rise to speak about the Gracious Speech if I thought that the right hon. Lady's plans were in the interests of all patients. I have spoken to many of my constituents and many workers in the National Health Service and they have all said "No, this is not the way to do it; nor is this the time to do it". A galaxy of people may advise the right hon. Lady in the other direction, but I am certain that if she were to take a poll on this issue alone, she would find that the general public believe that this is neither the right time nor the right proposal to separate private beds from the National Health Service. Indeed, I would add that according to the recollection of many people, this issue was well hidden in the Labour Party manifesto.

I wish to refer to the tensions mentioned in the Consultative Document published in August this year. According to paragraph 7 the simple answer to the tensions was: to abolish private medicine entirely". The right hon. Lady has today reaffirmed her intention that at present that is not her particular way of going about the issue. However, I can recall previous years when she was not so strident about the subject of pay beds. I am referring to the first time I ever debated with her during a meeting at the University of London Union at the beginning of the 1960s. Therefore, the right hon. Lady's views change. There is a grave fear amongst the medical profession that what the right hon. Lady says today she may not maintain tomorrow, or in the years ahead, and that is one of the underlying problems.

Paragraph 7 of that Consultative Document also points out: The philosophy of a democratic society is one which allows minority views, tastes and practices. A philosophy which believes in balancing the freedom of the individual against the freedom of many. That is an essential question concerning not only health but many other issues raised in the Gracious Speech.

Let us concentrate on why the right hon. Lady insists that at this time, when our economy is under greater pressure than at any time since the 1920s and 1930s, she must introduce such a divisive policy. I believe that she is returning to her former colours. Doctors ask me whether the right hon. Lady is well, because they think from their professional observation of her performance and her failure to listen to reason that perhaps everything is getting on top of her. They are concerned. That is why my hon. Friend the Member for Sutton Coldfield (Mr. Fowler) said that perhaps it might be a very good thing if the Prime Minister were to intervene, for the doctors with whom the right hon. Lady is trying to negotiate may have greater faith in another person. Their faith in the Secretary of State has diminished to absolute zero.

I shall not harangue the right hon. Lady. I notice that she has left the Chamber, but she can read my speech later. I wish to examine some of the issues. I am sorry that the hon. Member for Hornchurch (Mr. Williams) has also left the Chamber. We know that he came in to fill a gap in the House, but that gap has reappeared.

When the hon. Gentleman said that the doctors did not want a continuation of private practice within the Health Service, he did not consult the figurework that has been done on this matter. He did not read that 75 per cent. of the senior registrars, doctors and consultants and a slightly smaller percentage but still a majority of junior hospital doctors as well as dentists believe that it is essential that private practice remains within the Health Service. Perhaps the hon. Member for Hornchurch would do better to stick to his own Department if he does not have time to read our briefs, because we admit we do not always have time to read his.

Let us examine the right hon Lady's reason for wishing to oppose pay beds in the Health Service. She talks of queue jumping and of the under-occupancy of private beds. In the Wirral Area Health Authority there are 1,250 beds in the Health Service and of those, 29 are authorised private beds. I draw attention to the authorisation of private beds, because the number being used in my area is 12 out of 29, which is not a large proportion of 1,250. However, we must compare that with the 500 empty Health Service beds on any one day within the area health authority. What is the sense of doing away with 12 beds which are well used and not using 500 beds? I find it impossible to follow the right hon. Lady's logic.

In Newcastle there is a similar situation with an even higher occupancy rate. There are 30 private beds in the Health Service hospitals with a 77 per cent. occupancy rate. It is possible that by allowing private medicine to concentrate better service on beds within the Health Service we can increase the occupancy rates and not diminish them.

Throughout the whole of the Service there are nearly 500,000 beds and of those 4,866 beds, according to the Minister of State, are authorised for private patients. We know full well that far fewer than the number of authorised beds are actually used for private patients.

Pay beds in the Health Service provide flexibility. We cannot localise all private or all public provision, but to have a few pay beds in Health Service hospitals gives those people who want to do so and who are willing to pay towards their care the opportunity of having it nearby. Far better than being 100 miles away in a private hospital where they cannot be visited by their relatives and friends, they can be near at hand without upsetting the so-called queue, which is certainly based not on the number of beds available, but on other factors.

The way in which the right hon. Lady announced her planned reduction of private acute beds in the Health Service as a whole was especially notable. She has announced that these beds will reduce over a period from 3·3 beds per thousand population to about two. However, that is rather a pipe dream when we consider the amount of money required for the community care to enable that to happen.

The difficulty is that where there is a private bed, it is probably well occupied, but we cannot at present occupy the other beds. Therefore, the right hon. Lady is just looking for another way out of the present situation. She is putting forward just another argument. I, too, believe in community care, but the right hon. Lady's present argument is not part of the real question.

We must also consider the discharges from the occupied beds. If we knew how many empty beds existed, either in our own areas or nationally, on any one day, and if we could staff and finance the Service properly, more people could be admitted to hospital. We all know that the shortage of resources is one of the basic problems. There is no sense in exacerbating the problem, which is exactly what the right hon. Lady is doing with her present policy.

Let us examine the situation of the consultants. Of about 11,000 consultants there are only 4,411 who are full time. What will happen to the part-timers who wish genuinely to serve the Health Service full time? When they apply, will they be told that there is no money to employ them as full-time consultants and that therefore they must remain on their part-time pay only? Or if they are to continue under the system which the right hon. Lady proposes, will they have to make journeys of 50 miles or more between hospitals? We talk of separation in the Health Service. The strain that will be put on consultants is that they will have to travel at risk over far wider areas while their patients lie in hospital also at risk. Those are a few of the problems facing consultants.

In 1948 the doctors were promised clinical freedom and the option to continue in private practice in the National Health Service, and they took it. In the beginning, some were opposed to the idea, but they took advantage of the offer is a reasonable compromise. We are now in a worse economic state than in 1948. I maintain that this compromise should be allowed to continue so that we do not worsen the state not only of the Service, but of the staffing within it. The Government's plan in the Gracious Speech is an abrogation of the Beveridge freedoms. No wonder consultants and doctors ask what will happen next!

Let us consider in more detail the policy of separation and the problems that it will cause. I asked the Prime Minister how he would honour the Secretary of State's pledge to separate, not to eliminate, private practice. This matter has already been referred to. The right hon. Gentleman did not understand the question, so he waffled away and said that the right hon. Lady had answered the question in our previous debate on the Service. Needless to say, she had not.

Let us consider this matter as it affects areas far away from my constituency. Norfolk is a widely spread county. What will be the effect of the separation, so called, of pay beds from Health Service beds? There are seven pay beds in King's Lynn, seven in Wisbech, three in Cromer, seven in Yarmouth, one in Beccles—I do not know whether it is still there—37 in Norwich and one in South-wold on the border. Those 63 pay beds in the Service in that area are to be phased out. There are 17 acute private beds available in the whole of Norfolk in one private hospital. Therefore, to all intents and purposes we are completely eliminating the choice of private health care in Norfolk by this policy.

I can repeat this exercise for Cumbria. There are eight pay beds in Carlisle, one in Workington, four in White-haven, four in Kendal, and no private hospital within 85 miles for those people. That is the effect of this policy.

Photo of Mr Stephen Ross Mr Stephen Ross , Isle of Wight

The hon. Lady is making a very good point. I am grateful to her for giving the figures, which substantiate some that I quoted earlier. Is she able to give us an idea of the difficulties facing these areas in obtaining consultants? Has she any evidence of that problem where there is no private practice?

Photo of Mrs Lynda Chalker Mrs Lynda Chalker , Wallasey

I am told that there is a great deal of evidence on this issue, but I do not have it to hand today. Consultants go to these hospitals willingly because they see a good job to be done. They also like to remain in those areas. If they were allowed to continue private practice in the hospitals in those areas in greater numbers, they would more happily go there. If there were a private hospital in the area, they would more willingly go there. I shall come later to some of the difficulties that we face with the licensing system.

The average number of pay beds in each of the 722 hospitals in this country is about six. The problem is that they are unevenly spread.

I turn now to under-occupancy and what the right hon. Lady intends to do about it. There was a notice on 13th May dealing with that problem. The right hon. Lady announced a 10 per cent. cut in pay beds—a reduction of about 430 private beds in the Health Service. However, she had the sense to realise and appreciate the basis of what I am saying when she made that announcement, because she said that if a hospital had fewer than five beds, they would not be up for the 10 per cent. chop. The Secretary of State also said that if a hospital had an occupancy of those private beds greater than 60 per cent., they would not be up for the chop. It seemed to me that the right hon. Lady then realised the problem she was creating for many areas, particularly the North Midlands, by wholesale elimination of private beds in Health Service hospitals.

There are many other aspects of the problem. The one thing that I cannot see in any of the speeches made by the right hon. Lady or by the Minister of State, both inside and outside this House, is the sense of proceeding with this policy of separating pay beds. The consultants do not want it, because they feel that they cannot give all the care that is needed by all their patients.

There has been a lot of unfair criticism of the consultants. They have been lumped together in the same way as the Government have lumped together the self-employed as a lot of people on the wrong side of the tax laws. They have been referred to in public speeches as money-grabbers by Labour Members of Parliament throughout the country. They are not. They are concerned for and with the care of their patients. The Minister of State looks at me in a slightly guarded way. We all know that in every profession there may be some who do not put their professional interest first. It is so in this House, regrettably. It is a grave mistake to blacken the whole because of the actions of a very small minority.

What does the so-called compromise proposed by the right hon. Lady involve for those who wish to have the freedom to spend their money on private health care? The licensing system was outlined in the Consultative Document in August. We know that the granting of licences will depend initially on meeting certain specified conditions. Obviously there will have to be inspection.

The problem arises when a new private hospital is planned to take the place of the so-called separated, but really eliminated, pay beds. The application for a licence must be consistent with Health Service planning and nobody will object to that. The application will go to the area health authority. I ask the House to note that the licence may be applied for only when a hospital is finished and fully equipped. The House should take cognisance of those words.

This is a mad plan which will not encourage the building of private hospitals, even if that is supposed to be the reason. If it is not an acute private provision, everything goes ahead more or less as now. There is registration under a process similar to the existing procedure. However, where it is a new or expanded facility in the acute sector, other things must happen. First, the Secretary of State has to decide whether in view of any overriding statutory duties—not yet spelled out, of course—the application for a licence may be allowed to proceed. If it is allowed to proceed, there is an automatic public inquiry.

The Consultative Document goes into the detail of the application and points out that there shall be advertising within a 100-mile radius of the siting of that private hospital so that objectors may object. An inspector is appointed, and after his inquiry the first report is confidential to the Secretary of State. It will then be published when the Secretary of State makes her decision.

If the right hon. Lady says that the application may not proceed, only certain groups of people are allowed to request a public inquiry. They are a county council, a London borough council, a district council, a community health council, or an area medical committee. The people who are prepared to fund and to run the private hospital have no right to a public inquiry. Therefore, the proposed provider is at the behest of the Secretary of State.

I find it difficult to see how this will encourage the provision by the private sector of this so-called separated health care. We have on the one hand the definite elimination in some areas—there is no doubt about that now—but on the other we also have this so-called answer from the Secretary of State. It is no answer whatsoever, and the country must recognise that now.

This is the problem underlying the attitude and the feelings of the doctors, be they junior hospital doctors or consultants. We must remember that years ago the junior hospital doctors were quite prepared to work for small sums in order to be able to practise and, after 20 years of study and hard work, to give the benefit of their advice and learning at consultant level. But there is nothing today to persuade a junior hospital doctor to remain in the new great National Health Service proposed by the right hon. Lady.

If the Royal Commission is to do any good on this topic of the National Health Service, it must surely consider the subject of pay beds. I am prepared to leave it in the hands of the Royal Commission—even if it decides the other way—but I am not prepared at this present time to allow the attitude of the King in Alice in Wonderland "Let the jury consider their verdict" to be overridden by the Red Queen. Let us not forget what that Red Queen in Lewis Carroll's book said and what this Red Queen is saying "Sentence first, verdict afterwards".

12.54 p.m.

Photo of Mr George Thompson Mr George Thompson , Galloway

When I listen to hon. Members such as the hon. Member for Wallasey (Mrs. Chalker) I think that I ought to feel deprived because I received my education in State schools and because the health care I have received has been from the National Health Service. I do not feel in the least deprived on either of these counts. I reckon that I have received excellent service in Scotland from both the national education service and the National Health Service. I hope that in Scotland we shall not allow the burning issues of southern England—pay beds and agency nurses—to blind us to the true problems in Scotland.

In my last speech on this subject, about three weeks ago, I commended to the attention of English and Welsh Members the Scottish situation concerning pay beds and agency nurses in the National Health Service. I feel that it would be a useful exercise—if it could be done—to send some hon. Members from England to Scotland to study the situation there in depth. Perhaps they would be able on their return to better the English situation.

However, I do not make a practice of harangueing English Members on English problems. I am sure that they are the best qualified to run their Service in their own way. If they want a class-ridden system, it is their fault and not mine.

I should like to turn now to certain statistics which appeared in the Financial Times on 11th November 1975. The statistical table was headed "Europe's Health", but, of course, in the normal geographically illiterate situation of the present day, it was not to do with very much of Europe. It did not even, in this case, cover all the nine members of the EEC. It did, however, separate Scotland from England and Wales.

The table gave the population per doctor as 640 in Scotland against 790 in England and Wales, and the population per hospital bed as 80 in Scotland against 110 in England and Wales. These figures should, therefore, tend to show that Scotland is in advance of England and Wales, but this is only apparent. If we look at the rest of the table, we find that it is not so.

The general mortality rate, for instance, per thousand of the population is 12·4 in Scotland against 12·1 in England and Wales. We are, in fact, the second highest in Europe. Only the German Democratic Republic can beat us—if that is the proper term to use in the circumstances.

The infant mortality rate per thousand live births is 18·9 in Scotland against 17·3 in England and Wales. The life expectancy of a child born in 1970 is 67·1 years in Scotland against 68·8 in England and Wales if the child is a boy. If, however, the child is a girl, it is 73·4 years in Scotland against 75·1 in England and Wales.

We have the odd situation, therefore, that with apparently better health care in Scotland, we have a worse health record. I think that it will be important for the Royal Commission, as it is important for the Government, to consider why this is so. I am a mere linguist. I am not a medical man. I dare say that medical men, in their careful cautious way, would say that they do not know precisely why this is so. If so, there is good reason to investigate it. Perhaps it might be thought that it is the climate. I have no doubt that this plays a rôle. We have been told also that things like the prevalence of soft water in Scotland may have something to do with heart disease.

Photo of Mr George Thompson Mr George Thompson , Galloway

I have heard it said on many occasions that whisky can fortify us against the climate, and this is sometimes made the excuse for the excessive consumption of that beverage in certain parts of Scotland, if not all over the country.

It might also be thought that, because of the loss through emigration of sections of our population, the genetic stock has been rendered less healthy. It might be that it is our bad habits, such as our addiction to whisky, to which the hon. Member has just referred, our addiction to cigarettes, or our eating the wrong foods. I hope that we shall in the end be given guidance on these matters by those who are looking into them.

In the case of our bad habits, we should surely be aiming at prevention of the diseases rather than curing them when they arise. This means that we must allocate more resources, within the limited resources available, to health education. It also means that we, the individual citizens, have to be willing to alter our habits and our way of life—or at least that the Government should endeavour to persuade us that we should do so, and that, unless we are already ill, we can do so. Therefore, there is need for this to be emphasised at all levels in society—within the family, in the school and at the place of work—and for all these agencies to be involved in the process.

If health education can reduce the incidence of dental decay, lung cancer or alcoholism, this will be money well spent, because in the long run the money that will be saved can then be spent on the acute illnesses that will still, alas, chance upon some of us in our lifetime.

We ought also to look again at advertising for cigarettes and for alcohol to see whether it is possible to deglamorise—if I may invent yet another horrible, barbarous word—these commodities so that people will not feel that there is something necessarily charming and delightful, manly or womanly, about them.

There is another aspect of this whole health problem in Scotland which, I regret to say, is nowhere specifically provided for in the Gracious Speech. I refer to social deprivation. How splendid it would have been if the Gracious Speech had contained the Government's precise intention to provide for a many-pronged attack on social deprivation. Nevertheless, I hope that this is covered in the sentence which reads: My Ministers will pursue vigorously their programmes of social reform by legislative and other means, within available resources. The connection between social deprivation and poor health is only too manifest, even if the medical men cannot establish a precise relationship of cause and effect. Overcrowding will provide an easy path for the spread of infection. Bad conditions in housing and local amenities will lead people to seek refuge in alcohol, and poor nutrition is a factor in many diseases because it weakens the body and makes it more susceptible to infection. Here again are factors that it is within the Government's power to prevent if they are prepared to launch a massive onslaught on them.

Having read many letters from Ministers and local government bodies on the subject I have no doubt that we shall be told that this cannot be done in present economic circumstances. I make only two comments in reply to such a suggestion. First, the liquid black gold called oil has begun to flow. Will the Government earmark a fraction of the revenues from it for the attack on urban deprivation, especially in West Central Scotland? Secondly, the Government may say that they cannot take action at the moment, but will the Minister assure the House that plans are being formulated now so that the action can be taken as soon as the necessary resources are available? If the Minister cannot give a firm "Yes" to both those questions, has not the time come for the whole matter to be passed to a Scottish Government in Scotland? The delay on devolution expressed in the Gracious Speech means delay in the attack on deprivation.

Tomorrow, I am to attend a workshop in Dumfries which concerns itself with the mentally handicapped. It would be very good if I could carry away from this House an assurance from the Government that the care of the mentally handicapped is to be increased through, for instance, encouraging the building of sheltered housing and hostels.

As for pensions, I hope that the Government will still be looking into the possibility of providing an additional allowance for people in the northern part of this island and the surrounding islands to make up for the fact that they have to buy fuel at a price which is increasing and that they need more of it than people in the more climatically favoured parts in the South of Great Britain.

I turn finally to a minor matter. I do so because it is one which has been raised with me. It is the problem of seniority payments to doctors who served in the Royal Navy. The regulations say that the Secretary of State will consult the Ministry of Defence on individual postings but that broadly the posts which will be recognised are those of senior medical officers in stations where general medical care is provided for Service men's families and civilian employees as well as the Service men themselves. I understand that the Royal Navy does not normally undertake this kind of medical care, although the RAF and the Army do.

I wonder whether the Minister will look again at the regulations dealing with service in the Forces, bearing in mind also that there seems to be an element of sex discrimination. Since girls were not compelled to do national service, the men start slightly disadvantaged in this matter.

My concluding comment is simply to repeat that if the Government cannot rise to the challenge in Scotland, they should clear the way as speedily as possible for a Scottish Government to do so.

1.5 p.m.

Photo of Hon. Robert Boscawen Hon. Robert Boscawen , Wells

The Secretary of State referred to the current dispute among the junior doctors as the most crucial issue today, in her view. At the outset, I must say that I do not believe that to be the crucial issue. It is part of the crucial issue in the National Health Service today, but it is far from being the whole one.

The basic trouble with the Health Service is that there is far too much partisan politics in it—politics which are now right through the bloodstream of the Service; politics which are destroying the laudable objectives of the Service, to promote better health for the whole nation equally as of right, politics which are destroying the morale of professional people, nurses and auxiliary workers in the Service.

I do not believe that there is any one cause. It has been going on for some time, and there are many reasons why the Health Service is in the situation that it is. However, in my view the right hon. Lady cannot absolve herself entirely from the situation which exists today because she herself is a major cause of the trouble.

As a soldier, in former times, I was always told that there were no bad troops without bad officers and no bad officers without a bad general. I hope that the right hon. Lady will take that old military adage to heart.

I welcome wholeheartedly the suggestion by my hon. Friend the Member for Sutton Coldfield (Mr. Fowler) that in the immediate dispute with the junior doctors the Prime Minister should take a hand to try to remove some of the partisan political steam which has been generated and to remove it for the present from the hands of the right hon. Lady about whom there is so much cause for concern.

I have a constituent who has just come out from a lengthy stay in a large national hospital, though not one in my constituency. Only the day before yesterday, he told me that, although he had received excellent treatment and was delighted with the way in which he had been restored to health and helped as a result of the treatment that he had been given, he was all too well aware that everyone in the hospital was desperately worried about the way in which the Health Service was being torn apart by politics.

Morale amongst nurses is very low. Consultants are worried and confused to find that they of all people—one of the most responsible groups of men in the country—should be forced to talk about industrial action. There is even more anxiety and concern amongst the junior doctors about the action that they are finding some of their numbers being forced to take. Going further along the scale, there is also deep worry amongst hospital workers, members of NUPE and CoHSE. How is it that people who give up their lives for the sake of patients should be taking action in all parts of the country which is totally alien to their aims? How is it that the trouble that had arisen in the Westminster and the Charing Cross Hospitals should be taken out on the private patients? How is it that in the West Country recently there has been a threatened strike of CoHSE members in a hospital against taking in a person in need of psychiatric treatment described in newspaper headlines as "a wife-killer"? He was sentenced to life imprisonment because he could not be admitted to three psychiatric hospitals in the part of the world from which I come because of the refusal of the staff to allow him to be taken into those hospitals. I believe that this was a disgraceful happening and that not nearly enough attention has been drawn to it. John Brazil faced the possibility of being sentenced to life imprisonment simply because workers in the right hospitals to treat him refused to accept him due to his unfortunate malady. Thank goodness that at least a hospital has been found willing to take him.

All these happenings show that a form of leukaemia is penetrating every cell of the Health Service. I believe that the right hon. Lady has first and foremost to take politics out of the Health Service and to address herself to the real problems that lie within it. We know that there are many serious shortcomings. The worst symptom, I suppose, is that we have the longest hospital waiting lists in the Western world and we never seem to be able to get over this problem. We need a full analysis as soon as possible of why we have these tremendous waiting lists. Government after Government have sought to reduce them but have never been fully successful.

Is it a shortage of staff that is responsible for these waiting lists? Is it pay? Is it private practice that is causing these delays? Or is it that for years general practitioners—the family doctors—have been the Cinderella of the Service and as a result have been sending far too many of their patients into hospitals for investigation? Or is it because family doctors have had too much work to do or are too lazy? Or is it because they want somebody else to do the work for them?

Certainly something is very wrong it we have to contend with these long waiting lists, and I hope that when the right hon. Lady's Department gives evidence to the Royal Commission she will explain why it is that Governments have increased expenditure year by year in the hospital service and at the same time have decreased expenditure in the family doctor service, because this is one of the fundamental causes of much of the trouble in the Health Service today.

There are other deeper reasons for the breakdown in the Service. The right hon. Lady said that we must will the means if we want to will the end. Have we really willed the means for running a great edifice such as the Health Service? Have we studied nearly enough the alternative ways in which to bring more finance into this great Service? Have the Government given enough thought to the question of health insurance schemes? At a time when we need more and more finance to try to keep this Service in being, to try to restore morale and to try to take politics out of it, the right hon. Lady is proposing to end the system of pay beds and to cast uncertainty and doubt on the future of private practice. Is there anything more irresponsible than that? That is why I feel that so much of what the right hon. Lady says is wrong today has as its root cause her own actions during the past 18 months.

I do not want to confine myself entirely to the National Health Service during this debate on the Gracious Speech because, like so many other hon. Members, I am angry, sad, confused and for the time being feel helpless to do anything about the situation in our country today. Never, even in those dark days of the war, have I felt such dread for the future of our people over the next year or two, and what we have in the Queen's Speech is total irrelevance after irrelevance to our situation. The attack continues throughout the Gracious Speech on those very sections of our community that are striving as hard as they can to keep the country's head above water.

The attack continues on private enterprise. It continues on those individuals whose efforts and perseverance are doing most to sell the goods that we have to sell to earn enough to buy the food that we need to feed our people. The attack continues on those who are determined through self-employment and hard work to keep themselves independent of large concerns and independent of Government and bureaucracy.

Since the end of the last Session I have spoken to a leading international banker about that problems that we have and he made a simple but telling remark which might have been made by anyone, but it is alarming from someone who has power to invest many billions of pounds of his clients' money. He said, "I could not advise my clients to invest in the United Kingdom when the top rate of income tax is 98 per cent. and when there are many individuals at the lower level of the income scale who are not encouraged to work any harder because of the high level of marginal tax, called the poverty trap. That is what is debilitating your country. We cannot expect a country faced with those difficulties to expand and pull itself out of trouble".

Those are some of the things that we should be tackling in this Session of Parliament and putting right if we are to get out of our trouble. We are faced with the most serious economic situation that I can ever remember. It is more serious even than it was in the 1930s. The morale of our country is extremely low and constitutionally we face grave difficulties. Our internal security is in serious trouble. We have more terrorism in this country today than in any other country in Europe except perhaps Portugal. We are taking risks with our external security, that alarms me greatly having regard to the threats that we may have to meet. Ministers come to the Dispatch Box and talk about the situation, not only inside this country but outside it, as if they are living—as they do—in a dream world of unreality.

I speak with the deepest foreboding of what will happen during the next year or two unless we attack the real difficulties that we face. Dividing the country on such issues as pay beds, nationalising the shipbuilding and aircraft industries and extending the area of the Dock Labour Board will not solve our problems. We must make people realise that what we need is hard work, preserverance, effort, determination and selflessness. That is the only way out for our country. That is the call we want to hear from the Government, but it was totally lacking from what the Prime Minister said on Wednesday.

1.20 p.m.

Photo of Mr Richard Luce Mr Richard Luce , Shoreham

I very much share the views expressed by my hon. Friend the Member for Wells (Mr. Boscawen), not only about the condition of the social services, but about the condition of the country in general. The almost empty Chamber today—especially so on the Government side—is partly a reflection of the ebbing away of power from this Chamber over the past few years. That must be one reason why we are not attending the Chamber in the numbers in which we used to attend.

Secondly, despite what Labour Members say, I am sure that they must understand the demoralisation of the health services, much of which has been caused by the Secretary of State. The Prime Minister recently launched a new industrial strategy—that of "backing winners". He might start in his own Cabinet by dropping the Secretary of State for Social Services in favour of someone who is prepared to do something to build up morale in the social services.

As my hon. Friend the Member for Wells said, the Gracious Speech envisaged legislation that will take us still further towards State domination. Successive Governments have indulged in the belief that we shall solve our problems by legislation. Another fault is that the Gracious Speech envisages too much legislation. That is not what we want: we want leadership.

My main point concerns the social services, but in passing let me mention two aspects of the Gracious Speech that will have an adverse effect, particularly on my constituents. The first is the Bill that will ensure comprehensive safeguards for dock workers. In my constituency is the efficient port of Shoreham, specialising in the timber and wine trades. It is doing very well. What is the point of extending the dock labour scheme, which will give security to a group of dock workers at the expense of other people, inflate costs, and possibly even put smaller business men in the area out of business and, make employer-employee relations more impersonal by interposing a third force, the National Dock Labour Board? If, as is suggested, it will extend to five miles from the ports, it could include 70 per cent. of all our cold storage industry, which will increase industrial costs and food prices. That is an aspect that I shall be attacking strongly over the next few months.

The second aspect is the abolition of the agricultural tied cottage, which will damage the farming industry and seems to conflict with another statement in the Gracious Speech: My Government…will continue to encourage the maximum economic production of food at home in the interests of producers and consumers. That sounds fine until later we read: Legislation for the abolition of the agricultural tied cottage system in England and Wales will be laid before you. The abolition of the tied cottage system will make farming more expensive and less efficient. It will be more difficult for farmers to find labour and provide a clear promotional structure. The livestock industry particularly, which depends on stockmen being immediately available day and night, will suffer badly.

This legislation will be based apparently on two assumptions—that all farmers are Rachmanites and that there is some stigma attached to living in a tied house. But if the latter is true, it applies equally to the police, to vicars, to miners and above all—here perhaps it is justified—to the occupant of the tied house at No. 10 Downing Street. There may be a stigma attached to that house.

Instead of constructive proposals for the social services, the Gracious Speech contains proposals which are completely destructive—the abolition of pay beds and the implication of stronger control over private hospitals and concerns. In an atmosphere of bitterness and low morale, this abolition will lead inevitably to less choice, less money available and less creativity in the profession.

Above all, these proposals are divisive. When we should be harnessing the public and private sectors, the right hon. Lady is setting out to divide them even further. This is destructive and is leading to regrettable disruption by consultants and others. They must be condemned, but we should also ask whether they would have happened if the Government had been more robust in condemning other strikes and disrupt tions. Over Clay Cross and in their failure to condemn strikes of all kinds the Government have much to answer for when we consider the present condition of the Health Service.

This is a typical example of how the Government are apparently encouraging the ineluctible trend of the last decade towards increasing State domination. I cannot help being struck by the words of James Madison in 1788 when he said: I believe that there are more instances of the abridgement of the freedom of people by gradual and silent encroachment of those in power than by violent and sudden usurpations. That is precisely what is happening and it is being encouraged by the Government. If the Secretary of State wants to be constructive and to create a new climate, I can suggest a course of action. Paradoxically, an opportunity is now provided by the inevitable cuts that are taking place and will take place in the social services, as in other sectors. These cuts at local authority level could act as a catalyst to reverse the trend towards State domination. Month in and month out we have been told that we face a crisis. However, individuals want to be told what they can do to help get Britain out of this crisis.

In these circumstances, our community has one great asset—namely, the voluntary spirit of the British people. I want to give some examples to illustrate how we can tap that spirit. Before I do, so, I ask the House to bear in mind some considerations. First, local authorities are being asked to undertake a wide range of statutory duties which they simply do not have the capacity or the resources to undertake. Secondly, in many circumstances local authorities will find that it is more cost effective to give grants to voluntary bodies which have special skills than to carry out the particular statutory service themselves. Thirdly, local authorities should consider the appointment of liaison officers, the lending of staff and the giving of guidelines on how voluntary bodies can back up the professional services in our society.

The mass of examples that I can give of areas where the voluntary spirit can be tapped is an illustration of the need for leadership from the Government. There is, for example, a desperate need for voluntary help to look after more people in their own homes. That is a point that my hon. Friend the Member for Sutton Coldfield (Mr. Fowler) so ably made earlier. If we did this, we should release more beds for acute cases in hospitals.

A second example is the use of a monitoring system for the elderly, particularly in areas where doctors are under strain, and a home care attention service, which could detect at an early stage the type of problem an individual faces and recommend urgent treatment.

A third example would be a voluntary register and monitoring system for those suffering from hypothermia and various inadequate heating problems. Fourthly, there could be a voluntary relief service for dependants of those looking after seriously sick patients. Fifthly, there could be the development of a proper neighbourhood contact system for the elderly if, under the present law, the council cannot justify or afford the provision of a telephone service.

A sixth example could be voluntary assistance for transport, particularly in rural areas, for the elderly and the disabled so that they can do their shopping, attend hospital and so on. If the Government in the Gracious Speech had said that they would introduce legislation to relax the licensing laws for public service vehicles with a view to enabling the development of a better rural transport system, they would have been taking a constructive step towards improving the situation for many of the elderly.

Another example might be the use of voluntary supervision for those serving under the new community service orders. Yet another example would be more voluntary assistance for the Government's campaign to improve the adult literacy situation. A further example could be the identification of those who suffer from handicaps of one kind or another and who need assistance under the 1970 Chronically Sick and Disabled Persons Act.

Those are just a few of a mass of examples that could be given of how the voluntary spirit in this country could and should be tapped. Recently, East Sussex and West Sussex got together under the leadership of the Sussex Rural Community Council to launch a campaign to mobilise voluntary effort to support the statutory services in those two counties. This is the kind of campaign that should take place throughout the country, led and inspired by a Government which would set the right climate.

However, over the past decade we have been walking down the terrible path towards more and more State control. It leads to the stifling of individual initiative and that helps to create a society that is soulless, grey and drab. We are in danger of sinking gradually into that slough of despond.

However, I simply cannot believe that that trend is inevitable and that it cannot be reversed. Somehow, sometime, we have to reverse it. I have a great deal of faith in the British people and I believe that they have the capacity to see the dangers when they are faced with them. Is it too much to ask the Government to give a lead now and to re-awaken the voluntary spirit in the British people?

1.37 p.m.

Photo of Mr John Stokes Mr John Stokes , Halesowen and Stourbridge

I wish to associate myself with the general remarks about the state of decline in this country made by my hon. Friends the Members for Wells (Mr. Boscawen) and Shoreham (Mr. Luce), who made those points most eloquently.

We are debating the Gracious Speech only a day after a most remarkable attack upon it was published in The Times. I thought at first that this might be somewhat puzzling to foreigners, who often believe that The Times reflects Government opinion. However, I remembered, alas, that today few foreign newspapers report what is happening in this country and that we are, indeed, alone with our self-inflicted troubles. Needless to say, I agree with all the criticisms mentioned in The Times.

There was no mention in the Queen's Speech of the general state of the nation in this year of grace 1975. Only economic and political problems were stated and only Socialist solutions proposed. We have the remarkable situation of a minority Government pressing extreme measures on a sullen country. We are, I believe, as a nation divided, envious and unhappy, as we are passing through a period which historians of the future may call a shameful stage in our long island history, comparable in some ways perhaps with the period of the Vichy Government in France.

How soon we shall emerge from this state of affairs I do not know and there is certainly no clue in the Gracious Speech. However, only a sense of unity and cohesion in this ancient kingdom and a resurgence of national pride and patriotism will put us back on the road to greatness again. We seem temporarily to have forgotten our glorious past and to be living in a fog of self-doubt, mediocrity and pettiness.

The number of Bills proposed again presumes that ills can be cured by Acts of Parliament. The attack on inflation surely should start by an attack on Government spending—nowhere mentioned in the Gracious Speech. Industry, which alone creates the real wealth of this country, is to be suffocated by a National Enterprise Board. Absurd proposals are made for further nationalisation. Petty spite is shown in dealing with private medicine and in selection for schools. Nowhere is it suggested, in these times of economic stringency, that some services provided now alone by taxpayers and ratepayers will in the future have to receive further finance by individuals themselves making some payment for these services, supported where possible, I would suggest, by national insurance schemes provided—if we can do it—by private enterprise.

There is no mention in the Gracious Speech of the plight of the millions of self-employed. There is certainly no comfort for the bulk of my constituents in the West Midlands, who depend for their livelihood largely on the success of private enterprise firms.

Further burdens are to be placed on ordinary people in respect of so-called racial discrimination, whereas what most people want is a reduction and eventually a cessation of the mass immigration which is still proceeding at an alarmingly high rate and which is now, unfortunately, never debated in this House, and receives no mention whatever in the Gracious Speech.

We are promised a new Bill to prevent terrorism, but terrorism continues in Northern Ireland, and now in England also, and I believe that it will continue and grow worse until sterner measures are adopted, including the death penalty for crimes of violence in which terrorism is involved. No mention is made of strengthening our defences in an increasingly dangerous world.

However, on top of our social, political, economic and moral problems we are apparently to waste eight to 10 weeks of parliamentary time discussing devolution. These proposals would be difficult and dangerous enough in times of prosperity and social stability, but a mania of change for the sake of change seems to have seized all Governments in recent years. I believe that we merely add confusion to our many problems by thinking that human satisfaction can be increased by changing organisations alone.

The root cause of the desire for devolution, which is not in any case strong or widespread, is, I believe, primarily dissatisfaction with government in general, and not just the Government here at Westminster. We are, as many Opposition Members have already said, over-governed. We pass too many laws and appear to have far too many civil servants at local and national level. I suggest that this fundamental malaise should be dealt with before we embark on dangerous constitutional change.

I welcome the Government's decision to hasten slowly in this complicated matter. I also welcome the caution expressed by the leader of my party on this subject. I do not believe that the implications of separate Assemblies for Scotland and Wales have been fully thought out. If they are to have separate powers to make laws and to tax, then the constitution of the United Kingdom will be fundamentally changed. The constitution will certainly have to be, for the first time in our history, a written constitution. If these new Assemblies or Parliaments, as I prefer to call them—demand full independence, as in time they surely will, we shall have broken the unity of the United Kingdom and created separate States. The effect of this on the Crown, on foreign policy and defence and on the economy will be incalculable.

Few English Members have yet spoken on this tremendously important subject in this debate on the Gracious Speech. I believe that it will go right across ordinary party political barriers. It is only right and fair now for me, as an English Member sitting for an English constituency, to give a warning to those fanatics for devolution that we shall not stand idly by while the unity of the United Kingdom is threatened and while England alone is granted a second-grade position by these new proposals.

Photo of Andrew Welsh Andrew Welsh , Angus South

The hon. Gentleman has completely misunderstood what devolution and self-government are all about. If there has been no adequate discussion about this matter within his party, that is his party's fault. This matter has been fully and widely discussed throughout Scotland for about 15 years. It is the hon. Gentleman's own fault if he does not know the issues involved.

Photo of Mr John Stokes Mr John Stokes , Halesowen and Stourbridge

I was speaking in Scotland recently after the EEC referendum. I think that the Scottish National Party had a shock. I believe that if there were a referendum in Scotland alone now, there would not be anything like a majority for separation from the United Kingdom.

However, if the United Kingdom Parliament is really determined to devolve some of its powers to Parliaments in Scotland and Wales, it would be absolutely monstrous for England to be deprived of similar national self-expression. English people will never agree to their representatives being denied the right to discuss Scottish and Welsh affairs in the United Kingdom Parliament while Scottish and Welsh Members of Parliament had the right to discuss laws for England. I hope that no one will think that because the English are a kindly and tolerant race they will never rise up and demand equal rights and equal status with their junior partners within the United Kingdom.

I do not wish, however, to conclude my speech on such a sombre note. I believe that in the end these devolution measures, which must inevitably be enormously complex and complicated, will be lost in the sands of time as more and more people throughout the United Kingdom realise the dangers involved. I am told that this year throughout the United Kingdom more people than for many years stood by their own war memorials on Remembrance Day, sensing, perhaps unconsciously, the dangers which we face in our present disarray. Will all that common sacrifice in two world wars have been in vain? I cannot believe it.

1.49 p.m.

Photo of Andrew Welsh Andrew Welsh , Angus South

The Gracious Speech is surely more important for what is left out than for what it contains. It contains statements about 28 major Bills, but it is the 29th Bill, the missing Bill on devolution, that is the most important. It is quite sickening to watch the reneging on a solemn pledge given at the last General Election to the people of Scotland.

I was sad to hear some of the comments of the hon. Member for Halesowen and Stourbridge (Mr. Stokes) because he has completely misunderstood what devolution is all about. I assure him that the resurgence of patriotism and national identity which he seeks is alive and well and living right now in Scotland, which is heading towards self-government. I sympathise with him in regard to his own country, and I hope that that country will find its own true soul and true identity.

It was interesting to note the statements made last week in the House in favour of self-determination and self-government. The Foreign Secretary eulogised on the rights of people to self-determination and self-government and on the principles of human rights and dignity which are involved. However, he referred to Belize and to Papua, New Guinea. Apparently when the rights of human dignity and self-government apply to the people of Scotland, hands are raised in horror in Parliament. That is a basic mistake. I ask the Foreign Secretary and his ilk to meditate on their words and their attitude to the ancient nation of Scotland.

We have heard many wrong arguments in this debate. The problem of the Health Service has nothing to do with the issue of pay beds. Pay beds do not exist in Scotland, or are so few as to be irrelevant. Therefore, it is important to look at the Health Service as a whole when we consider the needs of Scotland. We must not become involved in the traditional Labour-Tory class-ridden argument over issues such as pay beds. It would be more profitable to look at the problems of centralisation as opposed to the decentralisation of services. There is more need to look at cuts in the Health Service and social services and at the conditions and pay of the workers in the Health Service.

I hope that the Government will give their views, for example, on the relationship between general practitioners and specialists. The medical world is now increasingly heading towards technological and specialist change. I hope that the Government will give their views on the Brotherston and Crooks reports and on the spread of resources which they envisage as being necessary for the Health Service. I ask the Government to look especially at the problems in the burghs and rural areas in Scotland. In towns there is an understandable wish to concentrate specialties, but problems exist in the smaller and medium-size burghs which have been used to a good standard of service but which now find that their services are being withdrawn and concentrated in larger towns to suit the needs of centralisation.

Modern medicine has produced a multiplicity of cures which allow an ever-growing number of groups and individuals to be given the right of treatment, and even the right to life. That gives them new hope. That complexity and specialisation require greater investment of scarce resources in men and machines. Therefore the drive towards centralisation of these resources to meet specialised and smaller demands is understandable. However, what is the situation of the normal, relatively uncomplicated ailments which require less specialised treatment? I refer to coronary cases, cases of minor surgery and those who end up in casualty wards after accidents. Those cases tend to be grouped together so as to centralise equipment, the latest machinery and esoteric techniques. In Scotland such treatment is available in the large towns, but problems arise in the surrounding burghs and rural areas.

I should like to look at the problems in Arbroath. That burgh has over 23,000 people, and another 5,000 or 6,000 live in the surrounding areas. There is a military establishment of 1,100 people, which may be increased to 2,000. All those people enjoy basic medical services but rely on the town of Arbroath, which has an established and successful hospital which meets the needs of the surrounding area. That hospital is the subject of much local pride and it gives employment. There are great medical and social advantages in siting the infirmary at Arbroath. It allows easy access to specialist services. There is a close relationship between general practitioners, consultants and the hospital, which results in short waiting periods for admission. It fosters post-graduate education for family doctors.

The consultants in the hospital are full time and resident locally. Patients do not need to wait long, as they can be examined and discharged on a daily basis instead of waiting until such time as a consultant can visit the area. The infirmary is relatively small. That has great advantages. The more predictable cases can be admitted immediately, which leads to fewer medical crises. More individual attention can be given to the patients in a peaceful atmosphere. That is conducive to recuperation. I am told by the patients that the surroundings provide an excellent environment in which to recover. That leads to high staff morale. There are no difficulties in the recruitment of ancillary or nursing staff. That is an excellent situation.

The stability of the hospital undoubtedly contributes to the attainment of medical care. The Health Service can be rightly proud of that. It conforms with everything for which the pioneers of the Health Service aspired. The pioneers of the service, many of whom were members of the Labour Party, sought a high standard of service to be made freely available to all citizens irrespective of background or ability to pay. That is worth while, yet it will be lost in Arbroath. The Arbroath hospital is to be run down in the name of centralisation and so-called efficiency. Unless the plans are altered, the community will lose that asset against its own wishes.

Instead of closing or running down these services, there is a good case for their expansion. If anyone asks whence the money for this expansion will come, I point out that the Scottish nation is standing next to an asset worth £200,000 million. Those oil revenues should be spent on long-term capital assets such as roads, schools and hospitals, instead of being frittered away for short-term gain, or balance of payments or political benefits, as the Government propose. I prefer long-term capital projects such as hospitals, roads and houses, which will benefit future generations. Those are my priorities. In a self-governing Scotland there will be the cash to do that. If a bankrupt United Kingdom does not do so, the people of Scotland can draw the logical conclusion.

It is a great pity that the political parties in London have reneged on their solemn election pledges to the Scottish people. Devolution would have brought meaningful decision-making political powers back to Scotland. It would have provided the political machinery which Scotland needs so that the requirements of Scotland could be taken into account. Scottish problems would be dealt with in its own social and economic setting by people who understood the background.

The Gracious Speech could have pioneered constitutional change and progress in the United Kingdom. Instead it offers to the people of Scotland the insult of a broken promise and the continued failure to recognise our different and justified needs. I shall leave the Scottish electorate to judge what it was promised and the results of the promises. I leave that electorate to decide what it wishes to do about the situation.

1.59 p.m.

Photo of Mr Jonathan Aitken Mr Jonathan Aitken , Thanet East

I hope that the hon. Member for South Angus (Mr. Welsh) will forgive me if I do not follow him in his extensive tour of the Arbroath hospital and the new policies of devolution, although I hope to be able to return to the latter subject at a later stage during the Session, because I am sure that we shall all be spending a great deal of time on that subject.

As today is primarily a National Health Service day in the debates on the Loyal Address, I should like to take up the theme struck in the Secretary of State's speech when she referred in detail to the junior hospital doctors dispute, surely one of the most immediate short-term crises facing the National Health Service. Regrettably, we live in an age of militancy. Even more regrettably, the new leaders of the junior hospital doctors appear to be militants in the Scargill and Scanlon mould.

I use those names from the industrial relations battles of yesteryear, because it is perhaps not surprising that the objectionable philosophy of "might is right" should have spread from the trade unionists who disrupted the country in 1971 and 1974 to other groups who now think that they, too, have the muscle to hold a pistol to the nation's head. I hope that it will not be thought to be unduly party political if I say that it would be a great deal easier for the House to say with authority to the junior hospital doctors that their present plans for industrial action were wrong if only so many members of the Labour Party had not actively encouraged trade unions wrongfully to engage in industrial action in comparable situations a few months and years ago.

Having said that about the past, let me say that, as the present crisis looms, I believe that the House must make it clear, as my hon. Friend the Member for Sutton Coldfield (Mr. Fowler) made it clear, that we on this side of the House do not support any breach of the counter-inflation strategy by the junior hospital doctors, or anyone else, and that we utterly condemn the proposed plan of industrial action whereby hospital doctors will treat emergency cases only. A doctor's first duty surely must be to his patients. The policy of treating emergency cases only is a form of industrial action that must mean the taking of unacceptable risks with the lives of patients.

May I illustrate that point, if indeed it needs any illustration, by referring to a somewhat dramatic case from my own constituency? About two weeks ago, I was telephoned by a distraught mother whose daughter had recently been admitted to the Middlesex Hospital. In the course of an operation for appendicitis the girl had had an X-ray which had revealed the presence of a tumour on her lungs.

When the post-operational shock of the appendectomy had subsided, the surgical team in charge decided not to operate on the tumour on the grounds that it was not an emergency case and, therefore, the operation could be postponed indefinitely. That decision was taken in good faith on medical grounds, because it was thought that the chances of the tumour's being malignant were very small. I accept that prognosis entirely.

However, the mother of the patient was understandably in a state of near panic at being told that her daughter had a tumour and that it was not to be operated on. The only helpful advice she received from the surgeon in charge of the team was that she should send a telegram to the Secretary of State.

At this point my constituent contacted her Member of Parliament—that was me—and I telephoned the surgeon and listened carefully to the numerous points he made on the subject of this general National Health Service dispute. He assured me that in his view and that of his team the chances of the tumour's being malignant were less than one in 1,000 and therefore it could be said on medical grounds that it was not an emergency case. However, in the course of the long discussion I had with the surgeon—I have sent a letter about the case to the Minister of State, so he is apprised of this—I am happy to say that I was able to persuade the surgeon that the decision should be reconsidered and, as a result, an operation took place on the tumour on schedule.

The end of this story is disturbing for the tumour turned out to be malignant and, therefore, the one in 1,000 chance came up. That girl's life, which may still now be at risk, would certainly have been at much greater risk if the operation had not taken place. If it had been postponed indefinitely, as it would have been, the postponement would have occurred for political reasons. This is a classic illustration of the reckless danger involved in the policy of treating emergency cases only.

That policy is a sad and wrong escalation. The junior doctors should understand that the Government are not picking on them. Both sides of the House want doctors to be adequately rewarded. We salute them for their wonderful work and for the long hours they put in. We want to see this pay dispute settled in a conciliatory atmosphere.

However, the issues involved go far wider than the claim of the junior hospital doctors and, indeed, far wider than the National Health Service. This represents a major test of our national determination to counter inflation. That is what is at stake. Patients—and politicians, for that matter—do not want to see doctors exploited by being underpaid and overworked. We recognise that junior doctors have to a considerable extent had a raw deal. We greatly hope that this dispute will be solved by conciliation. However, if the hospital doctors are to use public health as a weapon in their battle, both sides of the House must condemn them as being utterly wrong.

Finally, having spoken at length on the specific topic of the junior hospital doctors, let me end by saying that, in common with many of my hon. Friends, I believe that the sickness of the National Health Service is basically political. I deeply disagree on moral, philosophical and political grounds with many of the present policies of the Secretary of State towards the National Health Service. These have to some extent poisoned the whole atmosphere of the medical world and of the Service.

For reasons that have been eloquently outlined by my hon. Friends, the decision to phase out pay beds is utterly wrong. What I find even more insidious is the proposal to limit the growth of private sector medicine through licences as to the quantity of clinics and hospitals. There should be a mixed economy in health as there is in other areas of the national economy.

There are some essential freedoms at stake—for example, the freedom of the citizen to spend his money as he chooses and the freedom of consultants to practise according to the Beveridge freedoms. We have enough trouble with the National Health Service already in terms of its failing resources without playing political football with the freedoms of individual patients and individual doctors.

I beg the Government to back away and to change their course from this policy of apparent confrontation on which they appear to be so inexorably set. Let them send the pay beds issue back to the Royal Commission and let us sit down in an atmosphere of reconciliation, because that is the right spirit in which to solve, not just the junior hospital doctors dispute, but many of the other ailments afflicting the National Health Service today.

2.8 p.m.

Photo of Mr Stephen Hastings Mr Stephen Hastings , Mid Bedfordshire

I regret that I shall not be following the excellent example set by my hon. Friend the Member for Thanet, East (Mr. Aitken), who confined his remarks principally to the National Health Service. I listened to him with great interest. He spoke ably and fluently and it was plain to me that his knowledge of the problems of the junior doctors and indeed of the National Health Service was deeper than mine. Further, I think that the subject was comprehensively and splendidly dealt with by my hon. Friend the Member for Sutton Coldfield (Mr. Fowler), who opened for the Opposition.

The decision to phase out private practice is a mean-minded piece of legislation typical of so much for which the right hon. Lady is responsible and has been responsible in recent years. But this is only one of a package of measures in the Gracious Speech which are just as damaging, if not more so. I shall list only a few of those which I think will cause most suffering.

Top of the list, probably, is the proposal to nationalise the aircraft and shipbuilding industries I do not know whether Labour Members are interested, but I have learned already that one firm threatened with nationalisation is losing orders from abroad. I do not know whether the Government have the slightest interest in or concern about this. Although they prattle about the need for exports, they are by this measure damaging firms that are doing their best to achieve them.

Then there are the contributions of the Secretary of State for Employment, who is to give power to the unions to sack any of their members without recourse to the law. This, coupled with the closed shop and coercion to join unions, will give the unions the right to deny a livelihood to anyone they choose without his having any recourse at all.

The right hon. Gentleman's second Bill will give to the dockers, as The Times pointed out yesterday in a much-quoted leader, a monopoly of the control of imported food supplies and exactly the same sort of power to hold the nation to ran-some as the miners have already. That is the great contribution of that outstanding defender of liberty, the Secretary of State for Employment.

Then we are to have the Bill to abolish tied cottages. When we come to that, we shall discover that most of the inmates of tied cottages have no wish whatever to see the law changed. There is also the development land tax, which will inevitably put an end to development. And there is to be the abolition of selection in secondary schools, brought in at a time when the arguments showing comprehensive education to be failing seriously in a number of respects are undeniable.

All these measures heralded in the Gracious Speech constitute a pattern. They are all Marxist in character and they will all do positive harm to the economy, to the harmony of our society, to liberty itself, or to all three.

The Government are presiding over a parliamentary democracy which, alas, is already sick. The dose they now prescribe will unquestionably exacerbate the disease and do nothing to help.

We shall be discussing the demerits of these miserable measures for months to come and, no doubt, far into the night. In due course, most of this rubbish, if not all, will reach the statute book and real damage will begin to result. But in this debate we should be asking ourselves seriously and deeply "Why do intelligent men foist these things upon us?" Is it because they really believe that the people want these measures? My conviction is that if there were a poll on each, even some who voted Labour at the last General Election would answer a straight "no".

It is certainly not the people who want such measures. Do Ministers really believe these things are necessary at this moment of crisis for the nation? Perhaps a few of them do, and they may include the Secretary of State for Social Services and certainly, I should guess, the Secretary of State for Employment—whatever their motives. But I am convinced that most members of the Cabinet know that these measures will achieve nothing but harm and are as I have described them. Yet they will vote for them. Why? Well, we all know why: it is because all these measures are part of holy writ. They emerge from the Labour Party manifesto.

The Queen's Government is no longer conducted through Parliament, as is provided in our constitution. It is fixed by manifesto—a Marxist manifesto. No one who reads this document in an unbiased fashion can put any other construction on it.

Who then is responsible for the holy writ which has given rise to these measures? That is the second question we should ask ourselves. Even the Prime Minister turns to his supporters or quasi-supporters behind him quite frequently and protests that this or that is all right because it is part of holy writ, of the Labour Party manifesto. I invite the House to consider some figures.

The Labour Party has 700,000 individual members, more or less. It has 22,000 co-operative and Socialist society members. It has 5½ million affiliated trade union members. These are not my figures but those of Mr. Ernie Roberts, an ex-Communist, until lately Assistant General Secretary of the AUEW and now Vice-President of the Institute of Workers' Control. He gave the figures in a pamphlet intended as instruction, or guidance, to the left wing of the Labour movement. The pamphlet is called "The Solution is Workers' Control". Mr. Roberts went on to draw perhaps a not very surprising conclusion. He said: It is clear from these figures that the block votes of the trade unions can determine the policies of the party's annual conference. He added that the sooner the trade unions acted to make conference decisions binding on the Labour leadership, the better. If that is not a clear statement of intent and policy, I do not know what is.

Luckily, the extreme Left is not reticent about its aims, or what it is up to, or where holy writ emerges from. I turn now to some quotations mostly from a publication called the World Marxist Review. In case it does not arrive every month regularly on your desk, Mr. Speaker, I should explain that it is the theoretical journal of the Soviet Communist Party and its aligned Communist Parties throughout the world. It is published in Prague and the chief editor is invariably a Russian.

In the World Marxist Review of February 1973, Mr. Sam Aaronovitch, a leading British Communist, was reported as follows: S. Aaronovitch spoke of the fight to sway the British trade unions and, accordingly, the mass base of the Labour Party, to the Left. He noted, in particular, the significance of the major strike struggles that swept Great Britain in recent years. It is the mounting revolt of the workers which is the biggest problem now facing the Tories.What has been the strategy of the Communist Party of Great Britain? It envisages a process of mass struggle carried into and reflected in the mass organisations of the working class and especially the trade union.'We see such a movement,' he said 'altering not only the policy but the leadership of these organisations. As a result we have seen the possibility of increasing sections of the trade union movement shifting to the Left on both immediate and long-term issues, influencing the policy of the Trade Union Congress, as well as the direction and composition of the General Council. Simultaneously, both directly and by way of trade unions, we see the increasing pressure on the Labour Party at all levels. We expect the result of this strategy, if successfully pursued, will be to break up the coalition of Right-wing trade union and Labour Party leaders and create a political crisis for the Right wing.' Mr. Aaronovitch is paralleled closely by Mr. Idris Cox, an expert of the British Communist Party on international affairs. He had this to say in May 1975: Notably, more Communists are being elected to leading key positions in the trade unions. Through the unions they can influence Labour Party Conference decisions. This was all for the benefit of world Communism. It was not aimed as any particular propaganda here. In October 1973, at an international conference of Communist research groups, Mr. Cox, who has been very informative by and large, was reported as saying: In the conditions existing in Britain it is most decisive that the Communists win over the trade unions. The Communist Party in Britain is not a big party. But it is able to influence the Labour Party through the affiliated trade unions, which, by virtue of its unique structure, represent the strongest force within the Labour Party.The Communists have visibly increased their influence in the unions in recent years. Our comrades hold key positions in influential organisations at a regional and national level and the stand of some of the unions on fundamental issues is shaped under their influence. Finally, I quote Mr. Gerry Cohen, a member of the Communist Party National Executive. In November 1973 he said: The Communist Party is exerting its position as a key section of the Labour movement in Britain. Because of the part which it plays as an organisation deeply rooted in the movement, it often initiates and advances policies on crucial questions of the day. Many of its members hold leading positions in organisations directly affiliated to the Labour Party. These people do not exactly disguise their aims. If we have not been warned by them, we should be.

The present Government were elected by a mere 28·6 per cent. of the total electorate. They are a minority Government. There is nothing particularly new about that. On both sides of the House we have supported minority Governments from time to time. But it remains a fact. The total membership of the Communist Party of Great Britain and its allies is, I should guess without fear of serious contradiction, between 30,000 and 40,000 only. I suggest—indeed, I assert—that we have a position in this country in which a minority Government are being driven by a tiny fraction working semi-clandestinely within it.

That is how the British parliamentary democracy is being betrayed. That is what lies behind the Gracious Speech. Incidentally, that is how the present Government present such a paradoxical appearance—vindictive oppression of the individual on the one hand and, on the other, craven weakness in face of Left-wing pressure.

It is not a position that we in Parliament—those of us who sit here in good faith—should ignore any longer. Labour Members, again possibly in good faith, sometimes resent outside interest in these matters and say "Shut up about all these things". They say, "They are our affair and we shall sort out the situation in due course." We are told to ignore the conflagration that has arisen in their midst.

But we cannot ignore it. We are all involved in this situation. If our presence here means anything as individual Members of Parliament, it must be that we try to defend the liberty of the citizen against oppression from any quarter—and that we do so, in the last analysis, regardless of the party to which we belong.

It is hard to see how this country can recover its confidence, let alone a position in which investment can make much sense, unless these Augean stables—this cancer—are eliminated. Magna Carta, the unwritten constitution, and our parliamentary system, based, more or less, on a two-party system, have sufficed up to now to protect our ancient liberties through Parliament. Much better that this should continue. But I must confess I am no longer persuaded or certain in my own mind that it is adequate to protect us against a subversive campaign so determinedly and cleverly organised and waged through the Trojan Horse of the Labour movement. That is what this debate ought to be about and that should be the chief subject and theme running through the next Session of Parliament.

I say one last word to the Government. I detect a new mood among the people I meet at my interviews and surgeries and I should be surprised if I were alone among my hon. Friends in this deduction. There is a new mood among the ordinary decent people who normally take little interest in politics and who, indeed, are bored with the subject, but who merely want to be allowed to get on with their own lives unmolested. They have had enough of this constant petty oppression and they are beginning to organise.

Ordinary folk do not want their constitution and system of parliamentary democracy to be destroyed. It has served them too well for so long. There is a tradition of liberty in this land which has broken more powerful oppressors than the British Labour movement in its present turmoil. The Government are sowing the wind. Let them take care—or assuredly they will rap the whirlwind.

2.25 p.m.

Photo of Peter Bottomley Peter Bottomley , Greenwich Woolwich West

I congratulate my hon. Friend the Member for Mid-Bedfordshire (Mr. Hastings) on increasing fivefold the number of Members on the Labour Benches. His speech has pinpointed the great gap in our deliberations in this House. If the Queen's Speech had promised fewer Bills in the next Session, there would be more time to go into that legislation in greater detail.

In dealing with the subject of the National Health Service, I should like to declare an interest—not as a private patient, but as somebody whose wife was taken seriously ill during the State opening of Parliament. She was dealt with in St. Thomas's Hospital on which there appears a sign saying "Emergency Cases Only". Like everybody else who has benefited from the National Health Service personally or through one's family, I pay tribute to all staff in the Health Service, especially to the junior hospital doctors for the work that they are undertaking in face of one of the most serious pieces of industrial conflict from the point of view of the patients since the inception of the Health Service.

I spoke to junior doctors at that hospital and it is clear that they are united in their view—not as to how the Health Service should be developed or as to the politics of the matter, but over the subject of pay beds. They believe that the way in which this matter is being handled is little short of disastrous.

Most of the junior doctors to whom I spoke were not insistent on extra money, but their major aim is to know exactly where they will stand in future and they are still unclear on that score at present.

The problems of the National Health Service and the areas administered by the right hon. Lady the Secretary of State for Social Services and her Department seem to be appearing in a number of running sores. They appear clearly when one looks at the question of status and pay of health visitors and NHS assistants. A number of health visitors are waiting to meet the right hon. Lady or the Minister of State to discuss the question of status. Before that group feels forced to take industrial action, I believe that hon. Members on both sides of the House should condemn militant action. When we examine industrial conflicts of one kind and another, we must conclude that the action taken at present by the junior doctors, who classify nearly all cases as emergency cases, is far better in terms of action than that taken by the power workers and the miners in the last three or four years when they just stopped work completely.

I am reminded of the plight of an 84-year-old widow who lives near me. During one of the power strikes she was left with half a scuttle of coal and three birthday candles to last her through a dispute that could have lasted three or four weeks.

The Queen's Speech is full of proposals that we are constantly told are "in the manifesto". The manifesto was sired in the Labour Party conference of 1973. However, many people forget that there was a Labour Party conference in 1975 on the Common Market and that it came up with a two-thirds' vote against joining Europe. We all know that the referendum result showed two-thirds of our people in favour of remaining in Europe. That puts the Labour Party conference where it belongs—on a pretty low pedestal, a matter of some interest, but not a gathering that should determine the policy of any Government of this country. It is worth reminding the House that the latest political opinion poll that counted was not a poll published in a newspaper but an occasion when people went out and voted. I refer to the recent by-election at West Woolwich where a Labour majority of 3,500 was turned into a Conservative majority of 2,300—an election where the Conservative vote, in a reduced poll, rose by a thousand.

The reason behind that vote is that people have now seen the behaviour of the Labour Government and also the results of some of their actions. They did not like what they saw. People were asked, "Are you a traditional Labour supporter?", and many replied "Yes". They were then asked, "Do you believe in some of the ideas put forward by the 1973 Labour Party conference, such as plans for more nationalisation, the need to get rid of pay beds, and the abolition of direct grant schools?" Most people replied that they were not in favour of those ideas. They were told, "If you have not time to go to your Labour Party meetings to elect delegates to the Labour Party conference, you had better vote Conservative because the Conservatives will vote against these proposals in Parliament".

We should not make too much play of the absence of Labour Members in this debate, but it enables me to point out that those who voted for the Government in February and October 1974 were not voting for people who leave the Chamber relatively empty when the House is considering 28 pieces of legislation which have nothing to do with creating more wealth for the country. They should be aimed at creating incentives for people to live their own lives without running to either the politicians or the Government for help whenever they want it.

In my constituency there are a number of fine hospitals, including the Royal Herbert which is looking after many of those people who were injured in Northern Ireland. There is also a voluntary aided grammar school and many of my constituents send their children to a local direct grant school. Both schools are threatened by the local education authorities at the behest of the Government. The feelings which have been demonstrated in the Health Service are being duplicated and encouraged by a number of the teaching staff.

Before the Minister takes the view that we talk about only those who have the opportunity to send their children to direct grant schools or to have private medicine for non-emergency treatment, it is worth reminding the House that in my constituency there is a comprehensive school which is over-subscribed in all ranges of ability and a primary school which becomes full shortly after the age at which an application for a child can be submitted—namely, after his third birthday—because the standards are known to be good.

Instead of the introduction of 28 major Socialist Bills, my constituents would be grateful to have the chance to hear what Parliament has to say about encouraging all schools in all areas to respond to the expressed parental views and wishes of children. It is no good drawing smaller and smaller catchment areas around a particular primary school in a city area simply because that school becomes more popular and parents believe that that is the type of school they would like their children to attend.

The good schools and the bad schools have the same staff-pupil ratio and the same resources allocated to them. During this Session of Parliament we could consider how to encourage the less effective schools to imitate the best and most popular schools.

The Queen's Speech also appears to have left a gap concerning housing. We are still left with the situation in most inner city areas, and certainly in my constituency, where the single person and the young married couple have virtually no chance of getting a home. They do not have the £3,000 for a deposit, or the three children who are needed to get on the council housing list. There is nothing in the Queen's Speech which will assist them.

The party political broadcast last Monday evening explained how all the profit from selling land is to pass through the council's hands and benefit the community. I asked myself how that would help the families which visit me each Saturday morning. If we want to reduce the price of land and make more land available, we must grant more planning permissions. If we cannot grant planning permissions in city centres, how can the Community Land Act help the housing stress in city areas where the greatest problems exist?

In general, the proposals for legislation contained in the Queen's Speech do not help to solve the three major problems which exist. The first problem concerns breaking through the political gap which separates hon. Members from the people outside. Indeed, 90 per cent. of the people outside Parliament are interested in politics only 10 per cent. of the time and that is when they are trying to get their children into a primary school in which they have confidence; when their children reach the age to transfer to secondary school; when their children need industrial training before they can get a job; when they have a 21-year old son or daughter who is getting married but who cannot get a home; or when they feel that they are not getting a fair deal from their employer or from a trade union which may be representing them. For 90 per cent. of the people those are the occasions when they look to Parliament to deal with their needs.

People have written to me during the past three or four months asking me why they are being forced to join a trade union which they do not want to join when the man in the grade above them is doing the same type of job, at the same rate of pay, but is not obliged to join a trade union. People point out to me that we have a Sex Discrimination Act and a Race Relations Act, but they ask what will stop political discrimination within the TUC. They ask why, if one person in three is a member of a trade union and votes Conservative, there is not a ratio of one Tory delegate to three in the TUC.

The answer is simple. The last great political oligarchy, besides our constituency associations which selected us and hoped that we would get elected, is the trade unions. However, the difference between the two is that we do not need a great reform Act to change the situation in the trade unions. We need the 90 per cent. of the people who are interested in politics 10 per cent. of the time to stand up at their branch meetings and to say to each person standing for election as branch officer, "Are you a Marxist?" If the answer is "Yes" then those people should say, "I would not vote for you in a parliamentary election and I shall not vote for you now".

If we could take politics out of the trade unions and make their major rôle that of representing people in employment, I am sure that more people would join trade unions and thus make it possible for this House to do its work more effectively.

This House is regarded with great respect by most people in the country. If we concentrate on the 28 Bills put forward in the Queen's Speech we shall be letting those people down. I look to many Labour Members during the next few months to stand up as one or two of them did concerning the Clay Cross legislation and to say, "I shall not support this." If they do so, the Labour Party, like the Tory Party, will represent the true interests of its supporters.

2.38 p.m.

Photo of Mr Geoffrey Pattie Mr Geoffrey Pattie , Chertsey and Walton

I should like to refer to the problems which are experienced by those who occupy 30 per cent. of the National Health Service beds—namely, the mentally ill. A recent White Paper was entitled, "Better Services for the Mentally Ill". I hope that we shall have an opportunity in the crowded legislative programme which lies ahead to have an early debate on this subject, because no matter what people may say in expressing pious hopes while addressing themselves to this problem, this is not a problem which will conveniently go away. All the indications are that it will be with us in a probably even more aggravated form for the rest of this century.

I pay due credit to the White Paper for describing the scale of the problem. The extent of the problem is recognised in the preface by the Secretary of State where she mentions the 5 million people in England alone who seek the counsel and advice of their general practitioners each year. Of that 5 million, approximately 600,000 are referred to specialist psychiatric services. It may well be asked whether it was a good idea to publish the White Paper at all. I notice that in New Society the White Paper is unkindly described as "a monumental damp squib". I do not share that view because it is important to try to chart the hope for progress, however much the financial situation of the day may make this difficult to attain.

Since the war there have been many forecasts of a brave new world for the mentally ill. We had the 1957 Royal Commission followed by the Mental Health Act 1959. Since then we have had the 1971 White Paper with a similar title, "Better Services for the Mentally Handicapped."

In the late 1950s we were told that the old Victorian custodial mental hospital was to be a thing of the past and as remote from modern society as Bedlam or Newgate Goal is today. The emphasis was put on lots of care in the local community. Psychiatric units were to be built in local hospitals.

The Minister of State may recall that he and I had one of those cosy late-night assignments a little over a year ago dealing with the development programme for the district general hospital in my constituency. I was glad that, before extreme financial privation descended upon us, the decision was made to go ahead with the building of the psychiatric unit at St. Peter's Hospital in Chertsey. In those far-off days we were told that we were to have more hostels, day-care centres and personal social services and in general the whole axis was for local community care to take the strain.

Things were going quite well in the 1950s in that direction. One trouble was that the same spirit of innovation which produced new drugs which materially assisted the conditions of many people then in mental hospitals also led to the discovery of various forms of psychiatric disorders which, although known before the 1950s—I am not claiming that they were discovered only then—came more sharply into focus during the 1960s with the realisation that such illnesses were not readily susceptible to modern drug treatment. Other groups—adolescents, drug addicts, what are familiarly known as dossers in general, alcoholics, and others—also came within the focus of psychiatric treatment.

The Government were right to publish this White Paper. I do not accept the criticism in New Society that this was a damp squib. It is easy for an organisation such as MIND, which does marvellous work, to hope that a Government in such financial difficulties as this one will be able to sweep all these to one side and address their attention to this particular interest. The tendency often is for people to subscribe to cuts in public expenditure in the generality but not in their own particular sphere of interest.

I am pleased that the White Paper recognises that the problem for many people who are described as being mentally ill is inadequate housing. One recalls the rather dramatic action taken in 1970 in Birmingham. The medical officer of health discharged a whole lot of people straight into hotel accommodation in the hope that that would produce such a salutary effect that the local authority and the health authority would do something about it. Instead, sadly it became the norm. That involved huge cost and no supportive services which these people so badly need.

The White Paper, in paragraphs 4.58, states: In a recent survey at the Camberwell Reception Centre, only 13 per cent. of the men who had received in-patient psychiatric treatment were homeless at the time of their first admission to hospital. This would appear to lend support to the theory that rather than homelessness having been a precipitating factor in the illness the long term effects of the men's psychiatric condition and the inadequacy or unacceptability of the services provided to help them may have led to their becoming and remaining homeless. Paragraph 4.59 states: The problem is that men and women who are homeless are particularly difficult to help. Hospital staff and others in the mainstream of such services often find it difficult to communicate with and help people who seem alienated and unco-operative and whose response to the help they give may be poor. Their lack of an address and settled way of life may make it difficult for them to find and go to a general practitioner, keep appointments or make use of health services: some discharge themselves from hospital without completing their treatment, and others who do complete treatment are sometimes discharged without proper after-care arrangements and with nowhere to go because of the difficulty of finding the right sort of supportive accommodation. In this context I hope it is in order for me, without in any way declaring a personal interest—unless my wife's interest is a personal interest—to mention that my wife is involved with and was one of the founder members of an emergency social help scheme in Brixton called "Help '71." This scheme, under the aegis of the Psychiatric Rehabilitation Association, has addressed itself to assisting people who have had psychiatric problems. It is obvious to "Help '71" that what is needed most urgently is some form of hostel accommodation; that is, a large house converted into bed-sitting accommodation with possibly a resident warden or, preferably, somebody who will go in on a daily basis to keep an eye on the general running of the establishment.

This need is clearly established, and there are many empty properties in the borough. This seems to focus sharply the need for some degree of local coordination between the health authorities and the local authorities. One criticism which I level at the White Paper is that there seems to be little apparent realisation of the need to redistribute resources from the centre to the local authorities and little appreciation of the urgent need to have some machinery for it. I understand that there is a Joint Consultative Committee. That is a title familiar to many of us in different spheres of interest. This seems to be the only known machinery for any kind of joint health service and local authority planning. The problem is that it has no financial or executive power.

I should like to conclude by quoting from an article which appeared in New Society on 23rd October: …these matters raise questions not just for people with mental illnesses, but for all those who fall into the divide between health and local authority responsibility. But not to tackle them here is almost to accept that people will end up in the mental hospitals which, one day, should be abolished, simply because they are still there. The mental hospitals may well be with us for some time to come. But not simply because of lack of cash for alternatives.

3.48 p.m.

Photo of Mr Anthony Grant Mr Anthony Grant , Harrow Central

Unlike my hon. Friend the Member for Woolwich, West (Mr. Bottomley), I believe that it is absolutely right for the House to draw attention to the disgraceful performance of Government supporters during this debate. Throughout the whole debate, which is, after all, on the Queen's Speech and proposals for the forthcoming Session on the burning issue of the National Health Service and the health of the nation, there has been one five-minute speech by a Labour back bencher. For nearly the whole of the time Labour Members have been notable only by their absence. This is deplorable and should be recorded as such.

I should like to come back to the main theme of the debate—the National Health Service and the problems within it. It is about the health of the nation, and that is absolutely fundamental. In my view, it overrides all other considerations. It is no good talking about employment, industry, education, or a whole range of other matters, if we are not to have a physically fit society.

I have always believed in the principle of the National Health Service and I have always supported it, but I have been deeply disturbed by the way in which it has developed over the past few months under this Government. I agree with about one sentence only of the Secretary of State's speech. That was when she said that her real concern was with the people who worked in the Service. That is absolutely right, for it is the people working in the system who are vital.

We all know of the importance of nurses, porters and everybody else, but without the doctors and the consultants the National Health Service might as well not exist. These are the people who have spent years of training, years of arduous work acquiring their undoubted expertise. They compare with any other group of doctors anywhere else in the world. But they must be free to develop their talents and to apply them in the best way they can in order to render the best service to the community.

I should like specifically in this context to refer to a hospital on the edge of my constituency—the Northwick Park Hospital and Clinical Research Centre. This is one of the newest and one of the finest hospitals in the United Kingdom, if not in the whole of Europe. It was opened only a few years ago by Her Majesty the Queen, and it is quite rightly described as the showpiece of the National Health Service. Many of my constituents and, indeed, people from surrounding areas have reason to be grateful. Many of them owe their lives to this magnificent hospital and to the dedication and skill of the people who staff it. But I must tell the House that morale in this great hospital has been damaged—I hope not irrevocably but very seriously—by the conduct of affairs by the Secretary of State over the last few months.

Photo of Mr William Molloy Mr William Molloy , Ealing North

Will the hon. Member tell me whether he has recently been a patient in this hospital, as I have? I heard nothing there of what the hon. Gentleman has just said.

Photo of Mr Anthony Grant Mr Anthony Grant , Harrow Central

I know that the hon. Gentleman lives fairly near, and I hope that he was well treated at the hospital. I am glad to see him making a full recovery to health. But I doubt whether he has had the meetings that my colleagues and I have had and that paints a very different picture. It would be very uncharacteristic, if I may say so, for consultants and doctors to worry their patients, no matter how eminent they were, while they were undergoing treatment for their own problems. I can tell the hon. Gentleman that over the last two years in that hospital no fewer than six consultants and six doctors in training grades have emigrated and have no intention of returning.

It is not just in this hospital alone that that is happening. According to the information given by the Secretary of State herself, in the period ending September there were 106 consultants and senior registrars in England who resigned from the National Health Service with the intention of emigrating. She confirmed that this was causing anxiety. Indeed, the Minister of State said on 10th June that the signs were that medical emigration was increasing. All through the Service there is anxiety on this point. The director of radiology at St. Mary's Hospital—where my wife was herself a nurse many years ago—said that in the past 18 months 23 senior registrars and eight registrars trained in diagnostic radiology had left the National Health Service for posts overseas. This trend will continue, I very much fear, as long as the Government in general and the Secretary of State in particular pursue the mad, doctrinaire policy that they have put before us in the Gracious Speech.

It may help the hon. Member for Ealing, North (Mr. Molloy) to know that a letter was sent from the Northwick Park Hospital to the Secretary of State in October pointing out that most consultants at the hospital had whole-time contracts but nevertheless unreservedly supported the memorandum submitted by organisations representing medical and dental practitioners and requesting the Government to include in the remit of the Royal Commission the subject of pay beds. This document—I have it here—was signed by no fewer than 72 consultants, surgeons and senior medical officers—men of very great talent and very great dedication to the profession. It sums up the attitude within that great hospital, and I am only glad that the medical staff had the decency not to bother or burden the hon. Member for Ealing, North while he was recuperating.

This is not a matter affecting or concerning, as some may say, just the highly paid consultants and Harley Street specialists. It is not something affecting only those who choose to spend their money on private beds and private treatment. It affects every person in the country, no matter how humble, in need of medical treatment.

If the Government pursue this policy, I believe that the exodus of these distinguished people will be likely to increase into a stampede, with the result that the most humble citizens in the land, the most humble of our constituents, in need of medical care and attention, will find that they are getting a second-rate service, with the greatest expertise gone. This will be to their detriment and to the detriment of the nation. I wholly regret it, and I ask the Secretary of State and the Minister, who is himself in the profession, to think again.

On the subject of junior doctors, a different problem, I entirely agree with what my hon. Friend the Member for Sutton Coldfield (Mr. Fowler) said in his excellent opening speech. There must be something wrong with the system—although we want to maintain the counter-inflationary policy, and although we do not support strike action or the work of militants—when, as I was told in my constituency, there are doctors receiving less remuneration than the porters serving in the hospital. That cannot be right, and it cannot be good for the health of the profession.

We are dealing with a major crisis of confidence, and I suggest that there are only three possible ways out of it. First, I ask the Government to think again and to abandon the mad, doctrinaire policy on which they are embarking. They need not worry about breaking pledges. We know that in their election manifesto they pledged themselves to phase out pay beds. They also pledged themselves to reduce prescription charges, whereas they intend to increase them. That is one pledge that has been broken. Why cannot they break another if to do so is in the interests of the profession?

If the Government will not do that, I support the suggestion of my hon. Friend the Member for Sutton Coldfield that the crisis with the junior doctors has become such that the Prime Minister himself should take charge of the negotiations. What is more, he should take charge of the whole Department of Health and Social Security. There is precedent for such a course of action.

The Department clearly is in a mess. It may be because it is too big. It may be because the Secretary of State spends too much time fiddling about with pensions and is unable to apply her mind to it. But it is in disarray, and confidence will not return so long as the right hon. Lady appears to be in sole charge.

We quite understand the close friendship that has existed for many years between the Prime Minister and the right hon. Lady. But the situation has become such that she has too long a track record of failure, starting with the trade unions. She gives the impression of being too bigoted and too impaled on the doctrinaire hook ever to recover the confidence necessary to give this vital subject proper attention. I hope that the Prime Minister will take it over.

If the Prime Minister will not do that I see only one way out. It is, to use words to the Secretary of State, words which have been used in this place before on many famous occasions: In the name of God, go.

3.1 p.m.

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

There have been a number of interesting speeches today, but in many ways the most interesting commentary has been the almost total silence from Government supporters—

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

It has been commented on already by my hon. Friend the Member for Harrow, Central (Mr. Grant)—

Photo of Mr William Molloy Mr William Molloy , Ealing North

On a point of order, Mr. Deputy Speaker. Do you consider that I have a reasonable argument to submit to you if I suggest that when the hon. Member for Reading, South (Dr. Vaughan) talks about the silence of Government supporters, I rose with him and he was fortunate enough to catch your eye? If the hon. Gentleman withdraws his complaint or gives me an opportunity to make a submission, I shall consider that fair and reasonable.

Photo of Mr Myer Galpern Mr Myer Galpern , Glasgow Shettleston

No. The choice of speakers is entirely a matter for the Chair.

Photo of Dr Gerard Vaughan Dr Gerard Vaughan , Reading South

As I was saying, this situation has been commented on by my hon. Friend the Member for Harrow, Central and my hon. Friend the Member for Harwich (Mr. Ridsdale). There have been 12 speeches from Opposition Members and there could have been more if there had been more time, whereas there has been only one brief speech from the Government benches. There were more speeches from Scottish National Party Members than from Labour Party supporters. It is a striking commentary on the interest taken by Government supporters in these matters.

In his outstanding speech my hon. Friend the Member for Sutton Coldfield (Mr. Fowler) made the position of the Opposition clear. The inclusion of legislation against private medicine in the Gracious Speech is clearly political. What is more, it is provocative and quite irrelevant to the real problems underlying the National Health Service.

The Opposition agree that reducing inflation must be the country's top priority. Other considerations must be secondary to this. That is why we cannot support any attempt to breach the Government's pay policy. We have said as much on a number of occasions. What is more, we cannot support industrial action, and we believe that this could be avoided, even now.

We have to consider carefully and seriously, however, what has happened to make a non-militant group of professional people consider taking and actually take militant action in such a way in the past few weeks. In our view, the junior doctors have been misled and mishandled since their original agreement in September last year.

There was a serious difference between what was agreed and the subsequent minutes of meetings. This is a matter of record, and it can be checked. It took three months and eight letters from the BMA before the Secretary of State admitted that there had been a mistake. My hon. Friend the Member for Sutton Coldfield set out the tragic misunderstandings which followed.

The Secretary of State made great play of the money situation and the Pay Code, quite rightly. She spoke of the £12 million which is available. The figures are not in question, and it was not at all surprising that the junior doctors did not want an audit. They accept the figures. However, there is a very complicated working situation lying behind them, and what the junior doctors query is the basis on which the figures have been arrived at. That is what they want to have investigated.

The Opposition believe that there is nothing in the present situation with the junior doctors which could not be resolved by properly conducted discussions.

That is the point that I want to make to the right hon. Lady. That is why we have asked that the Prime Minister should be requested to conciliate. The House should know that since speaking this morning my hon. Friend has been in contact with the junior hospital doctors. He has been in touch with Dr. Wardle, the chairman of the junior doctors, who has agreed to this step. I hope that the Government will take that into account, because this is a major move on the doctors' side towards conciliation and some kind of agreement.

Sadly, I must tell the Secretary of State that her credibility is now so low that I cannot see her doing anything but make the situation steadily worse if she continues to try to look after negotiations herself. If, together with the intervention of the Prime Minister, we could be told that the whole private medicine question will be left to the Royal Commission, overnight the most immediate situation with the doctors would be transformed for the better. There is no doubt about that.

My hon. Friend the Member for Wells (Mr. Boscawen) talked about low morale in the National Health Service, and the hon. Member for Ealing, North (Mr. Molloy) queried this. I can tell him that I have been going round the country, and on every side I hear of disillusionment and disheartenment amongst medical staffs. This will take many months to put right, and I cannot see it being put right under the right hon. Lady's direction.

Anybody directly involved in the Service listening to the debate today, and having listened to the debate three weeks ago, must be appalled at some of the speeches, particularly that of the right hon. Lady. She has shown absolutely no concern for the real problems of the Service. Three weeks ago she was strident and personally abusive. Her remarks today will be regarded as specious and partisan, because once again she has shown no grasp of what it is like to work long hours in hospitals attending people who are anxious and often desperately ill. We are talking not about some game but about one of the most exacting and labour-intensive services in the community, and one which involves sick people. That is the real point.

There is no place for party politics in the Health Service, and I do not speak today as a party politician, because we are discussing a Service that is fundamental to the outlook of this country. I cannot believe that we have sunk so low as to fight over and fight in the Service for our ill people. That is why I see no place for divisive politicking, and this was commented on by my hon. Friend the Member for Shoreham (Mr. Luce). I see no place for militancy in the Health Service, and that is why we condemn it, but when the Secretary of State deplores the action of the junior doctors, why does she not deplore in the same outspoken terms the actions of the porters, the domestics and the ambulance drivers, the staff who at the moment are closing beds at the London Hospital?

I wonder whether the right hon. Lady has recognised the extent to which union muscle is being applied. We now have a situation in which a great many hospitals are overstaffed with porters, domestics and secretaries and no money is available for nurses and doctors and for keeping open some of the units within the hospitals. In my constituency, the district management team has a budget of £18million. Quite rightly, it was asked to economise and to reduce that figure by £250,000. A series of discussions took place, and out of them came an agreement to reduce the overall manpower within that section of the service. Immediately, representations were made and pressure was applied, resulting in a total reversal of the agreed policy, so that in that section any economies in staff will have to come from the nurses and doctors and the closing of units, which means the shutting down of hospital beds.

This is factual and can be checked. This is in a part of the country where some porters are paid more than the average registrar—a doctor who has worked into his 30s and has had many years of skilled training. This is in a part of the country—it is general nationally—where six out of 12 technicians receive a higher salary than a consultant at the top of his salary scale who also receives a C merit award.

It is facts like these that make one realise why the junior doctors, apart from their salary problems, are disheartened and demoralised. They see a future as a consultant which is not attractive, when the consultants themselves are unhappy, disgruntled and emigrating. The whole thing sickens many of them beyond words.

We called for the debate three weeks ago because we felt that a damaging crisis was imminent, and everything since has shown that we were right. We felt that that crisis would do lasting harm to the Health Service of which we are proud and that the House should be able to debate it. That debate was one of the most unconstructive we have ever had.

It may have surprised Labour Members—it should not have done so—that we did not reveal the whole case against the Secretary of State. We did not reveal the extent of the sheer, incompetence and mishandling of negotiations, the vacillations and sometimes incredible decisions which have been made at short notice and which have led people who are trying to engage in serious discussions to wonder whether they were dealing with a rational policy at all. The simple reason was that we felt that it would help, even at that late stage, for the Secretary of State to realise that, far from such a debate being flattering to her, she could not continue as she has been doing without a major disaster—a disaster which has driven completely non-militant groups of professional people into conflict with her and which is leading to harm to the care of patients.

In the previous debate, I quoted the President of the Royal College of Surgeons, who said: It is the safety of patients which is at stake now. It is not the doctors, faced with the right hon. Lady's seemingly implacable hatred, who are precipitating this crisis and chaos: it is the Secretary of State herself. The responsibility for the disaster, for closed beds, for every delayed treatment, must rest squarely on her shoulders and on those of her Minister of State and of Labour Members if they support her.

The medical professions had hoped that, after that debate, she would respond and that private medicine would not be an issue in the Gracious Speech. That would have cost nothing and at the worst, from their point of view, it could have been put into the hands of a Royal Commission. They would accept that. Instead, the junior doctors are likely to start action next week and, because of the private medicine issue, the consultants are likely to do so soon after. This need never have arisen if even a shred of awareness of how professional people feel had been shown by the right hon. Lady in the negotiations.

I had hoped that she would take some notice of the suggestions that I made to her at the end of my speech last time. Any one of these would have cooled the situation and made negotiations more likely. However, instead she has chosen to follow her own course. That is why today we have taken the major step of asking that the Prime Minister should intervene personally in this dispute. The Secretary of State has chosen to be totally intransigent with the whole medical profession and to ignore the advice of the colleges of nursing and the hospital administrators. The hospital administrators, who have no vested interest in private medicine, say that the proposals must be regarded as ill-judged. They say that licensing: would remove freedom of choice from the individual citizen. Therefore, the Secretary of State has thrown down the gauntlet to the hospital consultants knowing that every representative of every major medical group in the country is totally opposed to what she is trying to do. Quite clearly she must be regarded as a puppet, unable to deviate one fraction from the pull of the union strings which seem to be guiding her.

I have visited many different parts of the country. Everywhere I have found disillusionment, mounting militancy and a quite frightening antagonism and lack of confidence in the way the situation is being handled. We must remember that when we discuss private medical beds, we are discussing less than 1 per cent. of the total. It is absolute nonsense to say that this small fraction of the beds could cause damage to the whole National Health Service. We are talking about only 4,000 beds as at July, 1975. Even that is not the true figure because over 1,000 of those beds are now being used by NHS patients. We never hear mentioned the 3,500 National Health patients who are in private beds in private units outside the National Health Service.

That is what NALGO calls an "appalling wastage" of resources. That union refers to reductions in private beds as a gain for the Health Service. It says that they are beds which are kept waiting for private patients while National Health Service patients queue. That is a complete nonsense and quite ignores the fact that sick people in this country have to be treated somewhere.

There is no gain nationally, merely a reduction in the cost to the State because the private patient pays a fee that covers all the costs, except the costs of the consultant. The numbers of beds are so small that if they were abolished the effect on waiting lists would be negligible. It is quite wrong to think that if all the private beds were abolished, waiting lists would be substantially reduced. As many hon. Members know, in the three years from 1966, when the number of pay beds was reduced by 24 per cent., the National Health Service waiting lists actually rose by 4 per cent. When the pay beds were increased again, the waiting lists fell by 6 per cent.

In the countries of Western Europe where little or no private practice is allowed—hon. Members should look at this—the waiting lists are the longest and the bed turnover is the lowest. Therefore, there is a powerful case for increasing, not decreasing, the private sector.

Much play is made of bed occupancy. It has been said that only 60 per cent. of private beds are filled compared with 85 per cent. of NHS beds. If we examine the number of patients discharged through private beds, we begin to get a different story. In 1955 70,962 patients were discharged from or died in 5,656 private beds. The average duration of stay was just over 14 days. In 1971 there were 114,856 discharges from only 4,500 beds, with a duration of stay of only just over seven days. That is a very efficient turnover indeed by comparison with the apparently more fully occupied National Health Service beds.

There is a line of reasoning against private beds which goes as follows: first, it is said that they do damage to the National Health Service. As I have said, that is arrant nonsense when the total number of beds is so small. Secondly, it is said that they are needed to provide more beds for the National Health Service. But there are about 15,000 beds empty already because of staff shortages and more are being closed every week. Thirdly, it is said that they take nursing staff away from the National Health Service. But there is mounting unemployment in the Service. The Secretary of State made great play, as she did three weeks ago, that this was not so. How is it possible then for a newspaper to interview not merely the nurses but the chairman of a health authority and for him to say, When 75 per cent. of our budget is spent on our 18,000 staff, this is where the first cuts must be made", and for a district nursing officer to be able to say, The situation is tragic. My sympathies are very much with these girls because I think it is dreadful to qualify and then find you cannot be employed"? How does this fit in with what the Secretary of State said earlier? She said that this was just the normal problem of finding employment for girls when they qualify. How does this fit in when one of the nurses interviewed says I suppose I will have to take a job outside nursing, but to be a nurse was my childhood ambition and I feel now as though I have wasted two years of my life. That does not sound a very happy situation.

Then there is the other prong of this argument, and this involves the finance, the income. Here the official figures are soft-pedalled as much as possible, but the estimate for the current year, since April of this year, is a minimum income of £31 million. That is about £10,000 or £11,000 per bed. In total, it is enough to pay for a third of all the consultants in the country. Interestingly, that figure is almost exactly the same amount as the Government say they would like to spend to make the improvements that are so desperately needed in the mental health field but for which no money can be found. Let the private beds stay, and here is the money for the mentally sick.

Most of the private beds are in London, anyway, so to make them available to the National Health Service is a load of nonsense as we already have too many beds, not too few beds, in the London area.

The private bed issue would be a total irrelevance but for the fact that these beds are of immense significance to the doctors. A porter or a domestic can take his or her services elsewhere; a surgeon, an anaesthetist or a radiologist cannot. He needs a team and he needs equipment. Outside London, although the number of private beds is very low, there would be absolutely no private facilities with which to replace them, so many doctors would face a totally State Service if the beds were arbitrarily removed in a short period. Moreover, the continuation of private beds in the NHS is a vital principle for the majority of consultants and it is one which transcends any self-interests of which they are accused.

In September 1974 only 42 per cent. of doctors answering a questionnaire were in private practice yet 82 per cent. wanted it to continue and 73 per cent. wanted it to continue within the NHS. There have been a number of later polls since then which have shown the same result. The minority referred to by the hon. Member for Hornchurch (Mr. Williams) in his brief speech—at the conclusion of which he walked out—demonstrated a total misunderstanding of the situation. The majority of doctors feel that the existence of an alternative to State medicine is an expression of independence. Doctors value that, whether or not they are engaged in private practice.

The decision to phase out pay beds is a unilateral breach of the agreement made with the doctors by Aneurin Bevan in 1948. It is also contrary to the findings of the Royal Commission on medical education which was set up by the Labour Government in 1968 and which recommended that private facilities in the National Health Service should be expanded, not restricted.

Most serious of all, we face under these proposals a philosophy that professional people cannot accept—a philosophy that all who are educated by the community lose the freedom to choose how they shall employ their skills. Does a man's skill belong to himself, does it belong wholly to the State, as the right hon. Lady clearly believes, or does it belong to both? That is a fundamental question for professional people. Should a doctor, through his access to a small number of private beds, have the freedom during a small part of his life to do his own thing, to have people consult him by choice because they trust him and are prepared to pay extra for that trust?

It is extraordinary that in the current issue of NALGO's journal Public Service the main demand to save the National Health Service is that it should be controlled by the working class. The greatest applause at a recent meeting was for the representative of the south-west trades union council who suggested that the workers should occupy hospital wards and departments. That is a deplorable and tragic situation in our Health Service.

The private medicine issue is a smoke-screen introduced as a result of class envy to detract attention from the Health Service issues which matter. I refer to the lack of resources and the problems of the cumbersome administration, the health centres and community care. There are many aspects which we should far better discuss than the tiny isolated issue of private medicine. We should be holding a wealth of constructive debate. I believe that Members of Parliament, as a result of their close contact with their constituents, could play a major part in that process. Instead we shall have to wait, I suppose, for a Royal Commission—a Royal Commission which will not consider one of the most important issues facing the medical profession.

However much the Secretary of State says otherwise, the responsibility for the conflict in the Health Service today lies firmly and fairly with her. She has promoted strife on every side. She will go down as the most disruptive and damaging health Minister of all time. I plead with her yet again to take advice from people within the health professions who want to see the Health Service back on its rightful path as a united Service, to be conciliatory, and to put the question of private medicine before the Royal Commission. It is not yet too late to do that. But if she does not stop going down her present road, sadly I must tell her that when she closes her door as Secretary of State for the last time it will be to a background of universal sighs of relief at her departure.

3.29 p.m.

Photo of Dr David Owen Dr David Owen , Plymouth, Devonport

The basic issues that lie behind the Gracious Speech concern the challenge facing Britain and many of the Western nations. Britain faces one of the gravest recessions it has ever faced. It is certainly as grave as that which so damaged us in the 1930s.

The issues we face are primarily how to manage our economy in the months and years ahead so as to ensure that the sacrifices that will undoubtedly be required from all sections of society are evenly and fairly shared, that we are able to look after the needs of those less fortunate than others through inability to find a job, inability to earn a sufficient income, or who from sickness or disability have to face even more daunting problems than others. Those are the issues facing Britain—how to protect the cohesion of a society facing the ravages of inflation, how to bring back under control the spending in all walks of life which has exceeded the earnings of the country as a whole, how to do this in a way that will carry conviction and the support of the majority of people in the country.

It is not unreasonable that we should have chosen the National Health Service as one of the subjects for debate on the Gracious Speech. The Service is the largest single employer in Britain. Last year it consumed 5·4 per cent. of the gross national product. Despite the financial and economic difficulties that we face, during the first year in which my right hon. Friend held responsibility for the Department of Health and Social Security she was able to achieve the greatest increase in the percentage of the gross national product devoted to these ends in our history—an increase from 4·9 per cent. to 5·4 per cent.

That injection of money, which has largely gone into salaries, will make it much easier for the Service to face the strains and financial stringencies of the next few years. No one would claim that all the problems related to salaries in the Health Service are settled; there are still considerable injustices in comparison with other incomes. However, it needs to be put firmly on the record that, far from my right hon. Friend's record being one of disruption and damage, she has, for instance, secured social justice for one of the most important of the professional groups working in the Service, namely, the nurses. The 60 per cent. increase in average earnings of nurses which has been achieved since we came to office—the increase was thoroughly deserved, albeit difficult to finance—was a considerable achievement.

It is against that background that we should be discussing the problems of the Service. The speeches of right hon. and hon. Members opposite have contained constant mention of divisiveness. They have talked about politics, and have constantly derided what they call the divisive nature of the legislative proposals in the Gracious Speech.

Hon. Members opposite, and none more so than the hon. Member for Reading, South (Dr. Vaughan), seemed to be obsessed with this issue. The whole of the hon. Gentleman's speech was devoted to the question of private practice. If the hon. Gentleman wishes from the Front Bench constantly to put the aspiration of a doctor to become a Harley Street doctor, he would do well to consider the views of others in the Service who feel equally passionately and equally strongly about the issue of pay beds. The Opposition will not face the fact that this is and has been for many years a very divisive issue within the Health Service.

The issue has become more divisive over the past four or five years. One reason it has become more divisive is that, as the economic realities of financing a health service have become increasingly apparent, so what has always been felt to be an injustice has become increasingly apparent to many others of the Health Service workers. This is the issue which must be faced.

My right hon. Friend or any one faced with responsibility for the Service would have to recognise that this is predominantly an internal dispute within the Service. Those of us who know the Scottish and Welsh health services are aware that because private practice is a very small part of the overall service it is not a divisive element. It is not there a major issue of principle. There is no challenge to the freedom or independence of the profession there. Indeed, in many parts of England also, private practice does not exist within NHS hospitals.

My right hon. Friend and I have made it repeatedly clear, as my right hon. Friend the Prime Minister has, that it is not the intention of the Government to stop private practice. It is not the intention of the Government that any licensing arrangements that might be introduced should be challenged by disruptive action by anyone who holds responsibility, either as an administrator or as a clerical worker associated with those arrangements. We believe that, in bringing forward a policy of separation of private practice from the NHS, we are trying to heal the divisions which exist within the Service.

The Opposition must face the fact that, by constantly presenting only one side of the case, that of the doctors, who do not, in any case, all think alike on the issue, they do a disservice to the serious nature of the issue. It is a law and order issue. That I do not deny. The hon. Member for Reading, South recalled that there had been disruption earlier in the year, particularly at the start of the dispute over nurses' pay, in April and May, and going on through the summer. He said that he deplored that disruption as he deplored all industrial action. We deplored it at the time, and we deplore it now where it is occurring in the NHS, as it is in some small, isolated hospitals.

Some action is still being taken over the question of private patients. We have done all we could to urge on individual trade union leaders, who have tried to respond and to pursuade their members accordingly, that the way to solve this issue is here in Parliament through the legislative process. We could, if we had so wished, have decided the issue by the use of the Secretary of State's discretionary power, but we knew that the issue was divisive within the medical profession and that it felt strongly about it, so we said we would bring the matter to Parliament to be decided in the normal democratic way, just as the major division within the profession in 1946–47 was decided in the House, by democratic process, subject to debate, amendment and vote.

That is the way the issue will be settled, but in the meantime we have made it clear that, although we have made the decision to separate private practice by the legislative process, on the question of timing and the manner in which it is done my right hon. Friend wishes to continue discussions before finally putting legislative proposals in order to hear what the medical profession has to say. I hope that it will respond to her invitation to discuss these matters, just as we have had discussions already with many of the other health service workers, including the nurses, trade unions, independent hospital insurance companies and other interested parties. My right hon. Friend's offer is there.

We have also made it clear that on the wider questions of the whole place of private practice outside the NHS and of the NHS itself, which are complex issues, we are open to discussion and genuine consultation.

The other major issue is the whole question of inflation. Here again, we have been discussing in the debate the one major challenge currently being made to the Government's pay policy. I welcome the clear and unequivocal statement by the hon. Member for Sutton Coldfield (Mr. Fowler) that he does not support industrial action for a breach of the pay policy. That view was repeated in many speeches, notably that of the hon. Member for Thanet, East (Mr. Aitken).

There is no doubt that if the pay policy were to be breached by the junior hospital doctors it would not be long before it would be breached in many other respects. I do not think that we would be able to justify that situation to 2 million workers who have already settled within the pay policy—and more particularly to the 200,000 workers who are renegotiating downwards agreements made on earlier occasions.

I could go back over the history of various claims, and indeed the hon. Member for Sutton Coldfield tried to do so, but I do not think that exercise is profitable. I remember the many discussions that took place over junior hospital doctors during the time of office of the Conservative Government. We have never tried to hide the fact that to some extent those staff have been caught by the introduction of the voluntary pay policy.

I must also stress that the British Medical Association has made it clear that it does not wish to challenge the pay policy. The consultants, almost all of whom earn more than the £8,500 limit, have agreed to abide by the limit, and many of the junior consultants, who looked forward to the change in incremental scales introduced following the April award, have agreed to abide by the policy. Indeed, many general practitioners have agreed to accept changes that flow from the pay policy because in many cases their incomes are over £8,500. Therefore, it is untrue to say that the medical profession, or indeed, the country in general, is challenging the pay policy.

I must urge upon the junior hospital doctors, as did my right hon Friend yesterday—and this matter has also been emphasised by my right hon Friend the Secretary of State for Employment—that there is no way in which we can apply the pay policy more flexibly without breaking the pay policy.

There has been a total absence of any suggestions in this debate of any concrete way in which we can so order the negotiations that within the pay policy we can meet the demands of the junior hospital doctors. We are always ready to examine suggestions. We have already been criticised in some quarters for having gone as far as humanly possible on the question of pay policy. The whole system of pooling and the offer of a no-detriment provision in phasing the introduction of the contract—in other words, using the £6 limit to cover the no-detriment situation—has been a flexible interpretation of the contract. We recognise the peculiar aspects of the contract. We have done our best.

We have no wish to pick on the junior hospital doctors. It is fair for them to say to the Government "We shall abide by the policy, but we shall break it if any other section of the community is allowed to breach the policy and the Government can expect industrial action from us very soon afterwards." The pay policy has to be voluntarily accepted, as, indeed, it has been accepted by every class and section of the community. It is vitally important that that should happen.

Personalised attacks on my right hon. Friend the Secretary of State for Social Services have become the obsession of the hon. Member for Sutton Coldfield. We have already dealt with that matter in a censure debate. We do not want that subject served up yet again. It does great disservice to the situation. Doctors have come to believe that everything that has happened has been the responsibility of my right hon. Friend the Secretary of State. They should appreciate, as I do, the fight that my right hon. Friend has made to preserve money for the Health Service and to try to ensure a fair deal for that Service. It was not easy for the Government to accept a 35 per cent. pay award for the consultants in April, when inflation was already going way ahead. It was not easy to get complete acceptance on the part of the Doctors and Dentists Review Body. If my right hon. Friend was being vindictive towards the consultants, it would have been easy for her not to have fought on that issue. But my right hon. Friend has not conducted her policies in that way. She now faces, as do the Government, a challenge to our pay policy.

The hon. Member for Sutton Coldfield made much of the Prime Minister's statements on this subject. It is an old tradition for the Opposition to attack a Prime Minister, but let us consider what my right hon. Friend said on Wednesday in the debate on the Queen's Speech. He stressed …the fundamental importance of the attack on inflation, which carries the overwhelming endorsement of the British people… He also stressed …the need for ail of us, Government, Parliament and the people, to maintain our determination…must not be abrogated, however strong the circumstances in any particular case or negotiation."—[Official Report, 19th November 1975; Vol. 901, c. 38–39.] This was an issue dealt with not just by my right hon. Friend the Prime Minister but also by my right hon. Friend the Secretary of State for Employment. Is it now suggested that two Cabinet Ministers are not sufficient to convince the junior hospital doctors of the strength of the case about the pay policy?

Photo of Mr Norman Fowler Mr Norman Fowler , Sutton Coldfield

Is the Minister rejecting this proposal? If he is I should like him to be clear about it at this stage.

Photo of Dr David Owen Dr David Owen , Plymouth, Devonport

The Prime Minister's decision is his own. The policy against inflation is every bit as much the Government's policy as it is the Prime Minister's.

Photo of Mr Norman Fowler Mr Norman Fowler , Sutton Coldfield

This proposal was put forward as a means of conciliation in what we all recognise is a difficult dispute. The Minister heard one of my hon. Friends say that the Chairman of the Junior Hospital Doctor's Association is prepared for such an initiative to take place. Does the Minister also realise that the present Prime Minister intervened in other disputes such as the railways, seamen's and the Liverpool docks dispute? Indeed, I believe that he has intervened in six disputes as a matter of last resort. Will the Minister give an undertaking to the House that he and the Government will give serious consideration to the proposal which is put forward as the basis for a way forward and not for political advantage? It is viewed as a way of solving a dispute, which, presumably, we all want to solve.

Photo of Dr David Owen Dr David Owen , Plymouth, Devonport

As far as I can recall all the cases which the hon. Gentleman has mentioned are not related to the interpretation of the pay policy or whatever might have been a pay policy in the past. The hon. Gentleman knows perfectly well that his proposal is a familiar one which is often heard in these circumstances. The situation is clear. The Government stand collectively by their pay policy, which has been explained to the junior hospital doctors. We have asked them to write to us, in the light of the meeting which took place yesterday, to try to define any aspect or area in which they think we can interpret the pay policy fairly. That is the attitude which the Government take to the matter.

Photo of Mr Myer Galpern Mr Myer Galpern , Glasgow Shettleston

Order. The hon. Member for Sutton Coldfield (Mr. Fowler) must resume his seat if the Minister does not wish to give way.

Photo of Mr Norman Fowler Mr Norman Fowler , Sutton Coldfield

I ask the Minister to give way on this point, which is of some importance.

Photo of Dr David Owen Dr David Owen , Plymouth, Devonport

I have answered the hon. Gentleman.

Photo of Mr Myer Galpern Mr Myer Galpern , Glasgow Shettleston

Order. The debate must finish at 4 o'clock. The hon. Member for Reading, South (Dr. Vaughan), who wound up for the Opposition, was not interrupted.

Photo of Dr David Owen Dr David Owen , Plymouth, Devonport

The hon. Gentleman the Member for Sutton Coldfield had a long time to make his own speech.

I wish to turn to some of the central issues in relation to the National Health Service as a whole. It is a tragedy that we have been unable to spend more time on them, but we all recognise the need to discuss other issues.

It has been said by a number of hon. Members during the debate that the Health Service faces considerable problems in terms of the relationship between primary care or community health and the hospital service. The hon. Member for Wells (Mr. Boscawen) spoke about that matter. Often it is not sufficiently recognised that services such as general medical, dental, ophthalmic, pharmaceutical, health visiting, chiropody, family planning outside the hospital service and preventive medicine, including vaccination, immunisation and fluoridation, are currently likely to cost this year about £725 million, which is about 17 per cent. of the total health and personal social services budget. Yet we spend so much of our time discussing the hospital services as well as the acute hospital services. The hon. Member for Sutton Cold field, when he opened his attack on my right hon. Friend, tried to imply that the only thing this Government have done has been concerned with private practice. He should note some of the positive improvements which have been made to the Health Service.

This Government introduced a free comprehensive family planning service which, in my view, should have been introduced two decades or more ago. This Government, despite considerable financial difficulties, have done everything possible to maintain and expand the health centre building programme and, perhaps more important, have for the first time introduced indices of deprivation to try to ensure that health centre building is focused on areas of health deprivation. This Government have made a commitment, which we intend to keep, to vocational training for general practice.

We have tried throughout the last difficult months, despite the administrative structure of the Health Service and the reorganisation of local government, both of which are expensive, disruptive and extremely bureaucratic administrations, and which were handed to us by the previous Government, to weld together the health and personal social services. We have tried all the time to see the planning of geriatric, mental illness, the mentally handicapped and the physically handicapped services across the board as Health Service and personal social services are closely linked. We have constantly urged the necessity for joint planning. At a time of very limiting financial restrictions, it is crucial to use the resources of the personal social services and the Health Service as one. At a time When the capital building programme is considerably limited it is immensely important to plan those services together.

That was why we introduced the new concept of the mental handicap National Development Group and the mental handicap development team which we put out for consultation. That was why we suggested that the Hospital Advisory Service should be changed to the Health Advisory Service and that it should have representation from the social workers and social work services. We have constantly stressed the need for a cross-financing fund to be used by the Joint Consultative Committees to try to decide jointly on projects which will keep people in the community and not put them into hospitals. This orientation towards community services and practical local achievement by planning across the artificial boundaries between the health and personal social services has been one of the central themes of my right hon. Friend's policies.

I strongly resent any attack to the effect that during this time of considerable innovations over attitudes, perhaps often far more important than over new projects and finance, my right hon. Friend has made no contribution. Indeed, she has made a major contribution. It will take time, and it will not be easy.

Another area of massive significance in the long term is the decision to look at the way that we allocate resources in an endeavour to try to redress the gross inequalities between different regions in the Health Service. I do not want to go into the statistics. They are well known to everybody. However, there was the decision to establish the resources allocation working party. No decisions have yet been made. The proposals by that working party will be difficult to achieve. It is not easy to switch revenue from the four London Metropolitan Regional Health Authorities and the Merseyside Region to other regions. We must carefully consider the matter and consult the area health authorities and regional health authorities before any such switch can be made.

We are looking at the pharmaceutical budget, which is expensive—about 5 per cent. of the overall budget—to try to see whether restrictions can be made there.

I tore up and down the country trying to get people to accept the realities of the financial difficulties facing us. We inherited a hospital building programme which was at a complete standstill as a result of the 20 per cent. cut in December 1973. We face the possibility of a moratorium of two to three years on all starts, although we found some extra money to lift it a little. I am glad that the psychiatric provision could be made for the hospital to which the hon. Member for Chertsey and Walton (Mr. Pattie) referred.

We need to concentrate on expanding the medical student intake. Of course, emigration is worrying. Training is very expensive. It costs about £27,000 to train a doctor, and if he stays on for postgraduate work, it is even more expensive. If he goes to another country, he leaves a hole. We need to expand our medical student intake and to get a better distribution of doctors throughout the Health Service.

It is true, of course, that all those things will be difficult to achieve if the medical profession decides to take industrial action. Industrial action is nothing new to it. Industrial action was taken over the consultants' new contracts. Industrial action is being taken in various parts of the North-West at the moment. It is not always a matter of caring only for emergency cases. In my own constituency the junior hospital doctors did nothing for a whole day. Luckily the consultants filled in the gap.

I strongly believe that it is not in the profession's own interests to continue to behave in this way. I read just recently in The Lancet an article entitled "A profession destroying itself", and I hope that the profession will think very carefully about its present conduct and action. It does not enhance the prestige of the profession, it does not enhance the calling, or the respect in which the profession is held by the public, to behave in this way. I have not heard a single speech in the House concerning the views of the patients. We know what the Patients' Association has to say. All these actions can be very damaging, and we cannot at this time, when the National Health Service faces such financial difficulties, allow any one sector to hold the rest of the Service to ransom.

We are trying to achieve policies which may not be acceptable to everyone. No doubt, the rate at which we decide to phase out pay beds will not be acceptable to all my hon. Friends or to all the unions. There are many people who think that we should be abolishing private practice. They are not getting everything they want, any more than the doctors are getting everything they want.

Let us have a little more balance and a better sense of proportion in this debate. Certainly we never get it when the hon. Member for Reading, South speaks. He has an even greater responsibility than others to think from other than the doctors' standpoint, and to think of the whole of the hospitals.

As for the personal social service, today my right hon. Friend the Secretary of State for the Environment is making a statement about the standstill settlement for next year. At one moment it looked as if there would be a cut in these services next year. Such a cut would have dealt a blow to community care, to meals-on-wheels, home help, and so on. Fortunately, my right hon. Friend has been able to find some extra money, so that the £40 million which might have had to come off, because they were overspent, has been reduced. There is now only to be a shortfall of £5 million, which I think can be made up by administrative savings, and savings in research and development. It will still mean a standstill on current expenditure for next year in the social services, and that will pose very serious and difficult problems.

The Government are facing up to the financial difficulties, trying to make the country realise that we face make-and-mend years in many different social services. We remember the Barber years, when expenditure was allowed to go grossly out of control and this country was left with bitter divisions. There is a lot to be said for the way in which the Government have slowly made people realise that we have all to work together, and have achieved a voluntary agreement on pay policy which would have been almost inconceivable even six months ago. That achievement on pay is a fairly formidable one.

It will be difficult to persuade and to explain to people why we need to cut back in some of our social services, which most of us hold very dear, in order to increase industrial development and earn our living in the markets of the world. The speeches from hon. Members opposite, and particularly from the Opposition Front Bench, have not contributed one jot or tittle to the effort that is required. My hon. Friends have had to accept sacrifices in relation to the optical charges and dental charges. None of them likes these charges, but they are prepared to face the realities confronting this country. The Opposition spend all their time as proponents of the doctors' views, and it is high time that they were prepared to look at the problems of the Health Service in the round. They are difficult problems. They will be difficult to settle and to solve.

I only hope that the doctors will be prepared to play their part as they have in the past, and as, I think, the great bulk of doctors want to do in the future, so that we may settle down and work these problems out together. They want a Health Service which is not divided and bitter. They do not want a conflict with the hospital porters, the technicians or the nurses. I want to get back to the days when the staff of a hospital worked together as a team. I believe that that can be done, but it will be done only—

It being Four o'clock, the debate stood adjourned.

Debate to be resumed upon Monday next.