§ 4.4 p.m.
§ The Chairman
I think there are certain Amendments consequential upon the first Amendment on the Order Paper and perhaps they can be taken at the same time.
§ Mr. J. Enoch Powell (Wolverhampton, South-West)
I beg to move, in page 1, line 9, after "recovered," to insert:in accordance with the following provisions of this section and.I think it would be to the convenience of the Committee not only to take the first Amendment which stands on the Order Paper but four others with which it is connected. With your permission, Major Milner, perhaps I might draw the attention of the Committee to those Amendments and indicate the manner in which they hang together. The second of the Amendments is that in page 1, line 13, to insert a new subsection. The third Amendment is that in page 1, line 14, to leave out subsection (2). The last two of the five Amendments that hang together are those to Clause 4, page 3, line 10, to omit subsection (2) and Clause 4, page 3, line 24, to leave out "or the National Assistance Act, 1948."
The general effect of these five Amendments taken together can be expressed very briefly. They take the National Assistance Board out of this Bill and they substitute for it an entirely different and, I believe, a far preferable method of assessing means and reducing—in appropriate cases—the charges to be levied under the Bill. This, briefly, is how the alteration is carried out. Where the appliances are supplied under Part II, it is made the duty of the regional hospital board, and where the appliances are supplied under Part IV, it is made the duty of the local executive council to assess those charges, having regard to the means of the patient and acting upon principles to be laid down by the Minister.
Consequentially upon the introduction of that new machinery for the assessment of means and the fixing of the charges, two alterations follow. It becomes no longer necessary to apply the National Assistance Act for the purpose of this Bill, and consequently Clause 4 (2) and reference to the National Assistance Act in Clause 4 (3) disappear. It also becomes unnecessary to have the present Clause 1 (2), which exempts from the operation of the Bill persons resident in hospitals, because they will come under the general machinery which it is proposed to set up.
I would emphasise particularly the fact that the Amendment to omit Clause 1 (2) is purely consequential upon the group of Amendments I am now discussing. 1201 Should those Amendments fall as a whole, there would be no question, in my view, of allowing a charge to fall upon persons resident in hospital. I shall have a word to say about the weaknesses of that subsection at a later stage. I am only concerned for the moment to emphasise that the Amendment on the Order Paper to omit Clause 1 (2) is purely consequential on the group of Amendments which the Committee is now considering.
I want first to consider the method of assessing means which is at present written into the Bill, and which I wish to take out and replace by a different one. That method is that the patient, on being called upon to meet a charge under this Bill, will then, if he thinks fit, go as an independent operation to the National Assistance Board and will attempt to make out a case to them that he is entitled to a refund of a part or the whole of the sum he has been called upon to Pay.
I emphasise that the application to the National Assistance Board has to be made as a quite separate operation. There is nothing automatic or incidental about it. It is a separate act which the patient has to make on his own decision and volition. I believe that is a mistake, because that is going to result in allowing the charge to fall in full upon a large number of cases which I think every hon. Member would agree ought not to bear it. It is very often going to be precisely the most deserving type of patient—those who, on any reasonable view, should be relieved of the necessity of making this payment—who will not go to the National Assistance Board.
I hope that no one on either side of the Committee will argue in favour of the method in the Bill on the grounds that it will act as a deterrent, because many of the people whom it will deter will be precisely those people whom we want to assist. I would certainly be no party to regarding the use of the National Assistance Board in this Bill as the Poor Law Commissioners regarded poor relief in 1834, when they conceived it to be their duty so to organise poor relief that as few people as possible would apply for it. Unless that view is taken, it must be agreed that the machinery will automatically eliminate from the purview of the means test and of a possible refund many 1202 categories of people whom we should wish to be within its scope.
Even persons who are in receipt of National Assistance payments and who, ex hypothesi, would be suitable subjects for a refund under the Bill, will in many cases not make the application in the manner which is required, because, as hon. Members will be aware, many payments made under the National Assistance Act are made by a kind of cheque and are purely automatic, and there is no question of frequent or regular visits by the recipient to the offices of the National Assistance Board. I can well see numerous cases of old age pensioners who are receiving supplements to their old age pensions from the National Assistance Board and who, although on any view they would be entitled to assistance, will not make a claim under Clause 4 as it stands at present.
The difficulties which the Government have got themselves into by attempting to use the National Assistance Board as their chosen instrument in this case are exemplified by Clause 1 (2). The very clumsiness and inherent absurdities of that subsection arise partly from the unsuitability of the National Assistance Board to do the job which is required of them. Clause 1 (2) says that a person resident in hospital shall not be required to make payments for appliances supplied under Part II. The reason which we have been given in the Second Reading debate is that normally persons in hospital will have lost for the time being their earning capacity, and therefore they, at any rate, can be isolated as a class upon whom the charge ought not to fall. That, on the face of it, is not correct, because there are large categories of people who for a long period of illness are no worse off financially than when they are earning. For example, the teacher, for a great many weeks after his first illness, receives exactly the same sum as during health, and consequently, whether he is in a hospital or not, the fact that he is sick is irrelevant to his ability to pay. That is one inherent absurdity in Clause 1 (2).
There is the second point that a person may be in hospital, quite regardless of his means. I understand that the word "resident" in subsection (2) has no special force; it does not restrict the application of the subsection to persons resident for a long time. It means "being 1203 for the time being in hospital," in un-technical language. As I interpret this subsection in connection with the National Health Service Act, 1946, it would follow that even persons in pay beds, let alone those in amenity beds, would secure the same exemption. I think that is the case.
At any rate, the points to which I have drawn attention in this subsection do show a great clumsiness in this attempt to isolate one class of person to whom the National Assistance Board machinery should not be applied, and they show a consciousness of the unsuitability of that machinery itself. After all, what I think was at the back of the minds of the Government was that they could not expect a person in hospital to make an application to the National Assistance Board, and so they simply exempted that category.
Thus, one main reason why I object to the use of the National Assistance Board in this Bill is that it will not enable us to give help to the right people. The second reason is that the National Assistance Board is in itself not a suitable instrument for the kind of assessment which ought to be made for the purposes of the Bill, because the standards which will have to be used in deciding whether a refund ought to be made for spectacles or dentures are quite different, or largely different, from the standards which are applied by the National Assistance Board. After all, the basic conception of the National Assistance Act is that there is a basic minimum to which a person applying to the Assistance Board is entitled to be brought up. That is the essential conception on the basis of which the National Assistance Board operates.
But here the idea is quite different. One cannot bring the question of a claimant for dentures or spectacles within the conception of a basic minimum to which the applicant is brought up. Indeed, that is borne out by the necessity of opening applications to the National Assistance Board to persons in full-time employment. The National Assistance Board, applying their present methods and rules of assessment, will find it very difficult to decide in the case of a person in full-time employment whether or not he is a suitable subject for relief under Clause 4. That is the particular category of people whom we know the Minister has specially in 1204 mind, because the Minister, on Second Reading, said:This"—that is, the opportunity of applying to the National Assistance Board—may be particularly valuable to lower-paid workers who have a number of children."—[OFFICIAL REPORT, 24th April, 1951, Vol. 487, c. 244.]That category of applicants is going to present the National Assistance Board with an entirely new assessment problem—one that I believe the National Assistance Board is not the suitable organ to solve.
Then there is the wider consideration that if this is indeed, as I think the majority of hon. Members feel, a new departure of principle, then the machinery which we adopt at this first step is of great importance. If it be true—and I am using words which come from the other side of the Committee that the National Health Service is in danger of being ground between an upper and a nether millstone, the upper millstone of a fixed Budgetary ceiling and the nether millstone of rising costs, then, make no mistake, these charges which are imposed in this Bill will not remain isolated.
In order to save the essentials of the Health Service, it may be necessary under any Government, and under any policy to carry this principle further, however regretfully. If that be so—and the major premise has been conceded from the Government side of the Committee—then we are setting out to load the National Assistance Board with an increasing series of separate problems of means assessment for separate payments or remissions of payment, and that is a task which I believe it would be wrong to set them.
What we have to do, as far as we can, is to restore in the new circumstances some much more humane, some much more adaptable and suitable method of accommodating charges and means. After all, in the old days before the National Health Service Act, there was such a means test, which was applied by the practitioner himself. It was applied, however imperfectly, however variably, with a great degree of knowledge and a great degree of humanity, and by and large it worked. Are we right in saying that the instrument to replace that personal and humane approach to the question of a charge to the patient is the National Assistance Board? I think not, 1205 and I believe our eyes are turned in the right direction by analogies which already exist both within the Health Service itself and within the education service. To these I now wish to draw the attention of the House.
Under the health services which are administered by the local authority under Sections 28 and 29 of the National Health Service Act, the local authority is empowered, in accordance with the means of the patient, to recover part of the cost of the services which it provides. Those two types of service are shown in Section 28—"Prevention of illness, care and aftercare"; and in Section 29—" Domestic help." In each case a local health authority—and I now quote from the Act—may, with the approval of the Minister, recover from persons availing themselves of the services provided under this section such charges…as the authority consider reasonable, having regard to the means of those persons.Thus, within the framework of the National Health Service Act we already have a means test—a system of scaling charges, if hon. Members prefer to put it in that way—which is administered by a body quite different from the National Assistance Board and is administered on quite different principles. I might here point out that I think the Secretary of State for Scotland was under a misapprehension in his speech on Second Reading. Having accused me of having been guilty of "an attempt at political mischief "—I am not complaining of that—he went on to say:It is nonsense to pretend that the Assistance Board has not already been employed in this service. It is also nonsense to pretend that there has been no question of charges before in this service. There have been charges from the beginning, charges for a great range of services. The hon. Member for Enfield. West, drew our attention…"—[OFFICIAL REPORT, 24th April, 1951; Vol. 486, c. 334.]to these. Quite so, but these are services the charges for which are not assessed by the National Assistance Board.
The Secretary of State for Scotland (Mr. McNeil)
I am sure the hon. Member is not attempting to mislead anyone on this subject. I made the point, which I repeat, that the Assistance Board has already been used within the framework of the Act for the assessment of charges and that upon such an assessment, for 1206 example, expenses are refunded. I made the point perfectly plainly but, of course, I did not attempt to say in relation to the charges to which the hon. Member for Enfield, West (Mr. Iain MacLeod), drew our attention, that the Assistance Board was the instrument used in that case. The instrument used there is usually the local authority which, of course, has machinery for that purpose and experience for that purpose, which is not resident either in the regional board or in the local executive council.
§ Mr. Powell
We shall perhaps hear from the Government later in the debate a list of those charges under the National Health Service Act for the partial or total remission of which the National Assistance Board is responsible. The only one of which I know personally is that of the refund of travelling costs on visiting a patient, and that was not originally dealt with my the National Assistance Board but was transferred to them last year. The fact remains that those charges which have been made "from the beginning"—and these were the right hon. Gentleman's words—were, under the Act, not made subject to the discretion of the Assistance Board but to that of the local authority.
I turn from that to the local authority functions under the National Assistance and Children Acts. There again, a means test is applied in order to recover a part or the whole of the cost of the care of old people and of children from the "liable relatives," and there again the assessment is not made by the National Assistance Board but by the local authority.
Next we have the education service. Grants or payments, many of them closely similar to these payments for dentures and spectacles in the sense that they may be required only once or twice in the school life of a child, are assessed by the local education authorities; payments which may be made for maintenance or for clothing or for free meals under the Education Act are assessed or remitted by the local education authority itself, which applies a quite separate scale and quite different methods. It is true that these are authorised by the Minister of Education, but the body which carries out the assessment is the local education authority itself.
Thus we have within the range of social services closely allied to that which we 1207 are considering means tests already in force, methods of remissions and charges already being practised, which are administered not by the National Assistance Board but by the local authority or by the local education authority. We have scales applied which are not National Assistance scales. In one case we have a grade of scales of the Association of Municipal Corporations—that is, under the Health Act—in another case a scale laid down by the Ministry of Health, and in a third case a scale laid down by the local education authority and approved by the Minister of Education. There we have a separate, flexible scale for each type of case administered by the authority responsible for the provision of that service.
There, I believe, is a fruitful analogy which shows us the right course to take in this Bill. It is for that reason that these Amendments, the first of which I have moved, propose to make the assessment of means and the fixing of the charge the responsibility of either the regional hospital board or of the executive council, as the case may be. In case there may be misunderstanding, I should perhaps say that these are the bodies which will ultimately be responsible. It does not necessarily follow that the administrative work in question would be carried out by the regional hospital board itself or at its headquarters. [HON. MEMBERS: "Who would do it?"] I can well understand that it would normally be in the offices of the hospital management group that the assessment would take place; but the use of the term "regional hospital board" is to place the responsibility where it quite clearly will ultimately lie—short, of course, of the Minister.
Let me give the Committee an illustration of the sort of way in which I conceive this machinery would work. I do not stand to be held to the details, but I offer this as a picture of the manner in which I believe the means test and the assessment should work. Let us imagine the patient at the dentist's, either before the extraction or when he goes for the first fitting for a set of dentures. He fills up a simple form of the type which an applicant for assistance from the local authority under the Health Service Act or an applicant for maintenance under the Education Act is asked to complete, and that goes to the appointed administrator of the executive council who, on the basis 1208 of the information in it, indicates the charge—whether any or a part or the whole of the schedule of charges—which should be made in accordance with the sliding scale laid down by the authority and approved by the Minister.
The advantage of that scheme is that, in the first place, it is simple. There is no particularly elaborate verification required. Local authorities and local education authorities content themselves in all but the tiny minority of cases merely with the counter-signature of the employer as to the amount of salary or wages. It is a quite simple operation to make the relevant statement. It is automatic in that anyone who obtains the appliances fills in the form and is either charged or not, according as he is entitled. The thing is automatic. There is, at any rate, as complete privacy as there ever was up to the inception of the National Health Service in the levying of charges by practitioners. It is perfectly true that the practitioner, if this method is adopted, will know if a charge has been wholly or partly remitted. That is perfectly true.
Finally, the scales which are applied are subject to Ministerial approval, and they could, if necessary, be made subject to the approval of Parliament. I submit, therefore, that here is an outline of a scheme which has useful and successful analogies already in the social services, and which avoids the difficulties and objections to which I have already drawn attention in the use of the National Assistance Board.
It may be said that this will place the discretion in the hands of a distant authority. That is a complete misconception. The local executive council and the agency of the regional hospital board are not more distant either administratively or in terms of space than many county education authorities or the local authority of a county borough like Birmingham or Manchester.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Blenkinsop)
Will the hon. Gentleman allow me? Surely he is not arguing that there is not a very real difference in space as between the area covered by the executive council and that covered by an Assistance Board office? There is all the difference in the world.
§ Mr. Powell
Yes, indeed; I recognise that the Assistance Board offices do cover smaller areas than the hospital management commitees on the whole, or the executive councils. That is perfectly true; but what I am arguing is that here is a body which is no more distant, covers no larger an area, than the bodies which are already applying means tests under the other social services—and, incidentally, a type of authority which is no more impersonal.
So while emphasising that I am not necessarily wedded to the exact method indicated by the wording of this group of Amendments, I submit to the Committee that it would be wrong to leave the National Assistance Board in the Bill as the body which will determine whether or not, and if so, how much, payment is to be made by patients for these appliances, and I submit to the Committee that the local authorities and local education authorities, in their administration of the charges under the social services, provide us with an indication of the right means of applying the means test under this Bill.
§ Mr. Messer (Tottenham)
The National Health Service, as we all know, is full of inconsistencies and anomalies. This Bill does not lessen them; in fact, it increases them; and the Amendment which has just been moved increases them still further. I will agree with the hon. Member for Wolverhampton, South-West (Mr. Powell) that the Government are rather in a difficulty in this matter because of some of these anomalies. I cannot see any way out of these difficulties except by withdrawing the Bill—[HON. MEMBERS: "Hear, hear."]—and going back to where we were.
I notice one very great weakness in the Amendment. The hon. Member refers to the regional boards and executive councils. What is to happen to the patients who happen to go into teaching hospitals? He has said nothing about the boards of governors. Do I take it that what he is going to do is to create that further anomaly of saying that in a regional board hospital there shall be assessment of means—that the executive council will be justified in assessing means—but that in a teaching hospital there shall be no assessment? The Amendment leaves us in the difficulty that it creates fresh anomalies.
1210 I am going to agree with some of the things the hon. Member said. I do not like the Assistance Board coming into the business for assessing. Right from the beginning, I have always thought there was value in this National Health Service in that we got away from that poverty basis which is typified by the Assistance Board. If the Bill goes through, if it were possible for us to set up an agency to do this job which was not the Assistance Board, nobody would be more pleased than I. I am bound to say that my contact with the Assistance Board has shown me that it is very much more humane in its administration and in its approach to the poverty problem than were the boards of guardians in the old days.
The difficulty, however, in which I find myself is this. Just how are we going to combine responsibility with authority? The hon. Member did disclose what, in his mind, was the difficulty of administration. The regional board has to accept responsibility. Everybody knows that the regional board could not administer this Amendment—a regional board covering a population of between 3,000,000 and 4,000,000 people in an area stretching, in some cases, some hundreds of miles, with the periphery so remote from the centre. It would be literally impossible for the regional board to do it themselves. What then would it do? It would have to agree on principles that would be laid down, and then it would have to take responsibility for doing the job through management committees. I suggest that that is just the sort of thing we want to take away from management committees.
Before the Act came in we had two types of hospital, voluntary hospitals and the local authority hospitals. It should be noted that I do not say we had two systems, because neither type of hospital was a system. In the voluntary hospitals patients were assessed and it was not a very happy experience, Before one went to the doctor who was to make the examination, one saw the almoner and had to disclose how much one earned and how much one paid in rent and what one's obligations were, and then, when one had finished giving evidence against oneself, one was sentenced to pay so much whilst in hospital. Notwithstanding what the hon. Member says, and while it is true that there are some people who 1211 receive pay or part pay while they are ill, the vast majority of people get nothing more than their 26s. sick benefit. By far the majority of the workers get nothing more than that.
Are we to go back to the days when, before the patient saw the doctor who was to determine whether his condition was such that all his teeth had got to come out, he had to disclose all this information? If it is going to be done at all, it is as well that it should be done by people who are experienced in doing it, and the present management committees are not the right type of body. Do not ask me what is the right type of body. Failing everything else I think the Assistance Board is possessed of the necessary staff and the necessary experience, but I was hoping that we should, by this Bill, relieve as many people as possible of the necessity of paying. The Amendment will mean that people who go into hospital will pay. It is to be regretted that when the surgeon in charge of the case says that, as a result of their condition, their teeth should be extracted and they should have a new set of dentures——
§ Mr. Powell
I am sure that the hon. Member will remember that I pointed out that the deletion of Clause 1 (2) is purely consequential upon the adoption of machinery which would apply automatically to everyone whether they are inside a hospital or outside. If they qualified when in hospital they would not pay in any case.
§ Mr. Messer
But there is also the main stream of my argument to be considered. I hope later to be able to speak on an Amendment of mine. I agree on the illogicality of the Bill. I agree that if one happens to be in hospital one can have free teeth, but if one has been so long on the waiting list that one has to be treated by the general practitioner, one cannot. That is an illogicality, but the main Act is illogical. The Bill is illogical but we shall not overcome that by making it still more illogical, and that is what the Amendment does.
I hope my hon. Friends will support the Minister in resisting the Amendment, because it creates an instrument for doing a job to which it is not suited. In the 1212 regional board with which I am associated we have to face the criticism of the public about what is done by a management committee which they appoint. The regional boards do not very effectively control management committees. That is one of the illogicalities of the Act; it does not allow them to do so. We shall have different management committees applying this in different ways, and instead of getting what we may get under the National Assistance Board, something in the nature of a general level throughout the country, we shall have a wide variation, which is what we want to avoid. I hope that the Minister will not accept any of the Amendments.
§ Mr. Iain MacLeod (Enfield, West)
On a subject like this, which perhaps provides a good interlude before stormy debates later on, there is no one in the Committee or the country whose opinion counts more than that of the hon. Member for Tottenham (Mr. Messer). He said, fairly, that he had a certain sympathy with the idea behind the Amendment, which is to take the National Assistance Board out of the Bill if it can be done. I think he will agree that most of his argument was not against the Amendment but against the Bill itself.
On Second Reading the matter was first raised by the hon. Member for Orkney and Shetland (Mr. Grimond) and from then on it formed the main common thread of the debate. The hon. Member for Holborn and St. Pancras, South (Dr. Jeger), said:We are creating a new class of people who will apply for national assistance."—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 263.]The hon. Member for Manchester, Exchange (Mr. W. Griffiths) said:… I suspect that it will be extremely difficult to operate, in particular in its application to workers in full-time employment."—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 289.]4.45 p.m.
I tried to make a similar point, and so did my hon. Friend the Member for Wolverhampton, South-West (Mr. Powell). The point was taken up by the hon. Member for Bermondsey (Mr. Mellish) and also by my right hon. and gallant Friend the Member for Kelvin-grove (Lieut.-Colonel Elliot). In the additional debate that we had on the Financial Resolution the hon. Member for 1213 Stoke-on-Trent, South (Mr. Ellis Smith), said:I never remember any responsibility of this character being put on the shoulders of the Assistance Board before.…"—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 343.]The hon. Member for Holland with Boston (Mr. Butcher), also spoke on the subject. These were comments from Front Bench and back bench Members. Liberals, Liberal Nationals, Conservatives and Socialists. They include those who are for the Bill, those against the Bill and those who are lukewarm about the Bill. It would be remarkable if all those differing opinions which refer to the considerable trouble which there is likely to be in this matter, were wrong.
The question resolves itself into a problem of whether this is practicable or not, and, if it is practicable, whether this is the best method of doing what we seek to do. If it is argued that executive councils are not designed for this sort of work, equally the National Assistance Board was not. It is because of Section 9 (1) of the 1948 Act that we have to make some subsequent Amendment to the Bill. It was never contemplated that people in full-time employment should be eligible for this kind of grant. As to the second argument which is being adduced, we cannot have it both ways. We cannot argue on the one hand that this will require a tremendous new bureaucracy to work, and, on the other argue, as the Minister of Health did on Second Reading,… no wide recourse is likely to be necessary to these arrangements under the Assistance Board because, after all, dentures, unlike medicines, are things which people require comparatively rarely during their lives."—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 244.]It is true that this is not a procedure for which the National Assistance Board was ever designed. Normally payments are made, usually weekly, sometimes individually, to meet emergency problems or the problems associated with ordinary living and the cost of living at the present time.
The Secretary of State for Scotland has also had something to say about the Assistance Board under the Bill. He will agree—I think that the point has been conceded—that the National Assistance Board had no part, for obvious reasons, in the original Acts of 1946 and 1947 and that they have come into the picture not through the parent Act but because of 1214 regulations which have been introduced since.
I believe that this is the third time that the House of Commons, either here or in Committee upstairs, has had to consider the problem. This time is a great deal more serious. The first time was in connection with the Legal Aid Bill in which it was laid down that the inquiry would be undertaken, often in the case of people in full employment—so it is somewhat similar—by the National Assistance Board. In the Scottish Grand Committee there was a very long debate, and the solution proposed then was that a statutory declaration should be requested. That proposal went to a division, and, surprisingly enough, one found in the same Lobby my right hon. and gallant Friend the Member for Kelvin-grove, the hon. Member for South Ayrshire (Mr. Emrys Hughes), the hon. Member for Renfrew, West (Mr. Maclay), the hon. Member for Bridgeton (Mr. Carmichael) and Mr. William Gallacher, all supporting the idea that, if possible, the National Assistance Board should be removed from the not dissimilar problem in the case of legal aid.
My right hon. and gallant Friend the Member for Kelvingrove was the parent of the father of the National Assistance Board and he is, in a sense, a grandparent of this legislation. I do not believe that he can be happy now because he was not happy then about the additional duties that we are putting on the National Assistance Board. There is a wide variety of problems undertaken by the National Assistance Board, and as they have already been indicated, I do not propose to go over them again. I know that this is a difficult problem. After all, there is only one dental board for the whole of the country and many of these problems have gone to bodies a great deal more remote than even the regional hospital boards may be from the patients.
It is true, as the hon. Member for Tottenham said, that these matters should not be done in executive council or by regional hospital boards. Incidentally, he is quite right about the teaching hospitals. I am sure there was an omission in the drafting and there was no sinister intention behind it. They would not carry out the procedure envisaged by my hon. Friend any more than Mr. George Buchanan hands out the money paid 1215 under the regulations of the National Assistance Board.
I sum up the problem in this way: If this is a practicable Measure everyone wants it, but I am sure that everyone wants to take the National Assistance Board out of this sort of service, if we can find a way to do so. I think that we have suggested a way which would be easy for the hospitals and more difficult, although by no means impossible, for the much wider variety of cases that come under Part IV. Certainly there are difficulties—I believe that this difficulty to some extent has argued itself into this debate—but I think that the difficulties are small in comparison with what we are trying to do, and that is to ensure that, in this service, the National Assistance Board has no part at all.
Where a man is in full-time employment, we should try to find a way—I will not say more humane because administratively the National Assistance Board is admirably humane in every way—but at least more attractive to himself, and, I hope, for the reasons that we have put forward that, without tying ourselves necessarily to any particular form of scheme, we should seek this afternoon on both sides of the Committee to find a way of solving this problem.
§ Mr. MacColl (Widnes)
This is a plausible Amendment, and, because it is plausible, I think that it is very mischievous. There is really only one sub-tantial argument that I can see in favour of it. That is, that it is a recognised, undoubted fact that many people at present have a reluctance to go to the National Assistance Board. Therefore, I think that it is very arguable, and probably true, that some people will resist the suggestion that they should go for assistance to the Board for their dentures. That, I think, is a very short-sighted reason for altering the proposals in the Bill for leaving the decision with the Board. This is a transitory phase due to the slowness with which public opinion recognises the great step forward under the National Assistance Act, 1948.
To say that because the National Assistance Board has still about it a certain amount of the ill-founded strictures of Poor Law, therefore this should be taken away from the Board, is a 1216 thoroughly fallacious and specious argument. A way of killing once and for all the taint of the Poor Law is to bring more services under the Board, apart from the mere relief of destitution. That was the whole idea of having the National Assistance Board—not that it should be a survival of the Poor Law, as the hon. Member for Wolverhampton, South-West (Mr. Powell), seems to imagine it is, but that it should be a residual body filling up the gaps left in the administration of the services.
That is why, in the case of the Legal Aid and Advice Act, and the regulations under that Act, assessment was left with the Assistance Board. Just as I think it is good that the Assistance Board should have to deal with members of the public who want to bring legal actions, so I think they should have to deal with members of the public who otherwise would not come within their purview but who require dentures. I think that either of the difficulties suggested are very much exaggerated. The old local authority public assistance committee did, in fact, help people who were in employment with their dentures. Therefore, the administrative problems are not at all insuperable.
It strikes me as being a very remarkable thing that hon. Gentlemen opposite, like the right hon. and gallant Member for Leicester, South-East (Captain Waterhouse), should talk about the need to cut down administrative expenses and want to create a new executive council, and under the regional hospital boards an entirely new type of official who would have to have quite a different experience from that which they need for their ordinary work. The hon. Member for En-field, West (Mr. Iain MacLeod) has said, "Oh, but it is going to be a very little extra burden on the National Assistance Board to employ officials of this type of experience." If we set up a new department with entirely new district officers to be of ready access to the applicants, that will mean a tremendous increase in the administrative overheads of the service.
We are not at the moment discussing the pros and cons of whether we have a payment or not: the question is that, if we are having a payment, what is the most economical and best way of making an assessment. I am certain that the line 1217 to take, which is more in focus with the general progress of legislation under this Government in the past few years, is to put the responsibility on the National Assistance Board, and, I would say, to put as much responsibility as possible for other assessments under it. The argument that under the Education Act people would go to other bodies ignores the fact that the National Assistance Act was passed in 1948.
§ Mr. Powell
Will the hon. Gentleman refer to the Health Act itself, which prescribes the different means of assessment paid in Sections 28 and 29?
§ Mr. MacColl
As neither of us remembers them, whether we would come to the same conclusion or not I do not know. One difference which occurs is significant. In 1946, there was no National Assistance Act and no National Assistance Board. There was an Assistance Board which was quite different from the National Assistance Board, otherwise there would have been no point in passing the 1948 Act. Therefore, to use precedents taken from the time before the Board was established to explain why we should now transfer functions to some other body seems an extraordinary piece of illogical thinking.
§ Mr. Iain MacLeod
Surely, when the National Assistance Act of 1948 was being debated in this House, it could well have been argued then that the National Assistance Board was the ideal method for all these things, and that the provisions of the Education Act could have been brought within it?
§ Mr. MacColl
There were many difficulties. The most important was to get the Act through and not to alter things which were already in operation. I am arguing that, on the precedent of the Legal Aid and Advice Bill, the right line to take is that where assessments have to be made, they should go to one body, and an ad hoc body should not be set up to do the work. Therefore, I hope that the Committee will reject the Amendment, because, in the short run, it will create administrative difficulties, and, in the long run, it will be disastrous for the future of the National Assistance Board and to the whole of the idea of helping people through the Assistance Board.
§ 5.0 p.m.
§ Dr. Hill (Luton)
I think that the Committee are indebted to my hon. Friends the Members for Wolverhampton, Southwest (Mr. Powell), and Enfield, West (Mr. Iain MacLeod), for raising this important question of general principle and general interest. I want to confine my remarks to two points. First, it has not yet been made plain that if this series of Amendments is passed, there will be two methods of assessing persons in need of help. Those who are already in receipt of National Assistance will be assessed under the National Assistance method, and, if this proposal is accepted, those who are in full employment will be differently assessed.
The second point to me is the commanding point. The majority of persons will go through the local executive council. There is one local executive council for the whole of the London County Council area. There is one local executive council for the whole of the county of Middlesex. The local executive councils were set up with a well-defined but fairly narrow series of functions. It fills me with dismay that, on purely practical grounds, there should be added to the functions of the local executive council, created with its existing function in mind, this additional task of assessment.
In the short time in which I have been in the House, and have so come into contact with constituents, I have learned of the immense consideration that is given by the local officials of the National Assistance Board. I know, too, that this is not merely the application of a scale. It is not merely a kind of mathematical affair which can be done in an office. Not only is it an intensely personal affair, but there is a technique of National Assistance, the technique of assessment, which is absolutely essential to the satisfactory performance of this function.
One of my hon. Friends referred to the Dental Estimates Board being centred in Eastbourne. If it had been able to do its job a little better, there might not have been any need for dental charges. I am told that it has 300,000 estimates arriving every morning, and I believe I am right in saying that the number of skilled staff to examine these estimates is in the region of 12—the number of 11 sticks in my mind. The idea that this should be done on anything like the same basis seems to 1219 me to be wrong. If it be true that we have to create some kind of assistance machinery besides the local executive councils to give effect to this proposal, it seems to me, however well informed its advocates may be and however logical their case, that it falls to the ground because it would mean not only a wasteful duplication of an existing service but, I suspect, a far less human and far less satisfactory method grafted on to a system not intended for the purpose.
§ Mr. Blenkinsop
I am grateful to hon. Members on both sides for the contributions they have made on this subject. It is quite true that it is right to have some general discussion on what is quite an important principle involved in this question. Hon. Members who have put down this series of Amendments are suggesting a fairly considerable change in our existing practice. These are not minor Amendments in any way. They would make a major alteration in our whole approach to this question of how we are to meet cases of hardship that might arise under this Bill. I am particularly grateful for the comments made, on both sides, on the practicability of this proposal, and I refer particularly to the hon. Member for Luton (Dr. Hill).
I was very glad to hear from both sides, the tributes paid to the work of the National Assistance Boards and to the way in which they carry out their duties. I think that the very worst thing we could do would be to try to circumscribe the work of the National Assistance Board into the old confines of what we, perhaps wrongly, came to regard as the public assistance attitude. I agree with what my hon. Friend the Member for Widnes (Mr. MacColl) has said. It is important that they should have a wider sense of their responsibilities. It is because I am quite sure that they have that wider sense that we regard them as a very suitable means to meet the cases of hardship which may arise. As has already been pointed out, these Amendments fall down mainly on the issue of practicability. The more one looks at this, the more impracticable the suggestions seem to be.
There can be no doubt that if there were to be a scheme of assessment of hardship carried out by the local executive councils, the regional hospital boards 1220 or their agents, we should have to create entirely new machinery. There is no doubt, for example, that we should have to open new offices—or use the offices of the National Assistance Board, which is the reductio ad absurdum of the proposals before us. It is true that the National Assistance Board has much closer contact with the general public than the local executive council or the regional hospital board can possibly have.
In many cases people wish to make a personal application. Taking London as an example, it would be quite impossible for people to make such applications if they had to go to the central office of the London Executive Council. The thing would be quite absurd and impossible. On the other hand, the National Assistance Board premises are comparatively easily accessible to everyone in the country.
§ Mr. Iain MacLeod
I simply cannot see why people should have to go in person. Let us consider for a moment the infinite variety of education grants that are made in any county. I was talking to a director of education on this point yesterday. One fairly simple form is filled up, and unless the L.E.A. has reason to suspect fraud or a full declaration has not been made, in which case the applicant is invited to get the form certified by the local inspector of taxes or whoever it may be, there is no need for personal applications to be made in 99 per cent. of the cases.
§ Mr. Blenkinsop
We have a great deal of experience here. The Parliamentary Secretary to the Ministry of National Insurance will intervene on any detailed point about the work of the National Assistance Board. He will bear out the fact that, while they encourage applications to be made by letter, it is nevertheless true that there might very well be quite a number of cases where immediate application and immediate assistance were essential. Many cases of that type now come before the National Assistance Board. Far from making matters easier, this Amendment would in many cases be making matters rather more difficult.
The National Assistance Board are already dealing with claims under the National Health Act for refunds of travelling allowances. The practice here would be that where the claimant was 1221 already in receipt of any assistance from the National Assistance Board, a grant would be made immediately without any further question. But if we set up new machinery under an executive council, there would be the position that someone who had already had his means examined would be subject to yet another inquiry. Of course, a very high proportion of the cases falling to be dealt with under these proposals would be such cases. There would be others, but those would be the great majority.
I was surprised when hon. Members, who have introduced the series of Amendments, suggested that employed persons are a new category for the Assistance Board to deal with. That is only partially true. It has been recently dealing with employed persons for travelling expenses and for legal aid What do hon. Members opposite deduce from that argument? They say that this job should be handed to people who have no experience in dealing with it. That seems to be quite extraordinary. They are arguing that the Assistance Board has only limited knowledge and experience about a particular category of people—those who are employed—and then they say that such cases should be handed to those who have no experience at all and would have to start from scratch.
I do not think that after any careful examination of this question there can be any doubt at all in hon. Members' minds that the only way which is administratively practicable and will avoid waste of expenditure is to use the staff and offices already available. For the reasons given by my hon. Friend the Member for Widnes, therefore, these proposals must fall to be rejected. I should like to make one matter clear. I appreciate that my hon. Friends and hon. Members opposite are anxious about some cases where people may not be aware of their rights. It is important that we should make sure that all those who receive attention from a dentist or an optician are fully aware of the way in which they can make their claim, and of how they can get relief in case of hardship. That is a matter that we must very carefully bear in mind as we proceed with this Measure.
I am sure I can give this assurance. We shall take every step we can to ensure that all who are attending a dentist or an optician shall have the fullest information 1222 on the way in which they can get assistance. We do not want in any way to deny the opportunity to persons of applying for immediate assistance, but we wish to assure hon. Members on both sides of the Committee that the proposals put forward are impracticable, wasteful and not in the best interest of those whom hon. Members wish to help.
§ Mr. Alport (Colchester)
We on this side of the Committee, and particularly those who have put their names to this Amendment, fully recognise that the Minister has found it necessary—indeed, it is inevitable—to exaggerate the practical difficulties which are involved in this scheme. It is obvious, as was pointed out by one of my hon. Friends, that if these powers were given to the bodies named in the Amendment, they would delegate them to appropriate bodies. Speaking for my own part of the world, I see no great inconvenience, from the point of view of location or anything else, in an application of this type, should repayment be made to group management committee funds rather than to National Assistance funds.
The second point is that the Parliamentary Secretary thinks that this will cost more money from an administrative point of view. I imagine—and I think it it is a reasonable assumption—that the National Assistance staff are fully extended in carrying out their present commitments, and they will not be able to take on these additional commitments without further staff. Therefore, it is not a question really of whether there is to be a small addition of staff to the National Assistance Board or whether there is to be a rather larger addition of staff to the bodies that we suggest. It is simply the question: To which of the two bodies that are at present under controversy, should some volume of staff be added.
I should like to take up another point, which was raised by the hon. Member for Widnes (Mr. MacColl). I could not agree with the main point of his argument, which was that it does not really matter so much about the present generation, who may still harbour prejudices against using the National Assistance Board machinery to help them in any difficulty in which they may be. Hon. Members on both sides of the Committee will agree that those prejudices exist, 1223 whether justified or not. I personally, like many of my hon. Friends have received great help and sympathy from the National Assistance Board officials. But that is not the point. The point is that there are a great many people, particularly of the older generation, who still have the feeling that it is against their sentiments and ideas of self-respect to apply for assistance to the Assistance Board.
§ Mr. MacColl
Does not the hon. Member see that if this Committee reaffirms those prejudices, which the older generation have got, they will by substituting this Amendment for what is in the Bill, make it all the more difficult to get rid of them. As it is, many of the younger generation have adopted a very sensible attitude in this matter.
§ Mr. Alport
I quite understand the hon. Member, but it is all very well for us to sit here in this detached atmosphere and say that we must overcome the prejudices of the older folk of 60, 65 and 70. The truth of the matter is that whatever we say in this Chamber will not alter those prejudices. They are part of the makeup of the older people, and it is very lamentable that it should be so.
I quite agree with what was said on this subject by the hon. Member for Bermondsey (Mr. Mellish) on Second Reading, when he referred to:the question of the many people who would, perhaps, qualify for help at a National Assistance office, but who, for one reason or another, would dislike very much going to such a place because—and here I do not want to raise a political point—there is still some legacy left of the Poor Law and the way in which it used to deal out assistance in the past."—[OFFICIAL REPORT, 24th April 1951; Vol. 487, c. 315.]I am not going to argue that. I am not making a political point, but trying to emphasise something which hon. Members opposite know to exist, just as well as we do. The reason I point to this is that it illustrates the different approach which hon. Members on the other side of the Committee and we on this side are making to this problem. Their approach is to use this particular method for raising money in order to meet certain financial exigencies. A large number of hon. Members opposite appear not to be really concerned to ensure that people who require assistance get that assistance.
§ Mr. Blenkinsop
The hon. Member for Colchester cannot be allowed to get away with that. I made it perfectly clear in my statement that we are most anxious to ensure that everyone who feels hardship should be dealt with. I have even suggested that the proposals to which the hon. Member has attached his name may inflict hardship on many of those who are already in receipt of National Assistance.
§ Mr. Alport
I am willing, and I am sure it is right, to respect the Minister's point of view on this matter, but I must make my point, which I hold very strongly. The hon. Member for Widnes (Mr. MacColl) has given a very clear indication of the attitude of hon. Gentlemen opposite. They are not concerned lest the method which they suggest in the Bill, should provide an obstacle to a number of people obtaining the assistance which they require, although they may deserve it as much as, if not more than, others. They are concerned merely with what they conceive to be administrative tidiness, and, at the same time, with ensuring that the financial impositions involved provide the money which is required.
That is not our attitude. We are not prepared, on these social matters, as we have said often in the House, to accept the rather rough justice which appears to be good enough for the Government. We are just as much concerned with the small number who have, very rightly and understandably, prejudices in this matter, although these may be out of date, and we are determined to see that no obstacle arises which will prevent them from obtaining that help. In moving the Amendment we are fulfilling much more closely the interests of the majority of the people who are likely to be personally concerned with the problems which we have under discussion, than we would if we supported the subsection set out in the Bill and embodying the point of view of the Government. We have tried to express our point of view and for that reason I support the Amendment.
§ Mr. George Wigg (Dudley)
When I saw the Amendment I was very interested 1225 in it, and I agree that hon. Gentlemen opposite have performed a useful service by bringing it before the Committee. I knew that it was not put down with the idea of making things easier for those who want dentures or spectacles. The hon. Member for Wolverhampton, Southwest (Mr. Powell), and the hon. Member for Enfield, West (Mr. Iain MacLeod), are two of the pillars, or so I understand, of the Conservative Central Office, and my researches into Conservative social philosophy over the last few days——
§ Mr. Iain MacLeod
On a point of accuracy. My hon. Friend the Member for Wolverhampton, South-West (Mr. Powell), resigned from any position he may have had with the Conservative Party at least three years ago, if I remember aright, and I did so before the Election took place.
§ Mr. Wigg
I am obliged to the hon. Gentleman for that confirmation. My own researches have been up-to-date enough for me to have noted the facts he has given us but, of course, they do not contradict my assertion that both hon. Gentlemen came from the Conservative Central Office, and their influence is evident in the political implications of the Amendment. During the the last few days I have studied the speeches and the broadcasts of the hon. Gentlemen. I want to try to see what they are getting at. They know, of course, that the Bill does not commend itself too strongly to hon. Gentlemen on this side of the House. When the day comes for us to get rid of it, there will be a feeling of joy. We do not want this Bill, which is introduced to deal with a very special set of circumstances.
Hon. Gentlemen know very well that feeling is very strong here, and that throughout the country there is, they suspect, a strong feeling against the National Assistance Board although, under the administration of Mr. George Buchanan, the National Assistance Board is an humane institution; it is run intelligently and does its best, as it ought to do, to serve the community. Hon. Gentlemen opposite know very well, and so does the hon. Member for Colchester (Mr. Alport) when he talks about what the public think about the National Assistance Board, that what the public remember about the National Assistance Board today is the way in 1226 which it was handled by the party opposite.
I find it very significant indeed that hon. Gentlemen want to take the administration of the charge for dentures and spectacles away from the National Assistance Board. They want to exploit the memories of the past. They know it is impracticable. They know that it will not work. The hon. Member for Luton (Dr. Hill) has given the game away. What hon. Gentlemen opposite are really after is to try to create the maximum amount of mischief that they can. One ought to examine closely the social philosophy which is behind the Conservative Central Office statement. I have studied the philosophy of the hon. Member for Enfield, West, with very great care. I remember particularly when we were discussing the incidents surrounding the hon. Member for Seven-oaks (Mr. John Rodgers) that he made a point of his connection with the Church. That very excellent recommendation is supplemented by other social activities. He is also a contributor to the Sunday papers. He writes bridge articles. Perhaps it is true that, so far as Conservative Central Office philosophy is concerned, it is a matter of having a pack of cards in one hand and a Prayer Book in the other. Any working-class person who joined the Conservative Party under the influence of this philosophy would be really well advised to stick to pontoon and not play bridge because there would be fewer cards to watch.
This point reminds me of a story by the late Edgar Wallace. On one occasion Chief-Commissioner Sanders heard that the lands up the river had all been accumulated by one Chief M'Gombie. It was causing a great deal of trouble. Chief-Commissioner Sanders learned that a missionary had gone up the river and had taught the local chief how to play cards. M'Gombie, being a friend of the chiefs, played cards so well with them that he won all their lands. Chief-Commissioner Sanders said: "I know something about cards," and he learnt a few tricks that the missionary did not know. He went up the river and played against M'Gombie and won all the lands back. As the last card was turned and M'Gombie realised that he had lost all the lands he had won, he turned and said: "Thou art indeed a great 1227 Christian." That sums up what is behind the Amendment on the Order Paper. The Amendment put down by hon. Members opposite has got nothing to do with the Bill. Their Amendment is calculated to create the maximum amount of mischief, and I hope that the Committee will reject it.
§ Mr. Mikardo (Reading, South)
My hon. Friend the Member for Dudley (Mr. Wigg) has cast aspersions on the motives of hon. Members who put down the Amendment. For myself, with that ineffable charity which, as everybody knows, is my major characteristic, I will give hon. Gentlemen opposite the benefit of the doubt and try to look at the Amendment on its merits, if it has any.
It seems to me that the replies which have been made by the Parliamentary Secretary and by a number of hon. Gentlemen with great experience of the administration of the hospital services, like my hon. Friend the Member for Tottenham (Mr. Messer), my hon. Friend the Member for Widnes (Mr. MacColl) and the hon. Member for Luton (Dr. Hill), have disposed of the argument that we ought to use the hospital authorities instead of the National Assistance Board as a method of assessing what sort of charges ought to be paid.
In so far as the motive of this Amendment is, as hon. Members opposite put it, to take the National Assistance Board out of the Bill, I am in agreement. I think I would carry all hon. Members with me in saying that that is no reflection upon the way in which the National Assistance Board goes about its regular job. Indeed. I have been pleased to hear from both sides of the Committee the tributes paid to the way in which the Board is doing its job. I was particularly glad to hear the glowing tribute to its work paid by the hon. Member for Luton, although, while I was listening to him, I felt myself wishing that he would talk half as much sense when he is broadcasting with me on the radio.
We all accept that the National Assistance Board does its job in a great way, and I accept the view expressed by my hon. Friend the Member for Widnes, that there could be no objection to their having the job given them under this Bill 1228 merely on the ground that people might be put off by the Poor Law atmosphere. In view of some of the remarks of my hon. Friend, I think I ought, on behalf of all the hon. Members of the Committee who were here before February, 1950, to apologise to him and to all other new Members for the mistakes that we all apparently made in the last Parliament, and to say that we shall sit with watchful humility at their feet to make sure that we shall learn to do better in the future.
The objection to the National Assistance Board being in the Bill is one which I think the Board itself would share, namely, that the Bill may impose upon them a burden which might well make difficult the continuance of the high standard of work they are already doing in their own real field. As has been pointed out, the Amendment proposes that we should jump out of the frying pan into the fire; that we should take the administration of this part of the Bill away from the National Assistance Board because it is not a suitable body for the purpose, and that we should give it to some other body still less suitable for the purpose.
Those who put down the Amendment found themselves in a difficulty in which we all are. It is imposed not by the mode of their thought but by the nature of the Bill itself. Clearly, however we do it, whether by the method of the Bill or, as I think, by the worse method of the Amendment, it will be very difficult to protect those who really cannot afford to pay these charges from the effects of having to pay them, and the only inference which I draw from that is that the only sensible thing to do is not to levy the charges at all. What this debate has shown most clearly, if it ever needed showing, is that the Bill generally and this Clause in particular are bad and ought never to have been introduced.
§ Lieut.-Colonel Elliot (Glasgow, Kelvingrove)
We are indebted to the hon. Member for Reading, South (Mr. Mikardo) for facing up to the difficulty the whole Committee is in this afternoon. The Committee undoubtedly feels that it is dealing with a task to which it has not fully found the correct answer. The hon. Member for Reading, South, says, of course, that the simplest thing is to say that this is a bad Bill and to withdraw it. The responsibility for that lies with his own Government, and he must 1229 address those remarks to the Government and not to us.
This is a very real difficulty which has gone on for a considerable time. We were all interested in the somewhat jocular remarks of the hon. Member for Dudley (Mr. Wigg) in his references to card games in West Africa, though they seemed to have very little to do with the Amendment. His researches seem to have been singularly unfruitful, because when he took it upon himself to lecture the House on the evil, purely mischief-making motives which lay behind the Amendment, he was addressing his remarks to the wrong address. He ought to have addressed them to his hon. Friends the Members for Bridgeton (Mr. Carmichael), South Ayrshire (Mr. Emrys Hughes), and other hon. Members who supported an Amendment of precisely this type when, upon another occasion, it was proposed to put assistance under the aegis of the Assistance Board. If he likes to lecture his very senior and sincere hon. Friends in that way, I trust he will do so outside the House, and I hope I may be there to watch the succeeding scrap, for I am sure it will not be long delayed.
This is not the first time that this matter has come up, and the danger of finding that the Assistance Board is in some way the Czar of all the social services is by no means negligible. It may well be that this machinery is not the best machinery to bring about the object we desire, but that my hon. Friends have done a great service to the Committee by initiating this discussion, would, I am sure, be denied by none. The debate has, on the whole, been conducted in a non-party spirit because it is a non-party problem. I only say that, unless the Committee is willing from time to time to discuss these administrative problems in a non-party atmosphere, we shall have greater and greater difficulties as we go on, remoulding, as we are, the social services.
It has been said that the Assistance Board is the best machine for this job. It may well be that on this occasion and at this time the Assistance Board is the best machine to do it. No one is more pleased to hear that than myself. I remember very well the torrents of denunciation from which I had to suffer when initiating the task of the Assistance Board in British politics. I have a 1230 number of quotations here, with which I shall not weary the Committee, from acknowledged experts on the matter—I mean the matter of invective—such as the right hon. Member for Colne Valley (Mr. Glenvil Hall) and the hon. Member for Merthyr Tydvil (Mr. S. O. Davies). He who said things about the Assistance Board and the probable fate of people who were put under it, which I should not like to quote in the comparatively friendly atmosphere which we have reached here today.
I would not even like to quote the remarks of the right hon. Member for Ebbw Vale (Mr. Bevan), but I assure the Committee that they will repay study. If hon. Gentlemen opposite say, "Ah, that was in the bad old days," I recommend them to read the remarks of George Buchanan, who, in that debate, said that he preferred the Assistance Board, and gave testimony, which was not so frequent at that time, to the humanity and decency with which Assistance Board officials approached their task. I think it is very suitable that he should now be the head of that body which at that time, under much less favourable circumstances, he so stoutly defended.
§ Lieut.-Colonel Elliot
If the hon. Gentleman reads the debate and what was said about the officials at that time, I assure him his face will turn very red indeed, and that a great many of his views will alter. The case put up against the Assistance Board then—as it was in Committee upstairs—commanded the support of many hon. Gentlemen opposite, some of whose names I have quoted, and I therefore do not think it fair for hon. Gentlemen opposite to say that this is a mere party device intended to produce the maximum of mischief. It is the study of a serious social problem to which we have not yet found a satisfactory answer.
As I say, my hon. Friends have raised a debate of great interest. I am sure the Committee will agree that they have initiated it in speeches of singular knowledge and of wide human sympathy. But it may well be that the Committee is not prepared to give assent to this remedy which they have brought forward. I am sure that we have not yet 1231 got the appropriate remedy for this difficulty and that Parliament will need to continue to address itself to this problem. However, on this occasion and at this time, the discussion has probably gone as far as it usefully can, and the maximum use has been obtained from the debate. I would suggest that, having achieved at least two-thirds of their object, my hon. Friends might be willing to withdraw the Amendment.
§ Mr. Powell
I am much indebted to my right hon. and gallant Friend for the judicious summing up of the debate which he has given the Committee. I felt that while the Parliamentary Secretary was not entirely fair, either to the Amendments or to their administrative implications, he made an important point which carried the Committee a good deal further. The hon. Gentleman forecast a method whereby patients would automatically have brought to their notice their possible rights under the Bill to a refund.
That, at any rate, shows that the difficulty in the minds of so many hon. Members on both sides of the Committee, which motivated the putting down of this Amendment, has now been appreciated by the Government. It is an idea which could be elaborated further. It seems to me that it would be possible to go beyond the stage of mere notification and to give, on the same occasion, an opportunity for some form of application. That is a matter to which I should like myself to give thought before the next stage of the Bill, and I hope that the Government might do the same. In the meantime, and in view of that hopeful lead which I think the Committee has been given, I beg to ask leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ Mr. Keeling (Twickenham)
I beg to move, in page 1, line 13, at the end, to insert:Provided that charges amounting to the full cost of such dental or optical appliances may be made and recovered in respect of the supply thereof at the request of persons who do not fulfil such conditions as may be prescribed under section one of the National Insurance Act, 1946, as to residence in Great Britain.Sir Charles, I think it would be for your convenience and the convenience of 1232 the Committee if we discussed this Amendment with the third Amendment on page 850 of the Order Paper, namely, in page 1, line 15, after "a," insert:person who fulfils the said conditions and is a.The purpose of these Amendments is that visitors, whether of British or foreign nationality, should pay in full both for spectacles and for false teeth. The purpose of the second Amendment is that they shall do this even when they are in hospital. Most of the other Amendments on the Order Paper reduce the yield to the Exchequer or increase expenditure. My Amendments, without any extra expenditure, will increase the yield and would, therefore, enable the Minister of Health to spend more money on hospital or other services. Therefore, I hope that he at least will support these Amendments. Three questions arise on them. First, is it desirable to make visitors pay in full? Second, how does one define a visitor? Third, how does a dentist or an optician distinguish a visitor from a resident?
The first question is: Is it desirable that visitors should pay in full? The 1946 Act, which introduced the National Health Service, spoke of a health service for the people of England and Wales. The similar Act which introduced the health service north of the Border, spoke of a health service for the people of Scotland. Nothing at all was said about providing a free health service for visitors from other nations. We are delighted to see visitors from abroad, but it is difficult to understand why they should get either free or half-price false teeth and spectacles any more than free or half-price beds or food or railway tickets. We welcome visitors, but is there any reason why the British taxpayer should pay their bills?
I think it is quite possible that the stories one hears of Lascars in ships coming to this country, getting dentures free and then selling them in the bazaars of Port Said are as false as the teeth, and I do not rely on those stories. But there are two incidents which have come to my notice. The first is of an American citizen who was crossing to this country in the "Queen Elizabeth." As he was travelling in that ship, he was presumably fairly well 1233 off. The suggestion was made to him that while in this country he should get a new set of false teeth. His reply was, "Hell, I thought you wanted dollars!"
The second incident was that of an unmarried lady in a European country who found that she was going to have a baby. She came to this country and she got a free denture, she got free spectacles and, when the time came, she got a free baby. She did not take the baby back home. She left the baby in this country and she returned home with the other assets—all provided by the British taxpayer—but without a stain on her character.
We have often been told in discussions on this matter that the cost of providing teeth and spectacles for visitors is negligible. That simply is not so. Two years ago the Parliamentary Secretary, who, I am sorry to see, has left the Chamber, made what he described as a rough but generous estimate that the total cost of providing all the health services to visitors was £200,000. At that time there were about 600,000 visitors to this country in a year. This year, because of the Festival of Britain, there will certainly be many more visitors, and the cost to the taxpayer of treating them will be greater. Part of that money, without a shadow of doubt, goes in teeth and spectacles, and I am quite sure that the amount to be saved, if my Amendments are accepted, is not to be despised.
In the last Parliament the Government, after a good deal of pressure from these benches, itself recognised the justice of charging visitors, at least in certain cases. Accordingly, they introduced an Amendment which became law as Section 17 of the 1949 Act. By this they took power to introduce regulations for that purpose. That was 18 months ago, but no regulations have been issued. I wonder why. There are several possible explanations. One is that the then Minister of Health, now a back bencher, never had any intention of making these regulations when he introduced that Clause into the Bill, just as he never had any intention of making a charge for prescriptions. That is the most likely explanation of the failure to make regulations.
Another possible explanation is that the Government had the hope—I think the foolish hope—that to defer making a charge on visitors would stimulate a reciprocal arrangement. The former 1234 Minister himself said, on 19th October, 1949:If we set an example …"—that is, in providing a free health service for visitors—there is every prospect that other nations will follow."—[OFFICIAL REPORT, 19th October, 1949; Vol. 468, c. 637–8.]That was more than 18 months ago, and we now know that there has been very little response. The present Minister, in a written reply to me on Monday, stated that there was no reciprocal arrangement at all for the supply of false teeth and spectacles. The supply of free teeth and spectacles is entirely a one-way traffic.
The third possible reason for not using these powers is that the Government said they hoped to check abuses by questioning visitors, on arrival at the English ports, whether they were coming over in order to take advantage of the Health Services. Of course, that is too ridiculous. It puts an impossible burden on the immigration officer. Anybody who has arrived at Dover by Channel steamer must know that no such investigation is feasible. Incidentally, such an inquisition is a very poor welcome for anyone to these shores. And even if visitors come to see their friends, or our beautiful country or the Festival of Britain, that is no ground for asking the British taxpayer to pay for their teeth and spectacles.
I submit that none of these possible explanations of the Government's failure to use their powers under the 1949 Act is an obstacle to the acceptance of my Amendment. The former Minister of Health has gone; the attempt to get reciprocity has failed; and the efforts of immigration officers to stop people coming into the country for that purpose have been as irrelevant as they were futile. I submit that the case for charging visitors has been made out, always provided that it is practicable.
That brings me to my second question: How do we define a visitor? My Amendment defines a visitor as a person who does not fulfil the conditions of residence prescribed under the National Insurance Act. I want to make it clear that I do not seek to make visitors pay for spectacles and teeth because they do not pay the National Insurance contribution—that has nothing whatever to do with it. The sole purpose of mentioning the National Insurance regulations is that they supply 1235 a ready-made definition of a visitor. Generally speaking, these regulations define a visitor as a person who is in this country for less than six months unless he becomes employed or a student, when he ceases to be a visitor and probably becomes a taxpayer, at any rate if he is employed.
My hon. Friends and I are not wedded to this precise definition. If the Minister of Health has a better one, we will accept it. I point out, however, that among all the arguments advanced for not using the powers given to the Government in the 1949 Act, the difficulty of defining a visitor was not one.
§ Mr. Leslie Hale (Oldham, West)
What happens when a person goes to a dentist? Does he have to produce his passport or his birth certificate?
§ Mr. Keeling
That is my third point, to which I was just coming. The third question which I pose is: How does a dentist or an optician recognise a visitor when he sees one? How does he distinguish between a visitor and a resident? We have often been told by the Government that masses of red tape would be involved. Whatever truth there may be in that as regards the Health Service as a whole, although I doubt whether it has any truth, it certainly is not true of the supply of teeth and spectacles. A visitor, on arrival, gets no identity card whatever until he has been here for 56 days. If he wants a ration book, he gets it by the use of his passport. After 56 days, he gets a yellow identity card and then is given a blue National Health Service leaflet which tells him that he will get the benefit of the whole National Health Service free. I quote two paragraphs from this leaflet. The first says:You can go to any dentist taking part in the new arrangements. You need no application form. Just call by appointment on the dentist of your choice. All necessary fillings and dentures will be supplied without fee.As regards glasses, the leaflet says:If you need glasses, these will be provided without charge.
§ Mr. Paton (Norwich, North)
Without expressing any opinion as to the merits or demerits of the leaflet which the hon. Member has been reading, I wonder whether he could tell the Committee—it is important—how many people have succeeded 1236 in getting themselves placed on overburdened dentists' lists or have been accepted by opticians to obtain spectacles? Has he any hard evidence of the demand?
§ Mr. Keeling
That information has been asked for several times from the Government, but the Government have no information and, naturally, I have not got it. How could I have it?
§ Mr. Keeling
As I have explained, a visitor who has been here fewer than 56 days does not want any identity card at all. After 56 days, he gets a yellow identity card and the blue leaflet to which I have referred, which tells him all about the free services. It is only when permission is given to him to live here permanently that he gets the ordinary blue identity card which we all have or ought to have.
There are two Statutory Instruments—Nos. 505 and 1273 of 1948—which require that the National Registration number shall be stated in any application for teeth and spectacles. It is true that one is not required in terms to produce one's identity card, but the card usually is produced, because the patient does not carry that sort of information in his head—I certainly do not carry my identity number in my head. It would not cause any great hardship to require that one should produce the identity card. When the card is produced, the dentist or optician can tell a visitor at a glance, for either he has no identity card because he has been here fewer than 56 days, or he has a yellow identity card because he has not been accepted for permanent residence here.
I may be reminded that we on this side have sometimes advocated that identity cards should be abolished as soon as possible—I certainly hope so myself; but it is certain that while rationing persists, identity cards must be continued. If, as we hope, they are abolished, I am quite sure that some other way of distinguishing a visitor from a resident will be found.
I conclude by quoting an invitation issued by the Minister of Health last week, when he said in the House:If hon. Members can discover any way of finding out whether a person who requires treatment is a foreigner without imposing vexatious and unnecessary questions on British 1237 nationals and imposing extra clerical work on doctors, I shall be pleased to hear of it."—[OFFICIAL REPORT, 26th April, 1951; Vol. 487, c. 570.]I have suggested a method, and I hope the Minister will accept these Amendments. But I present him with an alternative. I shall be quite satisfied, and I think my hon. Friends will be satisfied, if he undertakes instead to introduce regulations under the 1949 Act requiring visitors to this country to pay in full for false teeth and spectacles.
§ 6.0 p.m.
§ Mr. Boyd-Carpenter (Kingston-upon-Thames)
I do hope that we shall have from the Minister a considered reply to the case which has so clearly been deployed by my hon. Friend the Member for Twickenham (Mr. Keeling). As the Minister knows, for two years he has had power to do this, not only in respect of teeth and spectacles, but over the whole sphere of the National Health Service. Therefore, one must assume that an investigation has taken place in the Department about the precise administrative difficulties which its acceptance would involve. I hope we shall have a clear statement of the Government's decision on this matter.
Although the Government have had the power to do this for two years, the desirability of their doing it has been substantially increased by the events of the last few months. We have now a ceiling—to use the horrible jargon of Whitehall—upon expenditure under the National Health Service and it therefore follows that if the right hon. Gentleman can make a financial saving, however small, in the conferring of benefits upon visitors, he will have that amount more to spend on residents in this country.
There is the further consideration that when the financial position of the country, in the view of the Government, demands that British residents should have to pay—with certain exceptions—half the cost of these particular appliances, surely that imposes on the right hon. Gentleman a further duty to investigate at least the possibility of securing that non-residents should pay the full charge. Therefore, I hope we shall have a considered statement of the Government's case. If we have this considered statement, I hope we may have the figures. If the right hon. Gentleman has carried out an investigation, I 1238 assume he has some idea, in broad terms at least, of the amounts involved. If he has, I hope he will give them to the Committee, as that would undoubtedly be of assistance to hon. Members in making up their minds on this proposal.
Finally, there is the aspect of the matter of making reciprocal arrangements. As my hon. Friend said, we have had no success and we all regret that in making these arrangements with foreign countries, with the result that British residents who go abroad and have the misfortune to fall sick or have an accident are placed in a position of some difficulty. If the right hon. Gentleman were armed, as he would be by this Amendment, with full power to impose at his discretion these full charges upon foreigners, that would give a much bigger incentive to foreign Governments to come to a reciprocal arrangement under which British residents abroad might have the advantage of the free services. At the moment foreigners have all that is available without giving anything in return. If the right hon. Gentleman has the power to impose charges on their nationals, he will be armed with a bargaining weapon to use with other countries.
I hope that he is exploring this aspect of the matter, because it is within the experience of hon. Members that when constituents have the misfortune of being ill or of having an accident abroad, the consequences are very serious, the more so in these days of currency restrictions, which make it more difficult for those who otherwise would be in a position to pay medical charges in a foreign country.
I do not think this Amendment raises any of the controversial and partisan issues which may be raised by other Amendments, and for that reason I think it is entitled to serious consideration by the right hon. Gentleman. I do not pretend, and my hon. Friends do not pretend, that the amounts involved can be very large, but, be they large or small, if these amounts can be saved it is the duty of the right hon. Gentleman to use his skilled administrative staff to attempt to save them, and I hope we shall hear that he is prepared to accept the Amendment.
§ Mr. Leslie Hale
The hon. Member who moved the Amendment quoted two stories in support of the arguments he 1239 was making to the Committee. He quoted the oft-told story of the Lascar who comes to Cardiff, has his teeth extracted and gets a set of false teeth and then sells them for what price a set of false teeth which do not fit anyone, could fetch in the bazaars of Port Said or Calcutta, where prices are supposed to be rather lower than anywhere else. Then he goes without food on the long and rather arduous journey to Cardiff in the hope of getting another set of false teeth and goes back to Calcutta, again selling them for whatever they may make. Having troubled the House with that broad proposition, it is fair to say that the hon. Member intimated that he was not suggesting seriously that he believed it.
§ Mr. Keeling
I opened with that story, which I said I did not believe, in order to show that I was not going to exaggerate.
§ Mr. Hale
I am very much obliged. Now we know that it was an example of the fact that he was not going to exaggerate. Then there was the story of the mythical American on the "Queen Elizabeth," who either took a passage on the "Queen Elizabeth"—where the menus are about a mile long and most people set out to enjoy themselves—and came without any teeth at all, or was advised to have his teeth extracted in this country so that he could go back to America and say he had a set of false teeth, which he wanted, free. There seems to be no other explanation. It is a little surprising that these people who go on the "Queen Elizabeth" have not had the necessary dental attention in their own country.
§ Mr. Hale
One of the more facetious hon. Members opposite suggests that he probably dropped them overboard. If it happened to be the Lascar in the story 1240 who dropped them overboard, there might be every reason for saying that he got the necessary provision to enable him to continue his work in decency.
This country has a reputation for hospitality. This country is trying to take the lead in world affairs and many of us are taking active steps in approaching a united Europe and in more detail trying to fulfil the principles which the right hon. Member for Woodford (Mr. Churchill) put in his Copenhagen speech. I should not have thought that it was a great contribution to the international spirit or the brotherhood of man—[Laughter.]
§ Mr. Hale
I do not regard it as a joke that we should be discussing a proposition that, in order to save an unknown sum, which must be infinitely small, we should send out 40,000 or 50,000 circulars giving directions to dentists on how to behave in their surgeries and to opticians on how to behave in their premises in relation to the testing of the nationality of the patients who come to them.
I do not know how colonial students would be affected by this and whether they would be excluded or not. I think it would be rather a tragedy if they were, because I should have thought that we wanted to help them and to make their stay comfortable. Presumably, it might be necessary, when reciprocal arrangements are made, as we all hope they may be, to exclude certain nationalities because their countries do not provide reciprocal arrangements.
The hon. Member for Twickenham (Mr. Keeling) spoke about abolishing identity cards, which he said we all wanted to do. I do not know what my views are on that; identity cards seem to me to be a slightly archaic survival of a former time. But this Amendment might mean the introduction of a new system. That seems to me to be a further ground why the Amendment should not be accepted, and I hope that the Minister will not accept it.
§ Mr. Michael Astor (Surrey, East)
I rise to support this Amendment and say that my hon. Friend the Member for Kingston-upon-Thames (Mr. Boyd-Carpenter) stressed a very valid point in speaking about the lack of reciprocity in connection with this scheme. The hon. 1241 Member for Oldham, West (Mr. L. Hale) voices the opinion of hon. Members opposite, which is that merely because foreigners may not understand the benefits which are supposed to exist in a Socialist State, they should be treated as if they deserved these benefits and there is no reason why we should not go ahead with Socialist planning and set them an example. Socialist planning, unfortunately, has nearly been the ruination of this country. I can find no reason in his argument for suggesting that lack of reciprocity is not a very serious consideration. The aspect of the abuse of these services is relatively unimportant. What is important at this stage is to refrain from making any jokes about false teeth, which are a very serious matter for those who have to wear them. I would suggest that there is an abuse here in the same way as we know there are certain abuses throughout the National Health Service.
My point is that by accepting the Amendment, absolutely no harm is done, and certain benefits will accrue to the Exchequer. Foreigners who come to this country do not expect these benefits in the first place; they are always surprised when they find that they are offered to them. It is a real bone of contention with the British public. I know that only a small amount of money is involved, but it violates the principle which, although hon. Members opposite may not admit it, we still hold to in the National Health Service, that one does not get anything of this character unless one pays for it oneself. Whether we pay nothing or half the cost of these appliances, we know that all of us who benefit from the National Health Service are paying for it ourselves. The matter with which this Amendment is concerned violates that important principle.
§ Mr. Bing (Hornchurch)
When the hon. Gentleman speaks of foreigners, does he include, for the purposes of his speech, members of the British Commonwealth of Nations.
§ Mr. Astor
If the hon. and learned Gentleman chooses to follow my remarks, 1242 he will see the principle to which I am referring and what I am attacking.
I think that the fallacy behind the Government's view is that of pure doctrine—everybody must be treated as if they deserved the benefits of Socialist planning. I would point out to the Government that that is more often malicious than helpful. For my part, I hope that the Government will have the wisdom to accept the Amendment.
§ Mr. Joynson-Hicks (Chichester)
I wish to refer again to what was said by the hon. Member for Oldham, West (Mr. L. Hale), particularly in regard to the currency of these stories. There are two points about that aspect of the matter. The first is that, accepting, as I think one must, that rightly or wrongly, there are stories current in the country concerning people from overseas who get false teeth and spectacles, it is a matter which causes a good deal of perturbation and irritation to the people of this country. Therefore, if those stories are not true, and if those people are not getting free dentures and spectacles, let us make it perfectly clear that they are not able to get them free of charge, and so, once and for all, put a stop to the currency of these stories.
The second point is that whether the stories are false or true, they are at all events going about, and they create the atmosphere among the people of this country that if foreigners or people coming from overseas are able to abuse the Health Service of this country, why should they not do so, too; that it is the Health Service of the people of this country, and if people who have contributed nothing towards it may abuse it by getting dentures and spectacles which they may not require, why should not the people of this country, who are paying for the service, at least get the maximum out of it that they can, whether by legitimate or illegitimate means. That is the other reason why these stories, whether false or true, are serious, and should be taken seriously. I ask that that point of view should be taken into account. I regard this matter as one of principle. I do not think it is a matter dealing solely with the detail of dentures and spectacles: they are the objects upon which the principle fixes.
1243 I wish to join issue with the hon. Member for Oldham, West, on the question of hospitality. The question of supplying people who come to this country with free dentures and free spectacles is not a test of hospitality.
§ Mr. Leslie Hale
I hope that the hon. Member is not suggesting to the Committee that someone who comes over from Paris or elsewhere gets dentures. Only people who can show that they are resident in this country and have nowhere else to go are likely to ask for them and they are likely to be people who want them and cannot afford them.
§ Mr. Joynson-Hicks
That is a fallacy. There are people who come to this country who have had false teeth and hear that they can get a spare set free of charge. They put their own in their pocket and go and apply for a new set.
§ Mr. Joynson-Hicks
No, because such people are not among my friends. But that is perfectly possible, and it is the answer to the hon. Member for Oldham, West.
I repeat that I regard this matter as one of principle. I have no hesitation in saying that I, and I believe a great many people in this country, do not want the taxes that we pay out of our hard-earned incomes to be used in providing people who come to this country, and who contribute nothing towards the Health Service, with dentures and spectacles free of charge. We have better uses than that for our money, and we expect the Government to make better use of what we pay in taxes.
We are prepared to pay our taxes for the re-armament of this country and for essential purposes, including the social services for the people of our country. But I do not consider—I speak for myself and for those, I believe a great many, who think like me—that it is part of our civic duty for us to have to spend out of the taxes, which we pay at a higher rate than is probably the case in any other country in the world, money to provide benefits for other people who do not confer similar benefits on our people when people from these Islands are in their country. I say that that is 1244 a matter of serious principle which should be taken into consideration.
If there are only a few foreigners or people from overseas who are making use of this facility, why not clarify the situation and make it clear that they are not entitled to this benefit? It will not create any adverse feeling among people coming from overseas, whereas it will create a good feeling in our country. If, on the other hand, it is argued that there are many people concerned, and this Amendment will mean that a great need of people who come from overseas will not be met, there is a correspondingly severe hardship on the taxpayers of this country. In addition, it would be an advantage, as my hon. Friend the Member for King-ston-upon-Thames (Mr. Boyd-Carpenter) pointed out, to the Government of this country in negotiations in which they are trying to obtain reciprocal arrangements.
From all points of view, particularly from the practical point of view, the Amendment proposes a method whereby there is no difficulty for the dentist or the optician to assure himself whether the service he is being asked to provide should be supplied free of charge, or subject to payment. The proposal is fair, it is one of principle and one which I submit should be supported.
§ Mr. Joynson-Hicks
If the right hon. Gentleman had heard the whole of the speeches, he would have heard how that is to be done. It was made clear by my hon. Friend who moved the Amendment.
§ Mr. Joynson-Hicks
As my hon. Friend pointed out, under a regulation very likely introduced by the right hon. Member for Ebbw Vale—about that I am not sure—it is an obligation for the identity card number to be supplied. I believe that the Amendment proposed is practical and essential and in conformity with a principle which this Committee should adopt.
§ The Minister of Health (Mr. Marquand)
I hope I shall not be accused of not living up to the spirit of the occasion if I do not tell any amusing stories. I am afraid I have not brought any along with me.
1245 I think that the hon. Member for Twickenham (Mr. Keeling) and his hon. Friends realise—indeed they almost said so—that the Amendment which they have moved is not necessary to achieve the object they have in mind. Under Section 37 of the National Health Service (Amendment) Act, 1949, my right hon. Friend the Secretary of State for Scotland and myself have the power to make regulations to provide for the recovery of charges in respect of prescribed health services from prescribed persons not ordinarily resident in Great Britain. We can use those powers, if necessary, to recover the cost of dentures and spectacles from non-residents. It is true that the powers thus conferred upon the Minister have not been used——
§ Mr. Keeling
May I make a correction? I think the right hon. Gentleman should have said Section 17 and not Section 37.
§ Mr. Marquand
I stand corrected. I have not a copy of the Act before me, but the note I have says Section 17——
§ Mr. Marquand
Oh, did I? That was due to the fact that I had not then put on my spectacles. As I was saying, the powers have not been used. That was not because they were taken in some frivolous spirit, but because, as I have said in answer to Questions in the House, there are grave administrative difficulties in the way. It is not easy to ascertain who is a non-resident without asking everybody else, British subjects included, to prove their position. There have been explorations. It would not be true to say that since the powers were taken no exploration has been made within my Department as to the possibility of exercising those powers in suitable cases.
The other day I did say I would consider any practical proposal which might be put forward. I recognise that the hon. Member for Twickenham has realised that there are practical difficulties and has tried to produce a practical scheme. Fortunately, or unfortunately, the scheme he suggests is not one which is practical for this purpose. It is true that identity numbers are asked for when people go to the optician or to the dentist for treatment or for the supply of appliances; but 1246 there is no power whatsoever to enforce the disclosure of that number. The number is asked for because it is a convenient way of checking up whether somebody may in fact be charging twice over for a service to the same person. Or perhaps two opticians—I do not say they do it necessarily—may be charging for an identical operation.
The identity card number is a convenience to the Dental Estimates Board and the executive council when making their payments, but they have no power to require that that particular number be disclosed. The vast majority of our citizens willingly disclose it, but under the National Registration Act an identity card need only be produced to a police officer in uniform or a national registration officer at his office. There is no power to compel its production to a dentist or an optician.
§ Major Tufton Beamish (Lewes)
Does the right hon. Gentleman know officially of any case where a person asking for dental treatment has refused to give his identity card number?
§ Mr. Marquand
Yes, I do. I think that perhaps in many ways the less said about this matter the better for the operation of the service. If we give great advertisement to the possibility of people refusing to produce their identity card number, it will not be very helpful to the service generally. But I can certainly say that there are instances where that refusal has taken place, and where, in consequence, the bill have been paid without ascertaining the identity card number of the person concerned.
If we try to enforce this scheme, we should require additional legislation to impose an obligation on all persons to produce their identity cards as a prior condition to securing treatment under the National Health Service. That would be imposing a condition on our own residents which at present they do not have to fulfil. I think the House would want to consider for a long time whether it would be proper to accept the powers requiring the production of a national registration identity card——
§ Captain Ryder (Merton and Morden)
Is the Minister aware that one is now under an obligation to produce one's identity card in order to obtain a ration book?
§ Mr. Marquand
But that is production for a national registration officer. It still remains true that hon. Members must think long and hard whether they wish to extend this requirement. There has been a good deal of complaint and grumbling about identity cards in general, and hon. Members must consider whether they wish to extend to dentists and opticians the power to require the production of national identity cards. I think the less said about this at the moment, the better it would be. It is a convenience to ask citizens for this information, and it is a good thing that the vast majority of them willingly provide it.
§ Mr. Donnelly
Before my right hon. Friend leaves that point, may I ask whether the gravamen of his argument is that he is accepting the point made by hon. Members opposite in principle, but is saying that it is practically impossible to carry it into effect?
§ Mr. Marquand
What I am saying is what I have said already; that there is power already under the Statute to recover charges and that this particular Amendment is therefore unnecessary. I am adding the further fact that it is, in any case, unworkable, unless further legislation were introduced——
§ Mr. Marquand
After what I have said about the national registration identity cards, I should have thought it was undesirable.
§ Mr. Keeling
May I ask the Minister two questions? First of all, why were these powers taken by the present Government, or by their predecessors in the last Parliament, under the 1949 Act without proper investigation as to whether they could be put in force without further legislation? My second question is: Is the Minister satisfied that the power to require the production of an identity card to an optician or a dentist could not be given by Statutory Instrument?
§ 6.30 p.m.
§ Mr. Marquand
I doubt very much whether, when these powers were taken, there was any thought in the mind of my right hon. Friend about charging people for services such as the supply of dentures and spectacles. It is far more likely that what was in mind is what we 1248 have since attempted to check by the use of aliens officers at the ports—the possibility of persons coming here for a substantial piece of medical attention, such as the use of professional skill, consultants, and the like, and a long stay in hospital. It is doubtful whether it is possible to ascertain the nationality of the people wishing to use the service without imposing hardship on our own residents.
In any case, it would be difficult for dentists or opticians to ascertain whether the card actually belongs to the person who presents it. It would be administratively onerous; and to postpone treatment in every case until the particulars produced by the practitioner had been verified at some central bureau would cause great difficulty. It is an extraordinarily difficult proposition. These powers were not taken blindly by the Government with no intention whatever, in any circumstances, of using them. If schemes can be devised which are workable and which allow for the application of this power to make a charge in such a way as to prevent abuse, so as to relieve the British taxpayer of some substantial outgoing in respect of foreigners not resident here, I will certainly look at them.
§ Mr. Leslie Hale
Would my right hon. Friend say a few words about the principle? He is speaking as a Member of a Government which is at the head of a great Commonwealth and Colonial Empire. Is it really to be accepted as a principle by the Government, because this applies not only to spectacles but to the whole Health Service? Are we really, in this argument, giving away the whole principle that we wish to treat people who come here in this way?
§ Mr. Marquand
Powers have been taken for this purpose. They were taken some time ago. I have indicated what I think were the objectives in mind when those powers were taken. We are now considering whether, if practical methods can be devised, charges might be made for substantial pieces of medical treatment received by foreigners not resident in this country. That point might well be looked at in regard to the making of reciprocal arrangements with other 1249 countries which would be of advantage to us.
So far as we have gone in such negotiations about reciprocity, we have met with little success. Our Allies in the Brussels Pact have entered into arrangements with us which apply only to indigent persons. They do not provide for their own citizens the far-reaching services which we provide, and they have been unable to offer us reciprocal concessions for any but indigent persons. I do not exclude the possibility that at some time it might be possible to negotiate a reciprocal arrangement of a wider extent with some other country. In that case, such powers might provide a valuable method.
But before we go any further we should consider carefully whether we are prepared to consider any arrangements which impose any kind of charge upon our fellow citizens of the Commonwealth. My view is that it is of doubtful wisdom to consider anything of the sort, even though those Commonwealth countries may not be able to offer reciprocal equivalents to United Kingdom citizens visiting Commonwealth countries. Certainly under the Amendment there would be many classes of persons normally resident outside Great Britain, such as those in the Channel Islands or the Colonies, against whom it would be most undesirable indeed to discriminate.
I am not even clear whether hon. Members opposite agree among themselves about this. From what I have heard this afternoon it appears that some think that charges, if levied, might be levied against Dominion citizens, but others disagree with that. They themselves are not agreed about the matter. Though these powers have been taken, the administrative arrangement suggested by the hon. Member for Twickenham and his hon. Friends is completely impracticable. Therefore, I ask the hon. Gentleman to withdraw the Amendment, or my hon. Friends to reject it.
§ Air Commodore Harvey (Macclesfield)
Will the right hon. Gentleman give the Committee an estimate of the annual cost of this service to non-residents?
§ Mr. Marquand
It is difficult to estimate. My hon. Friend the Parliamentary Secretary gave an estimate some time ago. 1250 That was a figure of about £200,000 a year. It is difficult to calculate. In 1950 there were about 700,000 foreign visitors to the United Kingdom, 56,000 of whom stayed for more than six months. Of the total, 372,000 were holiday visitors, 106,000 were business visitors, and 77,000 were in transit. The average stay is substantially less than a month—probably less than a fortnight. It was calculated that, at most, some 55,000 persons could have obtained any form of treatment under the National Health Service.
That included a wide range of cases where obviously it was sensible to provide treatment, such as looking after a foreign visitor who falls ill with some temporary illness. Another example, which is the only example I ever discovered when I was Minister of Pensions, is when we supplied free under the National Health Service an artificial limb to a French fisherman who met with an accident at sea off the coast of Cornwall. He was brought into this country and supplied free of charge with an artificial limb. I thought then, and I still think, that that was a reasonable action to take.
On the other hand, I would say that if a millionaire, hearing of some special advantage that he could obtain by way of treatment of some special kind, came here and contributed nothing towards its cost, there is something to be said against it. I do not think that it is an infringement of the principle to ask such a person to make a contribution. The principle embodied in the Act is that the Service should be free to the people of Britain. I do not think that it is an infringement of the principle in cases where people can well afford to pay and where one is satisfied that they had come to this country solely for the purpose of obtaining treatment. The difficulty with this small group of cases is to find administrative methods which are suitable and practicable. For the purpose of this Bill, however, I must ask the Committee not to accept the Amendment.
§ Mr. Bevan
The figures which the right hon. Gentleman has just given about the cost of treating foreigners are, of course, based upon the assumption that the number of visitors to this country would make the same use of the National Health Service as a similar number of British residents would make. That is a wild 1251 surmise, because people do not normally travel abroad for holidays when they are in poor health. Therefore, we can assume that the figure of £200,000 is very much higher than the real total. All that he has done in the circumstances is to make an approximation.
The Amendment of the Opposition is a peculiarly mean one, mean in spirit and mean in intention. They have been saying this for some time. From 1945 to 1950 I used to have to answer Questions from the Opposition time and time again about the restricted use of the National Registration Card, and I made regulations limiting the use of those cards, because we all felt that British citizens ought not to have to produce identity cards unnecessarily. Now the Opposition are suggesting that all the British people should be compelled by Statute to show identity cards in order to catch a number of sick foreigners.
The idea that Great Britain is the first nation to grant hospitality of this kind is entirely untrue. As a matter of fact, it is not even a Christian idea, but an Arabian one.
§ Mr. Bevan
The hon. Member's interruption was not a very good one. I remember reading an account of the adventures of a monk in the 14th century. He was captured by Barbary pirates and taken to Arabia as a prisoner. He fell sick, was in hospital for six months, and was treated entirely free, being released from hospital and put back into prison again. At that time the infidels of Arabia were more Christian than the Tory Party is at the present time.
I should like to remind my right hon. Friend that he was slightly in error in what he said about the reasons for taking these powers. They were not taken in order to find means by which to charge foreigners; they were taken in order to prevent abuses by foreigners, which is not quite what the right hon. Gentleman said. I think he would be going far beyond our intentions at the time if he now tries to exercise his ingenuity, which, I admit, is considerable, in order to try to make regulations to put charges on foreigners for the use of the National Health Service, as such.
§ Mr. Bevan
I am perfectly prepared to manoeuvre to do a virtuous thing.
These powers were taken in order to have in readiness statutory authority to deal with any abuses which became so widespread that attempts would have had to be made to deal with them in order to protect the Health Service. If we accept this Amendment in regard to teeth and spectacles, there is no logical reason why we should not do it in regard to the whole of the Health Service. I assume, though it may be an unwarranted assumption, that people do not visit Great Britain in order to have an accident, that, if they do have an accident here, it would be something which they did not want to happen to them, and that it would be a natural piece of hospitality for the British people to care for the person who sustained the accident.
Furthermore, there is a good deal of pressure behind this proposal which does not appear on the surface. It is that certain elements of the medical profession may be able to charge fees. [HON. MEMBERS: "Oh!"] Oh, yes. In fact, if I were going to put my finger—[Interruption.] It is no good hon. Members complaining about this, because there is evidence. If I were asked to put my finger on where abuses in the Health Service take place, I would say that it is in the manipulation of fee-paying beds by specialists in hospitals. There is more abuse from that than in any other part of the Health Service, and it is due to the fact——
§ 6.45 p.m.
§ Lieut.-Colonel Elliot
On a point of order. This is a very interesting line now being opened up by the right hon. Gentleman. Will it be possible for us to extend our arguments into the fields which he has opened up?
The Chairman: The right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) is possibly going a little wide. It is certainly not possible to extend the argument.
§ Mr. Bevan
I do not propose to use that in any other sense than as an illustration, but there are so many wild and unsubstantiated charges of abuses in the service that it is sometimes necessary for 1253 us to describe where these abuses take place, and they take place very often among the dentists and among the opticians in the National Health Service, which has not yet existed long enough to eradicate commercialism from the medical profession.
Therefore, I do hope that my right hon. Friend will resist these importunities from the other side. Furthermore, I should like to give this explanation to the Committee. One of the results of having a good Health Service and good nutritional standards—because it would be a mistake to claim that the higher standard of health of our people is solely on the therapeutical side; our preventive services are very considerable indeed, and our nutritional standards are reasonably high—one of the consequences, if hon. Members will suppress themselves for a moment, is that we have not a very large experience of certain types of epidemic diseases on which to train our doctors. I wish hon. Members would not be so facetious. The fact of the matter is that many of our doctors are liable to have been inadequately trained in certain types of tropical diseases, because they do not occur in Great Britain to the extent which they did. In fact, there was an instance the other day in which, on board a ship, one of our doctors could not diagnose smallpox because he had no experience of it at all.
Therefore, the reason we do not want to put charges on foreigners is that it may become necessary for us—in fact, I discussed this with my medical advisers before I left the Ministry of Health—it may become necessary for us, both for treatment and for clinical teaching material in this country, to bring patients from different parts of the Colonial Empire to be treated in Britain.
§ Major Beamish
I apologise to the right hon. Gentleman. I thought he was discussing the Amendment, which we are doing.
§ Mr. Marquand
If my right hon. Friend will forgive me, I said that there were instances, of which I cited some examples, in which charges would reasonably be made, and which would have the effect of preventing abuses. I took the liberty of assuming that my right hon. Friend, when he asked for powers to impose charges, had in mind that he might impose charges.
§ Mr. Bevan
I thought the right hon. Gentleman would appreciate the source of his support. If my right hon. Friend will read in HANSARD tomorrow what he said, he will see that he went far beyond that, and that he was challenged at the time by my hon. Friend the Member for Oldham, West (Mr. L. Hale), and others. What I am saying is that I consider it to be a grave encroachment on the National Health Service, and that it would be a mean and inhospitable thing to listen to the importunities of hon. Members opposite, who have no other intention than to destroy the National Health Service.
§ Miss Horsbrugh (Manchester, Moss Side)
I have listened with interest to the discussions that have been taking place on the other side of the Committee. I have always been interested in the building up of the National Health Service. [Laughter.] Hon. Gentlemen may laugh, but if the hon. Member opposite will look up HANSARD, he will see that we were dealing with it, in its main points, before he was ever in the House.
§ Mr. Bing rose——
§ Miss Horsbrugh
Because I do not sit down, I am asked why I make assertions. Most of our speeches are assertions, and, if that were a reason for sitting down, we would never get up.
1255 The discussion has been extremely interesting, because, for the moment, we seemed to leave spectacles and the teeth behind, and went on to discuss abuses, the training of doctors, various illnesses in the Colonies and suchlike things. Many of us would very much like to discuss such points, but, if we keep to the Amendment, surely, the facts are these. First of all, the Amendment does not deal with the subject of abuse. I think that the right hon. Member for Ebbw Vale (Mr. Bevan) was labouring under a difficulty because he had not heard the beginning of the debate. The Minister of Health, of course, was present. He heard the beginning of the debate, and realised the problem with which we were dealing.
The right hon. Member for Ebbw Vale said that he did not like commercialism being brought into the Health Service. But the only difference in the commercialism is this. In future, everybody will be required to pay half the cost of teeth and spectacles, and it is only a question of whether some people should be asked to pay the whole cost. I do not think that makes much difference to the aspect of commercialism; it is only a question of the amount. Therefore, I do not think we need bother any further about that point.
§ Miss Horsbrugh
I do not think that has anything to do with this actual point. All we are discussing at present is whether, as residents in this country are to have to pay half the cost, people not normally resident in this country should pay the full amount.
§ Miss Horsbrugh
We might have it laid down by regulation that it is twice half the amount. There is always that possibility.
The hon. Member for Oldham, West (Mr. L. Hale) thought that a scheme like this might worsen the international situation. The interesting thing is that the principle about which hon. Members have been talking this afternoon has already been accepted by the Government. 1256 It was accepted by the right hon. Member for Ebbw Vale when he was Minister of Health, and, as we have already heard from the present Minister of Health, we find it laid down in Section 17 of the National Health (Amendment) Act, 1949. So the principle that people not resident in this country should pay—and it is quite right that they should—for certain things in the Health Service—and at that time it was not confined merely to spectacles and teeth—has been accepted by the Government.
§ Miss Horsbrugh
There is nothing in the Act which says that this provision is only for those who abuse the scheme. As the Act stands at present, it gives the Government power to charge people not normally resident in this country for using the Health Service. In this Amendment, we are dealing only with teeth and spectacles for which now, for the first time, people resident in this country are to pay part of the cost. The only point now is whether it is possible to find some way, administratively, to use the powers which the Government have had since 1949, and of which, I believe, the whole of the House was in favour.
I have tried to find evidence that hon. and right hon. Members were against that principle and whether they showed by their speeches or by their vote at that time that they were against it. I cannot find any such evidence. The House accepted the principle in 1949, and the Minister of Health has told us today that he agrees that they accepted the principle at that time. He says that our Amendment is not necessary because the Government already have the powers which we seek to insert in the Bill, and that the only difficulty is how to administer those powers.
We have heard various things said about identity cards. Although I do not want to stir up any further internecine warfare among hon. Members opposite, there is one point which rather interested me. The Minister of Health said that he could not make any change in the use of the identity card because it would mean legislation. The right hon. Member for Ebbw Vale, if I heard him aright, said that by regulation he had stopped identity cards being used for a great 1257 many other things. We know that at present they are used in connection with the savings bank, the food office, and in various other places, and we know that on the form of application for spectacles or dentures the identity card number is inserted.
As far as I can gather from the Minister of Health today, if a patient refused to give his identity card number, or refused to put that number on the application form, he would still be entitled to have his spectacles or teeth. If I am wrong in this assumption, no doubt the Minister will interrupt me. The patient has that right, and though the optician and the dentist may ask him for his identity card number, they have no right to say that the patient must produce the number, and have no right to withhold the dentures or spectacles if the patient refuses to give it. I think I am right so far.
§ 7.0 p.m.
§ Mr. Marquand
The right hon. Lady will realise that the purpose of asking for the identity card number is to prevent the possibility of abuse. If the recipient of the treatment refuses to give his number, then, of course, other methods must be found to try to track down who received the treatment so as to avoid any abuse. There are no doubt other methods available for doing that.
§ Miss Horsbrugh
The right hon. Gentleman said we all accepted the principle, but the difficulty is administration. I will not suggest or use the word "manoeuvre" of which we have heard so much lately or to say that deliberately these powers have not been used. I take the answer as given—that it has been found administratively impossible. Today, we are told by the Minister that although there is no power to ask for the production of an identity card or identity number it is done and, in case there was abuse, some other way would have to be found if the patient did not produce the identity card or give the number.
§ Miss Horsbrugh
The hon. Gentleman can suggest that if he likes. If the hon. Gentleman wants finger prints to be taken he can still put down an Amendment to the Bill. When we ask our people to pay half the charge we should not say 1258 to the people of other countries, in the leaflets that we send out, that they should pay half. We could well ask them to pay in full. If, when asked for an identity card or number, a patient refuses to say. "I have no identity card, because I have come from abroad," why could not exactly the same inquiries be made as the right hon. Gentleman says would be made in a case of the residents of this country? A few people, of course, can get away with anything. In future a document should be given to people who come into this country stating that under the National Health Service medical attention would be free, but that dentures and spectacles would not be free.
If, as the Minister says, he wants this, and the only difficulty is that it is administratively impossible, the sooner he gets down to finding a way of doing it the better. Hon. Members have said that they have had stories in this debate and have had no facts. I have only one fact and I can give it to the Committee. I broadcast at one time—not during the election—and I mentioned the Health Service and the fact that at that time there was a great deal of discussion in the House of Commons on the subject of everything being given without payment to those coming from overseas. I can assure the Committee of the numbers of letters I had from people who belong to other countries and who were taking advantage of the service here.
In a letter a man wrote that a friend of his said to him:You are going to England. Do not be so silly as to get spectacles before you go. You can get them free there. Since you and I go over frequently and are friends, if they are not ready we can pick them up another time.This is how the letter ended:You may think we are wrong, but you in your country are 'mutts,' and if you give us all this free we will take it. You will be much more sensible if you ask us to pay.I believe the people of this country agree with the Government, who have accepted the principle that there should be payment. We accept the principle, if this Bill goes through, that people are to pay a part of the charge for spectacles and dentures. I believe now is the time to tell people from abroad that they must pay. The Amendment lays down that arrangements should be made—it need not apply to people from the Commonwealth or the Colonies.
§ Miss Horsbrugh
We leave it to the right hon. Gentleman to make regulations. We are trying to help him in every way to carry this out. He has accepted the principle, the Government have accepted it, and the right hon. Gentleman the Member for Ebbw Vale has accepted it. Now we are told that it is appallingly difficult to carry it out and that the Government cannot find a way of doing it. We are trying to show them how to work it.
§ Mr. Blenkinsop
The right hon. Lady has not yet explained what her hon. Friends mean by the Amendment—whether they mean it to apply generally to all foreigners or not. They merely say, "We leave it to you to decide."
§ Miss Horsbrugh
We are really discussing the Amendment. If it is adminitratively possible, I should like to see a scheme under which people from the Dominions would get more benefit than those from other countries; but, in this Amendment, we have left it to the Government to make the regulations. We feel we should no longer continue to give foreigners free dentures.
§ Miss Horsbrugh
The people who are not British and are not members of the British Commonwealth and Empire.
We leave it to the Minister to find a way of working this scheme. I shall ask the Committee to divide to show that we want the Minister to find a way, since he has accepted the principle. If the principle is accepted and cannot be worked, the people of this country will be annoyed to hear that the taxpayers' money is to be used for the benefit of those who, in many cases, do not require the service.
§ Several Hon. Members rose——
§ Mr. Mikardo
I am anxious very briefly to support the right hon. Lady the Member for Moss Side (Miss Horsbrugh) in one of the things she said. [Interruption.] The gentlemanly party are in one of their ungentlemanly moods 1260 this evening. In the first sentence of her speech the right hon. Lady based the general tenor of her argument, and the disputation of the purity of her motives in her argument, on the fact that she and her colleagues had supported the National Health scheme. Since we were unfortunately deprived of her presence during the last Parliament, I want to help her by telling her how her right hon. and hon. Friends supported it.
§ Lieut.-Colonel Elliot
On a point of order. If the hon. Member is to be allowed to develop this argument, shall we also be allowed to develop the counter-argument showing how long before that we had been working on national health projects?
§ Mr. Mikardo
I am surprised that the right hon. and gallant Gentleman should take exception to my endeavours to support his right hon. Friend the Member for Moss Side (Miss Horsbrugh). All I wanted to say was that in the last Parliament the Opposition did support the National Health Service in every way possible, apart from one or two lapses. It is true that they voted against the National Health Service Bill, on Second Reading——
§ Mr. Mikardo
I will not pursue the matter. I will merely add that they voted against the Bill on the Committee stage and the Third Reading, and, apart from that, supported it in every possible way.
§ Mr. Donnelly
I was very sorry that the right hon. Lady the Member for Moss Side (Miss Horsbrugh) failed in her manoeuvres, and I am afraid it is now too late in more senses than one. At the same time, I felt very deeply for her because she was in some considerable difficulty in dealing with this matter. She made the prime howler of imagining that ordinary dental and medical charges outside the Health Service, were in some way controlled by the Ministry of Health.
§ Miss Horsbrugh
I never made the slightest suggestion that charges for services outside the National Health Service were controlled by the Minister of Health—certainly not.
§ Mr. Donnelly
If the right hon. Lady will look in HANSARD tomorrow morning, 1261 she will realise that she was completely at a loss when dealing with this position and she sheered off it, not realising that she had made a mistake. I think it was probably as big a howler as the one she perpetrated when she referred to people eating carrots. I felt very sorry for her having to take part in this debate with a very limited knowledge of this subject.
The hon. Member for Twickenham (Mr. Keeling) made a joke about dentures, but failed to convert his own tribe. I fail to see what particular point was intended by the Opposition's argument in supporting this Amendment, except that it was to do one thing, namely, to pose before the electors of this country as the saviours of public expenditure and to try to show how active they were in curtailing expenditure in the public interest.
In point of fact, though the Opposition may think that by this kind of Amendment they persuade the public that they will save money, they really lose a great deal of good will. Whenever we on this side of the Committee talk about Marshall Aid, there is a kind of religious service on the part of the Opposition who say that we must be particularly grateful to our American friends. Whenever we suggest any small gesture on our part to any other country in the world—America or anywhere else—and say that we are prepared to give something to other people, every hon. Member opposite says "Oh, no, we cannot possibly do that; it is the British taxpayers' money; we could not possibly contemplate such a thing."
It is a good thing for us that the hon. Member for Twickenham, who moved this Amendment, was not in Congress at the time of the Marshall Aid proposals; otherwise we should have fallen at the first £200,000. This Amendment really exposes the fundamental meanness of the Tory Party towards their fellow men in other parts of the world.
Perhaps I might turn to the remarks of my right hon. Friend the Minister of Health. I was more than a little bit surprised by the way in which he accepted the principle of the Opposition's Amendment. If I may put forward very diffidently a serious word of advice, I would say to my right hon. Friend that this is typical of the kind of thing that he is going to get if we start whittling away 1262 the Health Service in accepting the principle of any of these Opposition proposals. It will not stop at this particular point.
I was very sorry and surprised that my right hon. Friend did not reject completely the principle behind this Amendment. We on these benches are very sorry to find that a Minister of the Socialist Government accepts in principle proposals such as the hon. Member for Twickenham made, and says, "I am sorry, but from a practical point of view we cannot do anything about it." I join with my right hon. Friend the Member for Ebbw Vale (Mr. Bevan), my hon. Friend the Member for Reading, South (Mr. Mikardo), and others who have advocated the rejection of this Amendment. I would say to my right hon. Friend the Member for Ebbw Vale that he is not alone in being proud of the National Health Service. There are many on these benches who are profoundly proud of it, too, and not least amongst the things we are proud of is the fact that we have extended this social benefit to other people visiting this country at any time.
§ Mr. Walter Fletcher (Bury and Radcliffe)
What is the hon. Gentleman's definition of meanness? Is it generosity at somebody else's expense?
§ Mr. Niall Macpherson (Dumfries)
The hon. Member for Pembroke (Mr. Donnelly) seems entirely to have overlooked the fact that this Bill, which has been brought in by his own Government, imposes a charge for dentures and spectacles and limits that charge to dentures and spectacles, and that the Amendment seeks to impose a full charge for dentures and spectacles on those foreigners who come to this country not for the purpose of working, because if foreigners are in possession of identity cards they are entitled to the benefits under this Bill and will only have to pay half. The people who will have to pay the full charge will only be those who come over for a very limited period and who may very easily choose to come over for that particular purpose.
The purpose of this Amendment is simply to do what the right hon. Member for Ebbw Vale (Mr. Bevan) was himself seeking to do, and to prevent abuses. 1263 People who come to this country for a very short time are probably well aware if they are likely to require the attention of a doctor or an optician or a dentist. Visitors to this country do not get optical appliances unless they have come with that particular intention in mind.
§ Mr. Crossman
Would the hon. Gentleman say that breaking one's spectacles in England would involve an abuse of the Service?
§ Mr. Macpherson
No, certainly not, but if a foreigner comes here for a very short time and breaks his spectacles, not having contributed to the National Health Service like other foreigners who do work in this country, surely there is no reason why he should not pay the full cost.
§ Mr. W. Griffiths (Manchester, Exchange)
May I point out to the hon. Gentleman that until very recently there were very long delays in the provision of spectacles and also in receiving attention from dentists? Therefore, to speak of people coming over here for a short time and seeking to take advantage of the Health Service does not fit in with the realities of the situation which has obtained until very recently.
§ Mr. Macpherson
I have come across cases where an order has been placed for spectacles and a long time has elapsed before they have been delivered, and when the delivery was made the person who ordered them was not in this country and could not be found, so that was a direct waste. The acceptance of this Amendment would discourage that sort of thing happening.
§ Mr. Leslie Hale
Would the hon. Gentleman tell us how the Amendment, as now drafted, would help in that situation?
§ Mr. Macpherson
The Amendment would help because the person ordering the spectacles in that case would think twice, knowing that he would have to pay for them when they were delivered, even though he did not know exactly when they would be delivered. He would not order the spectacles if he knew he would be outside the country before delivery took place. My complaint is that at the moment these people do not very much care, but if they were asked 1264 to pay for the spectacles when delivered, they would be more careful.
It has been suggested that when accidents happen it is only reasonable that we should give the same facilities to foreigners, no matter how short a time they may be here, as we give to our own people. Can that really be applied to dentures? A person may have had a denture made for him abroad, probably by an entirely different process from the process in this country. Let us see what happens if he breaks his dentures while here on only a short visit. Demands reach the Dental Estimates Board saying "Please expedite this because the person is leaving the country in a short time." In fact, such people could quite easily have the repairs done when they reach home—and done by the makers. Surely that is much more reasonable.
Exactly the same thing is happening in cases where new dentures are ordered. Accompanying the order is a chit saying, "The person who has ordered these dentures is going outside the country in a short time. Please expedite." That is the way in which the service is being abused at the moment, and this Amendment has been put down to prevent that sort of abuse. It is ridiculous to say that because we have put down an Amendment dealing with dentures and spectacles, therefore we want to extend the principle that foreigners should pay the full cost to all other cases. These are particular cases which are the subject of this Bill—dentures and spectacles. That is why we urge that it is right and proper that those who are in this country for only a short time and who are not working here, or are in no way contributing towards the National Health Service, should pay the whole cost of the service provided.
When the right hon. Member for Ebbw Vale says this Amendment is only in order to enable an additional charge to be made over and above the normal charge, his statement is not borne out by the terms of the Amendment. If hon. Members opposite will look at the Amendment, they will see that it is directly related to the charges made under the service. It does not say that people cannot have the service. What it says is that they shall pay the full charge under the National Health Service. The purpose 1265 of the Amendment is quite clear and I see no reason why it should not be accepted.
§ Mr. Sydney Silverman (Nelson and Colne)
Will the hon. Gentleman tell me something? I gather from the last few sentences of his speech that he seeks to differentiate between the resident of this country and the alien visitor only in respect of these charges for spectacles and teeth. Will he tell me whether that is so and, if it is so, on what principle he does not wish the same discrimination to apply to all the other servies?
§ Mr. Macpherson
The answer is clear. We are dealing here only with this Bill, the purposes of which are limited. The purpose of the Amendment is directly related to dentures and spectacles, and that is all we have to deal with under the Bill.
§ Mr. Fernyhough (Jarrow)
The arguments which we have heard from the other side of the Committee this afternoon are, in my opinion, a very grave reflection upon the dentists and the opticians in this country. If the Questions put down on the Order Paper from time to time by hon. Members opposite have been truthful, we have been led to believe that many of our people have to wait months and months before they can get either the optical or the dental treatment which they require.
The hon. Member for Dumfries (Mr. N. Macpherson), on the other hand, said that a number of people came to this country for a limited period for the particular purpose of obtaining the benefits of the free Health Service. That suggests that our dentists and opticians have been giving them priority and have been putting the interests of the foreigner before the interests of our own people. I very much doubt whether hon. Members opposite would make such an accusation about the dentists and opticians in their own constituencies. They would not accuse them of behaving in that way towards their own clients.
There is a principle involved here. If we make this charge in the manner which hon. Members opposite contemplate, why should we stop with the Health Service? There will be hundreds of thousands of people coming to this country in the next two or three months. They will be eating subsidised food. They will be eating food 1266 which will cost the taxpayers of this country a sum of money almost identical with the cost of the Health Service. [An HON. MEMBER: "Disgraceful."] An hon. Member opposite says it is disgraceful; in other words he believes they should be charged more for the food than the normal price. In fact, nobody would suggest that they should be charged in that way.
What has happened this afternoon is just a piece of pre-electioneering by the Opposition. They have stood for a free health service so long as it has not cost anything. When it costs something, however, then it is never opportune for the scheme to be introduced; it is always put off, as they put off such things in the inter-war years. The scheme will cost more this year than it cost last year, and I am not one of those who grumble about that, because I believe that one of the first things we should do, is look after those who are sick and who need this treatment.
I hope, therefore, that we shall resist this Amendment and make perfectly clear to the country what the dangers would be if hon. Members opposite ever returned to power. The gate has been opened an inch; they would open it a mile. We should resist that.
§ Dr. Hill
When hon. Members opposite have finished, perhaps I may begin by saying that I think this is much ado about nothing. When the hon. Member for Oldham, West (Mr. L. Hale) was describing the contribution that this part of the service made to international and Empire relations and the harm it would do to those relations if visitors to this country were required to pay in full for their teeth and spectacles, I wondered whether he and his profession would add a further contribution and——
§ Mr. Leslie Hale rose——
§ Dr. Hill
I will give way when I have finished my sentence, because it may add further point to the interjection. I wondered whether we might not extend the field of free services in order to cement these relations. When the hon. Member for Jarrow (Mr. Fernyhough) was speaking, I wondered whether his conclusion 1267 would be that in the interests of international relations we should charge the foreigner half-price for his food, and when the hon. Member for Oldham, West, was speaking—and I believe exaggerating—I wondered whether he was about to suggest that the legal profession might give free advice to the foreigner; but perhaps that might lead not to a cementing but rather to a disturbing of international relations.
§ 7.30 p.m.
§ Mr. Hale
I am much obliged to the hon. Gentleman for giving way. Let me say at once that the legal profession always has given legal aid in these circumstances. Every foreigner charged with a criminal offence in this country can have free legal aid. Secondly, it has been the case since 1945 that we have given subsidised food to every foreigner coming here, whether an American on board the "Queen Elizabeth" or a Lascar in the East End of London. We have never asked them to pay extra for their bacon because it was subsidised to us. Thirdly, I did not say what the hon. Gentleman says I said. What I said was that this was just an elementary conception of common decency. I believe that the hon. Gentleman would understand that. I am not sure all his colleagues would.
§ Dr. Hill
I want to be quite blunt about this. I do not really think that the visitor to this country regards it as necessary or reasonable or sensible that part of the hospitality we should provide, should be free dentures and free spectacles. If I thought for one moment that it would damage international relations for a charge to be made for these things, as is made in every country which we visit, then I should support the hon. Member.
The right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) had to invoke the aid of tropical medicine in order to support his case, but he was merely obscuring the fact, or seeking so to do, that he it was who took upon himself to use these powers, even though he proposed to use them for another purpose. If there is criticism of payment for dentures, the criticism rests with the Government, for they are charging half price for them; if there is a power to charge foreigners the whole lot, the responsibility 1268 rests with the Government and the right hon. Gentleman the Member for Ebbw Vale because they took the power upon themselves to do it.
It seems to me to be nonsense to suggest that we can be as a people expected to give these things. I do not think the sum of money matters at all. I do not think there is very much abuse, although I am bound to say—perhaps I get more letters than most on this subject—that I get about three letters a week asking me how the writers can come to this country for the purpose of benefiting under the Health Service—quite sensible letters from people seeking to benefit from one part of the service or another. I have never had a letter, I confess, asking how they could obtain free spectacles and free teeth, but I do suggest——
§ Mr. Manuel
I am sure the hon. Gentleman is aware that many of us receive a fair proportion of letters from abroad appreciating the Christian spirit which is being shown by this Government in coming to the aid of those who need aid.
§ Dr. Hill
The feeling of a foreigner who got free teeth in this country would be a mixture of astonishment and gratitude; and the foreigner who discovered that he, being possessed of a pair of false teeth, had only to go to a dentist in this country and say that they were ill fitting and uncomfortable to get another set at our expense, would probably feel the same. I am certain that such people would be sensible enough to recognise their obligation to pay for what they got, and I suggest that it is reasonable and sensible——
§ Mr. Crossman
I have been listening with very great interest to the hon. Gentleman, but if, as he says, the cost of this astonishing thing is negligible, is it not worth that expense because of the very good publicity for us that the foreigner should find that he does come within this amazing service?
§ Dr. Hill
No, for this reason, that the future efforts of the dental service are going to be in large part devoted to the replacement of existing dentures—as I hope to show in some detail later on—and if, in fact, the replacement notion gets abroad, if, in fact, foreigners know that, being already possessed of one set of dentures, they can come here and, after making complaint, get another without 1269 cost, I believe this may grow into something considerable. Let us be sensible about this matter. People visiting this country expect to pay. Let them be charged a reasonable amount for the teeth and spectacles they get.
§ Mr. S. Silverman
I was a little disappointed at the contribution we have just had from the hon. Member for Luton (Dr. Hill), who very often manages to get outside his party affiliations when he is discussing these matters. The Committee has frequently been grateful to him for his commonsense contributions to matters relating to the National Health Service, which have been overlaid by partisan prejudices. I was very disappointed indeed to find that, in his contribution to this debate, he did not conform to the expectations that he has aroused in all of us before.
Let us get back to the simple fact. It is that we initiated in this country a service based on the principle that anyone within our borders, whatever his racial origin, anyone who felt the need of medical assistance, could get that medical assistance, and that the cost of it would not be borne by the person upon whom the disaster had fallen, but would be borne by the whole community. Of course, if there were evidence that people came here deliberately to take advantage of that, there would be ground for preventing them. That would be an abuse. That would be the kind of abuse that people have had in mind in discussing this matter. But there is already ample power in the hands of the Home Secretary—and he has never hesitated to exercise it—to keep away people who come here for an improper purpose; and people who
§ came only to derive benefit of that kind would be coming for an improper purpose, and could be kept away, and frequently are kept away.
§ But the hon. Gentleman did not claim that there was any evidence of any such abuse. He said that the cost of the whole thing is negligible, and he said, quite rightly, I think, that the whole matter was a very small matter indeed. Why does he think it worth while, if it is such a small matter, and if there is no real evidence of abuse, to depart from the principle he was prepared to support? He is asking us to give way on our principles for what he says is a very small thing, and to achieve precisely nothing—except the satisfaction of partisan prejudices of hon. Members on the benches opposite who surround him. He may think he has done a poor service——
§ Mr. Henderson Stewart (Fife, East)
On a point of order. Would it be possible, Major Milner, to invite the Government side to be quiet, so that one of their own party may be heard?
§ Mr. Silverman
I want to finish, and I certainly saw no reason to complain. I suggest to the hon. Member for Luton that if he thinks he has rendered some kind of forensic debating service to his political associates he is even mistaken in that, and I would further suggest to him that even if he were not mistaken in that, it would still not be worth while doing it.
§ Question put, "That those words be there inserted."
§ The Committee divided: Ayes, 254; Noes, 285.1273
|Division No. 80.]||AYES||[7.40 p.m.|
|Aitken, W. T.||Boothby, R.||Cooper, Sqn. Ldr. Albert (Ilford, S.)|
|Alport, C. J. M.||Bossom, A. C.||Cooper-Key, E. M.|
|Amery, Julian (Preston, N.)||Boyd-Carpenter, J. A.||Corbett, Lt.-Col. Uvedale (Ludlow)|
|Amory, Heathcoat (Tiverton)||Boyle, Sir Edward||Craddock, Beresford (Spelthorne)|
|Arbuthnot, John||Bracken, Rt. Hon. B.||Cranborne, Viscount|
|Ashlon, H. (Chelmsford)||Braine, B. R.||Crookshank, Capt. Rt. Hon. H. F. C.|
|Assheton, Rt. Hon R (Blackburn, W.)||Braithwaite, Lt.-Cr. G. (Bristol, N.W.)||Crosthwaite-Eyre, Col. O E.|
|Astor, Hon. M. L.||Bromley-Davenport, Lt.-Col. W.||Crouch, R. F.|
|Baker, P. A. D.||Brooke, Henry (Hampstead)||Crowder, Capt. John (Finchley)|
|Baldock, Lt.-Cmdr J. M.||Browne, Jack (Govan)||Crowder, Petre (Ruislip—Northwood)|
|Baldwin, A E.||Buchan-Hepburn, P. G. T.||Cundiff, F. W.|
|Banks, Col. C.||Bullock, Capt. M.||Cuthbert, W. N.|
|Beamish, Major Tufton||Bullus, Wing Commander E. E.||Davidson, Viscountess|
|Bennett, Sir Peter (Edgbaston)||Butcher, H. W.||Davies, Nigel (Epping)|
|Bennett, Or. Reginald (Gosport)||Carr, Robert (Mitcham)||de Chair, Somerset|
|Bennett, William (Woodside)||Channon, H.||Deedes, W. F.|
|Bevins, J. R (Liverpool, Toxteth)||Clarke, Col. Ralph (East Grinstead)||Dodds-Parke A. D.|
|Birth, Nigel||Clarke, Brig. Terence (Portsmouth, W.)||Donner, P. W.|
|Bishop, F. P.||Clyde, J. L.||Douglas-Hamilton, Lord Malcolm|
|Black, C. W.||Colegate, A.||Drayson, G. B.|
|Boles, Lt. Col. D. C. (Wells)||Conant, Maj. R. J. E.||Drewe, C.|
|Dugdale, Maj. Sir Thomas (Richmond)||Lancaster, Col. C. G.||Renton, D. L. M.|
|Duncan, Capt. J. A. L.||Law, Rt. Hon. R. K.||Roberts, Major Peter (Heeley)|
|Dunglass, Lord||Legge-Bourke, Maj. E. A. H.||Robertson, Sir David (Caithness)|
|Duthie, W. S.||Lennox-Boyd, A. T.||Robinson, Roland (Blackpool, S.)|
|Eccles, D. H.||Lindsay, Martin||Robson-Brown, W.|
|Elliot, Rt. Hon. W. E.||Llewellyn, D.||Rodgers, John (Sevenoaks)|
|Fisher, Nigel||Lloyd, Rt. Hn. Geoffrey (King's Norton)||Roper, Sir Harold|
|Fletcher, Waller (Bury)||Lloyd, Maj. Guy (Renfrew, E.)||Ropner, Col. L.|
|Fart, R.||Lloyd, Selwyn (Wirral)||Russell, R. S.|
|Foster, John||Lockwood, Lt.-Col. J. C.||Ryder, Capt. R. E. D.|
|Fraser, Hon. Hugh (Stone)||Longden, Gilbert (Herts, S.W.)||Salter, Rt. Hon. Sir Arthur|
|Fyfe, Rt. Hon Sir David Maxwell||Low, A. R. W.||Sandys, Rt. Hon. D.|
|Gage, C. H.||Lucas, Sir Jocelyn (Portsmouth, S.)||Savory, Prof. D. L.|
|Gatbraith, Cmdr. T. D. (Pollok)||Lucas, P. B. (Brentford)||Scott, Donald|
|Gatbraith, T. G. D. (Hillhead)||Lucas-Tooth, Sir Hugh||Shepherd, William|
|Garner-Evans, E. H. (Denbigh)||Lyttelton, Rt. Hon. O.||Smiles, Lt.-Col. Sir Walter|
|Gates, Maj. E. E.||McAdden, S. J.||Smith, E. Martin (Grantham)|
|Gfyn, Sir Ralph||McCallum, Major D.||Smithers, Peter (Winchester)|
|Gomme-Duncan, Col. A.||Macdonald, Sir Peter (I. of Wight)||Smithers, Sir Waldron (Orpington)|
|Gridley, Sir Arnold||Mackeson, Brig. H. R.||Smyth, Brig. J. G. (Norwood)|
|Grimston, Hon. John (St. Albans)||McKibbin, A.||Snadden, W. MoN.|
|Grimston, Robert (Westbury)||McKie, J. H. (Galloway)||Soames, Capt. C.|
|Harden, J. R. E.||Maclay, Hon. John||Spens, Sir Patrick (Kensington, S.)|
|Hare, Hon. J. H. (Woodbridge)||Maclean, Fitzroy||Stanley, Capt. Hon. Richard (N. Fylde)|
|Harris, Frederic (Croydon, N.)||MacLeod, Iain (Enfield, W.)||Stevens, G. P.|
|Harvey, Air Cdre. A. V (Macclesfield)||MacLeod, John (Ross and Cromarty)||Steward, W. A. (Woolwich, W.)|
|Harvie-Watt, Sir George||MacPherson, Major Niall (Dumfries)||Stewart, Henderson (Fife, E.)|
|Hay, John||Manningham-Buller, R. E.||Stoddart-Scott, Col M.|
|Head, Brig. A. H.||Marlowe, A. A. H.||Storey, S.|
|Headlam, Lieut.-Col. Rt. Hon. Sir C.||Marples, A. E.||Stuart, Rt. Hon James (Moray)|
|Heald, Lionel||Marshall, Douglas (Bodmin)||Studholme, H. G.|
|Heath, Edward||Maude, Angus (Ealing, S)||Summers, G. S.|
|Henderson, John (Cathcart)||Maude, John (Exeter)||Taylor, Charles (Eastbourne)|
|Hicks-Beach, Maj. W. W.||Medlicott, Brig. F.||Taylor, William (Bradford, N.)|
|Higgs, J. M. C.||Mellor, Sir John||Teeling, W.|
|Hill, Mrs. E. (Wythenshawe)||Molson, A. H. E.||Teevan, T. L.|
|Hill, Dr. Charles (Luton)||Moore, Lt.-Col. Sir Thomas||Thomas, J. P. L. (Hereford)|
|Hirst, Geoffrey||Morrison, John (Salisbury)||Thompson, Kenneth Pugh (Walton)|
|Hollis, M. C.||Morrison, Rt. Hon. W. S. (Cirencester)||Thompson, R. H. M. (Croydon, W.)|
|Holmes, Sir Stanley (Harwich)||Mott-Radclyffe, C. E.||Thorneycroft, Peter (Monmouth)|
|Hope, Lord John||Nabarro, G.||Tilney, John|
|Hopkinson, H. L. D'A.||Nicholls, Harmar||Touche, G. C.|
|Hornsby-Smith, Miss P.||Nicholson, G.||Turton, R. H.|
|Horsbrugh, Rt. Hon. Florence||Nield, Basil (Chester)||Tweedsmuir, Lady|
|Howard, Gerald (Cambridgeshire)||Noble, Cmdr. A. H. P.||Vane, W. M. F.|
|Howard, Greville (St. Ives)||Nugent, G. R. H.||Vaughan-Morgan, J. K.|
|Hudson, Sir Austin (Lewisham, N.)||Nutting, Anthony||Vosper, D. F.|
|Hudson, Rt. Hon. Robert (Southport)||Oakshott, H. D.||Wakefield, Edward (Derbyshire, W.)|
|Hudson, W. R. A. (Hull, N.)||Odey, G. W.||Wakefield, Sir Wavell (Marylebone)|
|Hulbert, Wing Cmdr. N. J.||O'Neill, Rt. Hon. Sir Hugh||Walker-Smith, D. C.|
|Hurd, A. R.||Ormsby-Gore, Hon. W. D.||Ward, Hon. George (Worcester)|
|Hutchinson, Geoffrey (Ilford, N.)||Orr, Capt. L. P. S.||Ward, Miss I. (Tynemouth)|
|Hutchison, Lt.-Com. Clark (E'b'rgh W.)||Orr-Ewing, Charles Ian (Hendon, N.)||Waterhouse, Capt. Rt. Hon. C.|
|Hutchison, Colonel James (Glasgow)||Orr-Ewing, Ian L. (Weston-super-Mars)||Watkinson, H.|
|Hyde, Lt.-Col. H. M.||Peake, Rt. Hon. O.||White, Baker (Canterbury)|
|Hylton-Foster, H. B.||Perkins, W. R. O.||Williams, Charles (Torquay)|
|Jeffreys, General Sir George||Peto, Brig. C. H. M.||Williams, Sir Herbert (Croydon, E.)|
|Jennings, R.||Pickthorn, K.||Wills, G.|
|Jones, A. (Hall Green)||Pitman, I. J.||Wilson, Geoffrey (Truro)|
|Joynson-Hicks, Hon. L. W.||Powell, J. Enoch||Wood, Hon. R.|
|Keeling, E. H.||Price, Henry (Lewisham, W)||York, C.|
|Kerr, H. W. (Cambridge)||Prior-Palmer, Brig. O.|
|Kingsmill, Lt.-Col. W. H.||Profumo, J. D.||TELLERS FOR THE AYES:|
|Lambert, Hon. G.||Redmayne, M.||Major Wheatley and Mr. Digby|
|Remnant, Hon P.|
|Acland, Sir Richard||Bing, G. H. C.||Champion, A. J.|
|Adams, Richard||Blenkinsop, A.||Chetwynd, G. R.|
|Albu, A. H.||Blyton, W. R.||Clunie, J.|
|Allen, Arthur (Bosworth)||Boardman, H.||Cocks, F. S.|
|Anderson, Alexander (Motherwell)||Booth, A.||Collick, P.|
|Anderson, Frank (Whitehaven)||Bottomley, A. G.||Collindridge, F.|
|Awbery, S. S.||Braddock, Mrs. Elizabeth||Cook, T. F.|
|Ayles, W. H.||Brook, Dryden (Halifax)||Cooper, John (Deptford)|
|Bacon, Miss Alice||Brooks, T. J. (Normanton)||Corbet, Mrs. Freda (Peckham)|
|Balfour, A.||Broughton, Dr. A. D. D.||Cove, W. G.|
|Barnes, Rt. Hon. A. J.||Brown, Rt. Hon. George (Belper)||Craddock, George (Bradford, S.)|
|Bartley, P.||Burke, W. A.||Crawley, A.|
|Bellenger, Rt. Hon. F. J.||Burton, Miss E.||Crosland, C. A. R.|
|Bernn, Wedgwood||Butler, Herbert (Hackney, S.)||Crossman, R. H. S.|
|Benson, G.||Callaghan, L. J.||Cullen, Mrs. A.|
|Beswick, F.||Carmichael, J.||Daines, P.|
|Bevan, Rt. Hon. A. (Ebbw Vale)||Castle, Mrs B. A.||Dalton, Rt. Hon H.|
|Darling, George (Hillsborough)||Jones, David (Hartlepool)||Reid, William (Camlachie)|
|Davies, A. Edward (Stake, N.)||Jones, Frederick Elwyn (Weal Ham, S.)||Rhodes, H.|
|Davies, Harold (Leek)||Jones, Jack (Rotherham)||Richards, R.|
|Davies, Stephen (Merthyr)||Jones, William Elwyn (Conway)||Roberts, A.|
|de Freitas, Geoffrey||Keenan, W.||Roberts, Emrys (Merioneth)|
|Deer, G.||Kenyon, C.||Roberts, Goronwy (Caernarvonshire)|
|Diamond, J.||Kay, Rt. Hon. C. W.||Robertson, J. J. (Berwick)|
|Dodds, N. N.||King, Dr. H. M.||Robinson, Kenneth (St. Pancras, N.)|
|Donnelly, D.||Kinghorn, Sqn. Ldr. E.||Rogers, George (Kensington, N.)|
|Driberg, T. E. N.||Kinley, J.||Ross, William (Kilmarnock)|
|Dugdale, Rt. Hon. John (W. Bromwich)||Lang, Gordon||Royle, C.|
|Dye, S.||Leo, Frederick (Newton)||Shackleton, E. A. A.|
|Ede, Rt. Hon. J. C.||Lee, Miss Jennie (Cannock)||Shinwell, Rt. Hon. E.|
|Edwards, Rt. Hon. Ness (Caerphilly)||Lever, Harold (Cheetham)||Shurmer, P. L. E.|
|Lever, Leslie (Ardwick)||Silverman, Julius (Erdington)|
|Edwards, W. J. (Stepney)||Lewis, Arthur (West Ham, N.)||Silverman, Sydney (Nelson)|
|Evans, Albert (Islington, S.W.)||Lewis, John (Bolton, W.)||Simmons, C. J.|
|Evans, Edward (Lowestoft)||Lindgren, G. S.||Slater, J.|
|Evans, Stanley (Wednesbury)||Lipton, Lt.-Col. M.||Smith, Ellis (Stoke, S.)|
|Ewart, R.||Logan, D. G.||Smith, Norman (Nottingham, S.)|
|Fernyhough, E.||Longden, Fred (Small Heath)||Snow, J. W.|
|Field, Capt. W. J.||McAllister, G.||Sorenson, R. W.|
|Finch, H. J.||MacColl, J. E.||Soskice, Rt. Hon. Sir Frank|
|Fletcher, Eric (Islington, E.)||McGhee, H. G.||Sparks, J. A.|
|Follick, M.||McGovern, J.||Steele, T.|
|Forman, J. C.||McInnes, J.||Stewart, Michael (Fulham, E.)|
|Fraser, Thomas (Hamilton)||Mack, J. D.||Strachey, Rt. Hon J.|
|Gaitskell, Rt. Hon. M. T. N.||McKay, John (Wallsend)||Strauss, Rt. Hon. George (Vauxhall)|
|Ganley, Mrs. C. S.||McLeavy, F.||Stress, Dr. Barnett|
|George, Lady Megan Lloyd||MacMillan, Malcolm (Western Isles)||Summarskill, Rt. Hon Edith|
|Gibson, C. W.||McNeil, Rt. Hon. H.||Sylvester, G. O.|
|Gilzean, A.||MacPherson, Malcolm (Stirling)||Taylor, Bernard (Mansfield)|
|Glanville, James (Consett)||Mainwaring, W. H.||Taylor, Robert (Morpeth)|
|Gooch, E. G.||Mallalieu, E. L. (Brigg)||Thomas, David (Aberdare)|
|Gordon-Walker, Rt. Hon P. C.||Mallalieu, J. P. W. (Huddersfield, E.)||Thomas, George (Cardiff)|
|Greenwood, Anthony (Rossendsle)||Mann, Mrs. Jean||Thomas, Iorwerth (Rhondda, W.)|
|Greenwood, Rt. Hon. Arthur (Wakefield)||Manuel, A. C.||Thomas, Ivor Owen (Wrekin)|
|Grenfell, D. R.||Marquand, Rt. Hon. H. A.||Thorneycroft, Harry (Clayton)|
|Grey, C. F.||Mathers, Rt. Hon. G.||Thurtle, Ernest|
|Griffiths, David (Rother Valley)||Mellish, R. J.||Timmons, J.|
|Griffiths, Rt. Hon. James (Lianelly)||Messer, F.||Tomlinson, Rt. Hon. G.|
|Griffiths, William (Exchange)||Middleton, Mrs. L.||Tomney, F.|
|Gunter, R. J.||Mikardo, Ian||Turner-Samuels, M.|
|Hare, John E. (Wycombe)||Moeran, E. W.||Ungoed-Thomas, A. L.|
|Hale, Joseph (Rochdale)||Monslow, W.||Usborne, H.|
|Hale, Leslie (Oldham, W.)||Moody, A. S.||Vernon, W. F.|
|Hall, John (Gateshead, W.)||Morgan, Dr H. B.||Viant, S. P.|
|Hall, Rt. Hon. Glenvil (Colne Valley)||Morley, R.||Wade, D. W.|
|Hamilton, W. W.||Morris, Percy (Swansea, W.)||Wallace, H. W.|
|Hannan, W.||Marl, D. L.||Watkins, T. E.|
|Hardman, D. R.||Moyle, A.||Weitzman, D.|
|Hardy, E. A.||Mulley, F. W.||Wells, Percy (Favertham)|
|Hargreaves, A.||Mulvey, A.||Wells, William (Walsall)|
|Harrison, J.||Nally, W.||West, D. G.|
|Hastings, S.||Neal, Harold (Bolsover)||Wheatley, Rt. Hn. John (Edinb'gh, E)|
|Hayman, F. H.||Noel-Baker, Rt. Hon P. J.||White, Mrs. Eirene (E. Flint)|
|Henderson, Rt. Hon. A. (Rowley Regis)||O'Brien, T.||White, Henry (Derbyshire, N.E.)|
|Herbison, Miss M.||Oldfield, W. H.||Whiteley, Rt. Hon. W.|
|Hewitson, Capt. M.||Oliver, G. H.||Wigg, G.|
|Hobson, C. R.||Orbach, M.||Wilcock, Group Capt CAB|
|Holman, P.||Padley, W. E.||Wilkins, W. A.|
|Holmes, Horace (Hemswortn)||Paling, Rt. Hon Wilfred (Dearne V'lly)||Willey, Frederick (Sunderland)|
|Houghton, D.||Paling, Will T. (Dewsbury)||Willey, Ostavius (Cleveland)|
|Hoy, J.||Pannell, T. C.||Williams, David (Neath)|
|Hudson, James (Ealing, N.)||Pargiter, G. A.||Williams, Rev. Llywelyn (Abertillery)|
|Hughes, Emrys (S. Ayrshire)||Parker J.||Williams, Ronald (Wigan)|
|Hughes, Hector (Aberdeen, N.)||Paton, J.||Williams, Rt. Hon. Thomas (Don Valley)|
|Hughes, Moelwyn (Islington, N.)||Pearson, A.||Williams, W. T. (Hammersmith, S.)|
|Hynd, H. (Accrington)||Peart, T. F.||Wilson, Rt. Hon. Harold (Huyton)|
|Hynd, J. B. (Attercliffe)||Poole, C.||Winterbottom, Ian (Nottingham, C.)|
|Irving, W. J. (Wood Green)||Popplewell, E.||Winterbottom, Richard (Brightside)|
|Isaacs, Rt. Hon. G. A.||Porter, G.||Wise, F. J.|
|Janner, B.||Price, Philips (Gloucestershire, W)||Woodburn, Rt. Hon. A.|
|Jay, D. P. T.||Proctor, W. T.||Woods, Rev G. S.|
|Jeger, George (Goole)||Pryde, D. J.||Wyatt, W. L.|
|Jeger, Dr. Santo (St. Pancras, S.)||Pursey, Cmdr H.||Yales, V. F.|
|Jenkins, R. H.||Rankin, J.||Younger, Hon K.|
|Johnson, James (Rugby)||Rees, Mrs. D.|
|Johnston, Douglas (Paisley)||Reid, Thomas (Swindon)||TELLERS FOR THE NOES:|
|Mr. Bowden and Mr. Delargy|
§ The Deputy-Chairman (Colonel Sir Charles MacAndrew)
§ Mr. Eric Fletcher (Islington, East)
On a point of order. Do you not intend to call the Amendment standing in my name, in page 1, line 15, after "to" to insert:persons engaged in remunerative full time work or to"?
§ Mr. Messer
I beg to move in page 1, line 16, at the end, to insert:or under medical treatment in any institution or in his own home.This is an Amendment to subsection (2) which says:No charge shall be made under this section in respect of any appliance supplied under the said Part II to a patient for the time being resident in a hospital.The intention of the Amendment is to break down the differentiation between people who may be ill in hospital, ill in an institution, or ill in a home of their own or anybody else's. I cannot see why, the accident of being in hospital, should make any difference to the right of the individual to get dentures, especially if they are needed as part of the treatment.
As the Bill reads at present, one need only be an in-patient in hospital and suffering from anything which may have no direct relationship to the condition of the mouth, to receive free treatment. It may be a gastric case, a hernia case or a long-term case. But the patient happens to be in hospital. Just because he happens to be in hospital, he can get his dentures free, no matter whether he is rich or poor, merely because he is a patient in hospital.
Everyone knows that there is a large number of people in institutions. They are not called hospitals, because there is no resident medical staff. I am thinking of the long-term cases. There are some hospital authorities who have done their best to conserve accommodation by taking out the long-term cases and putting them in separate institutions. Long-term patients can be ill in the sense in which we understand it, although they are not actually ill. If they are in a place that is not called a hospital, as I read the Bill they are not entitled to free dentures, but if they had been left in a hospital they would be so entitled. That seems 1276 to me not to harmonise. Indeed, I do not quite know how We define our hospitals. Is it the case that we are going to give patients who are in a National Health Service hospital these facilities; and a person who is in a disclaimed hospital facilities for dentures, but not facilities for other appliances?
§ Mr. Blenkinsop
There is no intention to give these facilities to disclaimed hospitals any more than the other appliance facilities which are available to them.
§ Mr. Messer
We have lawyers present, and I wonder how they would interpret the words of the Bill, when it becomes an Act, where it says, "patients in hospital." I realise the modification of Part II.
§ Sir Hugh Lucas-Tooth (Hendon, South)
Surely the hon. Gentleman has forgotten that the subsection contains the words: "Under the said Part II" which, I think, mean that it is only where the hospital itself can provide the service under the National Health Service that no charge can be made; in other words, unless there is a dental service or an ophthalmic service under the Health Act in that particular hospital.
§ Mr. Messer
The trouble is that so many people are anxious to interrupt me that I could not finish what I was going to say. I was about to say that there are National Health Service patients in the disclaimed hospitals, because, under the Act, a regional board is empowered to enter into contractual relations with a disclaimed hospital. If the regional board has a patient in a disclaimed hospital, then it can provide dentures; but if the patient in the next bed is not a patient under the National Health Service that person is not able to get dentures. I am pointing that out to show just how difficult this is.
I am trying to make out a case that where people are ill, no matter whether they are National Health Service patients or not, they are justified in getting this treatment. It is merely an accident that they happen to be in a particular hospital. Let us take the case of a patient in his own home. Why should it be the case that a National Health Service patient, in the sense that he is being treated by his general practitioner who cannot get 1277 him into hospital, should not have this benefit? Every attempt to get him into hospital meets with failure because he is not an urgent case. He may have an ulcer which is not perforated—if it were he would be in a dangerous condition and would be rushed off to hospital. He is in a gastric condition, and the doctor says, "You ought to have your teeth out. You want a new set of dentures, but I cannot get you into hospital; you will have to stay at home. I will arrange with the local health authority to provide someone to do your housework, but you will have to pay. If you go into hospital you do not have to pay the ward maid; she will do it for you. I will arrange for the district nurse to attend you, but you will have to pay. If you were in hospital, the nurse there would attend to you, and you would not have to pay. I can arrange for a dentist to come to see you, and you can have extractions and a new set of dentures, but you have to pay. If you went into hospital you would not have to pay."
I consider that whatever differences there may be between us, there is no justification for differences in treatment when we are ill, whether we are at home, in a disclaimed hospital or in a National Health Service hospital. It seems to me that if we are justified in saying that a patient in a National Service hospital should have dentures free, then a patient in all hospitals should be provided with the same facilities. I know that this is opening a very wide door. I know that it will make too great a demand on the Minister to expect him to accept the Amendment in full. I would be glad to know whether he can make some concession, so that no hardship will be imposed on people through no fault of their own.
It is our fault if we do not provide sufficient accommodation. Everyone knows that we have long waiting lists of patients who want to go into hospital. Everyone knows that there are people who are ill in their own homes and who ought to be in hospital. We ought not further to penalise them by saying, "Your condition is such that you should have dental treatment. Your condition is of the type that we cannot hope for an improvement unless you have all your bad teeth out and get rid of the poison in your system," and then deny them free dental treatment.
1278 It seems to me that this is a special case where the Minister might give attention to that possibility, even if he only goes so far as to say that where there is a case for the treatment of the patient dentures should be provided under the same conditions as they would be provided if the patient were in a National Health Service hospital.
§ 8.0 p.m.
§ Mr. Linstead (Putney)
I very much appreciate the difficulty the hon. Member for Tottenham (Mr. Messer) has pointed out, and I am hoping that one of two solutions will be adopted by the Minister. The first is to adopt the wide solution proposed by the hon. Member, and the second, which is the more realistic one, is to provide a much clearer definition of what is meant by "resident," which I take it the hon. Member for Tottenham had in mind.
This Clause deals with a particular group of patients and assumes that they are people who cannot afford to pay for their dentures and glasses, and that they should not therefore be put to the trouble of having to go through the National Assistance Board machine to get a refund. I should have said that the group of patients that are most clearly in that position are the long-stay chronic sick. When I first read the Clause, I assumed that it meant the long-stay permanent patient who is never to go out again and can be regarded as permanently resident in hospital.
The difficulty arises from the introduction of the words "for the time being." We find ourselves asking whether one night is sufficient, the night perhaps after a man has had his teeth out. Is that to be regarded as "resident for the time being" and sufficient, therefore, to qualify for exemption? I doubt whether such a person could really be called "resident." I should have thought that the only group of people who could be so regarded is the long-stay chronic sick.
If that differentiation is made by the Minister and all others fall into the general scheme of the Bill, with the right to apply to the National Assistance Board if need be, we shall know exactly where we are. Failing that, I do not see any way out but to draw the line where the hon. Member for Tottenham drew it, which means that anyone who is laid up, 1279 whether in a Ministry of Health hospital, a disclaimed hospital, or, for reasons beyond his control, is in his own home, should be entitled to this exemption. If the Clause is left as it is, it is bound to create a great deal of confusion.
§ Mr. Blenkinsop
The points which have been raised illustrate the difficulty that unavoidably arises when we try to exclude certain categories from the imposition of this charge. We have to face the fact that if we attempt to do it, even in cases which seem to be as clear as possible of definition, we inevitably give rise to certain very real anomalies. It is quite certain, whatever we do, that there will be real anomalies as between one category of case and another. It must be remembered that those people who do not qualify for complete exclusion will be able to apply to the National Assistance Board, where we should certainly hope their case would be given special consideration.
Let me explain the sort of case we had particularly in mind. We felt it right that we should attempt to exclude cases, chiefly long-stay cases, although not always necessarily so, where the provision of new dentures was a natural part of some fairly serious general treatment. Here, quite clearly, was a category of case that might be dealt with separately—such as cases in a dental hospital which might not be staying for a very long time but where the provision of dentures is an integral part of the whole treatment. We felt that on balance it was wise that they should be excluded. There were also the chronic long-stay cases, which have been referred to. We felt that the great bulk of this category, if brought before the National Assistance Board, would almost certainly fall to be excluded, and that this would relieve the National Assistance Board of quite a lot of work which otherwise might fall on them.
§ Mr. Leslie Hale
Will my hon. Friend state what it costs the National Assistance Board for an official to visit a house to investigate a claim of this sort? Am I right in thinking that the Clause applies only to people who apply for dentures or spectacles in hospital and get them while they are in hospital; or does it apply also to those who have applied for dentures or spectacles before going into hospital and 1280 get them when they are in hospital; or does it apply to people who apply for dentures and spectacles while in hospital and get them after they have left hospital?
§ Mr. Blenkinsop
It applies to those who are treated in hospital and get them while they are there.
The point that has clearly arisen is that it would be quite impossible to make this exemption cover the great range of cases which will be included by the proposal of my hon. Friend the Member for Tottenham (Mr. Messer). There will be no clear line of division at all in that case. I am not trying to argue that there will not be anomalies as between one type of case and another, and I am perfectly prepared to see whether any rather clearer definition would help—I am not ruling that out. If we were to extend the exemption in the way my hon. Friend proposes—and I think he understands himself what it would mean—anyone who happened to be under treatment, say, for a cold or something of that sort, would be able to be excluded.
I quite appreciate the intention and the desirability of trying to ensure that those who are treated in hospital receive similar treatment to those who take their treatment at home. There are cases where it may be very desirable that people should be treated at home who, if they go into hospital, will have a great deal of relief from charges for board and lodging and so on. I can see the desirability of avoiding any further special protection for patients who happen to be in hospital. I think it is putting the case a little too strongly to suggest that this is almost an invitation to people to take hospital treatment as against treatment at home.
§ Mr. Manuel
Did I understand my hon. Friend to mean that, where a patient has ordered dentures or spectacles and does not receive them because of delay in supplying them until after he has left hospital, he will be expected to pay for them, as compared with the patient who receives his dentures or spectacles while he is in hospital and does not have to pay?
§ Mr. Blenkinsop
I can only say that I am quite willing to look at the wording to see what we can do to meet what I know are very real anomalies as between one category and another. I would ask my hon. Friends to appreciate that, in 1281 making this provision in the Bill, we have tried to cover one category that can be reasonably clearly defined; and it excluded the great bulk of those who would otherwise fall to be dealt with by the National Assistance Board. I think that the advantages of this proposal outweigh any anomalies that may arise.
I ask the Committee to realise that people who do not qualify for this exemption will be able to make their application through the Assistance Board, who will take special account of that illness, as they have in the past in dealing with claims for assistance from those who are taken ill in their homes. My hon. Friends should remember that.
I have a great deal of sympathy with the point raised in this Amendment, but I think my hon. Friend the Member for Tottenham appreciates that we cannot accept it as it stands. We are certainly prepared to look at the position to see whether any easement can be made, and a clearer definition found which may avoid any difficulties which arise. I am not hopeful that it is possible to do so, but that does not rule out the fact that I am prepared to look at the matter. On that understanding, I hope my hon. Friend will be prepared to withdraw the Amendment.
§ Sir H. Lucas-Tooth
I interrupted the hon. Member for Tottenham (Mr. Messer) to ask him to what he thought was the effect of the words "under Part II." I had hoped that the Parliamentary Secretary would deal with that. As I understand those words, they limit the operation of the Clause to the case where the hospital itself is providing the particular treatment, either supplying dentures or spectacles. In other words, in the case of chronic sick in a home, which does not normally supply either dentures or spectacles the Clause is inoperative, and the normal provisions apply; that is to say, half the charges made, though in such circumstances the amount can be recovered from the National Assistance Board. I should like the Parliamentary Secretary to clear that matter up, because it is extremely important. We cannot come to any satisfactory decision as to the meaning of the Clause until he does so.
§ Mr. William Ross (Kilmarnock)
Would the Parliamentary Secretary direct 1282 his attention to this particular case. Surgical treatment is given in certain cases where people attend merely as outpatients. They then go into the hospital for actual operation, but while they are in hospital the specialist prescribes glasses, which they have to get. However, they are out of hospital by the time they get them. What is the position there?
§ Mr. Powell
At an earlier stage in these proceedings the hon. Member for Tottenham (Mr. Messer) accused me, in the first place, of faulty drafting; and, in the second place, of creating more anomalies than I removed. It seems to me that both those objections can be retorted with increased force against the Amendment which he has moved.
First, as has already been suggested by my hon. Friend the Member for Hendon, South (Sir H. Lucas-Tooth), he has failed to appreciate that the words "supply under Part II" govern not only the words in the subsection at present, but the words proposed to be added by his Amendment, so that only those persons would be relieved by it of the necessity for payment who were supplied in institutions or in their homes under the hospital service. There may be people under medical treatment in their own homes under Part IV of the Act; but they would not be exempt by this Amendment. I do not think, therefore, that his Amendment, as drawn, would produce the effect which he anticipates. It will only be extremely exceptionally, if ever, that appliances are supplied under Part II to persons under medical treatment in any institution or in their own homes.
I come now to the substantial point which I wish to make. I suggest that there are far more anomalies created than exist already; and there are certainly enough in the Bill as it stands. The object of the Amendment is, broadly, to cover additional cases where there must almost certainly be financial need, and where the need for an application of the means test can be practically eliminated. But it does not do that. What reason have we to suppose that a person in an institution, who is under medical treatment, is in greater need than a person in an institution who is not under medical treatment? He is in the same financial circumstances. He is also being treated for something 1283 other than his need for dental or ocular appliances. Thus neither his need nor his ability to pay differs one way or the other.
Take the case of a person sick at home. The Amendment does not say just "sick at home," but that the person must be under medical treatment. Yet he may still be earning, though under medical treatment in the sense of receiving a visit from a doctor. Thus we are creating another anomaly. What reason is there to suppose that a person under medical treatment in his own home is either in greater need to have his teeth extracted or less able to pay the cost of the dentures or for the spectacles? The whole thing dissolves into a series of anomalies.
The object, which the hon. Member has in mind, is one which I entirely share, but I suggest that it can only be achieved if, before this Bill becomes an Act, we can introduce into it a satisfactory method of securing as nearly automatically as possible that real financial need remains exempt from payment. If we do that, we shall have solved the difficulty which the hon. Member—if he will forgive me for using the term—is fumbling at, and we shall solve a lot of other ones as well.
There is just one other point I want to mention. The hon. Member may have drawn attention to a weakness in drafting. I suggest that there should be words included in the Bill to say that it is to be interpreted as one with the principal Act. There is no interpretation Clause in the Bill, nor is there anything which directs the reader to the interpretations in the principal Act. I do not think that Clause 5, as it stands, is adequate to do that, and I suggest that the Minister might be good enough to see whether for purposes of drafting, a provision that the Bill should be interpreted as one with the principal Act should not be inserted.
§ Dr. Morgan (Warrington)
I should like the matter cleared up, because I am very anxious about the position of a person who goes to the out-patients department. It may be that in a hospital the specialist prescribes glasses for a patient and there being no financial difficulty the patient gets his glasses. What I am concerned about is the out-patient in the hospital. As the Bill is drafted, he might quite well be penalised. I want to see every man who needs glasses able 1284 to get them. After all, the qualification for benefit is a man's need for spectacles. All other things to my mind are secondary, such as whether he is in hospital, an out patient or at home. The overriding consideration should be if some specialist says a man needs benefit and spectacles having been prescribed, he should get them.
The Amendment meets the case properly and clears up any difficulty for a person who gets treatment whether in an institution, at an out-patients department or at home. Such a person, provided he gets a medical certificate saying, first, that they are needed, and, second, that if there is any financial difficulty that can be overcome, should be supplied with spectacles or dentures. I support the Amendment and I hope it will be agreed to by the Committee.
§ Mrs. Braddock (Liverpool, Exchange)
I dislike the whole of the Bill, with the exception of the subsection on tuberculosis, but if we are to make some charge there should be equity in the matter. The situation, which must be within the knowledge of the Parliamentary Secretary, is that cases are selected for admission to hospital. Those who need attention early go in early, but there are many people, as there were under the National Health Insurance procedure during and before the war, who need hospital attention but who have to stay at home because there is no room in the hospitals, or because there are more urgent cases for the hospitals. If, because they happen to go to hospital, they are to receive spectacles and dentures free, there ought to be some way of securing that persons at home who ought to be in hospital, get equality of treatment.
I see great difficulty likely to arise in connection with this matter. A person will say: "I ought to be in hospital. The doctors, a specialist and the domiciliary visitor all say that I should be in hospital. The only reason I am not in hospital is because there is not a hospital bed for me." In those circumstances, is that person to be deprived of a medical necessity unless he makes the payment that is laid down? The Parliamentary Secretary must know, as I know as a member of a management committee and of a board of governors, that any number of people are on the waiting lists who are very ill at home. 1285 They cannot be brought in because there is not a bed available.
Surely we are not going to start a process of sorting out those who should be in hospital and those who should not be in hospital. The only way to deal with the matter is to withdraw the charges altogether. I believe they should not have been proposed. It is a very bad principle to begin charging on these lines. It will cause all sorts of difficulties and raise medical and financial problems.
§ Mr. Alport
I have only one small point to make in connection with the Amendment. I feel that the mover, the hon. Member for Tottenham (Mr. Messer), is trying to do what we also are trying to do, to ensure that those who need spectacles and dentures but who cannot afford to get them, or are in difficult circumstances, shall get the assistance from the community which those circumstances require and entitle them to get. His Amendment, as far as I can see, merely carries further the illogicality of the subsection. As drafted, the subsection provides that the only people it will help will be those who can afford to pay for the spectacles and dentures.
If a patient in hospital has been earning money but is no longer able to earn on account of his illness and of his being a patient in hospital, he will automatically become eligible for assistance from the National Assistance Board. Therefore, the only people who will acquire benefit from the subsection are those who are patients in hospital, resident for the time being who, because they have a regular income, are not dependent upon their employment, and can afford to pay for the dentures and spectacles themselves.
All of us regard with considerable sympathy those who have the misfortune to become ill and who have to go to hospital, but there is no logicality in giving the service free to a wealthy person who happens to be a patient in a hospital and not giving the service to one who is not a patient in a hospital but has a very much lower income. For that reason I do not support the Amendment.
§ Mr. Emrys Hughes
I hope that the Committee will listen to the long experience of the hon. Member for Tottenham (Mr. Messer) and will stand firm and not allow ideas from the other side of the Committee to infiltrate into our side. 1286 There are anomalies. Those which have been pointed out by the hon. Member for Tottenham are only a very small sample of what we shall inevitably meet if the Clause goes on to the Statute Book in its present form. We shall create all sorts of anomalies among people who go into hospital. Some will get their dentures and some will not.
What does the Minister offer us? Some vague, sympathetic phrases. He says he is not hopeful of getting anything. In the circumstances, we are entitled to think primarily of our constituents, and I say that it is our duty to our constituents to tell the Government quite plainly that we are not going to stand for these anomalies and that there is a very strong feeling, indeed among many people who understand exactly how the Bill will work out, in practice, that the time to stop the evil thing is now. The Committee are supposed to consider a Measure in detail in the real spirit of committee work. Like the hon. Member for Tottenham, I have sat for years on the committees of local authorities and I understand clearly the difficulty of the person who happens to be upon a finance committee or a public health committee.
Too often on the public health committee we have had to face the fact that the person who was terribly keen about economy from the statistical point of view had not begun to understand it when it was applied from the human point of view. It is almost 20 years since I sat on the County Council of Ayrshire and had to deal with problems of this kind. It was when economies were imposed by the Government in which I believe the right hon. and gallant Gentleman the Member for Kelvingrove (Lieut.-Colonel Elliot) was then Secretary of State for Scotland. They told us to enforce certain economies, and in considering those economies the purely financial aspect was taken into consideration and the human problems were forgotten.
That was a fight which I fought for many years on that county council. My hon. Friend the Member for Tottenham has all his public life been fighting these mean miserable economies inspired by the "phoney" economics and inexperienced social principles of people who believe stories of huge sums of money being wasted through Lascars obtaining 1287 and selling false teeth. Members opposite may not attack us directly, but they are infiltrating their insidious anti-social ideas into the public Health Service. I say, no; let us tell our Government that we are going to do our best to stand up for the people whom we represent and that we are not going to let them down.
§ Brigadier Medlicott (Norfolk, Central)
The statement which the hon. Member has made is an attack on the principle of the Bill rather than a Committee stage contribution. If his conviction is genuine, why did not he vote against the Bill last week?
§ Mr. Hughes
Because I believe that the provision for tuberculosis patients which is made in the Bill, is good. I think that the rest of the Bill is rotten and reactionary.
§ Mr. Leslie Hale
The hon. Member for Wolverhampton, South-West (Mr. Powell), who is always listened to with respect, showed a little less than his usual generosity in referring to this Amendment. The Committee are familiar with the fact that if one wishes to raise an issue of principle on a Bill as drafted, one has to draft one's Amendment in accordance with the Rules of the House; and the only way in which this issue could be raised is on the subsection on which it has been raised, which, as the hon. Member correctly said, refers to hospital patients only. Those of us who agree with my hon. Friend the Member for Tottenham (Mr. Messer) have made it quite clear that we would wish the whole principle to be extended to the sick—I would say especially to the chronic sick.
I do not wish to be controversial, but I intend to say one controversial sentence, which I think should be said. We had a discussion of two and a half hours on the question Whether we should charge a few pence to foreigners for teeth and spectacles. The Tory benches were full. I have kept a record of the attendance during the present discussion, in which we have been discussing the real question of one of the fundamental issues of the Bill as to whether the sick should be charged, and the attendance on the benches opposite varied for a long time from nine to five. It ought to be placed on record that that is the position.
§ Mr. Hale
I am sorry if the right hon. and gallant Gentleman has not understood, as I should have thought that everybody in the country has understood, that on this issue I am attacking the Government and intend to go on doing so. I asked my executive some weeks ago to accept my resignation as Member for Oldham, West, not on the issue now being debated, but on the whole re-armament programme. But I explained that while I remained in Parliament I should always vote for a Labour Government to prevent a Tory Government from coming in.
§ Lieut.-Colonel Elliot
Then I am sure that the hon. Member will realise how wrong it would be for us to intervene in what is now an internecine war between the Government and their supporters.
§ Mr. Hale
Then why do it? I am making my remarks to the Minister and, so far as I can, in a persuasive fashion. I have never attempted to deceive the House on this matter. I am opposed to the whole extension of the re-armament programme. I have made that clear to the Prime Minister, the Ministers concerned, to my own executive and, so far as a humble back bencher can do so, to the country. Therefore, I suggest that I should not be charged with any dishonesty in this matter.
I come to the Amendment. While I have been in this House, I have tried, I am afraid sometimes inefficiently, to call attention from time to time to the position of the chronic sick. That seems to me to be one of the greatest problems confronting the country. We are faced with the problem of overcrowded hospitals. Everybody knows the difficulty with which the Minister is faced. Everybody knows, of course, that this extensive re-armament programme in its way affects almost every sort of social service. One aerodrome with a bit of reconstruction could be laid out to accommodate sufferers, for example, from disseminated sclerosis and could be equipped with a scientific and research laboratory which might do much for the sufferers who have unfortunately for too long been almost deprived of hope.
1289 These chronic sufferers are the people who suffer most. So many things are allied to these diseases. Disseminated sclerosis, for example, usually affects the retina of the eye. Eye trouble, constantly changing eye trouble, is a constant factor of the disease. These sufferers do not have to go once and have a pair of spectacles and finish and pay whatever it is—27s. 6d. on the standard model. They have to go from time to time and it is a burden and a distress.
§ Mr. Hale
I appreciate that. Although the Amendment applies only to strict drafting to Part II of the Bill, of course we are trying to make the service available to the whole of the sick; and no doubt they do go to the out-patients department of a hospital and do come within the Clause even as drafted at the moment.
There are sufferers from Parkinson's disease, and such diseases as miner's nystagmus who need constantly to obtain treatment, and from diabetes and from that series which includes silicosis, anthracosis and, in my own constituency, the dust in lungs disease which we call byssinosis. These people are chronic sufferers and I think amongst the most serious sufferers in the country. My hon. Friend the Member for Gower (Mr. Grenfell) will acknowledge that silicosis has been recognised as an industrial disease for a long time, but byssinosis was the last to come in and all those who contracted it before have failed to benefit at all.
My hon. Friend will say, as I know he has to say—I know his wide sympathies would lead him to wish to agree with this Clause and I would not suggest that they would not—"Very well, they are probably on public assistance." That may be true. But the border-line, because we have to draw a line somewhere, is being drawn very low indeed. It is really being drawn to exclude those people who are suffering most.
If we take that principle one step further, let us have a look at the Bill, in terms, of course, of the particular Amendment we are now considering. Does not this discussion mean just this, that under this Bill we have provided that all those people suffering from extreme poverty will, in general, be 1290 accepted; but all the people on the border-line of poverty, for whom the National Health Service was really provided—and I am not excluding the poorer middle class—all those fall to be charged under this particular Clause as drafted and fall to be charged when they are sick, if not in hospital?
Let us consider what the Clause means, because my hon. Friend did not make his explanation very clear on this point. Supposing I am a person just out of the National Assistance scale and going into hospital with abdominal gastric trouble. The specialist says, "My lad, you must have your teeth out and have a fresh set." I say to the specialist, "That is all very well, but I know the delays there are in the dental services in Oldham. I know these things are not done very quickly. If I have my teeth out in hospital, and if you discharge me before the dentures arrive, do I have to pay for them or don't I?" We are entitled to an answer to that. It is a reasonable and important question, and I will give way to my hon. Friend if he will tell us whether I would have to pay or not.
§ Mr. Hale
Clearly that is a factor which affects a man very much when he is in hospital. He has not been drawing his wages. Little bills are growing up. The insurance is accumulating, and when he comes out of hospital he is faced with a much harder situation than when he went in. The rent has gone on, and so on, whatever his allowances. Has he to pay for these teeth, or has he not, if they have not been provided before he leaves the hospital? I should be glad if my hon. Friend would answer.
§ Mr. Blenkinsop
At the moment, as this Clause is drafted, it is clear that a man who did not receive his dentures while in hospital would not be covered. But that is the sort of point we would want to consider to see if there is any way of avoiding the sort of anomalies which inevitably arise. I have already said that we are willing to look at that type of case, though I have also said that I cannot give any assurance because often when one anomaly is remedied another is created.
§ Mr. Hale
That is true. That is why the Government should never have introduced a Bill of this kind. The whole Bill is full of anomalies from start to finish. I am emboldened at least to feel that my hon. Friend's assurance was just a little bit stronger. There were two negatives omitted which were in the assurance on the last occasion. But I do not want to score points. I know that anybody can score points. Wherever the line is drawn, there will be people above and below it. If there is a limit of three months, it is very hard on the chap with 92 days, or something like that. There always are anomalies.
One can point to the really silly business where a man is perfectly fit and orders false teeth, and is then rushed to hospital with a broken leg. Then he gets the dentures free. Really, there cannot be any reason behind that. The Government ought to consider these anomalies and see what can be done. I seek to make a concrete suggestion in the most friendly fashion, with no question of dissension. Indeed, between ourselves this is the way to deal with it: withdraw the Clause.
My hon. Friend did not deal with another point I put. I hope I am not flattering my own interventions when I say that it was an effective point. What does this cost? Every time somebody wants 27s. 6d. or 25s. for spectacles, if they are on the National Assistance or just off National Assistance, what does it cost to send to the investigating officer, to fill up a form and to write about it, then to write to the local M.P. and get the M.P. to write to the Minister? Then after a fortnight, the M.P. has to write again saying, "I have waited a fortnight for a reply. Can I have one?" Then the M.P.'s secretary has to inquire, "What about these spectacles?" Then the Minister, having written back to Oldham, or wherever it is, writes to the M.P. and says, "I have decided to grant this case; you can have your 25s." What does it cost? Administratively it may well cost nearly as much as it saves; certainly, it must cost a very large amount—an amount of wasted money.
No one is being hostile about this. They really are not. I certainly have never been hostile to the Budget or anything connected with it. I have never said 1292 a word about it. I thought that the Chancellor of the Exchequer, having to provide for an arms programme which I thought was quite unnecessary, did fairly well. But it is the job of the Committee to consider this matter. I wonder whether there is anybody in the whole Committee sitting here tonight who will get up and say, "I am really proud of this Bill, and I should like to see it go through"? Is there anybody who will get up?
§ Mr. Blenkinsop
Perhaps I might intervene now to deal particularly with the point made by the hon. Member for Hendon, South (Sir H. Lucas-Tooth). He raised the question of the application of this subsection to those who are in hospital. It would apply to any National Health Service patient in hospital, and not merely to any National Health Service patient in a hospital where there are special provisions for dental treatment as such. Of course, it would apply to all patients who required that dental treatment. I want to make quite clear that it will apply to any patient under the hospital service who is resident in hospital, whether he is there for a short period or for a longer one.
§ 8.45 p.m.
§ Mr. Blenkinsop
If the hon. Gentleman will allow me, I have already said that we appreciate that, in attempting to meet that category of case which appears to us to be rather more definable than other categories, it is inevitable that we should raise some very real anomalies. I have already said that I am very willing to look at this subsection to see if we can make the actual definition clearer, in order to avoid the anomalies which inevitably would arise in this sort of case, and also 1293 to see if some of the points which have been raised by hon. Members can be covered. I say again that inevitably, in trying to make this provision for the exclusion of certain categories, we cause certain anomalies, but I am afraid that the Amendment moved by my hon. Friend the Member for Tottenham (Mr. Messer) would cause even greater anomalies than those to be created by the Clause as it stands.
We always like to hear my hon. Friend the Member for Oldham, West (Mr. L. Hale), and we appreciate the point of view which he holds about this Bill and this Clause in particular, but earlier we had been discussing the question of charges and the way in which cases of hardship would best be met. We were broadly agreed that the National Assistance Board would provide the best means of trying to meet cases of hardship. We were attempting in this subsection to deal with a particular category, for which everyone knows we have a very real sympathy, to see if we could relieve the pressure on the Assistance Board. We appreciate the difficulty of doing this, but we are certainly prepared to examine the matter again to see if we can arrive at a clearer definition.
§ Mr. Messer
I am sorry to be the cause of so much heaving over my Amendment, but I realise quite well the actual position. The Amendment was put down for the express purpose of getting some such undertaking from the Minister. Without some alteration, the Bill is going to create difficulties. I know that my Amendment would also have created difficulties, but I should prefer those difficulties to the ones that will just fall on the people concerned. However, in view of the assurance of the Parliamentary Secretary that he will look into the matter again, I beg to ask leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ Mr. Ellis Smith
I beg to move, in page 1, line 16, at the end, to insert:or to any person whose gross income before deduction of income tax does not exceed eight pounds per week.I want to make it quite clear that I stand by the Labour Party's policy of a free Health Service, but, as this Bill has passed its Second Reading, we are bound, in Committee, to consider what we can 1294 do to improve the Bill, and to try to produce evidence to show the need for Amendments of the character of that which we are now about to consider.
This Amendment raises the big issue of whether there should be any charges at all, or, if so, at what stage they should be made. Before dealing with its merits, so that we may have this on record, I want to remind the Committee of Labour's real policy. I would quote from a letter which most hon. and right hon. Members on this side have received from the Socialist Medical Association, dated 23rd April, It states:We would remind you that the Labour Party first accepted the idea of a National Health Service in 1934 and has never departed from the principle then laid down that it should be free from all economic barriers. The present proposals will hit the poorer sections of the community, and if any money is produced it will be at a cost in human deprivation and political repercussion that will be greater than the amount gained.I will satisfy myself by reading that extract, though it would have been of assistance if I had read on even further.
It should be remembered that we are still only in the transitional stage between the old medical service, which was chaotic, and the present service. We are only in the transitional stage between the old form of hospital management and the more scientific form of hospital management which we are now in the process of building up. If any hon. Members do not accept that, I have only to refer them to paragraph 72 of the Civil Appropriation Accounts for this year in which similar statements are made. On the other hand, if that line of reasoning is accepted, then it means that attempts are being made in this Bill to alter the Health Service even during this transitional stage.
In my view, the Chancellor of the Exchequer might have waited for the results of the new budgetary system and for the completion of the transitional period before making changes of this character. In addition, the Civil Appropriation Accounts for this year state that a new budgetary system is being introduced with closer controls, that monthly statements and costs analyses are being asked for, that a uniform system of costing is being made, that the payments made to dentists, opticians, and other professions are being reviewed, and that the cumulative effect of all these suggestions 1295 will mean a considerable saving in the Health Service by the end of this year.
Therefore, in my view, this Committee ought not to accept the suggestion of payments being made, in what was a free service, until the suggestions made in the Civil Appropriation Accounts have been carried out and the proposals made by the Auditor-General have been considered. It is now proposed in the Bill that charges should be made for dentures and glasses, and those of us who have some experience of this kind of thing are bound to say, "Dentures and glasses today: what next?"
§ Mr. Smith
What I am trying to do, Sir Charles, if you will be good enough to glance at the Amendment, is to produce evidence to show, first of all, that the charges being made ought not to be made until the various suggestions I have mentioned have been carried out, and, further, that there is no need to charge even a penny for glasses or dentures for any person receiving a gross income of less than £8 a week.
Those of us who have had some experience of this kind of administration cannot forget that once a start is made down the slippery slope it is only a matter of time before other excuses are made. There is this excuse today, there may be some more next year and some more afterwards perhaps, when another political party is holding greater support than it is at present. This is the thin end of the wedge. Hon. Members have only to remember how anomalies in insurance were dealt with—another example of this kind of legislation.
Some of us have spoken on scores of platforms throughout the country and right hon. Gentlemen have spoken on the wireless rightly taking pride in Britain's free Health Service as setting an example to the whole world and putting at the disposal of the poorest in this country the same kind of service as was available to 1296 the rich. A proposal of the character now before us ought never to have seen the light of day as one being made by the Labour Government. I am urging on the Committee that democracy should express itself. Democracy can express itself, within limits, on this Committee stage——
§ The Deputy-Chairman
Instead of dealing with the Bill I think the hon. Member should deal with the Amendment.
§ Mr. Smith
Does anyone deny that the proposals for making charges on glasses and dentures are being made to save money? I understand that the purpose is to save £25 million. [HON. MEMBERS: "Thirteen million pounds."] In a full financial year the purpose is to save £25 million while we are embarking upon an expenditure of £1,500 million in one year for war purposes. The total cost of the National Health Service is £398 million. The Chancellor puts on a ceiling of £400 million. He might have given a warning first of all to the Ministry that——
§ The Deputy-Chairman
I would most seriously ask the hon. Member to keep to the Amendment. He is really going very wide.
§ The Deputy-Chairman
Certainly, the Amendment seeks to exclude people 1297 whose gross income is £8 a week and less. That is really all that is before us at the moment.
§ Mr. Smith
Thank you. Under the old system millions in this country, including myself, were members of approved societies. Those who were members of approved societies and who received maximum cash benefits and maximum non-cash benefits received optical and dental treatment free. The point I am making is that it is most unfair for the Government to rob us of the millions of pounds that were paid into National Health Insurance. The reserve funds of National Health Insurance were taken over by the Ministry of Health and the National Insurance Fund was taken from the approved societies.
Most of the people who are keeping things going in this country, such as miners, engineers, and industrial workers in particular, have been paying for 10, 20 and 30 years into approved societies, and now they find themselves being charged for glasses and dentures. I ask the representatives of the Government to reconsider this matter before we part with their proposal.
On an income of £400 a year, a married couple pay £29 10s. in Income Tax. After deduction of tax and insurance, this income becomes approximately £7 a week, and today there are millions in this country receiving less than £7 a week. We on this side of the Committee have been so spoiled in life as a result of our experiences that we feel bound to take a reasonable line and propose a limit of £7 a week net. As I say, many people were members of approved societies. Is it right that they should be charged?
Since it became known that it was our intention to move this Amendment I have received scores of letters, many of them indicating the terrible position of people. It would not be right to inflict extracts from these letters on the Committee, but I hope that many other hon. Members have been considering this proposal and that the Government are prepared to accept this Amendment. If they do not do so we ought to make quite clear what the democratically elected people's representatives think of their proposal. The Committee should agree to the Amendment.
§ Mr. G. Thomas
I support this Amendment because it will do something towards lessening the evil effect which this Bill is bound to have upon the people of this country. The Bill is based upon the means test principle. My hon. Friends and I have proposed a limit, and we say that no one with an income below that limit should be required to make a payment. We feel that we have suggested a figure which will give protection to the mass of the working people of this country, taking the average rate of wages earned at the present time.
Who are the people who earn less than £8 a week? I think that the railwaymen, many miners and manual workers in the main, and also young people who have not had a chance to establish themselves will be required to pay, and it may well be that in their poverty they will be unable to meet the cost of spectacles or dentures. No young person's sight should be allowed to deteriorate. As soon as the need is there, the treatment ought to be available. How proud we have been in the past in saying that nobody should go without essential medical treatment merely because his pocket was not deep enough. This Bill introduces the old principle by the very fact that it says that some proportion of our community shall be relieved of the payment altogether—and why? Because they fall below the very low line which is to be laid down as a target, as a deadline, by the Chancellor of the Exchequer and the Minister of Health.
I think of the old age pensioners, whose incomes are certainly well below £8 per week. I know that the Minister of Health has told us that they are likely to have their dentures and spectacles provided free, but I remember seeing piles of spectacles in Woolworth's in the city of Cardiff, and I have seen people walk in, try on a pair, take them off and try on another pair, then pay their money and walk out to hasten the days when they would walk in darkness for ever. If there is not an adequate minimum level laid down in the Bill, that sort of thing can happen once again.
I want to tell my right hon. Friend that if he eliminates from the paying part of this scheme all those who earn less than £8 per week, it will not cost him much. Apparently that is a powerful argument with the Front Bench on this question. 1299 If the Minister of Health wants to intervene, by all means let him; but it is quite clear that the Bill has been introduced in order to save money. It is no good the Front Bench trying to run away from this. I find the entire proposal repulsive; I believe in a free Health Service, and my right hon. Friends must excuse me if I speak with more than usual indignation, for I know the people who will be hurt by this Measure, and they are not those who are comfortably off or well-to-do.
§ Mr. Gilbert Longden (Hertfordshire, South-West)
Will the hon. Gentleman tell me why he thinks that a Health Service which costs £413 million a year is freer than one which costs £400 million a year.
§ Mr. Thomas
It is a good job I was once a schoolmaster, because I believe that to explain simple arithmetic is within my capacity. Even the hon. Member surely is not as naive as he purports to be; he will know that money which has been necessary in the past to provide dentures and spectacles for our people is quite as necessary in the forthcoming year, but the amount is being reduced.
Let me give another illustration. I have a brother, two and a half years older than myself, and for years in the depression he was without teeth at all because he could not afford to pay for them. We are not ashamed to say it, because we know the people who imposed that dreadful system upon us and we know they are trying to bring it back again. That fellow—and there are plenty like him now—will be well under £8 a week maximum earnings. What we propose, therefore, in this Amendment, would be to do just the decent thing, apart from being in perfect harmony with our Socialist principles.
I know that some of my hon. Friends may say to me, "What are you going to do about the fellow who is earning £8 2s. 6d. a week—just over the line?" Unfortunately, since there is a means test at the heart of this Bill the same thing will happen to him under our Amendment as would happen to him under the Government's Bill, but it is far better for the fellow earning £8 2s. 6d. a week to have to pay than it is for the man earning £5 a week to have to find £5 in order to 1300 pay for a set of dentures. Let hon. Members remember that £5 is a small fortune to the chap who earns only £5 a week. It means months of saving, particularly if he has a family. Give him his family allowances as well, and add them on to his £5 or £6 a week, and still £5 is a small fortune.
Therefore, I say people who need these essential items will have to go without them if this Clause is not amended. I ask the Government Front Bench once again to remember the principle upon which we have always appealed to the people of this country, and that is—to each according to his need. It is in that spirit—[Interruption.] Yes, of course—and from each according to his ability. It is with that spirit in mind, and knowing the people for whom I have the honour to speak tonight, that I ask the Government to think again.
§ Mr. Carmichael (Glasgow, Bridgeton)
I hope my hon. Friends will not misunderstand me when I ask them not to press this Amendment. I am asking them that for a number of reasons. First of all, it has been apparent from the first word uttered on this Bill that if we had here a free opportunity there would be a very solid vote against the entire Bill. I am excluding the Government Front Bench, of course. The point that I want to make is that there is very strong opinion against the Bill, and my hon. Friends who have moved the Amendment are at one with us in opposition to the Bill.
However, if we introduce, as they do, a figure of any kind we are actually doing the very thing we have accused the Government of doing. We have said to the Government that as they have opened the door to charges, it is not likely that it will be closed again. As they have admitted the principle of charges, there will be no end to that principle. They have departed from the idea of a full and free medical service, and since they have done that, year after year—whoever may be the Government—the Government can bring in new legislation all the time to fritter away the entire service. That is what we are encouraging by this Amendment. I am not, of course, dealing with the Clause at the moment—because I hope to catch the eye of the Chair and to have an 1301 opportunity to deal with the Clause on the Question that the Clause stand part of the Bill.
My hon. Friends' case is forany person whose gross income before deduction of income tax does not exceed eight pounds per week.Of course, the breadwinner in the family can be earning £8 a week, but the mother who attends the youngster earns nothing. My hon. Friends are dealing with the earnings and only with people earning. I have no idea what will be the result of the Division, if there be a Division, but I do say that if we are against the Bill in principle, the Committee stage is the right stage at which to make our protests.
§ Mr. Carmichael
My hon. Friend is dealing with the persons with incomes, and I think that if he examines these words closely he will find that, much as he may assume he is dealing also with persons without incomes, he is in fact dealing only with the persons earning. Therefore, I say the Amendment deals only with a particular section of the community. That is the legal interpretation that would be put upon it, I think. We should avoid debating an Amendment of this kind when, in our opinion, we are opposed to the very principle of a means test of any kind.
§ 9.15 p.m.
§ Mr. Logan (Liverpool, Scotland Division)
I had not intended to speak in this debate, but I cannot in conscience fail to add my voice in pleading the justice of this Amendment. For 35 years, from the day the National Insurance Act came into force until it ended, I was a general secretary of an approved society, and during those 35 years, ending in July, 1945, I acquired a certain knowledge of the benefits people received under that Act. If ever there was a Measure which brought cheer and happiness to our people it was that one, with the medical benefits and appliances that were given under it. But had they not been given holus-bolus at first, there might have been justification in providing them piecemeal eventually.
This Bill will hit the poor, and more especially the very poor, and it is no credit to a Bill that it brings impoverishment. I think that the Government have the financial 1302 means to enable them to accept an Amendment such as this. We are not asking them to pay out the full amount, but there is a class of people requiring these benefits who are at present unable to pay for them. I contend that on the figures before us it is quite impossible for the families in the industrial areas to meet the charge for these essential things. I agree that we have not got very much meat to eat, but even so we want teeth. Although it might be argued that if the meat ration is to be less it is unnecessary to have teeth, that is not a good thing for our health.
I speak with no enmity. I have supported the Government and will continue to support them, but I know that this Amendment is just. I came to the House of Commons to speak my mind on matters concerning the people. What about the promises we have made? What about our position before the people? The tribunal which will eventually have to try us and come to a verdict want to know how we discharge our duties, and I want to be able to say, honestly and fearlessly, "We have done the best in the circumstances."
I do not agree with my hon. Friend the Member for Bridgeton (Mr. Carmichael) who says "We are out to get the whole lot." I know we shall not get it. Half a loaf is better than no bread. I hope the Government will understand the great feeling there is in the party about this. I have seen it and heard it during the last two or three weeks. Many of my hon. Friends may not feel inclined to vote for the whole Measure and in this Amendment we have a pacifying and ameliorating device, and I hope the Chancellor will be able to agree that the expenditure which would be involved by accepting this simple Amendment can be met within his Budget.
I do appeal sincerely to the Front Bench to consider this matter. I am no wrecker. I have never taken any part in trying to wreck my party, but the party must realise the cry of those who are not able to make ends meet. It is our job to alleviate want and distress, and I am convinced that we are doing our duty tonight in asking for the Amendment to be accepted by the Committee.
§ Miss Jennie Lee (Cannock)
I have very great sympathy for the motives which have led some of my hon. Friends to put 1303 down this Amendment. I think that they feel, like many others of us, that this is a mean, cruel, little Bill, and that by this Amendment, at least, we make it a little Jess mean and a little less cruel. That is a tempting proposition to those of us who are Socialists. But perhaps we had better look at it a second time from the point of view put by my hon. Friend the Member for Bridgeton (Mr. Carmichael), who warned us that what we are doing here is raising the sights a little bit and still putting in a means test.
What has struck me in my correspondence during the last week or two—and I have had very heavy correspondence on this matter—is that the actual charge factor is a very much bigger thing than lots of people, even some on this side of the Committee, have taken into account. It is more and more difficult as people grow older. It is the older, poor folk who require their eyes seen to and who require dentures most. Therefore, it is not enough simply to say that we are ashamed of this Bill because of the principle; it is also a very definite material burden.
I ask my hon. Friends who moved and supported this Amendment to think of the effect of all this on our proud people. A typical letter which I have received is from a mother. She says:You remember the struggles when your family were trying to send you to college. My girl is going off to college in a short time. When I work things out I can say that at the most I have £5 to cover housekeeping, clothes, and everything. What is going to happen to me? I was very proud of this Bill. I did not want to be among the first of those rushing into the dentists and rushing in to get spectacles. Because I have been a Labour woman all my life and have been through the mill I thought it was right for me to stand back and wait a little longer. What do I do now.Can I tell her to go to the National Assistance Board? We have told our people that we have abolished the Poor Law. We tell our people that they need not be afraid to go to the National Assistance Board because they are getting only what is their due. We know perfectly well, whether our roots are in Wales or among the proud, dour people of the North, or the Midlands or the South, that our folk do not like to go and tell all their private affairs to public committees. They do not like this sort of thing. They do 1304 not like to go juggling on the end of the razor trying to make out whether their income is £8 or a little bit below or a little bit above. How many people, both old and young, of those who need their eyes and their teeth seen to are just not going to bother, especially the older ones?
Therefore, I say to my hon. Friends that I have complete sympathy with the sense of shame which has made them bring in this Amendment; with their effort to make the proposal a little less cruel. But do let us be on our guard. Do not let us lend ourselves to this means test principle. We must still hope to educate some of our colleagues to the importance of sticking to Socialist principles. If we can do that, I think that we can aim at something higher than the Amendment.
The Secretary of State for Scotland (Mr. McNeil)
I hope and believe that not all of my hon. Friends will think I am without sympathy or compassion if I do not go back over the painful discussions we had on Second Reading. I do not mistake the feelings of my hon. Friends, like my hon. Friends the Members for Stoke-on-Trent, South (Mr. Ellis Smith), and the Scotland Division of Liverpool (Mr. Logan) and many others who have already spoken on this subject. They used language we all quite clearly understand. They said that they "did not feel inclined." They talked, as my hon. Friend the Member for Cardiff, West (Mr. G. Thomas), did, of "revulsion." All that we understand.
We tried to offer reasons during the Second Reading why we have taken this step, and we tried to explain that this step would certainly not be directed against people who were badly ill or urgently suffering, but on those whom we felt could best carry the strain. We gave our reasons why this amount had to be found, and we pointed out—I know that my hon. Friend the Member for Cardiff, West, did not mean to mislead anyone—that the cost of the health services in the on-coming year had, apart altogether from this, been extended by some £7 million.
I am grateful to my hon. Friend and for the straightforward way she puts her argument. I appreciate the point that she makes. But despite the present situation, we are extending such essential services, apart altogether from the Switzerland experiment, as the number of beds for tubercular patients.
We are discussing this Amendment which has been sincerely offered by my hon. Friend. It suggests without qualification that a person having a gross income of £8 per week or less should not bear the charges contained in the Schedule. I want to make it plain that this will not deliver us from the necessity of applying a needs test. The essence of the Amendment is that the needs test should be applied. But what justification is there for this test, as against the other which has been offered in the Bill?
I think that on reflection my hon. Friend will agree it is not a test which stands up in equity, nor is it a test which can be easily applied administratively. The figure of £8 per week in the context of my hon. Friend's speech reads fairly well; but if we are going to say that it is proper that a man married with a family not earning or not having a gross income, including his family allowance, of more than £8 a week should be exempt from charge, then it will be difficult to understand the reason why we should excuse from charge a young man, 18 years of age with no responsibilities except walking a girl out, and still earning £8 a week. I do not make the point from a debating angle. It is much too serious a subject for that, but it is an illustration of how difficult this would be to operate. Moreover it is very difficult to understand upon whom the responsibility will lie for ascertaining how much the patient seeking teeth or spectacles is earning gross per week.
§ Mr. Ellis Smith
That is easy enough. My right hon. Friend is sympathetically approaching this problem and I thank him. I should like to tell him that all of us who pay Income Tax obtain a statement from the Income Tax authorities as well as getting a code number. All that is needed is to produce the code number and statement to the optician or to the dentist.
Let us look at that, because it is sincerely offered. If the dentist 1306 is going to be excused the obligation to recover this money, and therefore, in turn is to recover the money from the Treasury, how does he satisfy the Treasury and to whom does he offer his satisfaction that the code number of Mr. A is so-and-so? It is very difficult. Have we any reason to expect that an overworked dentist—a dentist with quite a legitimate professional pride—is going to take very kindly to this business of looking at the code number and looking up the table we all get to see if the person is earning inside £8 a week? It is not very likely.
The real worry of my hon. Friends in offering this Amendment is largely taken care of in the Bill. My hon. Friend the Member for Cardiff, West, mentioned the old age pensioner. The old age pensioner, who has as his income a pension plus his supplementation, will be automatically excused charges of this kind. There is no doubt about that. That is the intention of the Bill. There will be people who will be moving up from that level who will still get exemption.
I am not saying to the Committee that there will be no hardship. That is nonsense. I am affirming that those people who quite understandably are the first and most important concern of my hon. Friends who offer this Amendment are taken care of. There will not be any kind of hardship visited upon the most hard-up of the community. Therefore, most reluctantly, I must on behalf of the Government oppose the Amendment, one, because I doubt if it is equitable; two, because it is administratively very difficult; three, because I affirm to my hon. Friends that these needy cases are taken care of in the present context of the Bill. I hope they will not find it necessary to press this Amendment to a Division.
§ Amendment negatived.
§ Dr. Barnett Stross (Stoke-on-Trent, Central)
I beg to move, in page 2, line 37, at the end, to add:(7) This section shall continue in force until the thirty-first day of March, nineteen hundred and fifty-two, and no longer, unless Parliament otherwise determines.The purpose of the Amendment is very clear, to put a specific term to the charges contemplated in the Bill. Every hon. Member on this side of the Committee, and perhaps in other parts of the Committee, is anxious to prevent any serious; breach of the principle of which we have 1307 always been so proud ever since the inception of the National Health Service Act. If a breach is to be tolerated, it should be only for a short time and should be closed as soon as possible.
I recognise that in this Amendment I have the sympathy of the Minister. I shall be very glad indeed if, when I ultimately sit down, the Minister will tell me what he has in mind, after my other hon. Friends have spoken. I wonder whether I might give one or two arguments why it is desirable to bring these charges to an end as soon as possible. Everyone will agree that the welfare and prosperity of our people depend, in this time of crisis, upon their productive ability, and one of the greatest factors in this is that they should be healthy physically and in every other way. I am not an engineer, nor have I had the experience of my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ellis Smith). He worked in one of the greatest industrial organisations in our country as a patternmaker, I believe. He will agree that, unless his eyes had been perfect, production would have been interfered with in a way that might have been a costly business. A small expenditure on the care of eyes could prevent the creation of flaws in great machine tools costing thousands of pounds.
The number of men and women who are trained or untrained in the country is limited. I believe that we have about 12 million men and women on whom we rely for industrial production. They bear the whole of our economy as it were on their backs, together with the managements who are associated with them. At present, we are scouring the world for machinery and machine tools. It takes more than five years to produce a skilled craftsman. We can produce almost anything in less time than it takes to produce a craftsman or a craftswoman for any specific purpose. Any damage that we allow to be done to the physical equipment of our workers means that we do damage to our economy.
We have always insisted that three phrases describe the type of Health Service that we have always wanted and which we consider we must have. One phrase is that it is comprehensive, another that it is really freely available and the third is that we apply its benefits universally. In asking, in this Amendment, that 1308 we should put a term to charges for dentures and spectacles, I am asking for an assurance that we shall return to those principles completely.
Before the war we used to assume that we normally had about 800,000 people sick at any one time, and we used to think that if, by means of a perfect Health Service, we could, by prevention of and rapid cure in the early stages of disease, bring that number down by 200,000 we could help to pay for a large portion of the service we instituted. My view is that that is being done now. I think that the financial savings that have already been brought about by the Health Service which this country enjoys are considerable. They are not easy to measure, but I think they easily match up to what we are now asked to give up financially.
I do not think I need argue the pros and cons of why we do not think charges for dentures are a good thing. The arguments have been put before the House on Second Reading and I do not think I need mention them. I would, however, say that the fifteenth century Englishman had better teeth than Englishmen of today, and there are specific reasons for that. I refer particularly to the yeomen of England, who lived simply from the produce that was available from the land. The yeomen of England did not have much red meat to eat; they had the white meats of England. Some of us feel that there is almost nothing we can say in favour of these charges. Although there could be arguments in reference to dentures, there are virtually none at all in regard to spectacles. I hope that we may hear a little more of the virtues of the service rather than constant accusations about abuses.
As a medical man, I feel, from my modest experience, that no money we spend is much better spent than in providing the best possible Health Service that the country can afford—except perhaps money spent on food subsidies, particular dairy foods. I am sure that the right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) would confirm that; indeed, I think he said so today. I urge the Minister to agree to this Amendment. It may well be that he thinks that the term I have put into it, 31st March, 1952, is rather short. Some of my colleagues around me think it is too long, but we must all recognise that 1309 we face difficult times, and if my right hon. Friend has a counter-suggestion to make, and he feels that a period of two years would be easier for him to accept, I say at once that I will listen to his views with great sympathy.
§ 9.45 p.m.
§ Mr. Snow (Lichfield and Tamworth)
I have considered this Clause very deeply since the Bill was first tabled, and after a great deal of heart-searching I have come to the conclusion that, for the first time in my Parliamentary career, I must find myself in opposition to what I understand to be the policy of the Government Front Bench.
The reason for introducing some charge appears to me to be based, first, on the need to raise some revenue—and I will come back to that in a moment—and, second, on what I take to be predominantly the Conservative point of view, to prevent abuse. I cannot forget that during the war it was considered necessary by the nation to provide serving men and women with false teeth and spectacles on the charge of the nation. I cannot see why, if it was necessary to keep those men and women fit in war-time it should not be equally necessary to do so in peace-time.
I also have come to this conclusion that if I had any criticism of my right hon. Friend the Member for Ebbw Vale (Mr. Bevan) it would be that during the early stages of the introduction of the Health Service insufficient action was taken to keep an actuarial watch on the people responsible for the expenditure. Indeed, this afternoon we have listened to examples from the right hon. Lady for Moss Side (Miss Horsbrugh) of certain hearsay evidence about abuse——
§ The Chairman
Order! I must point out that this Amendment is a very limited one. It deals with the question of setting a time limit. It is not an occasion on which general observations should be made. There are other opportunities for making general observations on the Clause or the Bill as a whole, but this is not one of them. The only question is that of a time limit.
§ Mr. Snow
I am trying to keep to the point, possibly in a rather tortuous way. The time limit proposed by my hon. Friend is, I think, realistic and should give sufficient time for actuarial scrutiny and 1310 thereby obviate the necessity to raise these charges. In the speech we heard from the right hon. Member for Moss Side, we heard hearsay evidence about abuse——
§ Miss Horsbrugh
If the hon. Gentleman will look at the OFFICIAL REPORT tomorrow he will see that I began my speech by saying that our Amendment had nothing to do with abuse. I said there was no abuse. If we allow foreigners to have the service free, they have a perfect right to take it.
§ Mr. Snow
The Committee will also remember that the right hon. Lady quoted, from memory, from a letter which she received, I think, from America to the effect that we over here were "mutts" for providing the Americans with false teeth. Anyhow, we shall see by looking at the record in the morning. I am merely trying to say that we also have heard hearsay evidence about alleged extravagance in the Health Service——
§ The Chairman
The hon. Gentleman is getting very far away from the Amendment, and I hope he will return to it.
§ Mr. Snow
I am trying, and finding it very difficult, to show that I think the year proposed by my hon. Friend is a reasonable period. We should be able to prove, in that year, that administrative expenditure could be saved which would eliminate the necessity to raise these charges. If my hon. Friend is criticised for that particular period I would say that actuarially that should be quite sufficient, and I think that the evidence produced in the White Paper supports this claim.
We have heard stories and this, I think, illustrates my contention, about doctors in the early days who, egged on by their political friends, deliberately gave stuff away—such as surgical boots—which was quite unnecessary; and which has created in the minds of people who are impressing the minds of hon. Gentlemen opposite that there has been abuse. So it is some doctors who have given colour to that idea. I would therefore wish to support my hon. Friend and place on record that I dislike this whole Clause very much.
§ Mr. Marquand
It is true that the Amendment refers to the duration of the charges proposed by the Bill. I hope, however, that I may be permitted to say a few words about the purpose. I cannot help feeling that the purpose for which 1311 the Bill is intended is related to the length of time for which it may be necessary to keep it in operation. The principal purpose of the charges proposed is to make savings of expenditure, and not, as my hon. Friend the Member for Lichfield and Tamworth (Mr Snow) said, to earn revenue. The purpose is to make savings in these parts of the National Health Service—the provision of dentures and spectacles—to meet the rising expenditure on more important parts of the Service, such as hospitals.
I should like to say, in passing, that many of my hon. Friends seem not to have read the speech which I made on Second Reading, in which I explained as clearly as lay within my power that that was the purpose of the Bill. For that purpose, we have proposed charges representing approximately half the cost to the Exchequer of these appliances. If, during the currency of the Bill, the cost of these appliances declines, then, of course, we will lower the charges accordingly by use of the power conferred in Clause 2 (1). We will certainly do all we can to get those costs down while the Bill is in operation.
It would be out of order to do more than refer to the Motion on the Order Paper in my name which deals with the activities of dental manufacturers in this connection; but every method that can be used for reducing costs will be used. When we reach a later Amendment on Clause 2, I forecast that what we shall have to say then about any possibility of raising the charges under the Bill will prove satisfactory to hon. Gentlemen in all parts of the Committee.
§ Mr. A. Edward Davies (Stoke-on-Trent, North)
On a point of order. Is the Minister speaking to the right Amendment, because he seems to be dealing with the question of charges? The remarks of my hon. Friends were addressed to the date until which the legislation shall operate.
§ Mr. Marquand
As I said when I began, I find it difficult to dissociate the period during which the Bill should operate from the purpose which it is intended to fulfil, and I sympathise with 1312 my hon. Friend the Member for Lichfield and Tamworth, who had the same difficulty. It is difficult to see how the nation's general economic position can change during the period of one year, which is what is suggested in the Amendment. That sufficient change can take place in the general economic position of the nation during one year to enable us to cease to make the charges and to maintain the hospital service at the same time, subject to a maximum expenditure of £400 million, is, I think, impossible.
Nevertheless, I sympathise with the view expressed by my hon. Friends that we should afford an opportunity to review the position and to be sure, after a reasonable interval, that the need for the charges still exists. At the same time, we should take the opportunity then to consider questions which ought to be answered. For example, how far have the charges—after this period has elapsed—been beneficial in improving the Service for children? How far has any reduction taken place in that rather alarming figure of 61 per cent. for dentures which I quoted on the Second Reading of the Bill? Has there been any improvement in the numbers of school dentists? Have the charges imposed caused any hardship to anybody? How many persons have received payment from the Assistance Board? How has the cost of glasses and dentures moved during this time?
Has it been possible to vary the charges downwards? Have economies, in the meantime, been worked out to make it unnecessary to continue the charges? Above all, what of the hospital services? Is it possible to withdraw the charges at the end of that period and still maintain the hospital service, which is the prime purpose of the Bill? All these things need to be reviewed at a reasonable time after the passage of the Bill, when we have had a reasonable opportunity of considering the effects that have been produced in all the directions which I have indicated.
§ Mr. Marquand
I do not quite see the point of these interruptions.
1313 I was saying that there should be a period during which my right hon. Friend and I can be quite sure that we can maintain our hospital service. At the end of that period we should review the matter and look into the sort of questions that I have mentioned. I would say that experience of one year would certainly be too short for that purpose and I think that we should have experience of two full years of the working of these charges. I think that would be a reasonable period during which to measure the effects of the charges, and to see how far they have been beneficial in themselves, and also how hospital expenditure was moving, and whether any improvements in administration or any economies or reduced costs might make it possible to reduce the charges.
To make an Amendment of that kind in the Bill, it would be necessary to introduce a new Clause. I have no new Clause ready at the moment, but I would be prepared to secure the drafting of such a Clause as quickly as possible, and to present it to the House on Report stage.
§ Mr. Edward Davies
What the Minister has said is most hopeful to my colleagues and myself, who are most anxious that we shall not give the Government carte blanche to begin with a reduction in the hospital and health services, without feeling under an obligation, after a reasonable time, to come before the House and tell us what the position is and give us an opportunity of a full discussion.
We recognise that the date mentioned may be quite arbitrary, and that 31st March next year may be too early, but it is the almost unanimous feeling on these benches that great endeavours must be made to maintain this wonderful service. People do not go to the dentist because they like having teeth drawn; nor do they go to the optician because it looks nice to wear spectacles.
Some reference has been made to abuses, but I think we all paid attention to what was said by the hon. Lady the Member for Cannock (Miss Lee)—that there is another side to the story, and that many decent citizens have really held back to allow more urgent cases to obtain attention. We should relieve these people at the earliest possible moment by restoring in full, generous and wholesome terms, this first-class investment, and make it possible for people to have those essential 1314 basic things—good teeth and eyesight—available to them. We should regard these things not as a waste of money but as something ranking of equal importance with anything else that we have done in peace or war to make our nation healthy, wholesome and comparable with any other country in the world.
§ Lieut.-Colonel Elliot
The Minister has stated two things; first, he rejects the Amendment, and secondly, he proposes to introduce or to place on the Order Paper, a new Clause of which he has given no indication whatever, save that it will review certain things. Naturally, we must reserve our right entirely to see what happens when the new Clause is set upon the paper. As I understand it, the Minister gave no pledge of any kind even as to the termination.
§ Dr. Stross rose——
§ 10.0 p.m.
§ Lieut.-Colonel Elliot
Wait a minute. The Minister gave no pledge even as to the termination. He promised a Clause offering a review, but the review would not take place until two full years of charges had elapsed, and there was no pledge whatever as to what that review would do. On that, naturally, we say that we wait to see what the Clause is, because obviously it would be premature to pronounce on the proposal which the Minister has made to the House, especially when he says that he has not even the Clause before him.
§ Mr. Marquand
Perhaps I might make it clear that my intention is to bring forward a Clause on the Report stage which would have the effect of bringing the charges proposed in the Bill to an end in April, 1954.
§ Mr. Marquand
I have already explained to the Committee that the estimated savings between the coming into force of this Bill and the end of the present financial year would not represent the savings for a full year and would yield us only £13 million. In the following full year, we would hope to get £25 million. I am asking the Committee to regard it as reasonable that we should have that full revenue for two full years 1315 and that well before the end of that time the House should be given an opportunity to consider by affirmative Resolution whether it wishes to continue the charges. In other words, the charges would come to an end in April, 1954, unless before that time they were renewed by the House by affirmative Resolution.
§ Mr. E. Fletcher
Can my right hon. Friend clarify what he said, because some of us understood him to say that the matter would be reviewed after two full years. He then referred to March, 1954. But March, 1954, is nearly three years from now. What some of us on these benches were hoping the Minister would say was that the House would have an opportunity of reconsidering the matter in about two years from now, because, by March, 1953, the Government would have had an opportunity of considering the effect of the charges both for the year 1951–52 and also for the year 1952–53, which will be for nearly two years. Speaking for myself, I hope the Minister will be able to say that the Clause which he proposes to bring forward on the Report stage will be such as to enable the House to have an opportunity of reconsidering the matter as soon as possible after March, 1953.
§ Mr. Mikardo
On that point, may I say for my part that I would be willing to accept the date of April, 1954, as representing a fair two years' trial, if the Minister, on his part, were willing to accept two years' salary to cover the period between now and April, 1954.
§ Dr. Stross
I am quite sure that those of us who sit behind my right hon. Friend recognise that he has come some way, if not as far as we would like, towards meeting us. At least, that is my view. He recognises also that it is not enough to satisfy us completely by any means. Nevertheless, in view of the promise that he will bring forward a Clause and we can look at it again, I beg to ask leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ Motion made, and Question proposed, "That the Clause stand part of the Bill."1316
§ Mr. Manuel
Before we part with this Clause, I think we should have an opportunity of expressing the repugnance of those of us who feel very deeply about the proposed charges after the many speeches that have been made in the country boosting this free National Health Service. As I understand it, the position is that because of our commitments it is felt that there ought to be a ceiling to the Health Service. It is hoped to have a saving of £13 million by the proposed charges this year and of £25 million in a full year.
I think my right hon. Friend the Minister and the Cabinet, in arriving at this decision to save, have not taken full cognisance of what is happening in the service today. All the indications are that the volume of work is falling in the dental service. In fact, in the debate on the provisions of the Budget, my hon. Friend the Member for Wolverhampton, North-East (Mr. Baird), indicated there was a considerable falling off in denture work in the first quarter of this year as compared with last year. I know that my right hon. Friend the Secretary of State for Scotland does not accept this for Scotland. Nevertheless, it is true in London and we know there is some unemployment among dental mechanics in London. I believe that it is also true that there is a falling-off in the provision of spectacles.
Everyone of us on these benches has acclaimed the value of the free Health Service many hundreds of times in our constituencies and the country. I believe it helped to return every one of us to the House of Commons. I am the more certain of its popularity because the Opposition at the last election tried to cash in on it as something of which they had been in favour, despite the fact that they voted against every stage of it when the Act was brought into being. I am not concerned so much with that tonight. What I am concerned with is that this Health Service of ours has been hailed throughout the world as a great social advance and as a beacon which ought to be welcomed by all free-living peoples. It has been hailed as something which ought to be followed and it has increased our prestige in Britain to a considerable extent.
I want to deal with the equity of the proposed charges and I want to put to 1317 my right hon. Friend several aspects that appear to me to destroy completely the claim made when the Budget was introduced that the Government were sharing the Budget equally over all sections of the population. I understand that, under the Bill, these charges will not be applied to people in hospital. This in itself is not a good principle. I am against the charges completely, because immediately we start to try this sort of thing, we find that administratively it is quite impracticable to get any equity at all. Certain patients in hospital, because of the nature of their employment, continue to draw full salary; they are the higher income groups in the middle class. They will be getting free dentures and spectacles simply because they are in hospital, and they will not in any way be troubled by a 50 per cent. charge, while persons outside the hospital getting £5 or £5 10s. a week will have to pay. That is a complete anomaly.
The lack of equity is apparent. There will be a 50 per cent. charge to the person with an income of £5,000 a year, as there will be a 50 per cent. charge to persons earning £260 a year. There is no real equity at all. I am sure my right hon. Friend the Minister and certainly my right hon. Friend the Secretary of State for Scotland know that in every decent working-class home there is always a long list of necessities, and every working-class mother has to arrange her budget and arrange priorities in obtaining things which she wants in her home. She has to decide, when the money is available, whether she should spend it on a carpet for the fireside or curtains for the windows or something for little Tom or Jeanie, or dentures for herself. I am certain that the decent working-class mother—and I am sincere in saying this—will decide that she will do without her dentures or spectacles and that she will spend her money on other necessities in the home. It is no use talking in this debate about equity or having equal shares among the different sections of the population.
I am certain that the saving is going to be greater than my right hon. Friend has estimated, because if this sort of thing to which I have referred is going to happen, quite obviously there will not be the applications for dentures and spectacles from the decent working-class homes which otherwise there would have been, if it means choosing one thing as against 1318 another. Therefore, the saving is going to be much greater than my right hon. Friend has estimated, and time will prove whether I am correct or not.
I am very willing to support any drive against abuses in the Health Service, but—and I have been saying this for the past year in my constituency—if I have to take sides in this matter of abuses in the Health Service, I am not going to side against the ordinary working people, the patients. I am going to side against the professional class, whether doctor, dentist or optician, who are signing the certificates in the initial stages, for this is causing the abuse. I believe we could have a very considerable saving if we tightened up on the abuses which are happening with the connivance of the professional people who are virtually in control of this service.
We know that many of them are allowing their political hostility to colour their action in the profession. We have many good doctors, dentists and opticians and I give them all credit for helping to make this service a success and for viewing it entirely from a humanitarian point of view.
From that humanitarian point of view, I want to say something about the very best of our people. A considerable number of the very best of our people in my constituency, because of the volume of work and the difficulties experienced in the service, have not yet procured dentures and spectacles. They wanted the scheme to be a success and they felt that they should see the bulk of the outstanding work attended to before they made any call on the service. But they are now to be penalised; a charge is to be imposed on them.
I see a great danger in the introduction of these charges. I am well aware that if the Opposition had their way, they would go very much further than the charges outlined in this small Bill. In that connection I want to quote from a speech made on the Budget proposals by the right hon. and gallant Gentleman the Member for Leicester, South-East (Captain Waterhouse) who, as recorded in HANSARD for 12th April, 1951, said:If we can get an economy by an administrative act, is it not to the advantage of everyone who benefits from the National Health Service that that administrative act should be made? If there is to be a charge 1319 for teeth and glasses, is it not right and proper that there should be some charge for hearing aids? This is my personal view, and I go further than that. It would not be at all a bad thing if a small charge were made for consultations."—[OFFICIAL REPORT, 12th April, 1951; Vol. 486, c. 1273.]I do not think the Opposition would have an alternative to this proposal. Indeed, they would considerably worsen the service if they had an opportunity. I therefore appeal to my right hon. Friends to recognise what is happening and what infiltrations are now taking place into the social services. As I see it, we have brought this great service into operation and we have gained tremendous benefits for the working classes of this country; and I have always believed that when we gain something for the working classes, we should hold on to it and not give it away.
All my adult life I have been trying to build up this Labour Party. I started in Ardrossan against very great odds, and that little band of people who returned me as the first Labour councillor on our local council gathered in strength because of our agitation for better conditions. I appeal to my right hon. Friends to consider what they are doing here in introducing these charges. I appeal to them to have second thoughts and to concede that the principle is this—not that we should lose something, but merely that we have to find the money. And, after all, there is not a great deal in it when we remember the £4,700 million which is the total Budget demand for defence over the next three years.
§ Dr. Hill
I would make but one comment on the speech of the hon. Member for Central Ayrshire (Mr. Manuel). I should be the last to claim that the professions upon which the success of the Health Service depends maintain higher standards of honesty and conduct than other sections of the community, but it is to be deplored that time and time again, usually in irrelevant observations unrelated to the issue under discussion, opportunity is taken to make loose charges against the professional men and women who are working this Service.
§ Dr. Hill
The hon. Member could not have heard my opening observation. I do not deny for one moment that there are lapses in this set of human beings as there are in other sets of human beings. There is ample machinery for investigation and disciplinary action. Although I recognise that the hon. Member for Central Ayrshire subsequently paid tribute to the professional people, I remember his earlier remark—and the kind of remark we have heard time and time again—which was intended to smear some honourable professions. His criticisms should be directed against the Front Bench of his own side.
§ Mr. Manuel
I want only to ask the hon. Gentleman this direct question. As he agreed that I paid a tribute to the good people in these professions—all three of the professions—would he not agree that before there can be any abuse a professional person has to connive at it by issue of a certificate?
§ The Chairman
I hope hon. Members will keep off the subject of abuse. It does not arise here at all.
§ Dr. Hill
I beg your pardon, Major Milner. I was following a line that was laid open for me.
I want to put certain questions to the Minister before we part with this Clause. As I understand it, simply put, it is sought to save, in a full year, £25 million; £17 million on dentures; and it has been decided to plant the whole of that dental charge in one place—on the dentures. It is anticipated that in a full year the saving will be £17 million. Like the hon. Member for Central Ayrshire I have some doubts whether that will be the result.
Nevertheless, that is the calculation. It sets out to be a saving of one half and if we set aside what may result from the provision by patients of a half or £4 5s., whichever is the less—if we assume for a moment that it is one half, clearly it is envisaged that the expenditure on dentures will be £34 million in a full year; but the proportion that denture cost bears to the total dental cost, as 1321 the Minister has said, is 61 per cent. Is he, then, envisaging, as total expenditure on the dental service, some £56 million, less the £17 million which the patient will contribute? That brings us back to the present expected figure of £39 million as the total expenditure. Will the Minister therefore explain how the estimate has been made that there will be a saving of £17 million? On my calculation, proceeding backwards, as it were, from the £17 million, it assumes an expenditure by State and patient on the Service of some £56 million.
Secondly, how did the Minister arrive at the conclusion, looking only at the dental side, of planting the whole cost in one place, namely, on the denture? I suspect that he may have been influenced by the sort of music-hall frivolity that has gone on about the subject. I suspect he may have been influenced because he saw that 61 per cent. of the cost went on dentures, and therefore thought, "Slap the whole charge on dentures." The possibility of people having to pay up to £4 5s. seems to me to indicate that he might have raised the same amount of money if he had examined the dental service with some care and sought to apportion out, to distribute, if it had to be done, those dental charges.
I have been looking into some of the possibilities. I may be wrong in my calculations, for I can only make my calculation on the meagre material available, but I find that at present some £3 million is being spent on second sets of dentures, the first set having been obtained on the service. It is a remarkable fact that so large a sum of money is being spent on second sets of dentures. If we can sustain the position that the first set of dentures is provided without charge I should have much less compunction about charging for the second set of dentures, which follows in subsequent years. Would it not be wise to examine this question? Would it not have been possible to make an even larger charge for the second set of dentures, except where they really resulted from a badly fitting first set?
I should also like the Minister to make some observations on this consideration, which I put forward tentatively. I find that under the present system, where the teeth are removed the dentures can be 1322 put in immediately. In the old National Health Insurance days there was a requirement that there should be a wait of three months. Today, they can be put in immediately. Let me point out what is happening to some extent. Let no one misunderstand; there are aesthetic reasons why some people should have dentures immediately; but there are also clinical reasons in others why the mouth should, as far as possible, be left to drain and harden before any dentures are put in. Today, in many cases dentures are being fitted for £9 9s. 0d., excluding the cut, and owing to the fact that they have been put in immediately have to be relined, possibly twice.
§ Mr. Janner
Does the hon. Gentleman deny that the modern method of inserting new denture is one requiring them to be inserted without any delay at all? Is that not done by some of the very best dentists in the country?
§ 10.30 p.m.
§ Dr. Hill
It is not the routine modern method, for even modern surgery cannot persuade all injured gums to heal immediately. I am not seeking to make any party point here. I am describing what is happening. In many such cases a second set of dentures is necessary at the end of 12 months and—the Dental Estimates Board can give information on this subject—the cost amounts not to £9, but to £28, if that procedure is followed. I hope that no one will accuse me of making general accusations. I am saying that this is being done. No man can completely escape being conditioned by the circumstances, including the financial circumstances, in which his work is done; so I would say to the Minister that before he plants the whole of the cost on dentures, with all the inequality that involves, whether he has considered what I said in the Second Reading debate. If a man has three teeth removed in such a way that there is no necessity for a dental plate, nothing is charged; but if he is unfortunate enough to have three teeth removed from such a position in his mouth as to need a denture he has to pay.
1323 I suggest, first, that it was wrong to proceed only from a purely financial angle. If there have to be charges, rather let them be related to a careful examination of the Health Service as a whole. Second, if there have to be charges, why should they be planted on one kind of recipient of that service. Let it be worked out in relation to the whole of the information available to the right hon. Gentleman. One last point—and I hope that here I may not be accused of suggesting some further expenditure: if there is a further reconstruction of the dental service, I hope it will be possible to put the dental estimates work on a regional basis. At the moment, those who are responsible for the scrutiny of the estimates are at Eastbourne. They receive 300,000 estimates every day and the task of keeping some sort of grip on expenditure is beyond them. I will not weary the House with further examples. There is orthodontics, where there is high expenditure. Possibly this could be a specialist service rather than a general practitioner service.
What I should like to ask the Minister is how he got the result. Did he just look at the 61 per cent. and plant the whole charge there, or did he really examine the various elements going to make up the dental expenditure and ask himself how best to impose charges so as to place the least possible barrier between citizen and dental service?
§ Mr. Emrys Hughes
In the light of what the hon. Gentleman has said, how can he logically vote for this proposal?
§ Dr. Hill
I accept the need for some cuts. What I am now doing is criticising the way in which this particular cut has been imposed. If my speech is to be interpreted as an invitation to enter the Lobby against the Bill, I have heard many speeches today, full of anger and indignation, which have not culminated in opposition! I hope hon. Members will not lead me into party exchanges which I think should not obscure our objective examination of this subject. I 1324 hope the House will not substitute a slapdash, easy, inefficient way of doing something which we should have done more fairly, more equitably and more consistently with the needs of the patient.
§ Several Hon. Members rose——
§ Mr. Harold Davies (Leek)
I think the hon. Member for Luton (Dr. Hill) was actually giving way to me, because, I believe, he was courteous enough to say earlier that he would allow me to intervene after he had finished. I believe I am right in assuming that he gave way to me, and with your permission, Sir Charles, this is the point I wish to make.
§ The Deputy-Chairman
I was under the impression that the hon. Member for Luton had finished his speech.
§ Mr. Davies
Thank you. The Committee has listened with interest to what I consider an honest speech from the Opposition benches, but what I fail to understand is how it was that the Conservative Central Office sent out a Press release this week to the effect that, if I may use the term——
§ The Deputy-Chairman
I cannot see what the Conservative Central Office has got to do with Clause 1.
§ Mr. Davies
I will make it clear. I want to ask the hon. Gentleman how he could agree with the Press release which said, "Nye Bevan thought he could fight Communism with false teeth"?
§ Mrs. Braddock
I never expected to have to oppose any recommendation made by my own party. I did know that at some time, if, by some misfortune, the Opposition were returned as the Government, I should have to fight vigorously all the 1325 suggestions they might make for curtailing the Health Service. [Interruption.] I know that because of the pronouncements they have made ever since the Health Act came into operation, and before that. They have said that we did too much too soon. They have said we should have done all sorts of things before putting into operation a free Health Service, and I knew that I should have to make some attack on them if they were on this side of the House. I am, however, disappointed to have to make an attack on my own party for going back on the scheme as it was suggested, and for going back on the free Health Service. I am speaking with the full support of my constituency, and in full support of the attitude of my right hon. Friend the Member for Ebbw Vale (Mr. Bevan). The stand he has taken with reference to this Clause and this Bill is the correct one so far as this party is concerned.
I want to call attention to one or two points in regard to Clause 1. The people in my constituency have said all along that there have been people—not of the working classes but of the better classes—who have abused this scheme; who all along objected to the Health Service being put into operation and made up their minds that they would do things which would bring it into disrepute. [HON. MEMBERS: "Ah."]. I am giving the opinion of people in my constituency and their opinion is just as good as that of anybody else. Most of them are dockers, railwaymen, warehousemen, earning an ordinary wage and who, at the moment, have their wage increases restricted. They are the people who will have to meet the charge on dentures and glasses.
We have had long experience of this sort of thing. We have been unable to get dentures and glasses because we were unable to pay for them, and we have had experience of the methods adopted by the then public assistance committees in relation to the supply of dentures and glasses. Many of my constituents went without false teeth for years because they were unable to make any contribution towards the charges levied. Many of those people who are working today—in the main people who are earning an ordinary wage—will be the ones who will have to make this payment. I say that from the point of view of this party that is definitely wrong and goes back on the promises 1326 made when the scheme was put into operation in 1948.
I want to ask some questions and make some comments about the regulations in regard to the assessment, for £4 5s. is almost a week's wage to an ordinary working class family. How will these contributions be collected? Will they be collected on a weekly basis, and will the teeth be delivered when payment has actually been made or when a contract to pay has been entered into? In the main it will be the older people round about the age of 50–60 who will require these things. I can imagine some of these working class people saying, "I cannot possibly make a contribution of £4 5s. out of one week's wages, but I could make a contribution, if I am bound to pay it, of perhaps 2s. 6d. or 5s. a week." If this Clause is proceeded with, will any such arrangements be made?
I hope the pressure that will come from the people of this country will prevent this Clause being put into operation, but if it is operated how is the payment to be collected? If we say, "If you do not pay, if you go to the Assistance Board and they say, 'The amount you are earning or the income of your family is outside the amount so that we cannot allow you anything at all'"—then if they say they are unable to pay on other than a weekly basis, will some arrangement be made so that the minimum amount per week can be paid, and will the teeth be attended to or delivered before that payment is completed?
There is one aspect of this matter which does not surprise but interests me. That is, that there has been no opposition from the other side of the Committee on the question of this payment. That makes me more suspicious than ever of the attitude that is being adopted by my own Front Bench. I have always been taught in my Socialist days—[Laughter.] Of course, hon. Members opposite would not understand that. In my early Socialist days I was always taught by my mother that anything that the boss class thought was good for the workers was bad for them. I still stand by that, and the fact that the Opposition are supporting this Clause makes me more suspicious than ever, and more determined than ever that anything I can do on platforms throughout the country I shall do to prevent this Clause being put into operation.
1327 10.45 p.m.
I am making that statement definitely. I am saying that I shall not in any circumstances, on any platform in the country, say that these charges ought to be put into operation, because I do not agree with them. I say that they ought not to be levied upon the people on whom they will be levied. I do not want to make any comment upon the amount spent by hon. Members in different parts of this Committee, but I expect that very often they spend more than £4 5s. a week on certain things. [Interruption.] I know that it cannot be suggested that they are at any time the worse for the type of drink which the ordinary working classes take, but sometimes when I see hon. Members on the other side of the Committee, they look awfully peculiar to me.
§ The Deputy-Chairman (Colonel Sir Charles MacAndrew)
I must remind the hon. Lady that she is speaking on the Motion that the Clause stand part, and she must only deal with what is in the Clause.
§ Mrs. Braddock
I quite agree, Sir Charles. On the question of spectacles we are forcing people to do what we condemned so much during the Committee stage of the present Act. We are forcing them to go to the cheap shops which will be ready again to supply glasses for half a crown or three shillings.
§ Mrs. Braddock
The hon. Member must not tempt me to make any comment, because if I do it will not be a comment which will be creditable to him in any way. I can assure the Front Bench of my own party that we are tempting the ordinary people in the country who need glasses, and who will not be able to pay the prices which are suggested, to go to the shops which get the customers for this particular type of equipment at cheap prices. That is wrong. It is bad from the point of view of the people whom we are supposed to be looking after, and I hope there will be sufficient pressure to prevent this Clause being put into operation.
§ Mr. Hylton-Foster (York)
I only wish to get information, and that is the only 1328 reason I rise after these exciting exchanges. If I am the only hon. Member of this Committee who does not understand this matter, I will apologise to the right hon. Gentleman for wasting time. Quite apart from its entertainment value, why are we asked to approve of subsection (6) of this Clause? Unless I misread it, it does not work in justice or in common sense. It means, so far as I understand, that if one's eyes change, or if one needs a new pair of spectacles, one has to pay the charge; but if one takes one's glasses outside and stamps on them, one gets off without paying the charge for a new pair. Can that be right, or sensible? Can it be the desire of this Committee that that should be the result of this Bill? That, as far as I can see, is what this means. Does loss include theft, or does one have to pay if one's spectacles are stolen, but not if they are lost?
§ Mr. Messer
Is the hon. and learned Member not aware that at present an executive council is empowered to deal with cases of loss or damage?
§ Mr. Hylton-Foster
I am obliged to the hon. Member. My difficulty is that in the 1946 Act there was an arrangement for some body to make a decision. The hon. Member no doubt will recall that the wording used was, "If it is determined in the prescribed manner." That body decided whether replacement or repair was needed because of lack of proper care by the patient. If that provision were in this subsection, I should not be troubling the right hon. Gentleman for information.
Who is to decide? Is the responsibility to be upon the wretched optician to decide, or on the general practitioner? Who is to decide that the spectacles were left in the cinema, or that the woman stamped on them outside so as to avoid paying for them? In all sincerity, I ask for this information because before this subsection is agreed to, the Committee should be told why, in logic and in justice, it is there.
§ Mr. Douglas Houghton (Sowerby)
I wish to refer to the speech by the hon. Member for Luton (Dr. Hill) because it was spoken of by another hon. Member as an honest speech from the Opposition benches. I should have thought that, in any honest speech from the Opposition 1329 benches, we should have heard what the Opposition would do with the National Health Service if, unfortunately, the Opposition were in our place. The hon. Member for Luton said that he accepted the necessity for a "ceiling" on the expenditure on the service, but then said there had been a cut. To understand how there is a cut when the expenditure on the service is to be £7 million more than last year out of taxation alone——
§ Mr. Houghton
Whatever may be wrong with my arithmetic, there is a great deal wrong with the hon. Member's manners. I was trying to ask how can this be a cut when the expenditure in the financial year 1951–52 is to be £7 million more than it was last year on the Health Service, out of taxation alone, quite apart from the contribution expected from dentures and spectacles, which will add another £13 million to the resources, and so to the expenditure of the Service this year. That is not a cut.
§ Mr. W. Griffiths
My hon. Friend has heard, of course, that there is to be a charge for dentures and spectacles. Surely that is a cut of the services available to the people?
§ Mr. Houghton
I was referring to what the hon. Member for Luton has said about a cut in the Health Service, and I assumed, as I imagine most other hon. Members assumed, that he referred to expenditure. I think I have disproved that there is any cut in the expenditure on the service this year, and that the very opposite is the case. As for a cut in services, there is to be no cut whatever. What is proposed is a charge for certain appliances given. That is a very different thing.
The hon. Member for Luton referred to this as a "slap-dash proposal" in Clause 1. What has he to put in its place? He made some play with the idea that something could have been worked out more equitably and scientifically in order to meet the need for a "ceiling" on the service. Does he propose that there should be a charge for prescriptions? Would he have made a charge for hospital treatment? Would he have made charges for some other parts of the service—for medical attention or surgical 1330 treatment? He offered no concrete proposals in that regard.
He asked why this contribution had been centred on dentures and spectacles? The answer is that in the many debates we have heard on the principles of the Health Service in the past, and in the Beveridge Report itself, the question of levying some charge for appliances was regarded as especially distinguishable from a charge for medical treatment. There, I suggest, lies the principle of the charge on two of the appliances under the National Health Service. My hon. Friend the Member for Cardiff, West (Mr. G. Thomas), referred, in very moving terms, to young and not very well-off people who might find these charges a tax on their resources. It did occur to me, as he spoke, that he was perhaps forgetting that this is a charge for dentures and not for conservation work or for the treatment of oral diseases or——
§ Mr. G. Thomas
Perhaps my hon. Friend will remember that when I referred to young people, I referred in particular to spectacles and to the sight of young people not being allowed to deteriorate.
§ Mr. Houghton
I beg my hon. Friend's pardon. I said that my hon. Friend was referring to dentures, but the charge for spectacles is more modest than the charge for dentures. Some of my hon. Friends on this side of the Committee have been painting far too pessimistic a picture and I may say to them, with great respect, that I wondered, listening to some of their speeches, whether they are going to ask the electors to send them back here for what the Labour Government has done or for what it has not done.
§ Mr. Houghton
My hon. Friend says for what it ought to do. May I, in the context of the proposed charge under this Bill, just mention two important figures of the services rendered by the National Health Service during the comparatively short time it has been in operation? If my recollection is correct, 17,000,000 pairs of spectacles have already been supplied free under the National Health Service. [Interruption.] I stand corrected if the number is higher than that. I am now informed 22,000,000 pairs is the 1331 number. For the purpose of my argument, 22,000,000 pairs is quite enough. Also something like 6,000,000 dentures have been supplied under the National Health Service. Is not that something for the Labour Government to be proud of?
Is the pride of my hon. Friends on this side of the Committee in the Labour Government's National Health Service so quickly changed to shame? Is there anything shameful in a Labour Government having to face the grim realities of the situation in the world today? May I point out to hon. Gentlemen opposite that no Government before in the history of Britain has undertaken the measure of re-armament in peace-time that the Labour Government has had the courage to do.
§ Mr. Houghton
Yes, Sir Charles. Unhappily, it is the background to the world situation which brings us to this discussion. [Interruption.] I am sure hon. Gentlemen opposite find Britain's greatest crisis a matter for great enjoyment and hilarity. I assert that we should not be discussing Clause 1——
§ Mr. Houghton
—were it not for the grim necessity of adjusting our resources to the over-riding needs of re-armament.
§ 11.0 p.m.
§ Mr. Rankin (Glasgow, Tradeston)
Is my hon. Friend aware that the Minister made it clear in his speech that these charges were not being imposed as a consequence of re-armament but were imposed, in his words, as savings in one part of the service in order to protect the hospital part of the service?
§ Mr. Houghton
I am obliged to my hon. Friend for that intervention, but surely he realises—and I am sure that nothing the Minister said would dispute this—that the need for placing a ceiling on the expenditure on the National Health Service is due entirely to the great strain on our resources arising from re-armament. If it were not for that, there would be no proposal to fix a ceiling on the National Health Service at present. This proposal arises, therefore, 1332 Sir Charles, indirectly but very clearly from the measure of expenditure we have now to face on re-armament. That is the reason for the need to restrict, temporarily I hope, the total expenditure on the National Health Service, just as there must be some restriction on expenditure in other directions of essential importance in our national economy.
But this is nothing to be ashamed of, I suggest, bearing in mind that when we embarked on the National Health Service we contemplated an expenditure of something like £285 million and now, despite re-armament, despite all the difficulties which confront the nation, we are budgeting to spend £400 million out of our national Budget for the maintenance of the National Health Service this year. There may be grounds—indeed, there are grounds—for great regret for this necessity, but there are no grounds for shame, and those of us who are prepared to defend this regrettable necessity in present circumstances expect at least some understanding of the difficulties of the Labour Government from our hon. Friends. After all, they will also have to go to their constituencies and explain what the Labour Government have been doing and why——
§ Mr. Houghton
Since hon. Members opposite have no useful contribution to make to this debate, Sir Charles, I suggest that they should leave the Chamber and let us have our own debate. There are times when the vitality of any political movement depends on having these things fought out between ourselves. I make no apology at least for expressing my own mind on this, because I feel it is desirable that we should get this thing in balance. There will be difficulties and anomalies; I might almost say that this Bill and this Clause will have their teething troubles.
§ Mr. Houghton
In reply to that interjection, I might say that I am trying to see this straight. I am trying to see it straight in the context of the situation with which we are faced at the present time. I hope, notwithstanding the criticisms, misgivings and regrets that have been expressed from this side of the House, that my hon. Friends will not lose sight of the over-riding achievements 1333 of the Labour Government, and that they will look at this matter in its proper perspective, and represent to those who may not understand, why the. Labour Government has had to depart in these grave times from the principle of the National Health Service, to which it still adheres in principle. [Interruption.]
I am sorry if the necessity of departing temporarily from principles is not understood when the over-riding principle of survival—of defending ourselves against the possibility of aggression—is involved. I was about to conclude by saying that this proposal—[HON. MEMBERS: "GO on."] If hon. Gentlemen are so in accord with what I am saying, they can rise and continue the debate.
§ Mr. Houghton
I hope my hon. Friends will put this matter in the perspective of the Labour Government in this field of the National Health Service, and relate it to the many other demands made on our resources at present.
§ Colonel Stoddart-Scott (Ripon)
The hon. Member for Sowerby (Mr. Houghton) will pardon me if I do not follow him with regard to the principles and achievements of the Labour Government. I want to speak not so much about general national re-armament as about ophthalmic and mandible re-armament. The whole purpose of the Bill is to cut down expenditure on the National Health Service, and Clause 1 is the operative Clause for reducing the amount of money to be spent. Exception is made for the provision of dentures to patients resident in hospital. In the Financial Memorandum there is a reference to another Clause which provides spectacles free for school children. I want to ask one simple question. Does the provision of spectacles for school children include the provision of splinter-free spectacles? Prior to the National Health Service Act it was possible to get school children this type of spectacle. Since the Act came into operation it has been extremely difficult, and at times impossible, to get them. Is it the Government's intention to see that this service is available free for the school children?
§ Mr. Carmichael
I listened with some interest to my hon. Friend the Member for Sowerby (Mr. Houghton). I want to 1334 say at the outset that there can be no doubt of his honesty of purpose in criticising some of my hon. Friends. I equally give him credit for being an hon. Gentleman who has painstakingly examined many problems in this House in order to assist the Government in its work. Having said that in all sincerity, I regret that I must part company with him in his approach to this Clause. I should like to remind him that it is not necessary to advise us on these benches to go into the country and give this Government credit for the great work it has done. One of our great regrets is that, after having spent five years genuinely and sincerely justifying the conduct of this Government, a pettifogging, mean Bill of this kind should retard us in that work. That is our biggest complaint. The great majority of hon. Members on this side were frankly astonished when the Chancellor first made reference to this Bill in his Budget speech.
It has been argued that this encroachment on the National Health Service was first made by the Chancellor because of the desire to find a sum of money to aid in the defence programme. It was also said by a Minister that it had been done to put a ceiling on the Health Service. In either case I cannot see that there is any justification for it. If the only way we can co-ordinate our finances and economy in the spending of over £4,000 million—and over £1,000 million of that for armaments—is to encroach on the Health Service to the extent of £25 million in a full year, then I say it is a peculiar approach to a serious economic problem.
On the other hand, if we accept the view that this is an attempt to reduce the Health Service, then may I make the point that it has already been conceded that after two years the Minister will examine the working of this new arrangement? Surely the wise course would have been to make a complete examination of the Health Service before introducing any measure touching one side of it.
During the last five years we have been through very serious economic conditions. Largely because of the approach of the Cabinet, guided by the Chancellor of those years, we have surmounted serious difficulties—much more serious than this £25 million. I say that it would do no 1335 harm, even at this late hour, for those Ministers who are handling this Bill to take it back. They know full well that the great majority of hon. Members on this side are very disappointed indeed. I go further. I go to the length of saying that were the situation reversed, and were we on the other side of the House—[An HON. MEMBER: "You soon will be."] I am not so sure. We shall be here for a long, long time, and the longer we are here the less chance hon. Members opposite will have of coming over. If we had been on the Opposition side it would have been extremely difficult for back benchers to have contributed to the debate, because of the Front Benchers occupying the time arguing the case against a Government so mean and contemptible as to introduce such a measure.
I have had some experience of fighting for relief for the poorest of the community. I remember one occasion in the City of Glasgow when we kept the Tories 17 hours fighting against their attempt to cut the scales; but if one examines the economy of that period, and the rates in industry, they had a far better case for that encroachment on poor relief than our Government has now. Yet we fought it line by line. I would be doing a great disservice to the people I represent if I remained silent on an issue of this kind.
I have been reading the speeches delivered on the Second Reading, in Committee and on the Third Reading of the main Act, and I could quote many hon. Members on this side, some now in the Government, who warned the Committee and the House against the danger of any kind of means test being introduced.
§ Mr. Carmichael
No excuse is good enough to justify that. Why at this stage in our deliberations should we get the idea of a complete departure from principle? Two of the greatest social services introduced into this House were the Health Service, which is the envy of people all over the world who think about social progress, and the National Assistance Board, in spite of its anomalies and faults. In introducing the latter, 1336 the Minister told the House that we were bidding good-bye to the old Poor Law.
If we read this Clause carefully, we see it not only makes a charge, but provides for regulations to be made. In my view, we are not only departing from the position of a free Health Service but we are re-introducing a mean form of Poor Law. It is a retrograde step to apply this provision by regulation. We could amend, line by line, the scales of the old Poor Law, but when regulations come before the House they have to be accepted in their entirety. We do not know what the scales are to be and what test is to be imposed, and I am very unhappy about these regulations.
I should like to give this advice to the Government, if I may be permitted as a back bencher to do so. Last week I attended the Scottish Trades Union Congress, at which a resolution dealing with this subject was discussed.
§ Mr. Carmichael
I concede that if you, Sir Charles, read that report, you read wisely. I am concerned with indicating the views of the people on the charges made in this Clause, and I think it is right and proper, because we represent the great community outside, to convey the opinions of that community to hon. Members inside this House. Last week I met the most representative people of organised industry in Scotland. They expressed their views against these charges very strongly, so strongly that the chairman did not ask for a vote to be recorded. The opposition was overwhelming. I bring that to the attention of the right hon. Gentlemen on the Front Bench because I believe they take some notice of the attitude of the Scottish T.U.C., so much so that two of the best Ministers were at that Congress. I think the Government should consider seriously the attitude of the Scottish T.U.C. Therefore, I say that whatever may be our final decision when this Clause is submitted to the House, I shall go into the Lobby and vote.
§ Mr. Carmichael
I am making this point because I do not want people to say later that I did not oppose the Bill.
§ Mr. Carmichael
I am not afraid to answer that question, but I will do it later on. The hon. Gentleman is trying to disturb me. I want to make my point about my attitude. It would be a setback for this country if the Government were to go out of office, and I am not going to allow procedure to be responsible for my playing a part that would put the most reactionary people in politics into governing this country. That is my attitude and I do beg the Government to have another look at it.
§ Mrs. Castle (Blackburn, East)
The more this debate has continued, the more it becomes apparent that we are causing a great upheaval in the minds and hearts of our people for a small financial gain. I feel that by this Clause we are being asked to surrender what we believe to be an important principle, though we have not a clear idea what the financial gain is to be. I must say that I thought there was a great substance and relevance in the remarks of the hon. Member for Luton (Dr. Hill) when he analysed—[Interruption.] I am sorry, but I happen to think that this financial point, which is the main Government point, is one which must be examined if we are to be asked to make a surrender which might have a certain result. We are entitled to ask if that result would accrue, and I think some relevant doubt was thrown on the question by the medical observations of the hon. Member for Luton.
I am concerned to question the estimate which has been put before us, and I want to ask, before we leave this Clause, if the right hon. Gentleman who is to reply will say whether the estimate which was submitted to us in the Budget, was drawn up and made before this Bill was drafted in its present form? In other words, does this estimate, or does it not, take into account the loss of revenue which will result from all the exemptions from these charges which are allowed in the Bill—not only exemptions for people on supplemental pensions or supplementary assistance, or in the case of children, but also exemptions for people who are in full 1338 employment but who, under the Bill, can go to the Assistance Board and ask to be relieved of these charges on the grounds of need?
My right hon. Friend the Secretary of State for Scotland, when replying to a debate earlier tonight on an Amendment moved by my hon. Friend the Member for Stoke-on-Trent South (Mr. Ellis Smith), said he could not for administrative reasons accept the amendment giving an overall exemption for everybody earning £8 a week or less. I suggest that, as the purpose of the Bill is to save money, my right hon. Friend could not have accepted the Amendment on financial grounds because it would have defeated the whole financial purpose of the Bill.
If we look at the White Paper on National Income and Expenditure and try to analyse the income distribution of this country, although it does not show how many incomes there are of £8 a week or less, it does show how many incomes there are of £10 a week or less. If we make some rather rough and ready calculations of our own, I would say that something like 60 per cent. of our people are living on incomes of £8 a week or less. So that if the Amendment of my hon. Friend the Member for Stoke-on-Trent, South, had been accepted, the saving from this Clause as a result of levying these charges would not have been £13 million a year but nearer £6 million a year, because we should have found that we were exempting such a large section of people.
How many of us in this Committee would say that at present prices, an income of £8 a week is a princely income for a family man, an income on which he can disregard such items as £4 5s. for dentures for himself or his wife? I am concerned about the new and very far-reaching concession which the Government have promised us later in the Bill for exempting people in full employment who are estimated not to be able to afford these charges.
If that concession is to mean anything at all, and if it has not been allowed for in this sum of £13 million, then what we are discussing tonight is a vital question, for probably what we shall get in return for it is very fragmentary indeed. That is of relevance in this situation. If the sum we are to get is not £25 million a year but nearer £15 million a year, or 1339 less, is it worth while making all this upheaval, not only the psychological and emotional upheaval, but the administrative upheaval as well? Are we not selling this vital principle for very little indeed?
Great play has been made with the fact that our expenditure on the social services has been steadily rising. On the Second Reading of the National Insurance Bill the same point was made by the Financial Secretary to the Treasury, who contended that our expenditure on social services in 1945–1946 was £770 million, including the National Health Service and everything else, and that this had risen in 1951–1952 to an estimate of £1,550 million—practically double.
Everybody has the impression that this thing is clearly out of all control and becoming grossly unwieldy. But nobody has yet made the point in relation to that argument that at the same time our national income has not been standing still—our national income has been rising during this period. During that same period it has risen from £8,800 million in 1946 to an estimate for 1951 of £12,800 million, and the proportion of our national income spent on our social services, far from having doubled, has risen from 9 per cent. in 1946 to only 12 per cent. estimate in 1951. As this was the period during which we were planning to expand our social services in any case, we should naturally expect the percentage of our national income on this expenditure to increase.
Therefore I do suggest that we have rather been stampeded into this surrender of something which matters very much to many of us in this Committee. We have been stampeded by a false presentation of the figures, not so much from this side of the Committee, but insidiously in the Conservative Press and from the other side of the Committee the impression has been given of a great Gargantuan burden of Socialist expenditure. One would expect a community whose wealth is rising, whose production is rising, and whose industrial virility is growing, to be able to carry a greater burden of community services than a community which is shrunk and debilitated.
1340 I ask the right hon. Gentleman to tell us whether it is a fact that this estimate of the yield for this Clause is a hard and fast figure of £13,000,000 this year, and whether that figure takes into account this very important, and as far as we can see, indefinite concession, in the later Clauses—one of which we have not learned the details yet, and which, when we come to learn those details, may make all the difference to the financial picture.
I hope that none of my hon. Friends will think that I am hurrying the debate at all; that is not my intention; but I thought it better to try to deal with some of the points made, so far, in relation to the Clause. There were some small questions put to me. For example, the hon. and gallant Member for Ripon (Colonel Stoddart-Scott) asked whether unsplinterable glasses would be provided under these charges. The answer is, no. As I have no doubt the hon. and gallant Member will remember on reflection, they are not provided under the existing scheme. Any additional charge has to be met by the patient before spectacles of that kind are provided.
The hon. and learned Member for York (Mr. Hylton-Foster) asked about subsection (6) of Clause I, and made a point about the apparent impression, as he read the subsection, that if a man went outside and smashed his spectacles, he could have them replaced, whereas if, because of the change in the condition of his eyes, he needed new focal lenses, he would have to pay for them. The answer is simply that, as usual, the relevant provision in the principal Act still obtains; replacement will only take place where the executive is satisfied that the loss, was not due to carelessness or irresponsible conduct.
The hon. Member for Luton (Dr. Hill) put some more substantial points, in one of which at any rate, he was joined by my hon. Friend the Member for Blackburn, East (Mrs. Castle). I do not want to interfere at all in the pontifical, if courteous, way in which he gave professional opinion about the best clinical methods of supplying false teeth. If I understood him correctly, he thought there might be saving at that point. I, of course, have no professional knowledge of the subject, and I am glad to 1341 say that I have no experience as a patient, unlike my hon. Friend who interrupted him.
I am told that the dental profession is quite sharply divided on this point. There are people who argue, apparently with good reason, that for good dental reasons it is proper to supply dentures quickly after extractions. If I understand their reasoning correctly, they argue that in that fashion a better shape of the mouth is retained.
§ Dr. Hill
I am grateful to the right hon. Gentleman for giving way. A fair summary of opinion is that in some cases it is proper; in many, it is not. The point which I think I did not make clear is that the records, as I understand, show that in some dental practices every person fitted is fitted immediately, but in other cases, not. In a mixture of cases, that is the position, the expenditure in one being nine guineas, and in another, £27.
I do not expect the hon. Gentleman will anticipate that I should say other than I would accept a professional man's judgment as to what is the appropriate treatment; but it is not to be anticipated that by a Bill, or by any sort of legislation, we can attempt to tell a man how to do his job.
Then, of course, somebody would have to decide if the second set was a clinically justifiable procedure. I cannot pretend to know how that can be tackled.
The argument of the hon. Member for Luton really turned on the point: Was this a calculation or a guess? My hon. Friend the Member for Blackburn, East in this connection asked if, in estimating the income from the charges, we were taking cognisance of the exemptions provided for in the Bill. The answer is, flatly, yes. We have made a most careful inquiry and have had discussions about the people who must be expected to be exempt from any charges. There are children, pregnant women and nursing mothers, and people conforming to a standard of need to be assessed by the 1342 National Assistance Board. Those classes were all in our minds.
§ Mr. Mikardo
In the past, whenever there has been a change in the scales of National Assistance, we have always been told that it is virtually impossible to estimate what new numbers of persons would be "attracted"—that is the expression—by the changes in scales. How, in this case, can my right hon. Friend estimate how many "new" people will be attracted?
My hon. Friend makes a fair point. Can I precisely estimate how many people will fall into the standards of the National Assistance Board; the answer is that I cannot. But we consulted the Board, and this is an estimate based on the best advice, and given faithfully to us. I should estimate, in answer to my hon. Friend the Member for Blackburn, East that the yield in this year will necessarily be a little lower than calculated at the time of my right hon. Friend's speech because some changes have taken place which were not anticipated.
My hon. Friend the Member for Central Ayrshire (Mr. Manuel) made some assertions about the dental waiting lists which were given some currency on the Second Reading of the Bill. There are no figures justifying that assumption at all. The figures available for the six months ended March of this year for Great Britain show that there was no general perceptible diminution in the dental demand at all.
§ Mr. Emrys Hughes
Is my right hon. Friend aware that on this point, on the Second Reading of the Bill he gave figures arguing that during the first quarter of this year in Scotland, the figures were higher than they have ever been? These figures have been checked by the official figures last year and are simply not true.
I am not certain what my hon. Friend expects me to reply, but the figures are not only true and have been checked but are available.
§ Mr. Hughes
Now that we are on this point, is my right hon. Friend aware that in his statement on the Second Reading, he said there were 126,000 cases in Scotland in the first quarter of this year? He argued that they were the highest on 1343 record. Is he also aware that his own publication says that last year there were 307,690 cases? Is he aware that he has painted a very erroneous picture of the position in Scotland, and, I believe, has unintentionally misled the House?
I obviously do not want to be anything but on the most friendly terms with my hon. Friend but I am sure he will find no difficulty in dividing by four. The figures which I gave are for the first quarter of this year, and the figures he has quoted are the figures published for our annual return for last year.
The figures I gave showed throughout a rise, but I will give them again in case there is any doubt about them. I am just reading this as I go along, but I think my hon. Friend is here quoting all dental treatment for the current quarter. I think now we are happy as we understand each other. My hon. and very friendly Friend is quoting from the Department of Health's Report last year, and he draws my attention to the new cases treated in the January-February-March quarter last year. Of course, I was not quoting the new cases at all. I was quoting at the time the demand for dentures. It would be inappropriate to give the new cases for that quarter because only the demand for dentures came into the Bill we were considering.
§ Mr. W. Griffiths
I am sorry to interrupt my right hon. Friend, but I am looking at his speech on the Second Reading, and I see that he says:I should say that for the first quarter of this year, from January to March, we ran up to 126,000."—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 336.]But he says nothing at all about whether it refers to dentures or new treatment.
I am very sorry if I misled anyone. It would seem absurd for me to be discussing anything else but dentures when we were discussing a Bill dealing with dentures. I beg the pardon of the Committee and I hope everyone now knows what I was talking about. I would not, therefore, bore the Committee 1344 any further with figures except to re-affirm that the latest figures for last month alarmingly confirm our fears. The point I was trying to make in reply to my hon. Friend the Member for Blackburn, East, is that our estimate of savings for next year will be diminished by that increased demand.
The hon. Member for Luton asked me how these figures were made up. They are made up not on our estimates but on our last year's experiences, plus a feature at which we have to guess—the amount of the deterring effect it must be assumed such a scheme will have. But the figures represent a reasonable estimate, with that one factor borne in mind, and——
§ Dr. Hill
I am grateful to the right hon. Gentleman for giving way. It means that for next year he assumes a certain expenditure of £34 million, paid partly by the State and partly by the patient. If that be so, and if the proportion on dentures by comparison with the total cost remains at 60 per cent., he is anticipating a total expenditure of £56 million. That is the point that puzzles me.
I am still in difficulties. If I add a factor which I will call a deterring factor, that will explain the £56 million.
I anticipate that there will be a decline in the service. I am not attempting to deceive anyone at all. The hon. Member for Luton also asked why we had decided to place all this charge inside the dental service on dentures. With great respect, I thought that point was adequately, dealt with by my right hon. Friend the Minister of Health in the Second Reading debate. The reason is a simple one. It was that we did not want to charge for services—medical, dental or any other kind—which we might expect to fall inside the Health Service. We decided that the charge should be applied to appliances, and we did that primarily because we thought that the fairest way to get the amount of money we needed.
§ Sir H. Lucas-Tooth
Can the right hon. Gentleman say what is the extent of the deterrent effect which he expects from this charge? What is the number of the 1345 reductions which will be effected by reason of the charge being imposed?
Perhaps the hon. Gentleman will forgive me when I say I cannot offer him the figures off-hand. I will take an opportunity of furnishing myself with them and will let him have them. The other point I wanted to make about the dentures was that, as other hon. Members have pointed out, there may be discrepancies——
§ Mr. Rankin
Would my right hon. Friend give way? I followed him in his reply to the hon. Member for Hendon, South (Sir H. Lucas-Tooth) only with difficulty. I gather that he said he could not estimate the figure of those who would be deterred by the charges for using the service. If that is the case, how do the Government estimate the savings?
My hon. Friend must not think that this is so sinister, but rather that it is a little stupid. I said I could not remember the figure but that I would take an opportunity of making it available. Apart from the fact that it is a much more effective and just principle to apply the charge to appliances, it was also true that this was a service which was weak in some respects—weak because there were gaps in essential parts of the service which should be conserving teeth. We might reasonably hope that some part of that weakness would be reinforced by taking the pressure off the demand for dentures. Indeed thinking back, I recall having heard the hon. Gentleman using the same argument.
The main argument comes from my hon. Friends who are unhappy about the charges altogether. It would perhaps not be unfair to suggest that the case was summed up, and no doubt persuasively put by my hon. Friend the Member for Bridgeton (Mr. Carmichael). But I must suggest with respect that in some ways, for quite understandable and admirable reasons, he does get the picture a little out of perspective. I have known my hon. Friend for more than 20 years. I had the great pleasure of serving on the Glasgow Corporation with him. I have seen him at work. There is no one more expert, deft or compassionate, but when he kept up the Tory members of the Glasgow Corporation for 17 hours what 1346 were they doing? [An HON. MEMBER: "Praying!"] They do not have such a subtle device. They keep that for their devotions and not for their municipal performances. The corporation were proposing to take one shilling a week off the Public Assistance allowance for children. I think my hon. Friend will agree that is accurate.
§ Mr. Carmichael
That is partly true. They were making a cut on all the scales. In other words, they were encroaching on the standard of life of the people who were poor, and in my opinion this Measure does precisely the same thing to the lower paid worker.
Let us look at that, and I know that my hon. Friend will believe that I do so honestly, and he will not think me evasive. His reaction to such a proposal as taking a shilling a week off public assistance for a child is understandable, and always typical of our party. That attitude has not always been confined to our party, but are we really considering anything comparable here?
§ Mr. Poole (Birmingham, Perry Barr)
Would the right hon. Gentleman not admit that in the case of the lower-paid worker with a wife and one child, who has to pay £4 5s. for his dentures, that a shilling a week is being taken off the child for 85 weeks?
My hon. Friend has no right to assume that the lower-paid worker with one child, and certainly not the very lowly paid worker with one child, will be asked to meet the cost at all. I cannot be expected to answer for the Assistance Board—and I have no right to do so—but I ask the Committee to believe that we have looked at this very carefully, and where National Assistance scales are involved, and hardship, is caused, there will be no charge.
§ Mr. Carmichael
We accept the statement made by the Minister that where National Assistance scales are involved there will be no charge, but I submit that we do not know where it is proposed to start. Does it start with the railway porter earning £4 15s.? That is why we are opposing this Clause. We have no knowledge of what the Government intend to do.
Let me give my hon. Friend an approximate example. I have no right to speak for the Assistance Board, but I offer the example in good faith. A married man with two children, earning around five guineas a week, would not be expected to make any contribution to the cost of dentures. Let me take this argument a stage further. I have previously admitted that this scheme does mean hardship for some people. It is bound to. But I suggest to my hon. Friend that he considers a shilling weekly deduction from the children's allowance and puts that against the infrequent need for a man or woman to have a set of dentures. They are scarcely comparable.
§ Mr. S. O. Davies (Merthyr Tydvil)
Then what is the sense in it? Really my right hon. Friend must forgive me. This is the first time I have intervened in this Debate. What is the justification for giving the shilling with one hand, and imposing £5 as penalty, in violation of the principle on which the Health Service has been reared?
I shall not address myself to the principle. That was dealt with on Second Reading. The short answer is this; for the Health Service we are going to find in a full year some £25 million by these charges, and we think we have so arranged it that there will be no undue hardship on any person needing teeth or spectacles. My hon. Friend the Member for Liverpool, Exchange (Mrs. Braddock) made a vigorous and no doubt sincere speech, but the point she made upset me not a little. She is a member of the governing body of a most excellent teaching hospital. She says: "What are we going to do with the £25 million?" In a full year we are going to find the funds to run 50,000 beds.
Unhappily it has everything to do with it. If there were a free choice, if we could say we will have free teeth, free spectacles, and the bed extensions we want, then my hon. Friend would have a perfect case. But we cannot say that. My hon. Friend must ask herself this: whether, in existing circumstances, which she may not like, she is going to say to her associates, "There is 1348 no more for beds for tuberculosis. We are going to have a system of supplying dentures without charge."
§ Mrs. Braddock
Does not the right hon. Gentleman know that the board of governors has nothing whatever to do with tuberculosis?
§ 12 m.
The board of governors would have to say, "We are not going to have any more extensions, we are going to be denied apparatus, because we think it more important to supply dentures free."
My hon. Friend the Member for Central Ayrshire (Mr. Manuel) told us about the worry of his people. He will forgive me, I know, if I say that a fortnight ago I had the great pleasure of speaking with him in his division. I spoke, no doubt boringly, on this subject for an hour. There were questions afterwards, and there was not one single question on this subject. No one likes the charges. No one would seek to make them if there was a reasonable escape from them. We have tried to make them form a ceiling to the Health Service, while ensuring that undue hardship is not felt by anyone. I submit to the Committee that the Clause as it stands does that.
§ Mr. McGovern (Glasgow, Shettleston)
I certainly intend to vote against this Clause tonight if it is not withdrawn. I am not accepting easy assurances in regard to the proposals to meet the charges in this Clause, because I realise that in politics once a change is made it is a tremendous struggle to get it removed from the Statute Book. I have experience of the "little changes" proposed in 1931. They were ever so little, and the people who defended them, defended them up to the last moment and then, when the Administration was swept out, they were the most virulent in attacking those who had opposed them.
I fail to understand why the Government should have precipitated this struggle within their own ranks over a small charge of this kind in relation to the social services. I have always believed what the hon. Member for South Ayrshire (Mr. Manuel) said, that once any change was made, the working-class and their representatives should stick to it and maintain and defend what they had gained. This is even more necessary in 1349 relation to a reduction of hours or advances in the social services, because these are real gains. Wage gains can be only a temporary fluctuation.
The attack which is being made on the social services will form the basis of argument across the Floor of the House and on the platform in the country. Labour organisations will be rent asunder over this quarrel precipitated by the Government. As hon. Members have said already, these charges are to be imposed on those who took a realistic and reasonable view of the social services and did not rush into the queue to be first to get dentures and glasses, but who held back to allow the scheme to develop, and said, "Let us be easy on it, because unreasonable people are making a rush from the beginning." These reasonable people are now being subjected to attacks that other sections of the community were not subjected to in the early stages.
We hear a great deal about those with low wages and pensions being sent to the National Assistance Board to get their glasses and dentures. But there is no guarantee that they will get their spectacles and dentures. I have had some experience of the Assistance Board, even when the old idea of the Poor Law is supposed to have been swept away, and I can hear them say, "You cannot have dentures". [HON. MEMBERS: "The dentist will say that"]. I can give cases in my own area where they have even examined people with their clothes on to find out what condition they were in. [An HON. MEMBER: "Rubbish."] Why does the hon. Gentleman, coming into the Committee at this time, say that what another hon. Gentleman is saying is rubbish? I can give facts, but all I say in connection with this is that for some people to have to go to the Assistance Board is a humiliation. Therefore, they will not go there, with the result that their standard of health and eyesight will deteriorate because there is no guarantee they will get their teeth or spectacles.
I do not want to interrupt my hon. Friend. On his second point I am not arguing, but his first point is misconceived. The applicant will go to the Assistance Board, and show a form from the dentist which he or she has signed. It will be the dentist who will say that the 1350 teeth are not required, but I am not conceding his second point at all.
§ Mr. McGovern
Whatever may be said about the charges, they are a fundamental and frontal attack on the social services of the country, and I have not the slightest doubt that if the Opposition had been the Government and we had been the Opposition, there would not have been a platform in the country which would not be ringing with attacks. I may be wrong, but I fail to understand why, in politics, we are expected to attack the Opposition when they are the Government, and to defend our own Government when they do the same sort of thing.
When I came into politics at the age of 17 it was with the conception that we had gradually to transform society into something worth while. I have defended the Labour Government for the last five years for the great schemes they have put over, and I hoped that, though there could not be tremendous changes made at this stage, because of the economic situation, we would never have to make an attack on the social services through charges such as these. If there had been a fundamental and deep crisis in society, and we were looking everywhere to try to raise money and effect economies or make charges, there are many ways of doing it that I could have put before the House. If the crisis was serious, then the members of the Front Bench should say to the country "We will surrender 50 per cent. of our salaries and ask hon. Members to do the same." But the crisis is not serious; it is not as serious as the advocates of these charges would try to make out.
We have hardly got over the 1929–1930 means tests discussion yet, and we are entering into a new one. The worst thing is that if this breach is made and a new Government comes into power, I will not guarantee what they will do, but they may say, "We will make people pay for the whole of the dentures and glasses. We will make them pay for hospital beds. We will make them pay a fee for calling in the doctor, because we believe that the country requires these changes." Once we begin on the slippery slope, it is easy to go right down to the bottom. Not only that, but if another Government comes in and does that, we lose our whole line of attack. 1351 They could turn round and say, "You showed us the way. You began it."
I say: Think once, think twice, and think three times before embarking on this new tack. If the Government do not withdraw this Clause and Bill then, so far as I am concerned, I shall go into the Lobby against them.
§ Mr. Mellish (Bermondsey)
I intervene in the debate because of the speech of the hon. Gentleman the Member for Shettleston (Mr. McGovern). I must say, quite honestly, that the speech he has just made will render a great disservice to the Labour movement as a whole. When he says that what we are proposing to do in this Bill will split Labour, let me tell the hon. Member that his week-end speech was deplorable and will do much more harm to the Government than anything else.
The hon. Member talks about precedent. He says that the Labour Government should not have introduced these proposals because it is a precedent for the Tories to follow. Let me tell the hon. Member that the Tories will not need precedents to introduce any Bill. If they ever come back into power and want a precedent, they will say, "We are going to impose a tax on prescriptions because the right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan), regardless of the fact that he did not introduce it, at least proposed it." They will say, on that basis alone, "We have a right to introduce a tax on prescriptions."
The hon. Member talks about the Labour movement in the country being split on this issue. What a lot of tripe that is. I can only say that I have not had a single letter from anyone in my constituency in connection with these proposed charges. I challenge my hon. Friends on this side of the Committee to say how many letters they have had protesting against these proposed charges. As I understand it, listening to the hon. Member, we have been inundated with thousands of letters protesting against these from our own supporters. My hon. Friend the Member for Cannock (Miss Lee) may have received a lot of letters but, if I may so say, she got a lot of publicity about it, too. I did not get a single letter—I give my word of honour—protesting against these proposed charges. 1352 May I say to the hon. Lady the Member for Cannock that I represent a constituency which is as much working-class as hers and that I was born in the same kind of surroundings as those from which she came.
None of us likes this Bill, but these charges have to be made. We regret it very much. The Front Bench have been compelled to bring in a Bill which they realise will not be popular among their own party but, as I see it, they had to put a ceiling on the National Health Act. [An HON. MEMBER: "Why?"] I will say why. Suppose the Minister of Health were to come along and ask the Chancellor of the Exchequer not merely for £400 million but £500 million or £600 million, are we on this side of the Committee to say that there shall be no limit to expenditure under the Health Act? That is the principle with which we are concerned.
If there was to be a ceiling—and in view of the economic position of the country it is suggested that there has to be a ceiling—I say frankly that the Minister of Health has no alternative but to devise ways and means to keep within that ceiling. Some of my hon. Friends say there should be no ceiling. With that I disagree. We could not allow the Health Service to go on with no limit. Hon. Members on this side, have from 3.30 p.m. today, consistently attacked their own Front Bench, and all that has been achieved has been to draw laughter and sneers from the other side of the Committee. I am not proud of it; I am ashamed of it. I think it is deplorable that we should have had all these sneers and jeers all day from that side of the Committee.
If we have to impose charges I believe that we have no alternative but to bring in those charges, as we are doing. I think that this party has done the honest, sincere thing. Any talk about precedent, so far as we are concerned, is beside the point, because the Tories would not care what this party had done. They would bring in charges on the social services, because that is part of their policy, and always has been. We have been charged, on this side of the Committee, by some of my hon. Friends with cutting the social services. We have not cut them. We have given a £56 million increase on the 1353 social services. Let us remind our people of that.
We are being told that, all we have done in this Budget is to cut the social services. That is not true. We are faced with the re-armament programme. We are unhappy about it, because we are a party of peace. But in view of the facts with which we are faced, though we deplore them, we have no alternative but to bring in this Bill. I cannot understand the attitude of the hon. Member for Shettleston. He is an older man than I am. I think that he was born, like myself, into the Labour movement. I cannot understand how he could make the kind of speech which he made at the week-end, or how he could attack his own party in this Committee. I hope I shall never live to see the day when I shall do the same.
§ Mr. Poole
I will not detain the Committee for many moments. I rise only to deal with a point made by the hon. Member for Bermondsey (Mr. Mellish). He always speaks with great sincerity and force, and we accept the views which he expresses as being held with deep conviction. He asked how could we face this position if we are not to have a ceiling on the Health Service. I want to ask why we must, at this point, have a ceiling on the Health Service of £400 million. I want to address to hon. Members and right hon. Gentlemen on the Front Bench this point. I was tempted to ask the Secretary of State for Scotland when he was speaking, but I refrained. I see, now, that the Chancellor of the Exchequer is here.
The issue confronting us is the excess ceiling this year of £13 million. I want to ask the Chancellor of the Exchequer, or whoever is to reply, whether he will tell the Committee if, in estimating in this Budget the expenditure on the Health Service during this year, he is prepared to pledge himself that there will not be a margin of error in excess of the £13 million. If he can, he will be doing something he has failed to do in any year since this scheme came into existence. Can the Chancellor state with any degree of certainty, in face of rising prices—when he cannot say what the prices of almost any commodity for which we will have to pay will be in three months' time—that he can estimate accurately 1354 that there will be no exceeding the £13 million?
There is no financial implication in this saving which it is hoped to effect. I believe that we are making a breach here which ought never to be made and for which there is no necessity. That is one thing, but there is a much more serious aspect, and that is that if we accept a "ceiling" of £400 million now, where do we get to next year when the Chancellor has to find, not the figure we have this time, but about £500 million in excess of the present Budget?
If the "ceiling" of £400 million on the Health Service is to stand, from where does he propose to get the excess in the next Budget? It will be a certainty that this door having been opened, it will be pushed still more widely open next year when the Chancellor finds himself in an even more difficult position. There is no budgetary reason for the imposition of this charge to save so much this year and £25 million in a full year. It is in sorrow more than in anger that I think the Government have seen fit to divide hon. Members on this side, who have stood so solidly together and fought so many worthy battles in the House. With their very limited majority, the Government are unable to get this thing as a solid body—[Laughter.] Hon. Members opposite should not laugh; I am not referring to what is above their shoulders; it is not that sort of solid body.
I feel that it is regrettable that we should have been divided on this issue because what we are being divided for is not worth while. It is not real, or tangible but is something based purely on scant imagination and, at the end of the financial year, it would be found to have been based on a wrong assumption.
§ Mr. McAllister (Rutherglen)
Like my hon. Friend the Member for Shettleston (Mr. McGovern), I am a Scottish Member. The speech which he made tonight and, even more, that which he made at the week-end, were very reminiscent of speeches made by the hon. Member in previous Parliaments. What we are seeing is a deplorable recurrence of the tactics of the Independent Labour Party—tactics which nearly wrecked the Labour movement.
§ Mr. Carmichael
I understood that we were being kept very tightly to the 1355 Clause. If so, Major Milner, how can this sort of matter be raised, whatever grievance or complaint the hon. Member may have?
§ The Chairman
The hon. Member for Shettleston (Mr. McGovern) made a good many general remarks and it may be that other hon. Members wish to reply to them. I cannot give one hon. Member latitude and deny it to others.
§ Mr. Carmichael
The hon. Member is entitled to speak as hard as he likes about the Clause, but surely we cannot talk now about something said outside the House; that is something altogether different.
§ The Chairman
I have no desire to argue the matter, but the hon. Gentleman will appreciate that the Member for Shettleston made remarks and observations on events, I think he said, of some years ago. I think I must allow the hon. Gentleman who has the Floor to continue, but I take note of what the hon. Member has said, and I will endeavour to keep all hon. Members in order.
§ Mr. McGovern
As you have mentioned my name, Major Milner, may I say that I have no feelings against the hon. Member for Rutherglen (Mr. McAllister) having his say, but the great difficulty is that he seems to object to me having my say.
§ Mr. McAllister
I am astonished at the sensitive character of some of the hon. Members who have risen to these points of order because there have been some savage attacks from below the Gangway on His Majesty's Government tonight. If, in the course of the debate, someone happens to say a word in support of the Government, I hope that will not be taken amiss. The hon. Member for Shettleston said that he has been—[Interruption.] If the Tories want to have their little private jokes, would they conduct them privately? The hon. Member for Shettleston said he had been defending the Labour Government for five years. That is a rather extraordinary statement when one comes to think of it, because most of us on this side of the Committee thought that we did not need to defend the Government; we thought that the Government's record spoke for itself in what we have done.
1356 It is a most extraordinary statement, coming from the hon. Member for Shettleston. I have listened to the hon. Member for Shettleston getting up time and time again, with great effect, great persuasion, great powers of oratory, and some powers of invective, to ask the House to be aware of the menace of the Soviet Union, to be aware of the need for defence in this world today. May I say that I do not go all the way with the hon. Member in taking up that highly militaristic attitude. I believe that there are other ways of reconciling the peoples of the world and introducing peace into the world. But within the scope of what was essentially a defence Budget, the hon. Member for Shettleston should have been more ready than any other Labour Member to support the Government, because they were implementing the demands that he had advocated for five years. I do not propose, on the strict subject-matter of this debate, to say that I agree with His Majesty's Government on the details, but is it the details that we are discussing?
§ 12.30 a.m.
§ Mr. McAllister
I will gladly reply to interjections if I can hear them. I know perfectly well that we are discussing Clause 1, but there are two aspects of Clause 1. There are the detailed proposals to the Clause and there is what certain hon. Members on my side of the Committee regard as a matter of fundamental principle.
I think His Majesty's Government ought to consider the details again. Indeed, we have had an assurance from the Secretary of State for Scotland that the details will be considered afresh, while the Minister of Health has promised that a new Clause will be put on the Order Paper. I think I am right in saying that the right hon. Gentleman said he would consider whether something could be drafted immediately and put down before our next proceedings. Hon. Members below the Gangway who are arguing on quite different grounds cannot have it both ways. It is either a principle or a matter of detail. They say that this is a matter of fundamental principle to our party and that we cannot agree to this proposal because it is a fundamental invasion of the social services.
1357 When we fix a ceiling for the National Health Service, are we doing something fundamentally different from what we do when we fix a ceiling to the food subsidies? When we propose specific charges in the National Health Service, are we doing anything different in principle from what we do when we put up the price of school meals? If hon. Members below the Gangway can accept one proposal after another without raising the question of principle, I fail to see how they are entitled to raise the question of principle now. I think they are misleading not so much the country, but certain elements in our own party when they raise this as a matter of principle. [Interruption.] If hon. Members want to interrupt, let them do so in such a way that we can hear the interruption.
§ Mr. McAllister
It is beyond comprehension that this matter is raised as a question of principle, when the proposed charge on prescriptions was not raised as an issue of principle.
I feel that the Government and this Labour movement will be able to explain to the people of the country the reasons why these proposals have been made and why a ceiling to the National Health Service is necessary. I believe that on the record of the National Health Service and the many other achievements of this Government, when the time for the next election comes, the Government will be returned to power, if only we can preserve the unity which resides in the great mass of the membership of the Labour Party. That unity is in danger only from speeches such as that we have heard tonight from the hon. Member for Shettleston.
§ Mr. Emrys Hughes
I have no intention of entering into the personalities which have arisen in this debate. What I wish to do is to try to outline why I intend to vote against Clause 1. I believe that is the only logical and consistent think I can do, in view of the attitude I have taken towards the National Health Act. This issue of teeth and spectacles was a minor issue at the General Election. I did not raise it because I wished to fight the election largely on the fundamental question of international policies. 1358 On the whole, I did fight it on that question.
But this issue was raised by my Conservative opponent, who addressed meetings throughout the constituency stating that he stood for certain economies in the Health Service, and his case was that in investigating fields for economies we must give urgent consideration to the question of whether a country which spends £700 million annually on drink and £700 million annually on tobacco, plus substantial sums on betting and gambling, did, in fact, require to have its spectacles and dentures absolutely free. I went round the constituency stating what I believed to be the Labour Party's defence of the Health Service, and I cannot see that, having gone before my constituents and argued this out, and asked them to send me to the House to vote against those proposals, I should be logical now in supporting a charge for spectacles and false teeth when it is proposed by His Majesty's Government.
After all, there ought to be a certain element of political honesty in public life. I recommend it equally, or even more so, to hon. Members opposite. I have nothing in common with them, ideologically or in any other way. I suggest that having taken up this stand, having argued my case logically throughout the election, and having said that I definitely stood against economies of this kind, I cannot do anything else—if I am to keep the respect of my constituents, which I hope I hold—but go into the Lobby to oppose this Clause.
This is not disloyalty to the great ideals of the Labour Party. I have been in the party as long as most Members on the Front Bench. I believe fundamentally in the broad principles of the great Labour movement. I believe that in this issue one has to remember that there is a point of view outside this House, expressed in the great Scottish T.U.C., whose decisions were against these charges. I believe that right throughout the great democratic movement in this country there is sufficient opposition to show that it would be quite a wrong interpretation of democracy if it were to go out tomorrow that the Committee was unanimously in favour of the Bill.
What is the position of the Government? I know they are in a difficulty, 1359 but I would point out that this is a Committee stage of a Bill. We are not against the whole Bill; we are against this particular Clause, and in the light of what has happened in the Committee any sensible Government which wished to maintain the unity of their party would think again, and wonder whether it was worthwhile going forward with the Bill in the light of the criticisms which have been expressed.
I agree entirely with the Minister of Defence that the Government should only go down on a vote of censure. When that vote of censure comes, I shall always be with the Government. The Minister of Defence and I have a great deal in common. I suggest that if he goes to the Cabinet and talks with the Chancellor he will advise the Chancellor not to resign if an alteration is made in the Bill. He has far too much common sense to resign himself on a question of this sort.
I cannot accept the tortuous explanations of the Minister of Health in introducing the Bill. He was very much like a person acknowledging, half apologetically, an illegitimate child, knowing full well that the father of the child was over on that side. [HON. MEMBERS: "Name."] Let me put it this way. The politics of this Bill are the politics of Woodford, the finance of it is the finance of Aldershot, and the economies are the economies of Orpington. I object to this kind of progeny being put on my doorstep. I do not intend to apologise for it, and I intend to disown it at the first possible opportunity, which will be tonight.
One of the main arguments for the Bill has been not so much the financial argument as the background argument that there has been some grave abuse in spectacles and false teeth. The Minister gingerly approached it in his speech with an extract from the Labour committee of Kingston-upon-Hull. But he quoted from the particular to the general, and on the basis of this judgment from Hull seemed to indicate that there was widespread abuse of the Health Service. One significant sentence in the evidence of the Hull chairman was this:Insufficient evidence is available to enable drastic action to be taken.1360 I do not think we should make up our minds that there is general and widespread abuse of this service because of the exaggerated instances which have been given from the benches opposite.
The Secretary of State for Scotland and I had a little disputation about the figures. I am quite prepared to admit that if he meant dentures, he was right and I was wrong. If I am wrong in the interpretation of that argument, I readily apologise. In the Second Reading debate the Secretary of State argued that for the first quarter of this year, from January to March, we ran up to 126,000. He did not say dentures, and I understood that was the number of cases comparable to the figure given in the Report of the Department of Health. If he were justified in arguing that there was a disquieting abuse in Scotland, surely there should have been some evidence of this in the Report for which he is responsible. But I submit there is no evidence that there is a big increase in abuse in Scotland. That is an argument which has been brought forward at the last moment to justify this Bill.
I looked at not only the figures for Scotland but also the figures for Ayrshire. I made special inquiries to find if there was any evidence of widespread abuse in my own constituency. I was given the information that the total number of cases in the first quarter of 1950 was 19,805, and, in the first quarter of 1951, was 19,218. In these figures of the general dental service, the only statistics which are available, I find that far from there being a great increase in the number of cases, they actually went down by 587. As one representing that area who has for many years been a member of the Public Health Committee of Ayrshire County Council, I think I am entitled to say that if these are the figures for my area there is no justification for my going into the Lobby and saying that I vote for these charges because there has been widespread abuse.
The Secretary of State for Scotland used another argument, which is rather a queer one. He said, "There has been newspaper comment and investigation does not belie that picture." Are we going to base our judgment on newspaper comment? The Secretary of State, like myself, has been a journalist. He was on 1361 the "Daily Express" and it was my business to track down the commentaries of the "Daily Express" every week in "Forward." I will not accept the theory that because there has been comment in the "Daily Express," there is evidence on which to base any conclusions about this Bill. There is a saying that comment is free, but truth is sacred.
I do not think the Secretary of State is justified in arguing that we should make charges on the basis of a case built upon anonymous newspaper commentaries. I would not be justified in going back on what I said in the constituency which I represent and saying, "Oh, yes, the Conservatives have converted me to this point of view." I do not believe I could argue that way in my constituency. The hon. Member for Luton (Dr. Hill) said on Second Reading that we had no arrangement for monocles. If the Secretary of State for Scotland and right hon. Gentlemen on the Front Bench went to their constituencies wearing monocles, that would be the Conservative case in its complete perfection.
I put down a Motion, not as a result of the dramatic atmosphere inside the Cabinet, immediately the Budget was introduced. I have no part in any particular group which is involved in differences of opinion in the Cabinet. I say, without any hero-worship or attempt to enlarge personalities at all or to make them loom larger in this controversy, that on this issue of the health services, public opinion in the Labour movement, and outside it, will listen respectfully to my right hon. Friend the Member for Ebbw Vale (Mr. Bevan).
I do not know whether hon. Gentlemen have read a remarkable article giving the results of public opinion—a Gallup Poll—in the "News-Chronicle" which showed that 49 per cent. of the people of the country were against the charges for spectacles and teeth contained in the Health Bill. [HON. MEMBERS: "Newspaper comment!"] An analytical survey such as this is very different from newspaper comment. The remarkable thing about this article, which I commend to the Opposition, is that 49 per cent. of the members of the Conservative Party were against these charges, and I believe we would be deceiving ourselves if it went out tonight, after this prolonged debate, that the House of Commons was 1362 unanimous in approving these charges. I believe the minority, who will go into the Lobby and stand for what they think to be right, will earn the respect of the country, whose support they will, I believe, ultimately have.
§ The Secretary of State for the Home Department (Mr. Ede)
We commenced the discussion on this Motion at five minutes past 10 o'clock, and we have now had a long and representative discussion in which we have had, from my hon. Friend the Member for South Ayrshire (Mr. Emrys Hughes) some strange constitutional doctrine, and, from some other hon. Members, outspoken comments, some on one side some on the other. I would suggest to the Committee that we might proceed to a decision on this matter. The Committee has been quite good humoured in spite of the hardness of some of the hitting and I would suggest that after nearly three hours' discussion, we might now reach a decision.
§ Mr. S. O. Davies
I would certainly never have got up at this time of the night, unless I felt that the Government were about to take one of the most disastrous steps that they have taken since 1945. The Leader of the House has appealed to us to end the discussion and consideration of this Clause and go into the Division Lobby. I feel that his appeal is very belated. My right hon. Friend and the other members of the Government should have considered the implications of this Clause and its probable effect, if it becomes law, upon the great movement which has placed this Government in power, and on which every hon. Member on this side of the Committee depends. I do not know how much time the Leader of the House has spent in the Committee today—I am not unkind in saying that, because I know he spends a great deal of time in the Chamber, and we all appreciate it—but if he had been here for very long he would be as much alarmed as another old Socialist who is now holding up the Committee for a few minutes.
Today, we have seen one of the most pathetic exhibitions that we have ever had from the Front Bench. Every hon. Member on this side of the Committee knows very well that every hon. and right hon. Gentleman who has stood up at that Box during this debate has been making the 1363 best, but withal, the most pathetic show of pretending to defend a Bill in which not one of them believes. I leave it to the good sense of my hon. Friends on this side of the Committee. The Minister of Health, and the Secretary of State for Scotland, have had placed in their hands something that no decent Government would have compelled two of its members to defend.
I was a little mystified when my right hon. Friend the Member for Ebbw Vale (Mr. A. Bevan) resigned from the Government. I am certain that we have seen put up at that Box today right hon. Gentlemen who, at times, in their attempt to defend this wretched travesty of Socialist legislation, must have wished they had resigned with the right hon. Member for Ebbw Vale. I am not saying it unkindly, but the playboys, the hon. Gentlemen on the other side of the Committee, have had a great day indeed. I noticed that when my hon. Friend the Member for Bermondsey (Mr. Mellish) said what he sincerely believed about my hon. Friend the Member for Shettleston (Mr. McGovern), about what harm he was doing to the Labour movement, tremendous cheers were heard from the Tory Opposition. This has been a great day—[An HON. MEMBER: "May Day."]—for them and I want to tell the Government that this wretched Bill has been the finest present, the most powerful inspiration, that the wretched Tory Opposition has had in the House since the Government came to power.
I must tell the Leader of the House that if this Clause is forced to a Division tonight, its effects will be disastrous. More than one of my hon. Friends reminded us on this side of the Committee of what has now become the declared opinion of hundreds of thousands of people who are opposed to this Bill. As an old Socialist, I appeal for the withdrawal of this wretched Bill. If the Government does not withdraw it, it has no right to risk the destruction of our great working-class movement by dividing its ranks. It has no right to do so, and it will be held responsible. The Bill cuts across, and violates, not only the principles of this movement, but the sensibilities of the millions who are supporting us.
1364 I do not think it is too late to withdraw this Measure. If this is forced to a Division, I shall, of course, vote as I have always voted, as a Socialist. I shall vote against the Clause, but not against my movement. My loyalty is to this great working-class movement and not to a group of individuals. It does not matter how they change, or how circumstances have changed them, or at what moment they may fall down in their duties and obligations. This matter will not end in a Division in this Committee. It will not be a question of what the votes were here. It will be a question—and surely the Government has had an earnest of what is coming—of creating resentment, though not of benefiting political hooligans who have no conception of social services, or any real desire to uplift the conditions of our people. The Tories will never gain as a result of this. Our movement is big enough, when its representatives let the movement down, to throw up greater and finer men every time.
§ Mr. Butcher (Holland with Boston)
I do not wish to detain the Committee for long, but I must say that in the succession of speeches from the benches opposite there has been, I think, far too much emphasis on the fortunes of what is called the great working-class movement and too little attention to the fortunes of the particular class which we are discussing, the ordinary people of this country.
I think there is no reason why anyone should take the trouble to vote for this Clause. The hon. Member for Rutherglen (Mr. McAllister) suggested that if members of the Labour Party had accepted the principle of a ceiling on the food subsidies they should not question the principle of a ceiling on the Health Service. The answer is that when a ceiling is imposed on the food subsidies, everyone benefits from those food subsidies whether the ceiling is imposed at a high or a low level. But if we impose this particular ceiling on the Health Service the only people who are going to contribute are a particularly limited section of the community. They are the people who will require, and must have, dental or optical treatment during the next 24 or 30 months. People who already have spectacles and dentures are exempt.
Already the waiting rooms of dentists and opticians are crowded with people 1365 seeking attention before the day appointed under the regulations. After the appointed day, those who must have this dental and optical treatment will make their contribution; but as the day for review comes nearer, there will be large numbers of people who will say they will wait another two or three months before going for their attention. I do not want to take up the time of the Committee, but nobody can claim that this side has been unnecessarily talkative. What is there in this Clause to make it worth while anybody voting for it?
§ Sir Richard Acland (Gravesend)
I am grateful to the hon. Member for Holland with Boston (Mr. Butcher) for having brought the Clause back to its proper status—that of a tax imposed upon certain people. I should like to defend myself and others from the charge made about the attitude we have taken, namely, that we are in favour of a "soft" Budget and that we hold the very peculiar view that if shortages of raw materials should make our whole situation tougher, we want the Budget to get easier and easier.
That is a complete travesty of the attitude which we take. On the contrary, if the situation is hard and gets harder what we want is not a softer Budget, but one which imposes a great deal more social equality. If the time has come when we have to impose a special tax of £4 10s. on a rather special set of people, namely, those requiring teeth and spectacles as mentioned by the hon. Member who has just spoken, then I should have thought that the time had come to make quite a lot of other comparable charges on a lot of other people who are better able to bear the burden.
I thought the Secretary of State for Scotland put to us a rather false pair of alternatives when he was in controversy with the hon. Lady the Member for Liverpool, Exchange (Mrs. Braddock). He was then trying to confine this issue as if it could be considered within the four corners of the National Health Service and as if a "ceiling" of £400 million must be assumed so that he could say, "You must choose either to accept this charge on spectacles or false teeth, or to see no expansion in the hospital service." There are, I suggest to the Committee, one or two other possible choices to which we could turn—one or two other 1366 courses to pursue either instead of this charge or as something to be done simultaneously with the charge on glasses and dentures so as to persuade those faced with paying these charges that the emergency is grave enough to justify what is imposed on them.
One of the things which might have been done, and which appear to be logical and consistent if we have reached the point where this special tax must be imposed, is to levy a prohibitory tax on many flambuoyant luxuries, then there could be a legal limitation of profits, an increase in death duties, a tax on gifts inter vivos, a sales tax on second-hand sales of cars——
§ The Deputy-Chairman
I would remind the hon. Baronet that he can now only speak about what is in Clause 1.
§ Mr. W. Griffiths
I intend to intervene for a very short time to raise a point which, I think, is a genuine Committee point. What I want to say, particularly to my hon. Friends, is that they really should appreciate what we are, in fact, doing as a result of passing this Bill. I am sorry to have to refer to experience of my own job, but I want the Committee to appreciate that if this Bill is passed, as is proposed, we are going back far beyond the provisions of the old National Health Insurance Acts, in respect, at least, of the eye service.
I mentioned this on the Second Reading. Those members of the public who paid National Health Insurance before the National Health Service Act was introduced got additional benefit, or many of them did. A great number of them did not. Some of the smaller friendly societies, and some of the trade union friendly societies gave extremely generous additional benefits but even the great industrial societies, like the Prudential, gave this benefit. They gave to those who were sending their insurance cards into them, a pair of free spectacles with the choice of having their eyes tested by either an ophthalmic optician or an eye specialist. Therefore, so far as about 8,000,000 people are concerned, if we pass the Bill as it is, they are in a worse position than they ever were before. It is a fact; and whether one likes it or not, it is the truth.
§ Mr. Griffiths
I know very well that my hon. Friend was the secretary of a friendly society. Before I became a Member of Parliament I received ophthalmic benefit letters, signed by my hon. Friend, from a society called the Pawnbrokers' Friendly Society. That society gave to members a free pair of spectacles. They had nothing at all to pay. Is that not so?
§ Mr. Logan rose——
§ Mr. Griffiths
I object to the charges which are laid down in Clause 1. I am pointing out to the Committee the effects which it will have on all sections of the public and which will worsen their position so far as the eye service is concerned.
I turn now to the provisions for the future. It has been widely publicised that the patient will, in future, under the National Health Service Act, have to pay 50 per cent. of the cost. I am sorry to say that from my reading of the position that is just not true, because I see, in the Financial Memorandum to the Bill, in paragraph (3), examples given of the charges that are envisaged. Let us take a typical example of the charges that are envisaged. Take the case of what is called the popular type of plastic frame. The charge to the patient will be 27s. 5d. In fact, the cost of the frames and lenses for the overwhelming majority of patients who go either to an ophthalmic medical practitioner or an ophthalmic optician will be very much less. Let me give the very common example of the simple spherical lens, including the frame, case and lens, for which the cost will be 13s. 10d. That will be the cost—and that covers a fairly wide type of case. The patient who gets that appliance will have to pay 27s. 5d. under the provisions of the Bill.
That is the position. We are told that under the Bill there is no charge for sight testing. We are told 1368 that the patient will pay only half the cost of the appliance. Examples are given. My argument is that this is deceiving the public, as the true position is that they will have a great deal more than that to pay. I make no further comment at this stage, but I hope my right hon. Friend will look into the matter and perhaps give us a little more information on the Report stage.
§ Mr. Mikardo
We have been debating Amendments to the Clause and the Clause itself for a very long time now, and for the greater part of that time the debate has been conducted exclusively on this side of the Committee, with the Opposition playing no role other than that of spectators—and of the rather specialised type of spectators represented by schoolboys on their annual outing with their tummies a bit too full of ginger pop.
During the six years in which I have been a Member, I cannot remember a day of debate in which a Front Bench has had such rough handling from the House or from a Committee of the whole House as the Government Front Bench has had today. I think the members of the Government will, by now, have become convinced that if they persist in pushing through this Bill with this Clause in it, they will be flying in the face of some very deep and very sincerely held feelings on the benches behind them.
I ask them, when they consider their future actions in respect of this Bill, to take that into account. On both sides of the debate the argument has, I think, been a little over-vehement, but I think no one will question the sincerity with which hon. Members have spoken—and the great majority of those who have spoken have done so, in a sense, against the Clause. I am not saying that it is necessarily true that the great majority of hon. Members on this side of the Committee are opposed to the Clause. That may well not be true. All I am saying is that the Government ought to recognise, out of the very uncomfortable time they have had today, that a considerable number of their supporters are feeling very unhappy about this; that those supporters represent a great deal of feeling throughout the country which is not by any means, if I may judge from my own constituency, confined to members or supporters of the Labour Party, and that 1369 this fact ought to be taken into account in considering the Government's future action.
It was not until seven hours after the debate started, not until 11 o'clock when my hon. Friend the Member for Sowerby (Mr. Houghton) rose, that the first word was spoken in the whole of this debate in support of the Government's attitude. As I watched the faces of my right hon. Friends while they were being defended, I had the feeling that they were slightly more unhappy while they were being defended than they were while they were being attacked. It is quite clear that they, too, have been rather unhappy in their advocacy of the Clause. We have all seen the Secretary of State for Scotland—who has a high place in the affections of the House—on many occasions more sprightly fluent, and more convincing than he was tonight. I suspect that his comparative lack of sprightliness, fluency and conviction was due to the fact that his heart was not as much in this job as it normally is in his other jobs.
I would not have risen at this late hour but for the fact that I have one or two points for the consideration of the Committee which have so far not been made. I am still not satisfied, after the explanations from the Government, that enough is being don© by the terms of this Clause to protect the poorest people, who will be hardest hit by it. I am not satisfied, in spite of the fact that outside and in the House I have expressed a great admiration of the work done by the National Assistance Board. Here, I differ sharply from the hon. Gentleman the Member for Shettleston (Mr. McGovern). I am not at all satisfied, in spite of my admiration for the work of the Board and its officers, that the provision in the Bill in respect of the National Assistance Board will protect the poorest people.
Many of these people will not go to the Board for help—not because the Board is a harsh instrument by any means—but for some of the reasons given today. A great change has come over the administration of the Board in the last few years. Because many people who have been forced with a sudden need, or whose incomes were constantly below the Board's scales, would feel it worth while disclosing their circumstances in order to get a continuing payment, they 1370 would scarcely think it was worth while to get a one-time payment. Moreover, those people who go to the Board for assistance with regard to spectacles will, on that account, be required to have nickel-framed spectacles, and hence proclaim their poverty to the whole world. Many, on that account, will hesitate to go to the Board.
My hon. Friend the Member for Manchester, Exchange Division (Mr. W. Griffiths), who speaks with practical experience as a professional optician, has pointed out that under the provisions of this Clause many people who need glasses will be worse off than before 5th July, 1948. I think it is not in dispute that before that date there were many people—mostly males and few females—who got for themselves but not their dependants, nickel-steel frames and lenses without charge, and these people will have to pay for the same service the sum of £1 3s. 4d. It is a piece of gross distortion, as my hon. Friend stated, to try to tell people that in paying this amount they are paying half the cost of the appliance with which they are supplied.
I was told yesterday by an official of a professional body of opticians that the overwhelming majority of lenses cost considerably less than 10s. so that the 10s. lenses charge is not merely half the cost, but more than the whole cost of the very great majority of lenses. Do not let us pretend we are asking people to pay half the cost of the appliance. Do not let us pretend—and this is obvious from the intervention of the Secretary of State for Scotland—that we are only asking them to pay for the appliance and not for the testing service. The minimum charge of £1 3s. 4d. covers the service of examination as well as the appliance.
Nobody has mentioned today the people—and there are a very large number—who need two different sets of spectacles, one for short sight and one for long sight. The majority of these people are elderly people. I am told that it is broadly true that, up to 45 years of age, most people can make do with one pair, but above that age the incidence of those requiring two pairs increases very rapidly as people grow older. That is why in May, 1949, the opticians accepted a very severe cut in the fee for a second pair, in order to leave them 1371 free to prescribe a second pair where they found people needing different lenses for reading and for other purposes.
It is only a few days ago that the House passed unanimously a Motion which recognised the importance of keeping old people at work longer. During the debate on that Motion elderly clerks and others doing similar work were specifically mentioned. Those are precisely the people most likely to need a second pair of spectacles. They will not be able to do their work without them. They are now to be required to pay considerably more than a minimum of £2 for their two sets of glasses. I do not think we should pass this Clause, with its charges which will deter so many people, without considering whether those charges are really unavoidable.
The hon. Member for Luton (Dr. Hill), in a speech which put the whole Committee in his debt, showed that it was at least open to question whether some better way could not be found of dealing with the charges for dentures. I understand that a representative body of the optical profession has put forward alternative schemes to recover the revenue without making these charges. In one of these it is proposed to remove the whole of the charge on nickel frames, plus simple lenses, merely by doing away with free spectacle cases. I have been through these figures, and they seem to me to hang together. Bearing in mind that the great majority of people have a spare case or two, I should have thought it worth while considering whether we could avoid the charge for the simplest frames and lenses merely by making people pay for their spectacle cases.
I hope that before this Bill finishes its course through the House the Minister will look at that suggestion. The real danger about this new provision is that a lot of poor people, especially elderly people, rather than pay for their spectacles, or go to the National Assistance Board, will delay getting their eyes examined—and most old people need re-examination about every couple of years. That is the real regression in this Bill, that we are giving a disincentive to people to look after their health properly.
1372 1.30 a.m.
There is also the danger that we might go back to the bad old days and that poor people, and especially older people, might be induced by these charges once again to buy their spectacles off the counter of a chain store, without having them prescribed. In the bad old days there was an outbreak of itinerant quacks, people without any qualifications, who canvassed from door to door, pretending to a knowledge they did not have, undercutting proper professional men and selling people glasses which in many cases were not fitted for their eyes. I understand that there is an Inter-Departmental Committee sitting under Lord Crook, designed to get rid of this danger, but the Committee will not report for some months. It will be an ironical thing if, meanwhile, it can be said that the first contribution to the National Health Service by the new Minister of Health, is to recreate the market in unprescribed spectacles or spectacles prescribed by quacks.
It has been said that the Health Service is costing £400 million and it has also been said that during the coming year the Treasury expect a price rise of about 10 per cent. That means that next year we must have payments for further parts of the Health Service amounting to £40 million in addition to maintaining the ceiling which has been proposed. The right hon. Member for Ebbw Vale (Mr. Bevan) said that if we accepted the precedent of a charge for upper dentures, the lower would go as well. The lower denture will not be enough to pay for £40 million, and other services will have to be paid for.
I beg the Government, and in particular the Leader of the House, who has always shown himself sensitive to the feelings of his colleagues whenever he has known these feelings to be deep and sincere, to consider the extent to which, on the evidence of our proceedings since 3.30 yesterday afternoon, our pursuit of this matter will fly in the face of the deep feelings of many of our supporters both within and outside the House.?
§ Question put, "That the Clause stand part of the Bill."
§ The Committee divided: Ayes, 262; Noes, 3.1375
|Division No. 81.]||AYES||[1.35 a.m.|
|Adams, Richard||Granville, Edgar (Eye)||Moyle, A.|
|Albu, A. H.||Greenwood, Anthony (Rossendale)||Mulvey, A.|
|Allen, Arthur (Bosworth)||Greenwood, Rt. Hon. Arthur (Wakefield)||Nabarro, G.|
|Anderson, Alexander (Motherwell)||Grenfell, D. R.||Nally, W.|
|Ashton, H. (Chelmsford)||Grey, C. F.||Neal, Harold (Bolsover)|
|Awbery, S. S.||Griffiths, David (Rother Valley)||Noel-Baker, Rt. Hon. P. J.|
|Nugent, G. R H.|
|Bacon, Miss Alice||Griffiths, Rt. Hon. James (Llanelly)||O'Brien, T.|
|Balfour, A.||Grimond, J.||Oldfield, W. H.|
|Barnes, Rt. Hon A. J.||Gunter, R. J.||Oliver, G. H.|
|Bartley, P.||Haire, John E. (Wycombe)||Orr-Ewing, Ian L. (Weston-super-Mare)|
|Bellenger, Rt. Hon. F. J.||Hale, Joseph (Rochdale)||Padley, W. E.|
|Benson, G.||Hale, Leslie (Oldham, W.)||Paling, Will T. (Dewsbury)|
|Beswick, F.||Hall, John (Gateshead, W.)||Pannell, T. C.|
|Bing, G. H. C.||Hall, Rt. Hon. Glenvil (Colne Valley)||Pargiter, G. A.|
|Blenkinsop, A.||Hardman, D. R.||Parker, J.|
|Blyton, W R.||Hardy, E. A.||Paton, J.|
|Booth, A.||Hargreaves, A.||Peart, T. F.|
|Bossom, A. C.||Harrison, J.||Popplewell, E.|
|Bottomley, A. G.||Hastings, S.||Porter, G.|
|Bow den, H. W.||Hayman, F. H.||Price, Philips (Gloucestershire, W.)|
|Boyd-Carpenter, J A.||Heath, Edward||Proctor, W. T.|
|Boyle, Sir Edward||Henderson, Rt. Hon. A. (Rowley Regis)||Pryde, D. J.|
|Braddock, Mrs. Elizabeth||Herbison, Miss M.||Pursey, Cmdr. H.|
|Brook, Dryden (Halifax)||Hewitson, Capt. M.||Raid, Thomas (Swindon)|
|Brooke, Henry (Hampstead)||Hobson, C. R.||Rhodes, H.|
|Broughton, Dr. A. D. D.||Holman, P.||Richards, R.|
|Brown, Rt. Hon. George (Belper)||Holmes, Horace (Hemsworth)||Robens, A.|
|Buchan-Hepburn, P. G. T.||Horsbrugh, Rt. Hon. Florence||Roberts, Emrys (Merioneth)|
|Burke, W. A.||Houghton, D.||Robinson, Kenneth (St. Pancras, N.)|
|Burton, Miss E.||Howard, Gerald (Cambridgeshire)||Rogers, George (Kensington, N.)|
|Butler, Herbert (Hackney, S.)||Hoy, J.||Ross, William (Kilmarnock)|
|Callaghan, L. J.||Hudson, James (Eating, N.)||Royle, C.|
|Castle, Mrs. B. A.||Hughes, Hector (Aberdeen, N.)||Shackleton, E. A. A.|
|Champion, A. J.||Hylton-Foster, H. B.||Shinwell, Rt. Hon. E.|
|Chetwynd, G. R.||Hynd, H. (Accrington)||Shurmer, P. L. E.|
|Clarke, Col. Ralph (East Grinslead)||Hynd, J. B. (Attercliffe)||Silverman, Julius (Erdington)|
|Clunie, J.||Irving, W. J. (Wood Green)||Simmons, C. J.|
|Cooks, F. S.||Isaacs, Rt. Hon. G. A.||Slater, J.|
|Collick, P.||Janner, B.||Smith, H. N. (Nottingham, S)|
|Collindridge, F.||Jay, D. P. T.||Sorensen, R. W.|
|Conant, Maj. R. J. E.||Jeger, George (Goole)||Soskice, Rt. Hon. Sir Frank|
|Cook, T. F.||Jeger, Dr. Santo (St. Pancras, S.)||Sparks, J. A.|
|Cooper, John (Deptford)||Jenkins, R. H.||Stanley, Capt. Hon. Richard (N. Fylde)|
|Corbet, Mrs. Freda (Peckham)||Johnson, James (Rugby)||Steele, T.|
|Cove, W. G.||Johnston, Douglas (Paisley)||Stewart, Michael (Fulham, E.)|
|Crawley, A.||Jones, David (Hartlepool)||Strachey, Rt. Hon. J.|
|Crockshank, Capt. Rt. Hon. H. F. C.||Jones, William Elwyn (Gonway)||Strauss, Rt. Hon. George (Vauxhall)|
|Crosland, C. A. R.||Keenan, W.||Stross, Dr. Barnett|
|Cullen, Mrs. A.||Kenyon, C.||Stuart, Rt. Hon. James (Moray)|
|Cundiff, F. W.||Key, Rt. Hon. C. W.||Summerskill, Rt. Hon. Edith|
|Daines, P.||Kinghorn, Son. Ldr. E.||Sylvester, G. O.|
|Dalton, Rt. Hon. H.||Kinley, J.||Taylor, Bernard (Mansfield)|
|Davies, A. Edward (Stoke, N.)||Lang, Gordon||Taylor, Robert (Morpeth)|
|de Freitas, Geoffrey||Lee, Frederick (Newton)||Thomas, Iorwerth (Rhondda, W.)|
|Deer, G.||Lewis, Arthur (West Ham, N.)||Thomas, Ivor Owen (Wrekin)|
|Delargy, H. J.||Lindgren, G. S.||Thomas, J. P. L. (Hereford)|
|Diamond, J.||Linstead, H. N.||Thorneycroft, Harry (Clayton)|
|Dodds, N. N.||Lloyd, Selwyn (Wirral)||Thurtle, Ernest|
|Driberg, T. E. N.||Logan, D. G.||Tomlinson, Rt. Hon. G.|
|Dugdale, Rt. Hon. John (W. Bromwich)||Lucas-Tooth, Sir Hugh||Tomney, F.|
|Dunglass, Lord||McAllister, G.||Turner-Samuels, M.|
|Dye, S.||MacColl, J. E.||Turton, R. H.|
|Ede, Rt. Hon. J. C.||McGhee, H. G.||Ungoed-Thomas, A. L.|
|Edwards, Rt. Hon. Ness (Caerphilly)||Mack, J. D.||Usborne, H.|
|Edwards, W. J. (Stepney)||McKay, John (Wallsend)||Vernon, W. F.|
|Elliot, Rt. Hon. W. E.||Mackeson, Brig. H. R.||Wade, D. W.|
|Evans, Albert (Islington, S.W.)||MacMillan, Malcolm (Western Isles)||Wallace, H. W.|
|Evans, Stanley (Wednesbury)||McNeil, Rt. Hon. H.||Weitzman, D.|
|Ewart, R.||MacPherson, Malcolm (Stirling)||Wells, Percy (Faversham)|
|Fernyhough, E.||Mainwaring, W. H.||Wells, William (Walsall)|
|Field, Capt. W. J.||Mallalieu, E. L. (Brigg)||West, D. G.|
|Finch, H. J.||Manningham-Butler, R. E.||Wheatley, Rt. Hn. John (Edinb'gh, E.)|
|Fisher, Nigel||Marquand, Rt. Hon. H. A.||Wheatley, Major M. J. (Poole)|
|Follick, M.||Mathers, Rt. Hon. G.||White, Mrs. Eirene (E. Flint)|
|Forman, J. C.||Mellish, R. J.||White, Henry (Derbyshire, N.E.)|
|Fraser, Thomas (Hamilton)||Moeran, E. W.||Whiteley, Rt. Hon. W.|
|Fyfe, Rt. Hon. Sir David Maxwell||Monslow, W.||Wigg. G.|
|Gaitskell, fit. Hon. H. T. N.||Moody, A. S.||Wilcock, Group Capt. C. A. B.|
|Ganley, Mrs. C. S.||Morgan, Dr. H. B.||Wilkins, W. A.|
|Gibson, C. W.||Morley, R.||Willey, Frederick (Sunderland)|
|Gilzean, A.||Morris, Percy (Swansea, W.)||Willey, Octavius (Cleveland)|
|Glanville, James (Consett)||Morrison, Rt. Hon. H. (Lewisham, S.)||Williams, Sir Herbert (Croydon, E.)|
|Gordon-Walker, Rt. Hon. P. C.||Mort, D. L.||Williams, Rev. Llywelyn (Abertillery)|
|Williams, Ronald (Wigan)||Winterbottom, Richard (Brightside)||Yales, V. F.|
|Williams, Rt. Hon. Thomas (Don Valley)||Wise, F. J.||Younger, Hon. K.|
|Williams, W. T. (Hammersmith, S.)||Wood, Hon. R.|
|Wilton, Rt. Hon. Harold (Huyton)||Woodburn, Rt. Hon A.||TELLERS FOR THE AYES:|
|Winterbottom, Ian (Nottingham, C.)||Wyall, W. L.||Mr. Pearson and Mr. Hannan.|
|Carmichael, J.||TELLERS FOR THE NOES:|
|Davies, Stephen (Merthyr)||Mr. McGovern and Mr. Emrys Hsghes.|
|Manuel, A. C.|
Question put, and agreed to.
§ Clause ordered to stand part of the Bill.