§ 3.46 p.m.
§ Dr. Edith Summerskill (Warrington)
I beg to move,That this House deplores recent Government measures in respect of social services, which place an undue and increasing burden on those least able to bear it.We have put this Motion on the Order Paper because it seems to us, from Government statements and Answers to Questions, that there is an unmistakable trend which is calculated, if continued, seriously to weaken the country's social services.
First, I should like to point out that the Motion refers particularly to those least able to bear an increasing burden, for while the social services are used by many in all income groups, nevertheless they were established and are intended to help the poorest in the community. This morning I read the Prime Minister's speech which he made at Leicester last night. I will describe it as a euphoric discourse. He spoke of wage levels three times higher than before the war, and of quantities of meat, butter and eggs being consumed. He did that, I presume, to convey the impression that real poverty does not exist under a Conservative Government.
The fact is that the so-called average wage is a delusion. Only one-third of working men are the sole bread winners of households containing children. Many fathers of large families earn much less than the average and many pensioners live at subsistence level. I believe that the only valid test of a social policy is to ascertain how the poorest are faring and I therefore propose to direct my remarks to the conditions of the vulnerable groups, particularly the dependent children in large families, because injuries inflicted by under-nourishment leave marks which can never be eradicated in adult life. I hope that Govern- 220 ment spokesmen will also deal with the welfare of those groups and will not follow the Prime Minister's example.
Over the last twenty years everybody has noticed the striking improvement in the physical condition of the children. That is a matter in which I take a profound interest. In fact, I may say that it brought me into politics. I should like to emphasis the point that I want to make by quoting from Dr. Arthur Massey's Modern Trends in Public Health, in page 36, under the heading of "The Revolution in Children's Diets." He says:Between 1935 and 1946 the death rate of children aged 1–5 years has been halved: that of deaths in childbirth has been reduced to one-third.He goes on to say that while recognising the part that certain drugs have playednevertheless improved nutrition has in the opinion of most played an important rôleIt takes many years for this to be achieved. That is why the Government's policy of reducing or, indeed, removing food subsidies is such a retrograde step.
There are some relevant facts which the Prime Minister deliberately omitted to mention last night. The Report of the National Assistance Board for 1954 showed that at least 309,000 children under the age of 16 are the children of parents on National Assistance. The Inland Revenue reveals that there were 2 million children in families whose income per head was less than £2 per week, and that of those 1 million were in families in respect of which the income per head was less than 30s. a week. These children had to be clothed and shod, and wear and tear was considerable.
They have large appetites, and those appetites should be satisfied with the more expensive body-building foods. The National Food Survey, which has been conducted by the Ministry of Agriculture, Fisheries and Food, reports that these children had much less than a fair share of these important foods. To reverse our food policy and deliberately to withhold cheap food and meals is deliberately to stunt these children's bodies. That has been proved in the past.
The most poignant speech that I have heard in my life was made in this House by a former Member, who had been a miner. When I first came into the House, in 1938, he stood at one of these benches 221 in a debate of this kind and said that he was not an orator, but was pleading for better conditions for the unemployed and their children. He said that he could not put a rational argument, but he asked hon. Gentlemen opposite to look at his body and to look at theirs. He was a very short man. I am not raising a party issue, therefore, when I ask the Government not to reverse the progressive nutritional policy of the last twenty years.
Many children in the category to which I have referred have school meals and welfare milk. Since the Conservative Government came into power there have been three increases in the price of school meals. The price per meal was 7d. in 1951; it increased to 9d. in 1953; it became 10d. in 1956; and it is now to be raised to 1s. The increase from 7d. to 9d. was followed by a 2 per cent. reduction in the number of children taking advantage of the service, and the increase to 1s. must inevitaby mean a further reduction in those numbers. I hope that at the end of the debate we shall hear that these children—and not only those whose parents are on National Assistance—will receive free school meals.
It is a pity that the Minister of Education, in one of his less flamboyant speeches, does not address himself to this aspect of his administration, for it is well known that the underfed child is less receptive to education.
§ Sir Keith Joseph (Leeds, North-East)
Can the right hon. Lady clarify past history? Can she say whether there were any increases in the price of school meals during the previous Labour Administration?
§ Dr. Summerskill
I believe that in the first place it was 5d. and that it was then increased to 6d. It was a very limited increase.
§ Dr. Summerskill
I am sorry if the hon. Member does not realise the importance of doubling the price of school meals, which is what is being done today.
Milk, which was sold at 5½d. a pint in 1951, is now 8d. a pint. Under the Labour Government milk consumption continued to increase; under a Conservative Government it is decreasing. One hon. Member opposite said last week that 222 we must try to increase the habit of milk drinking. It is not the appetite which needs whetting or the habit which needs forming; it is the necessity to keep prices low. Then these children of large families would drink the milk.
An investigation conducted by the Milk Marketing Board revealed precisely the same position as that shown by the National Food Survey, namely, that the consumption of milk was inadequate in large families in the lower income groups.
Is there a shortage of milk? Last year production reached an all-time record. It was 10 per cent. up on the previous year, and to dispose of it the milk had to be directed to the low-priced manufacturing market. With this great increase in production it is proposed, on 1st April next, to increase the price of welfare milk from 1½d to 4d. a pint. Welfare milk accounts for 11 per cent. of the total sales. In households with several young children the increase in the milk bill must be appreciable. What will the Milk Marketing Board do? To dispose of all this surplus milk it will have on its hands it will open mobile milk bars at shows and outdoor meetings.
I agree that the Minister of Agriculture did his bit the other day when he proclaimed that he is drinking one and a half pints a day, but it is an astonishing thing to proclaim that after the Government have announced that they are to increase the price of welfare milk. Last week an hon. Member suggested that there should be a milk bar in the House of Commons for hon. Members. With due respect, I would say that it is not the stomachs of Members of Parliament or of Ministers of Agriculture which need the milk; indeed, some of them would be better without it. [Laughter.] I do not wish to be offensive.
The policy of the Government should be to ensure that this surplus milk is directed into the stomachs of children, nursing and expectant mothers, invalids and old-age pensioners. That is the proper destination for it. It would be quite immoral to raise the price of milk for the poorest children and, at the same time, to relieve Income Tax and Surtax in the Budget next month. The very meanest economy which could be made at the expense of children and which many hon. Members opposite probably do not know has been introduced, was 223 the reduction in the amount of milk supplied in a day nursery from two-thirds of a pint—the children of less than five years of age had one-third of a pint in the morning and one-third in the afternoon—to one-third of a pint a day? Can any hon. Member justify such a step?
I want to draw the attention of the House to the fact that these nurseries are being closed because the National Health Service Act of 1952 has enabled local authorities to raise nursery charges so high as to make them prohibitive. The consequence is that even the priority classes—illegitimate children, children of widows and of disabled men—are now deprived of nursery accommodation in some neighbourhoods, to the detriment of the children.
I am glad to see that the Minister of Health is here. I should like him to answer certain questions in detail. The Minister will admit that we have recognised that he is new to his office. I am also glad the Leader of the House is present, because I wish to say that it is very surprising that the present Minister is the fourth in six years to take charge of this highly technical Department, the Ministry of Health. When Questions are asked, hon. Members on this side of the House know that the right hon. Gentleman cannot possibly know the answers. I went through the Answers which he gave to Questions yesterday. The right hon. Gentleman simply evaded everything. It was done in a delightful manner, but that is not enough. Soon we must have the right and the technical answers to Questions put from this side of the House.
I should like an unequivocal statement about the position of maternity accommodation in hospitals. Questions are frequently put by hon. Members on this side of the House because they are concerned about the closure of a maternity hospital, or the use of maternity accommodation for other purposes. I remember that an attempt was made to close the Fulham Maternity Hospital. There was a town protest, led by the mayor, and the Minister of Health decided that the hospital should not be closed.
We want to know what is the intention of the Government in this matter. Is the 224 policy regarding maternity accommodation also to be reversed? This policy has been slowly introduced over the last twenty years. Will the Minister make clear that he approves of maternity accommodation being provided on health grounds and on social grounds; for example, where there is overcrowding in the home and there is not proper accommodation for confinement?
On 25th February we had a full debate on National Insurance benefits, when the House was given an opportunity to bring to the notice of the Government the plight of the old-age pensioners. and particularly those in receipt of National Assistance. Again, the Prime Minister forgot to remind the country that of 2½ million people on National Assistance, 88 per cent. received retirement pensions. Perhaps the Minister will answer this question in detail. How far have the Government implemented the recommendations of the Phillips Report of December, 1954? Why does the right hon. Gentleman refuse to introduce a chiropody service which was also recommended in the Guillebaud Report?
Hon. Members may think this a small matter, but, of course, the whole purpose of such a service is to rehabilitate old people who are confined to the house and are even bedridden because walking is too painful a process. I have pointed out to the Minister and to his predecessors the benefit of an integrated domiciliary service. Our hospitals are crowded with old people who might well be at home were there an adequate domiciliary service. In the mental hospitals there are senile cases who might never have deteriorated had this Government placed special emphasis on a domiciliary service. Indeed, the overcrowding in our mental hospitals is little short of a national disgrace.
In December, 1955, the average overcrowding on approved standards was 14.8 per cent. This varied from nil in one hospital to 65.9 per cent. in a different hospital. In the same month the average overcrowding in our mental deficiency hospitals was 8.3 per cent. There were nearly 7,000 mental defectives on the waiting list and about half were urgent cases. Will the Minister tell us what is the position today, and how many of the urgent cases which were waiting in 1955 are still waiting?
225 Now I should like to turn to the effect of the Government's policy on prescription charges These increased charges came into operation on 1st December and we had a debate on a Prayer I agree that it is early to say what precisely is happening Unfortunately—I say "unfortunately" not only because it is unfortunate, but because it is difficult to sustain an argument when Ministers change in the way they do—it looks as though the warnings we gave to the right hon Gentleman's predecessor were fully justified.
The cost of a prescription on 19th December, 1955, was 4s. 6½d. On 19th December, 1956, it rose to 5s. 6½d. I think I am wrong there by a penny. There was an increase of 11d. and my figures show an increase of a 1s. Only part of December was included, but that may well result from the heavy and wasteful prescribing policy which the Minister has supported. He supported it last week.
The right hon. Gentleman will remember his remarkable statement when he told the whole country—he must remember that every Question and Answer and supplementary question and answer are reported in the medical and pharmaceutical Press and that everything he says is read by the doctors and chemists—after I had pressed for an answer, that he was willing to let chemists examine doctors' prescriptions, and in the event of them being able to prescribe something at a cheaper cost they were at liberty to do so.
Does he realise the harm that his statement will cause to the chemist-doctor relationship? Is he satisfied that this 1s. an item policy is working out as he thought? I have been supplied today by an hon. Member with information that he received from a chemist who has a small shop. There is no reason why the man who provided the information should attempt to give wrong information, because the hon. Member is prepared to have inquiries made.
The chemist concerned lives in an industrial area in the North of England. He states that in January, 1956, he dispensed 1,107 prescriptions at a value of £174. In January, 1957, he dispensed 1.039 prescriptions at a value of £231. In other words, since this policy has been imposed there was a fall in the number 226 of prescriptions dispensed from that small shop, but an increase in cost of 30 per cent. The Minister must have made inquiries of this kind. Can he tell me whether the inquiries which he has made from other chemists confirm the information given by this chemist?
From the Answers to Questions which have been put it is becoming quite clear—and again we warned the Government about it in a debate last year—that diabetics, cancer cases, colostomies and epileptics are among the greatest sufferers, for they need more than one item. It is difficult to understand why the Minister finally makes the concession for which we asked at the end of last year, that the diabetics should be given their various items for 1s. but is not prepared to extend this concession to these other cases. There is no dissent about this. Pharmacists and doctors agree that these are the most tragic cases. The Minister need not think that they will be a great expense to the country, because these people are almost certainly doomed to die in a very few years.
In a recent debate in the House I brought to the notice of the Minister of Health once more the cost of proprietary drugs. I have done this with successive Ministers of Health. Indeed, the racket "—I use the word advisedly—in proprietary drugs has been so great that in two debates which we have had in the last 18 months I did something which I seldom do in this House: I produced samples of the extensive literature brought to my house so that I could press the Minister to do something. There was no dissent from the Minister, who realised that there was a case here which needed attention; but why is it that nothing is done?
Last November, I cited the high cost of the so-called tranquilisers sold by an American firm at a huge profit. I said:I am not only concerned with the cost in terms of money of this American encroachment on the National Health Service, but with the harmful effect, both physical and mental, of this high-powered boosting of drugs which caters for the hypochondriac and the neurotic. Here, I suggest, is where the Minister should look for his savings on the drug account and not in the little purses of the sick and aged of this country."—[OFFICIAL REPORT, 29th November, 1956; Vol. 561, c. 672.]What has happened in the last fortnight? The World Health Organisation—its report was mentioned at Question 227 Time—has reported precisely on this. In the last fortnight the Organisation, which consists of a large number of responsible doctors, has been reported as saying:People who take 'tranquillisers' too often could become true drug addicts, the World Health Organisation warned yesterday.Meeting in Geneva, the organisation condemned the drugs as potentially habit-forming and said the rapidly increasing' use of them in a number of countries was causing concern.Last night, when I got home, wondering what my sample of drugs should be, it was perhaps appropriate that I should find a packet of 25 tranquillisers. [Laughter.]
§ Dr. Summerskill
I thought of bringing them here for the Government.
Hon. Gentlemen must not laugh. They are paying for these things. All this is coming out of the pockets of the taxpayers. I am quite bewildered when I look at the Government benches and see hon. Gentlemen who, quite rightly. demand a cutting of extravagance by the Government, but who do not realise that this thing is not only extravagant but harmful to the whole nation. I cannot understand why they do not realise it. All doctors know. I discuss these things with the most responsible people. I would not be so silly as not to. The World Health Organisation has told the world.
Last night, waiting for me, were the usual advertisements:Dear Doctor: Tranquillisers. You could name a dozen of them".It goes on to boost this one, saying:… it is safe and has no contra-indications. It is the ideal tranquilliser for the management of anxiety states.
§ Dr. Summerskill
I am hoping to get some support on this matter. I am told that these particular tranquillisers can be used for children from five years to ten years and—the Minister must listen to this—thatthis is freely prescribable under the National Health Service.One thing that the advertiser omits to tell the doctor is the price, because the price may be so frightening that the doctor may 228 think, "That's a little bit too stiff. I'm not prescribing that".
I come to the last point I want to make, which is on the British Medical Association dispute, the grave dispute which has arisen between the Minister of Health and the doctors. The Prime Minister has apparently taken charge here. His attitude, far from improving the situation, has aggravated it. I say this deliberately because, when the Prime Minister saw them last week, the doctors came away having been given no further information, and they decided forthwith to prepare a plan for withdrawal from the Service.
This is a most remarkable incident because, politically, the doctors are 90 per cent. Conservative. Doctors form a most conservative profession, yet the Conservative Government could not have handled them more clumsily if they had been an implacable Communist bloc[HON. MEMBERS: "Oh."] If hon. Members think that that comment is too strong, I ask them to consider what the Daily Telegraph says. It is the mouthpiece of the Conservative Party. [Laughter.] Yes, I am certain of it and I do not think right hon. and hon. Gentlemen need be ashamed of it. It does its job very well for the Conservative Party. It very often gives an excellent report of the business of this House, with a slant here and there, but nevertheless, Government supporters have a very good mouthpiece.
The Daily Telegraph said:… the Government has behaved shabbily and, indeed, shortsightedly as an employer… To bring those on whom the Health Service depends to the point of revolt suggests clumsy management at the best.This week, the doctors are meeting to arrange the final details of their withdrawal from the Service. There is no question of the British Medical Association wanting to withdraw its doctors. The Medical Practitioners' Union does not want to withdraw the doctors. It wants to support the Service. The British Medical Journal said, on 19th March:If politicians say that such an action—[withdrawal]—is an attempt to wreck the Health Service, who is the wrecker? The Government. The medical profession does not wish to wreck the Health Service. It acknowledges that today some public organisation of medical services is necessary, and it has played a large part in planning for them.The doctors are meeting this week. I ask the Leader of the House whether he 229 will take this opportunity, in the absence of the Prime Minister perhaps, to act as mediator in that dispute. It is extraordinary that the Conservative Government are unable to handle the men and women who were, I know, their chief supporters in the towns and villages.
The record of the Government in respect of the social services reveals a characteristic disregard of the needs of the poorest and a lack of co-ordination among the Departments. On the one hand, a Minister is subsidising harmful tranquilliser drugs for the wealthy hypochondriac while, on the other, another Minister is cutting down the subsidy on milk which should be drunk by the poor children. Where is the co-ordination in the Government? Is there anybody who regards the country as a whole and determines policy? Each Minister should think carefully about the conduct of the social services in his Department, and I particularly ask those who are in charge to see that this gross mismanagement ceases.
§ 4.18 p.m.
§ The Minister of Health (Mr. Dennis Vosper)
The right hon. Lady the Member for Warrington (Dr. Summerskill) complained to the Lord Privy Seal that I was the fourth Minister of Health under the Conservatives. I take it from that that she wishes me a long tenure of office.
§ Mr. Vosper
I am sorry that she took exception to my replies to Parliamentary Questions. I went through my Answers this morning and I noticed that two of her colleagues were more than satisfied with the replies that I gave.
The right hon. Lady made a rather extraordinary speech. I have been looking at the Motion which she and her colleagues put on the Order Paper. I will endeavour to answer many of her points, and my right hon. Friend the Minister of Pensions and National Insurance will do likewise: but I suggest that many of those points go right beyond the Motion. The right hon. Lady, of course, selected, as she had the right to do, certain changes and developments in the social services, but ignored, from lack of time or perhaps from lack of intention, other developments which give a distinctly favourable view of the social 230 services which an impartial observer could not fail to take. At times, it must be distinctly embarrassing for the right hon. Lady and her hon. Friends that after five years of administration the Conservatives have not slashed the social services, but have improved them.
To put these measures into perspective, the first part of my speech will seek to prove what I say. My right hon. Friend the Minister of Pensions and National Insurance will deal with his aspect of the services. I want, first, to deal with the general position of the social services today. They cover, of course, a very wide and undefined field. My responsibility today extends to the Health Service, but until more recently, in a more junior capacity, it concerned education.
I think hon. Members will agree that the provision of opportunities for the young and the maintenance of public health are particularly good indicators of the success or failure of social service policy as a whole. After all, the social services are rendered by the community to those who need them. Their adequacy is reflected not necessarily in the expenditure of public funds or in specific measures referred to in this or other Motions, but in the condition of those sections of the people who, formerly, were at a disadvantage. Over five years of Conservative administration there has been little variation in the proportion of the gross national product expended on the social services.
What is more, during that period I believe more efficient use has been made of the expenditure and it has also been a time of increasing purchasing power and lower taxation. Therefore, it is a matter of little surprise that in the last five or six years there has been a marked improvement in the social services. The right hon. Lady will contest that, but I believe it to be true. Surely this is the evidence of our own eyes. The right hon. Lady and I have adjacent constituencies. I find it hard to believe that in her constituency the social conditions of the people are anything but better than they were five or six years ago. What I say is supported by a mass of reports and statistics, some of which I shall have to give to the House today. I do not believe that this favourable trend in the social services will be reversed by the recent measures to which reference has been made.
231 I expect that the right hon. Lady and some of her hon. Friends will have had time to read the reports of the Chief Medical Officer of the Ministry of Health and similar reports on the health of the school child. They seem particularly relevant to what the right hon. Lady said, because while they reflect great advances made by doctors and others concerned, the success story, which is there for anyone to read, could not have been achieved without an improvement in social conditions.
There has been a continuing drop in mortality rates and a very welcome drop in deaths from children's infectious diseases. Improved social conditions, better housing and wider education have contributed. I do not think that it is unfair to mention the remarkable improvement in the tuberculosis figures. In 1948, there were 45 deaths from tuberculosis per 1,000 deaths. Today. that figure has fallen to 13 per 1,000. Of course, that is a tribute to those in the Health Service, but I believe it is also a tribute to those responsible for the social services generally.
Finally, as the right hon. Lady referred to the school child, I think that she must have overlooked a paragraph in the Report of the Chief Medical Officer for 1954–55. which stated:The health of the great majority of children was good; only 1.46 per cent, of them were considered to be in poor physical condition in 1955 compared with 2.55 per cent as recently as 1952.What better evidence could there be than that about the improvement of health of the children with which both the rigth hon. Lady and I are so much concerned? I realise that these very welcome trends have been evident for well over a century——
§ Mr. Vosper
Half a century.
I mention that to show that the trend has been accelerated. All these improvements have taken place while the Government have been pursuing a policy the logical continuation of which the party opposite seemed to be opposing in this Motion. This policy recognises that the amount which can be spent on social services is not unlimited. It is, therefore, 232 of extreme importance to eliminate all waste and inefficiency, and to ensure that the services are available to those most in need and to make certain that the resources are directed to where they can do most good.
It is my contention, after two and a half years in two Departments, that when the Opposition were in power they failed—maybe unintentionally—to establish these priorities and, as a result, spread their resources in social services too thinly. Limitations in finance for the social services are necessary if the burden on the workers, who have to pay for them, are to be kept within reasonable limits. It is necessary also to ensure extension in the right directions and this has been and remains the object of our financial policy.
Partly in answer to the right hon. Lady, I propose to give the House a few examples from my Department. She mentioned hospitals and no one can doubt the need for new hospital buildings. Many of them are at least a century old. In 1951–52, when we came into office, the amount allocated for England and Wales was £9.5 million. In the year which is just ending £13 million will have been spent and in the year about to start, 1957–58, the sum allocated will he £18 million.
§ Mr. James Griffiths (Llanelly)
What does the £13 million mean compared with £9 million? Is there any real increase in value?
§ Mr. Griffiths
The Minister is saying, of course, that whereas, in 1951, the expenditure on hospital buildings was £9 million it is now £13 million. is he asking the House to believe that there has been a real increase to £13 million?
§ Mr. Vosper
The amount for the year starting next April will be £18 million, almost exactly double that for the year when we came into office. It cannot be alleged that costs have doubled during that period. [HON. MEMBERS: "It can.'] The amount at present allocated for the year 1958–59 is to rise to £20 million and I hope that it will be possible to keep on allocating increased sums to what, possibly, is the most important part of the National Health Service.
§ Mr. H. A. Marquand (Middlesbrough, East)
With reference to the figure of £13 million, does the hon. Gentleman recollect that one of his predecessors, the present Minister of Labour, told me when he held that office—some little time ago now—that the equivalent of the £9 million allocated in 1951 would then be £12 million? Therefore, surely the £13 million today must be about equivalent to the £9 million in 1951.
§ Mr. Vosper
I do not disagree with what the right hon. Member said, but I have said that the figure is going up to £18 million for the year beginning next month.
The second point about hospitals, as I am sure the House will agree, is that a reduction of the waiting lists is of first priority. Owing to a change in the basis of the statistics, I cannot cover the whole period under review, but on 31st December, 1953, the waiting lists were 526,000 and on 30th September, 1956, they were down to 433,000. That is far too big I admit, but it is a great reduction from the figures for three years previously. It was due to a better use of beds and more beds becoming available and that, in turn, was dependent on better recruitment to the hospital service. I know of no category of hospital staff which has not added to its numbers in the last few years. I particularly mention mental hospitals, where, in the first nine months of last year, there was a 20 per cent. increase in the number of student nurses.
The right hon. Lady mentioned maternity hospitals. I can give the assurance for which she asked. There has been no change in the policy during the five years a Conservative Government have been in power. Our attitude to maternity hospitals remains as it was when the right hon. Lady and her party left office. At present, about 64 per cent. of mothers are confined in maternity hospitals.
I will not follow the right hon. Lady in her remarks about the doctors. I do not think that it would be in the interests of the doctors or their patients for me to comment on that controversy. I am sorry that she found the intervention of the Prime Minister not helpful. My right hon. Friend intervened because he felt it advisable for there to be a Royal Commission to investigate this matter and I 234 do not know that she has disagreed with that decision.
For that reason, my right hon. Friend exercised his prerogative to announce the Royal Commission which is to investigate the matter. I would not wish to comment further on that matter today, but I would remind the right hon. Lady that it is estimated that during the last five years no fewer than 2,000 additional general practitioners have come into the Service. That is a very necessary development.
I would say one further word about dentists. Nobody can afford to be complacent about the shortage of dentists, and I am at present studying the McNair Report. At the same time, and partly as a result of the Government's financial policy, there are some favourable developments. The number of dentists practising in the general dental service reached the highest total ever known on 1st January this year, and the number of dental courses estimated for the current year, 1956–57, is 11.1 million for England and Wales, 10 per cent. higher than the previous maximum before charges were imposed.
The advantages of charging policy can be seen in the proportion of dental resources diverted to the priority classes. Children under 15—the class which the right hon. Lady has so much in mind—received nearly 30 per cent. of all courses of treatment provided compared with only 7.3 per cent. in 1949, a fourfold increase. Hon. Members on both sides of the House will be familiar with the steady rise in the school dental service during the last five years.
§ Mr. William Ross (Kilmarnock)
Does the right hon. Gentleman intend to give any figures relating to Scotland? If not, I shall be able to get away for my tea.
§ Mr. Vosper
I can assure the hon. Member that I have some figures for the United Kingdom as a whole, but, generally speaking, the favourable trends in England and Wales were also noticeable in Scotland.
§ Mr. Vosper
I have given these examples because they are good examples of financial policy towards the social services not depriving those in need of 235 the service but doing what it was intended to do, improving their share of the service.
I agree with the right hon. Lady that when it becomes possible to introduce a chiropody service it will be a very welcome improvement. I am sorry that I cannot meet her wishes in that respect today. My argument so far is that there has been an overall expansion in the Health Service and that it has been most evident at the points where it was most needed.
The right hon. Lady did not refer to education, but I do not think that she would wish to dispute the expansion in education which has taken place in recent years. The actual advance can be seen in the steadily decreasing number of children in all-age schools, the number of pupils staying on longer at school, the massive increase—"massive" is the correct word—in the numbers taking the General Certificate of Education and the additional facilities now becoming available for further education.
The night hon. Lady and her hon. Friends will have noticed that only last week my hon. Friend the Member for Handsworth (Sir E. Boyle) announced an addition of £5 million to the school building programme for both next year and the year after, and my right hon. Friend announced a considerable increase in the quinquennial grant for the universities.
§ Mrs. Slater
Is the right hon. Gentleman aware that what is announced does not make up for the standstill since the present Government took office?
§ Mr. Vosper
I was dealing with a Motion which refers to recent measures. As both measures were announced last week, I thought that they would be of interest to the House.
I mention this expansion of education, not because, as The Times tells us today, it is receiving a high priority, but because it is against that sort of background that I want to refer to the proposal to recover £3½ million by increasing the price of school meals.
The right hon. Lady did not refer to the housing policy of the Government. I will leave that matter to my right hon. Friend when he speaks later.
I want now to turn to what I believe should be the essential part of the Motion, 236 and that is the financing of the social services, and particularly the Health Service. I should have thought that what was really worrying the right hon. Lady and her hon. Friends was the specific proposals which alter the distribution and the finance of the Health Service Vote.
My right hon. Friend the Chancellor of the Exchequer recently told the House that the estimated total cost—that is the cost met from all sources—of the Health Service for Great Britain for 1957–58 would be £690 million. This compares with about £450 million spent in 1949–50. Of course, much of this is due to the increase in pay and prices, but there has been a substantial increase in real terms of about 15 per cent.
To this increase of 15 per cent. in real terms must be added the improvements due to greater efficiency, the advance of medical science, and the redeployment of resources to meet the present need, to which I have already referred. All this has meant a considerable increase in the value of the Service to the patient, but it has added a not inconsiderable burden to that carried by the taxpayers and ratepayers.
§ Mr. J. Griffiths
I gather from what the right hon. Gentleman said that of the increase in the cost of the Health Service from 1949 to the present time 15 per cent. represents a real increase in service. I take it that all the rest is eaten up by increased prices.
§ Mr. Vosper
It is important to establish these figures. The expenditure for 1949–50 was £450 million. The estimated expenditure for 1957–58 is £690 million, and of that the increase in real terms is 15 per cent. That is the point that I wish to establish.
§ Mr. Vosper
If I may continue, the financial memorandum to the National Health Service Act assumed that the percentage of the cost of the National Health Service to be borne on the Exchequer would be 72.4 per cent. In the first year of operation it was 76.5 per cent., and this year it is estimated to be 80.2 per cent., which represents an Exchequer expenditure of £529 million.
I am sorry to weary the House with these figures, but they are particularly 237 relevant to the Motion. The Government's intention—the proposal to which the right hon. Lady did not refer, but which is germane to the debate—is to double the Health Service contribution and to reduce the Exchequer percentage to 74.1 in the year 1957–58.
The history of the National Health Service from the Beveridge Report onwards makes it clear that it has always been financed on a hybrid basis. Hon. Members opposite who may later argue that to have a weekly Health Service contribution is a regressive policy, must ask themselves why, during their years of office, they allowed this state of affairs to exist. All that the Measure which will shortly come before the House does is to enable the contributory element to resume its original place, allowing for the growth in the Service and the change in the value of money. Even under this proposal, when implemented, 75 per cent. of the money will be found by the taxpayers.
I would ask right hon. and hon. Members opposite these questions. Is it wrong that we should seek to limit a charge which, by its incidence—by the incidence of taxation—must discourage the worker from seeking to increase his output? Do we net agree that an expanding economy can do more than anything else to improve the social services? Do we not agree—as The Times does in its leader today—that inflation is the greatest danger to the social services?
§ Mr. Percy Shurmer (Birmingham, Sparkbrook)
Is the right hon. Gentleman not aware that the increased prescription charges will hit the poorest people, those who are more often and that it will have a detrimental effect on those who are, unfortunately, unable to pay for each prescription and, therefore, go short of medicine?
§ Mr. Vosper
I shall shortly deal with the prescription charge.
With regard to the proposal to increase the contributory element, I should like to say that there are plenty of honest precedents for seeking to limit the burden of the Health Service on the taxpayer. Every hon. Member must know the ceiling that was imposed by Sir Stafford Cripps, in 1950. I would remind hon. Members of what the present Leader of the Opposition said on 10th April, 1951: 238We did not feel that, in present circumstances, and with all the other burdens which had to be carried, it was reasonable to put upon the Exchequer, and, therefore, on the tax payer, another £30 million. We decided that the Health Service Estimates must be brought within a total of £400 million, which, for the time being, would have to be a ceiling."—[OFFICIAL REPORT, 10th April, 1951; Vol. 486, c. 851.]This, in fact, led to the policy of charges, and it was in respect of a potential increase in expenditure of £30 million.
This year, the potential increase is £49 million, and my right hon. Friend the Chancellor of the Exchequer and I seek to limit this not by imposing further charges, but by restoring the importance of the contributory element by asking those who are at work to pay towards those who are not. In days when taxation is so broadly based, and when it already contributes so much to the Health Service, surely this measure is fair and does fall upon those who can bear it.
I think it is pertinent to ask hon. Members opposite, if they oppose this measure on this or any future occasion, what their alternative is to be. To cut the Service, to impose more charges on the patient or to increase the tax on the worker? I think that we on this side of the House, if we are to be criticised for this measure, have a right to know. If the last is chosen, that is, to increase the tax on the worker, then presumably it is intended to remove even the existing insurance contribution, and, together with the abolition of charges, which I understand to be the Opposition's policy, this would add well over £100 million to general taxation.
The proposal to establish a health contribution will be the subject of legislation, and there is little further I can say about it, but I think I should say that it is the intention of the Government to establish both the existing contribution and the new one as a separate health contribution, and to seek by every means possible to make it clear that for each insured worker 1s. 8d. will be contributed towards the National Health Service, but that the major part of the cost of the Service will still be borne by the taxpayer.
While there might be much to commend an extension of the contributory classes, it is proposed that the contribution shall be paid by the same categories 239 who at present pay weekly National Insurance contributions, and this will, in fact, mean that the contribution will not fall on the young, the old or on those who are off sick.
§ Sir Spencer Summers (Aylesbury)
In reference to that 1s. 8d., which is the share in the contribution to the Health Service, could my right hon. Friend divide it up as between employee and employer?
§ Mr. Vosper
The figure for an adult man employee is 1s. 4½d and for the employer 3½d.; for an adult woman 1s. 0½d. and for the employer 3½d., and, for those under 18, 8½d. for the employee and 3½d. for the employer.
§ Mrs. Lena Jeger (Holborn and St. Pancras, South)
Could the right hon. Gentleman clear up one point about the contribution? Will those contributions have to be paid by widows who are making insurance contributions to become entitled to retirement pensions?
§ Mr. Vosper
I cannot anticipate all the Clauses of the Bill, but the contribution will be paid by exactly the same categories as are paying National Insurance contributions at present.
I would say, finally, to hon. Members who may oppose this particular proposal that if they would prefer the alternative of extending the charges which they themselves introduced, I hope that today or on a later occasion they will say so.
I want to turn now from this proposal to the charges policy generally, and I want to quote again from an Opposition speech, but it is the only other quotation which I shall give. The right hon. Member for Middlesbrough, East (Mr. Marquand), who has just left the Chamber, said this on 24th April, 1951:It was absolutely necessary to obtain money from charges upon some other parts of the Health Service so that we could maintain the essentials … But in a full year we expect to receive £25 million from the charges. This … is not a tax on the Health Service; it is a readjustment within it."—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 238–9.]I do not say for a moment that that is wrong. It remains existing policy, but on this occasion we have chosen the alternative of increasing the Health Service contribution.
240 I realise that the right hon. Gentleman on that occasion exempted the 1s. prescription charge on the grounds that the deterrent effect would be serious on those least able to bear it. Whatever the merits of the deterrent effect of charges may be, we must face the fact that, despite charges, the number of dental courses and the number of sight tests are increasing to record levels. Prescriptions for 1956–57 are estimated at 234 million, which would be the highest figure ever reached, and the estimate has taken into account the effect of the recent variation in the 1s. charge.
The right hon. Lady asked me what evidence I have of the effect of the variation of the charges. All I can tell her is that in the month of December, 1956, as compared with the previous December, there was a fall of 25 per cent. but if we take the month of January, 1957, which is a more recent month, and compare that with the previous January, the fall was only 14 per cent.
I have said in answer to Questions that it is too early yet to judge the effect of the variation in the 1s. charge. If the variation is to be considered a recent measure under the terms of the Motion, I should remind the House that the cost of the pharmaceutical services, without charges, in the year 1957–58 is estimated at £61.8 million. It was, therefore, essential to limit the charge on the public purse.
Both my predecessor and I were very conscious of the effect that this could have on the chronic sick and the old. The right hon. Lady mentioned the arrangements made to alleviate this by a variety of means. These included special arrangements with the National Assistance Board, prescribing for longer periods in certain cases, and, if possible, the provision of more composite packs.
I have answered a number of Questions on the subject, and I have examined a number of individual cases submitted to my Department and through hon. Members. I do not know at this moment of any individual case of hardship which my Department or the doctor has not been able to meet.
§ Mr. Shurmer
I made inquiries last weekend from a number of chemists in the poor district where I live in respect of the day on which these people can have their prescriptions and I find that they 241 can have them only if they produce the money. What is the position of an old-age pensioner or a person in the lower income group who has just sufficient to live on and so does not come within public assistance, on a Thursday, when expecting to get a prescription and has to wait until Monday, when the medicine might do that person a lot of good on the Friday or the Saturday? That is the position. Chemists have told me that they cannot give them their prescriptions unless they provide the money. The 1s. charge was bad enough, but when it comes to 3s. or 4s., it is worse still.
§ Mr. Vosper
It is very difficult to judge particular cases on general remarks, but I am perfectly prepared if the hon. Gentleman will give me a little more detail to look into this allegation. I do recognise this weakness in the arrangements for making prescription charges, and for that reason I am prepared to take considerable trouble to investigate difficulties. My predecessor asked hon. Members of this House to send him details of cases of hardship, and I am continuing that investigation as well as I can.
§ Mr. A. E. Hunter (Feltham)
I should like to put a point in support of my hon. Friend the Member for Sparkbrook (Mr. Shurmer). I have had a case, and I think the Feltham Council has written about it, in which the prescription charge was 12s., and the man concerned was entitled to a refund from the National Assistance Board, but he had not got the 12s. at the time and so could not have his prescription made up. Could the Minister think of a scheme by which the chemist could send the current prescription form to the Assistance Board.
§ Mr. Vosper
I am aware of the case or cases to which the hon. Member for Feltham (Mr. Hunter) refers. I think he will find that both his constituents are in receipt of National Assistance payments, and if they present their cases to the National Assistance Board, arrangements may be made to enable them to receive advance payment to meet the charge. I should be disappointed if, in fact, that cannot be done.
I would say a word or two about proprietary medicines. Although in no sense can it be considered a recent measure, I am well aware of the right hon. Lady's views on this particular sub- 242 ject. I think she will be wrong to suggest that vast savings on the pharmaceutical services can be found as a result of efforts in this particular field, but she will know that discussions have been proceeding for a vast amount of time with the manufacturers. If, in fact, the Opposition had postponed this Motion, as they did initially, for a week or two, I might have been able to answer the question more positively.
My right hon. Friend the Member for Thirsk and Molton (Mr. Turton) did announce the formation of a committee to go into the whole question, and I can only hope that it will throw some light on what is a difficult subject. I do not know whether the right hon. Lady was suggesting that proprietary medicines should be banned from the National Health Service altogether or whether she thought that we should only give the right to the doctor to prescribe them subject to certain limitations.
I have not so far been asked about welfare milk—[HON. MEMBERS: "Yes."] I am sorry. That is all the more reason, I think, why I should place on the record just a few facts about it. The history of this is, of course, that in 1940 the subsidy paid was 50 per cent.; in 1946 it rose to 66⅔ per cent., and now it has reached 81 per cent. As a result of our proposal, which has not yet been tabled, let alone approved by the House, the subsidy will, in future, be approximately 50 per cent.
I agree completely about the nutritional value of welfare milk, but I cannot accept the argument that no change should be made in the price, which has remained unchanged since 1946, or that half price is not a reasonable price to charge. Moreover, we should remember that those in receipt of National Assistance will obtain welfare milk free of charge, and that, in respect of large families, the family allowance for the third child and subsequent children was recently raised to 10s. Reference has recently been made in the House to a survey conducted by the Milk Marketing Board, and I would remind hon. Members of its conclusion, which was:Family income and the price of milk are probably not the main barriers to increased sales. In many cases there are tradition and habit which can be overcome by persistent effort through education and propaganda.
§ Mr. J. Griffiths
We have been told by the Chancellor of the Exchequer about the increase in the prices of welfare milk, and the amount which is being saved. I should like to ask the right hon. Gentleman whether, as Minister of Health, he has had consultations with his medical advisers, and has struck a balance as to what would be the gain to the nation on one side and the other. Having regard to what we have been told this week by his right hon. Friend the Minister of Agriculture about the continuing fall in the consumption of milk, is not this a false piece of social economy?
§ Mr. Vosper
Of course, I took advice before I made this proposal, and I should be very surprised if, in fact, there was any appreciable fall in the consumption of welfare milk.
Finally, I should like to say a word about school meals. The proposal is to increase their price from 10d. to 1s., which means that towards the cost of them—and today they cost about 1s. 10d.—there will still be a general subsidy of 10d., irrespective of the needs of the parent. It may be said that, for the first time, the price of the school meal will exceed the cost of the food, which today is between 10d. and 11d., but there is nothing sacrosanct about this arrangement, and it seems perfectly reasonable that some contribution should be made towards wages and overheads.
I would remind the House that where payment of the charge would involve financial hardship, local education authorities may remit it wholly or in part in accordance with arrangements approved by my noble and right hon. Friend the Minister of Education. At present, about 7 per cent. of the school population taking school meals benefit by this provision.
Having had the good fortune to study the school meals service at close quarters, I am a convinced believer in it, not only on nutritional grounds—and I realise that this is a controversial subject politically—but because of the opportunity it gives for training children in social habits and good manners. Together, in a rather different sense, with the morning assembly, it is a vital part of school life, and I wish that more parents would allow their children to make use of it. From my own experience and that of teachers to whom I have talked, I am quite sure 244 that price is not generally a deterrent. At 10d., and soon at Is., it represents extremely good value—[Interruption.] Right hon. and hon. Gentlemen on both sides would do well if they could get an equivalent meal in the canteens of this House at a cost of 1s.
The reasons why half the children do not take the school meals but prefer to go home are clearly set out in the Ministry of Education Report of an Inquiry into the Working of the School Meals Service published last year. I will not weary the House by giving the reasons, but if hon. Members will read it they will find that price is the least of all the reasons given, and I think that this Reports destroys much of the opposition to the charge increase which has just been announced
The increase will save the Exchequer about £3½ million a year, but the cost to the Exchequer in a full year will still be about £31½ million. That saving must be see n against the vast increase in educational expenditure, which is some 60 per cent. above that level of the year 1951–52. Once again, it seems good sense to reduce a general and indiscriminate subsidy so as to enable expansion in education to proceed in other directions
The Motion, as I understand it, suggests that these measures proposed by this Government are likely to undermine the social services in so far as they are designed to meet the greatest need. The evidence at my disposal suggests that they will contribute to the furtherance of the present policy of raising living standards and of ensuring that resources available for the social services are used to the best advantage
Hon. Members who are interested in this debate may have seen in The Times of Thursday of last week a most interesting and factual survey entitled "Social Payments." In this survey, reference is made to all the measures which should be the object of this debate, and the following question is posed:Is all this a plot to reduce the workers' standard of living, or is it an operation keeping charges in step with consumers' incomes and effecting reasonable economies which will help check inflation and reduce taxes?In answering this question, the survey rightly states that a fair answer can be given only by surveying the whole trend of wages and of charges falling on them. This it does, and shows that at existing 245 rents, rates and charges the average wage-earner's spendable income at present buys 18 to 20 per cent. more than in 1948——
§ Mr. Vosper
I do not think that I need go into that now.
The survey says of this:Much the greater proportion of this gain has occurred under Cory rule.The increase in charges will reduce this by less than 1 per cent and that of rents by, perhaps, 3½ per cent The survey goes on:Two years' advance in productivity should entirely make good both losses. Indeed, since one purpose of the first cut is to charge the citizen a little more as consumer of social services in order to charge him a little less as taxpayer, it could be offset at once by small reductions in taxes affecting the mass of ordinary families Even if that is not done this year, the cut is defensible as a price worth paying, if in fact it helps to check inflation and to promote a steadier advance in productivity.This survey was conducted by The Times, and I have referred to it because the right hon. Lady and her hon. Friends might consider it less partisan than any views of mine. Nevertheless, it confirms what I hope will result from these measures which, in themselves will, no doubt, he unpopular, but which will continue the improvements in living conditions which I have argued are clearly visible. I therefore ask the House to reject this Motion and to support instead a policy which seeks to maintain and develop the social services whilst limiting the increasing burden on the taxpayer.
§ 4.59 p.m.
§ Miss Alice Bacon (Leeds, South-East)
I am sure that on this side of the House we have all listened with considerable interest to the right hon. Gentleman, but I do not think that what he has just told us will in any way allay our suspicions about the future. All the cuts which the Government have recently announced will cause hardship to individual families. That has already been stressed, and, although it is extremely important, I do not want, in the few moments at my disposal, to stress that so much as to concentrate on the policy behind these cuts, and the present trend of the Government in regard to the social services.
246 It is quite true that more money in £. s. d. has been spent in the last few years, but it is obvious that there has been a great increase in population and that prices and wages have been rising. Indeed, on 19th February, when the Chancellor of the Exchequer announced some of these cuts, he said quite specifically that the increase of £146 million for the social services over the original Estimates was due to higher prices, salaries and wages and more children.
If we look at the Guillebaud Report, we find that the Committee says quite specifically that, if we have regard to increases in costs, the actual cost per head of the National Health Service in 1953–54 was the same as in 1949–50. Indeed, the Guillebaud Report goes even further than that and says that if we measure the cost of the National Health Service as a proportion of our total national resources, between the same two dates the actual percentage had gone down from 3¾ per cent. to 3¼per cent. I do not know whether there are any up-to-date figures as to what the percentage was for 1956–57, but that was the position then as reported by the Committee.
It is absolutely plain that, although the expenditure on the social services in £s. d. might have increased in the last few years, the policy of the Government with regard to the social services is not a progressive one, but is in many ways a reactionary policy. I should like to give one or two examples, and I take, first of all, the school meals service to which the right hon. Gentleman has just referred. The increase of 2d. brings the price of the school meal to 1s. a day, which is 5s. a week per child in each household. This is to save £3½million. The right hon. Gentleman said that there may be other reasons why children prefer not to stay at school for their meals. There may be some individual children or parents who, for reasons other than the price of the meal, prefer the meal to be had at home, but surely the right hon. Gentleman is not suggesting that a very large number of children do not stay at school because of the price of the meal? It is quite certain that many children today go home very long distances to their midday meal because of the cost of the school meal.
§ Mr. Vosper
Perhaps I might quote a passage from the Report to which I referred. The question was put to 756 247 teachers, of whom 326 said that the reason for not taking the meal was,There is a midday dinner at home and the parents like the children home for it.A further 173 teachers said,Children are 'faddy' and do not like the meals provided.A further 90 said,Dinners are unpopular because they are brought in containers,and 74 teachers gave as the reason, "Dining conditions are bad." Out of the 756 teachers to whom the question was directed, only 93 gave as the reason for children not taking the school meal asParents are not prepared to pay the charge.
§ Miss Bacon
From my own experience, which is quite considerable in this matter, as I shall explain, I am quite certain that thousands of children in this country do not stay to school meals precisely because of the charge.
It has been argued by the Minister that the school meals service is another example of a subsidy which is indiscriminate. It is argued that, because the service is available only to certain children of certain families who attend certain schools, and as it is an indiscriminate subsidy, there is something unfair about it. I will grant that there is a measure of truth in that; I am perfectly well aware that if the children of Mrs. Jones can go to a school where there is a school meal provided, Mrs. Jones can take advantage of the subsidy, whereas if the children of Mrs. Smith go to a school where there is no school meals service, Mrs. Smith cannot take advantage of it. But, surely, the remedy is not to raise the price of the school meal, but to make it possible for the Smiths to have the advantage of the school meals service as well as the Jones family.
What is the Government's policy with regard to the school meals service? Are we to press ahead and expand it? What has happened to the idea we used to have, that there should be a free school meal for every child as part of family allowances? We used to say that family allowances should be paid partly in cash and partly in kind, and through an expanding school meals service we should make available to every child a free 248 school meal as part of our social services and family allowances. What is the Government's intention? Are we really pressing ahead, or are we just going to let it dwindle away?
I fully agree with the right hon. Gentleman, in this perhaps more than in anything else he has ever said, when he says that there is more in the school meals service than the actual meal itself. As every teacher knows, there is a great deal in having the meal at school. Many local authorities employ dieticians. The meal is well balanced. But, apart from that, as the right hon. Gentleman said, there is a certain social value in children eating together. I have had two memorable experiences concerned with the school meals service. The first was at the time when a school meals service was inaugurated in what was then the very strict mining town of Featherstone in Yorkshire, a town which is known in history for many things, including the occasion when strikers were shot upon by soldiers. I well remember the occasion when we had to open what was nothing more than a soup kitchen and trail the children nearly half a mile to partake of a midday meal. That was one way of providing school meals. The other experience was when a school meals service was inaugurated in a brand new school where the children were able to sit at tables, eight or ten to a table, and be served out of tureens and with proper utensils. I believe there was a great deal of training in that, quite apart from the dietetic value of the meal.
I want now to refer to the increase of 10d. in the contribution for National Insurance. My right hon. Friend the Member for Llanelly (Mr. J. Griffiths), who is not in his place at the moment, knows that I have always been very critical of a flat rate contributory system of payment for National Insurance. I have never liked it because it has, in my view, been the most unfair method possible for paying the contributions. Not only does it mean that poor and rich alike pay the same nominal amount, but it means, in fact, that, because the National Insurance contribution is allowed as an expense for Income Tax purposes, the person with the bigger income pays less than someone with a smaller income. That is sometimes overlooked when we talk about the stamps which are paid for each week.
249 To put an extra 10d. on the contribution means that the only person who will in fact pay the full 8½d. which the employee is called upon to pay is the person with such a low wage or such a large family that he does not pay Income Tax at all, whereas the person with the higher income will be able to set off the 10d. against expenses for Income Tax purposes. Thus, the inequality in the previous contribution, which I have never liked anyway, will be accentuated.
While 10d. was the part of the National Insurance contribution which went to the National Health Service, the National Health Service has always been regarded as a non-contributory scheme. I think it was the Chancellor of the Exchequer himself who, when he announced this increase of 10d., said that the contributory factor for the National Health Service would now be one-ninth instead of one-seventeenth. That is rather important. The Government have said—and it has been repeated again this afternoon—that the Health Service will not in any way be cut. Today, there has been a kind of implied rejection of putting any further charge for this service on taxation. The only conclusion, therefore, is that if we spend more on the Health Service in future, more will be put on the weekly contribution paid by each contributor.
I regard that with great misgiving, and for this reason. I believe that if more is to be paid by contributions towards the Health Service, there is a danger that the service will soon cease to be non-contributory and will become a contributory service. It is a very small step from this to saying that only those paying contributions will get the benefits. I hope we are not going towards a situation where, before anybody is taken away in an ambulance, somebody will inquire how many stamps he has on his card. This is a matter of fundamental importance and we ought to know just where the Government are going.
There is something else which I rather deplore in recent statements. Up to now, the National Health Service has been regarded as universal. Recently, the Yorkshire Evening Post, which is the mouthpiece of the Conservative Party, because it is controlled by the Yorkshire Conservative Newspaper Company, Ltd., 250 was commenting on the results of the Warwick and Leamington by-election. It was, of course, an editorial full of apologies why the by-election had not produced better results for the party opposite. This is what it says, and I was filled with horror when I read it:It is all a question of means: unpopular means. For instance, Lord Hailsham's dark hint that the social services are going to mean bigger contributions will cost votes inevitably. But that is not the point. The point is whether Government policy is right.It goes on to say:The truth is that at the moment wages have never been so high, yet the high wage-earners are receiving massive free benefits of various sorts which are met out of taxation. The Conservatives have been trying to bring sense to this situation. We are taxed to death to provide free benefits for people who are quite well paid. Subsidies should he for the needy, not for everybody.[HON. MEMBERS: "Hear, hear."] Hon. Members opposite are saying "Hear, hear." This is the crux of the whole situation. Are we, in fact, to regard our great social services as subsidies for the needy, or are we to regard them as universal, to which everybody pays and from which everybody can draw? It was on that basis that they were created from 1945 to 1950.
We always knew that the party opposite did not like some of the social legislation that we inaugurated. I am very much afraid that if we get the idea that the National Health Service in particular is a sort of poor man's service, a kind of subsidy to be given only to those in need, we shall get a first-class service and a second-class service; and that will not be good for the country. Let me warn hon. and right hon. Members opposite that in the last few years it is not only the working-class people who have been glad of the National Health Service. It has been the middle classes too.
§ Mr. Robson Brown (Esher)
I am interested in the hon. Lady's argument concerning payment and the payment of one scale by some salary earners as against another scale for other incomes. Would the hon. Lady develop further what she has in mind? At the moment, there is a flat rate of payment irrespective of the salary earned. Is the hon. Lady suggesting a poundage related to earnings?
§ Miss Bacon
There is a great deal to be said for that. I do not want to elaborate it at the moment, because it is a big question. What I have said is that I have always regarded, and still regard, the flat-rate weekly payment, particularly when it is chargeable to expenses for Income Tax purposes, as a most unfair way of paying for our National Insurance benefits.
Mention has been made of education. I do not want to go into great detail today except to re-emphasise what my hon. Friend the Member for Stoke-on-Trent, North (Mrs. Slater) said last week concerning the additional £5 million, which is not an increase in school building but is the restoration of a £5 million cut made last year.
We are fearful of what will happen about education in the future. We have already been told that local authorities are to receive a block grant for their requirements instead of a percentage grant. Education is our greatest local service. If the block grant, instead of a percentage grant, is aimed at any service at all, it is aimed, therefore, at education, for that is the greatest local authority service to which the Government contribute.
Local authorities all over the country fear what is to happen. Although last week we pressed the Parliamentary Secretary to the Ministry of Education to give an assurance to the House that no local authority would receive less under the block grant scheme than under the percentage grant scheme, we could not get that assurance from the hon. Gentleman. It seems to me that unless we are very careful, the block grant method will be a means of keeping down the education Estimates without the Government actually having to announce a cut in the service. We on this side will be particularly vigilant when the matter comes up for discussion, because we see here a backdoor method of trying to cut our education services.
After the war, we built up a system of social services that was never liked by the party opposite. That party has occasionally paid lip service to them, but we know that hon. Members opposite have never liked the social services which we inaugurated. Now, they are trying to undermine the principles on which they have been built.
252 Why have we had these cuts lately? Is it to prepare the way for a gift to the Surtax payers in the next Budget? Some of us suspect that that is the case. Although the Minister of Health has said that no further burden will fall on the taxpayer, we on this side believe that Income Tax is the most equitable form of taxation, because it falls heaviest on those most able to bear it.
§ Mr. Vosper
Perhaps I should make it clear that the increase in the Estimates for the Health Services for 1957–58 will be £49 million over last year. There will be some saving, but only partially, because of the Health Service contribution, but there will certainly be an increase on taxation.
§ Miss Bacon
It will not be very much. because we were told that the extra 10d. will mean an increase of £40 million; so the difference would be very small.
We have seen the cutting down of the school meals service. We have seen the difficulties with the doctors, to which my right hon. Friend has referred today. We have seen the plight of the old people, about which the Government are not prepared to do anything. We have seen what has happened to the prescription charges, and we fear what will happen to education and to the cost of living as a result of the Rent Bill. The party opposite said in its last election address that in twenty-five years it would double the standard of living. If we are not very careful, and hon. Members opposite remain in office much longer, it will be the cost of living that is doubled and not the standard of living.
Those who have had an opportunity in recent by-elections of registering a vote have shown quite clearly that they are not at the back of the Government in the measures that they have undertaken. It is sometimes argued on the benches opposite and by Tory newspapers that it is because the country does not understand the measures which the Government are undertaking. It seems to me that it is because the people understand quite clearly what is happening that they are rejecting the Government. I hope, therefore, that the House will reject the Motion and give the Government notice to get out as quickly as possible.
§ 5.20 p.m.
§ Sir Keith Joseph (Leeds, North-East)
It is a pleasure to me to follow the hon. Lady the Member for Leeds, South-East (Miss Bacon) in her remarks because I have the honour of sharing with her the representation of part of Leeds in the House. She is known as sincere and expert on her subject and, although I shall have cause to cross swords with her later on certain matters, there were points in her speech which were worthy subjects of debate. It was, however, a great disappointment to listen to the opening speech of the right hon. Lady the Member for Warrington (Dr. Summerskill). Seldom have I heard or read a more negative and unconstructive speech from someone who is avowedly an expert. She obviously had to pad out a thoroughly inadequate cause with reminiscences and the bringing up of grievances which, while legitimate, such as complaints about the cost of proprietary drugs, have nothing whatsoever in common with the purport of the Motion.
It is true that the right hon. Lady concentrated on health, but it would be impossible to gather from her speech that when the Socialists were in office they had exactly the same problems as those with which the present Government are now grappling. Members of the then Government had the courage at the time to come before the House and argue in favour of charges on prescriptions and on costs of the Health Service with speeches of thorough good sense, but they lacked the guts to carry those things out.
No one would realise from the right hon. Lady's speech that during the Socialists' tenure of office the average cost of each prescription doubled and that now, under a Tory administration, every single service, whether health or insurance, has increased in real terms for the benefit of the public. No one would judge from her speech that the poorest families in the country are entitled to reclaim through the National Assistance Board all the charges which are being imposed by the Government.
§ Sir K. Joseph
Only too gladly, because that is a subject to which I want to return later. We define them by a subsistence scale judged by an independent body, the National Assistance Board.
254 I want to make further reference to the right hon. Lady's speech. No one would judge from it that a Government which she represented never touched family allowances from the date when they were introduced by an all-party Government in 1946, and that it took a Tory administration to raise family allowances twice, particularly for the benefit of large families.
§ Mr. J. Griffiths
The hon. Member should get his facts right. It was not an all-party Government in 1946.
§ Mr. Griffiths
We had better get our history right. The Family Allowances Act was introduced on Second Reading in the House not by the Caretaker Government but by the Coalition Government, when Labour was part of that Government and the Minister was a Labour Member. It was brought into effect in 1946 when I was Minister of National Insurance.
§ Sir K. Joseph
It was brought in by a Coalition Government.
No one would judge from the right hon. Lady's speech that if the Socialist Party were in power rents would have to be increased to solve the housing problem, just as they are to be increased by the Tory Government. The right hon. Lady had difficulty in finding substance for her speech and, therefore, she had to return to her hobby-horse—the cost of ethical drugs.
§ Mr. Frederic Harris (Croydon, North-West)
The right hon. Lady could not learn the difference between butter and margarine at one time.
§ Sir K. Joseph
I took the trouble to visit chemists in my constituency and ask about the effect of the raising of the prescription charges. I was told that there was one part of the community which 255 was being injured by it. I think that the hon. Member for Sparkbrook (Mr. Shurmer) touched on the same subject to which I should like to return.
It is abundantly clear that the right hon. Lady the Member for Warrington does not understand the influence of humanity in the administrative decisions which were taken at the time when these prescription charges were increased. It was specially laid down by the then Minister that he would encourage chemists to make up larger quantities so that the poorer families would have much the same service at the same cost over the year. Although the right hon. Lady found it extraordinary, that is why there were fewer prescriptions at the same cost in January and that is why the Minister says that we can judge the cost only over a year.
§ Sir K. Joseph
It is only natural that the right hon. Lady should concentrate on health, because she wanted us to forget that she was for several years the Minister in charge of pensions and that she was the cause, more than anyone else, of the sort of burdens of which she now accuses the present Government. We will not let the right hon. Lady forget it, and her behaviour then was a fair example of something for which she now wrongly indicts the present Government.
§ Sir K. Joseph
If the right hon. Lady thinks that makes any difference in substance, she is welcome to the correction.
The hon. Lady the Member for Leeds, South-East tried to explain the substantial increase in the real resources devoted to the National Health Service and to education by saying that we have had an increase in population since 1951. Of course we have had a million extra. It is now 52 million, and it was then 51 million. Does the hon. Lady pretend that that explains the vast increase in the actual number of nurses, doctors, midwives, health visitors, beds in use, and occupational training centres for mental defectives? I could go through the list of amenities and resources devoted to our social services and show that there has 256 been an actual increase in every one in real terms of people on the ground. How can the hon. Lady make out that cuts have been made in the social services by the present Government?
The House should not assume, however, that we can pretend that the National Health Service is perfect. It would have better become the right hon. Lady the Member for Warrington, with her experience, if she had been more constructive, because there are many problems associated with the services.
I should like the hon. Lady the Member for Leeds, South-East to face the dilemma which she posed. If we are to put more resources into these services, are they to be paid for by taxes, by increased contributions, or by increased charges? The hon. Lady happens to disagree with charges in principle, and good luck to her, but any solution of the problem must be a balance of all these things, and it is not a matter of villainy if the balance sways one way or the other. It would have been totally legitimate for the hon. Lady to say that taxes should go up. Whereas by our method taxation will possibly have to go up to increase the services in due course—though I hope that an expanding economy will enable us to avoid that—we shall also try to secure that those who are best able to bear the burden shall do so. The hon. Lady's Government in 1951 made absolutely plain that the charges must go up not only to relieve taxation, but to discourage abuses.
Here I come back to the point made by the hon. Member for Sparkbrook. I believe it is true that the prescription charges, and indeed other charges, hurt that class of the community which is just above the subsistence scale of the National Assistance Board, and which is not earning; the fixed income group so gallantly fought for by my hon. Friend the Member for Tynemouth (Dame Irene Ward).
I am making no new suggestion if I put forward the idea that the time must come when we no longer depend for all our tests on the subsistence scale, however properly worked out and calculated by the National Assistance Board. After all, we already have quite a different test for legal aid. We have quite a different test for assistance to people who send their children to university. We have quite a 257 different test for school meals. So I think there may come a time when people just above that subsistence scale may have to be relieved of health service charges, but only if they are not able to work to earn the necessary money.
Now I come to a real problem that could properly have been discussed by the right hon. Lady the Member for Warrington. The subject I am about to discuss does not involve any extra expenditure. it involves the better use of the resources already on the ground. It seems to me that in this Welfare State there are a large number of excellent welfare islands with bridges built between each of them, but that perhaps these bridges are not as fully used as they might be. In other words, we could do more by co-ordination. This is not just a question of tidying up the National Health Service. It is a question of humanity, of bringing the appropriate part of the health or other services in ample time to the people who most need them. In fact, this is the very heart of good preventive medicine.
I am not enamoured of the suggestion of a single service, as put forward in the minority report of the Guillebaud Committee. I think that such a vast machine would create far more difficulties than it would cure. I also recognise that there is no panacea for the problem of co-ordination. What we want to arrive at is a very high standard of service, and it may be of interest to right hon. and hon. Members to learn that there are as many as thirty-five different varieties of domiciliary visitor in most towns. That is wonderful—if they all co-ordinate, but do they?
This is not just a question of an excellent set-up, of a good system. It is more a question of personality and of the actual work that goes on in the street, in the household, in the committee room, rather than of the façade put up by the organisation itself. I realise that the Younghusband Committee is considering this and that we must always respect the privacy of the citizen. Yet I suggest that by coordination a great deal can be done to bring more real humanity into these services.
Let me give an example from a recent investigation into mental health services of which I had the honour to be chairman. There was a case of a hospital 258 which discharged as cured an elderly blind patient. He was discharged to his home where the hospital thought he would be looked after. In fact his home was occupied by a blind, vindictive and suspicious brother, and the hospital authorities would never have discharged that cured patient to his home had they paid a visit to it beforehand. I am not blaming that hospital. Far be it for me, who merely reads and speaks on these subjects, to blame anyone who devotes a dedicated life to these people, but were our hospital services to be coordinated by the almoners with the local voluntary services, with the activities of the Old People's Welfare Committees, with the activities of the health visitors and mental welfare department visitors, that kind of mistake could not occur.
I remember also that in the investigation with which I was associated we made a close examination of two precisely comparable local authorities. This was done through field workers. Each had the same population, each had the same type of district and the same rate expenditure on these services. We found that whereas in one local authority the service to the public was excellent, in the other it was much inferior. This was not because some of the people were not humane or conscientious or diligent, but because in one authority they had case conferences every week: there was careful, humane co-ordination between all the people involved. In the other authority they all ran busily about, doing their own jobs, and never getting together.
I have said that there is no panacea. This problem cannot be solved by dictate of the Minister. Here I will put forward another suggestion that will not involve much expenditure. I would like to see the National Council of Social Service, perhaps helped by the Government in part, setting up a "Social Services Staff College" which would give regular courses to representatives of local councils and especially to representatives of the local Press. For I believe that the local Press, if it knows the standard that can be achieved, will make sure that the citizens of the area know of it also, and so, through our democratic machinery, that standard will be achieved. Such a college might even evolve a system of measuring the efficiency of the social services, providing a kind of social photography to correspond with what, in 259 the economic field, is unit costing. At the moment we do not know for instance, whether better domiciliary visiting would relieve the hospitals of whether it would merely be an extra burden on the community for people who ought to go into hospital anyway.
We have no means of judging these things, and perhaps a good "Social Services Staff College," with a permanent small staff of its own, inviting visiting lecturers of all kinds, with courses open to councillors and the local Press and others, might provide a valuable weapon in this realm.
Above all, I want to return to a point made by my right hon. Friend the Minister in his opening speech. He said that we shall never all be satisfied with all we want to achieve unless we have an expanding economy—the greater production to which the right hon. Member for Llanelly (Mr. Griffiths) rightly referred. From that alone can we supply all the demands that this humane country and House wish to give to the people.
§ 5.37 p.m.
§ Mr. Niall MacDermot (Lewisham, North)
I have received advice from many sources and I have been informed that it is the tradition of this House that one's first utterances should be short and non-controversial. It lies easily within my power to make them short; it is perhaps a little more difficult to make them non-controversial on a Motion of this character, but I am most anxious not to offend in this respect. Since joining this House, I have been treated, as I am sure has every hon. Member, with the greatest kindness and courtesy on both sides, and if I offend in any way in that respect, I hope I may be forgiven.
The election at North Lewisham was the first time I had fought any election, and the first time in which I had the experience that many hon. Members here have had many times. I hope, however, that it will not be thought to be presumptuous on my part if I seek to give an impression to the House of the picture which I have formed as to what people are feeling and thinking now about the questions facing them, and about the record of this Government and the effects of its policies, particularly in relation to the subject matter of this debate.
260 The overriding impression formed is that people are feeling to some extent bewildered and considerably disillusioned by what they feel to be a lack of correspondence between the words and the deeds of the Government; the difference between what the Government said they were going to do, and what they have done. This has shown itself in many matters which are not relevant to the debate. One could develop it in terms of foreign policy, in terms of the Rent Bill, in terms of home ownership and interest charges. But, coming to the present topic, the overwhelming point relates to the cost of living and the social services combined, and the way that those two are inter-related. And, of course, they are closely inter-related, because the greater the pressure of the cost of living, the greater the need for the social services among those for whom they are specially designed. The greater the burden put on poorer people for the cost of the social services, the more they feel the effects of the continuing oppressive burden of the cost of living.
When the Government first came to power they did so because they had succeeded, amongst other things, in convincing the people of this country that they wholly accepted all that which had been built up during the six years of the Labour Government in terms of the social services, which was sometimes called the Welfare State. They had convinced the country that they not only accepted the structure of it but that they also accepted the principles on which it was based. I was glad to observe that the Prime Minister, in his magnanimous way, in his first broadcast just after becoming Prime Minister identified himself with these achievements of the Labour Government, saying, "We have built up our defences against want and sickness and we are proud of it."
What I think is happening is that people are now beginning to be disturbed and anxious about the future of these social services and where the burden of them is to lie. The problem resolves itself into this very simple question: are the social services to be maintained and, if so, who is to pay for them? Fine phrases about building an Opportunity State and giving greater opportunities to the bold, the strong and the adventurous, do not help to solve this problem. If the bold and the 261 strong and the adventurous are to be relieved of some of the burden and given greater opportunities, does that mean that the burden is to fall on the timid and the weak and those whose occupations give them no opportunity for adventures? The truth is that for the vast majority of the working population there is no opportunity to be bold and adventurous in their work. Indeed, if they tried to be bold and adventurous they would probably get the sack.
The simple question is, how are these things to be paid for, assuming for the moment that they are to be maintained? They can either be paid for directly by the consumer, which is the principle introduced to some extent with the prescription charges, or they can be paid for by insurance contributions or by general taxation. I entirely agree with my hon. Friend the Member for Leeds, South-East (Miss Bacon) in her view about the relative rightness of insurance contributions and general taxation as the source for financing the social services and with the reasons which she gave, but what is clearly happening by these most recent developments—and this is the whole subject matter of the Motion—is that an increasing burden is being placed on those who are least able to bear it.
The hon. Member for Leeds, North-East (Sir K. Joseph) rightly said that the people who are suffering most under the present measures are those who are immediately above the subsistence level. I do not wish to weary the House with individual cases, for I am sure that all hon. Members are well aware of individual cases amongst their own constituents, but I should like to give one which came to my attention recently. It concerns a lady who was an old-age pensioner, but, as her husband was working part-time, she did not qualify for National Assistance. She called in the doctor and he made one diagnosis and prescribed four items of medicine which cost her 4s. to buy. He called again later in the week and discovered that his first diagnosis was wrong. He made a second diagnosis, which fortunately proved right, and gave another prescription containing three further items. The result was that in one week this lady was burdened with a charge of 7s. To someone just above the subsistence level that is a very heavy burden indeed.
262 It is not merely that it is a heavy burden on her it strikes at the root of the whole principle of the National Health Service, which is that people should not have the additional financial burden put on them at the very moment that they are least able to bear it, namely, when they are afflicted with sickness.
We have to consider not merely the burden on the people but also the effect which these charges have on the administration of the National Health Service. There was a report in the newspapers recently of speeches made by the chemists at their annual conference. I have forgotten the name of the organisation. Many chemists from all over the country spoke and gave figures of the total reduction in the number of prescriptions which had taken place since the charges were increased. I think the average reduction was 20 to 25 per cent., but one chemist from Huddersfield spoke in terms of a reduction of 60 per cent. These reductions were undoubtedly the result of the increased prescription charges.
We have also to consider the increase in the charge for school meals. Again, people just above the subsistence level are most affected by this. I was surprised during my by-election campaign by the number of cases—not merely one or two—of parents who told me that as a result of the previous increase in the charges for school meals they had been compelled to make their children walk to school where previously they had taken buses. I have not yet had an opportunity to find out what the result of this further increase will be, but if they were led to those measures on the last occasion. I can only conclude that there is now serious risk that the children will not be able to have the school meals.
All this is on the assumption that, basically, the social services are to remain, but one may perhaps call this, too, into question. During the North Lewisham by-election the Minister of Education, Lord Hailsham, came to Lewisham and gave one of his vigorous speeches. If he was correctly reported—and, of course, he may not have been—in the Daily Mailthe next day, he outlined this broad idea of the Opportunity State which seems to form the subject of so many Conservative speeches at the moment and said that he envisaged a picture of bigger incentives and bigger 263 rewards for professional men and skilled men. He went on to say:But there may also be a scaling down of welfare services because they will no longer be necessary.The Prime Minister informed the House last week that Lord Hailsham always talked sense and that it was for that reason that he had appointed him Minister of Education. I should be interested to learn from the Minister who replies to the debate, as I think will other hon. Members, whether it is the view of the Government that there are welfare services which are no longer necessary and may have to be scaled down for that reason. If there are, we should be very interested to know which services are no longer necessary, and no longer necessary for whom?
I see that in the new National Insurance Bill which has been published there is a Clause providing for cuts in unemployment benefit for people on short time. Is that one of the welfare services which is thought to be no longer necessary? It is a cut which will cause heavy suffering if and when we have another crop of short-time working such as that which we have seen recently in the motor industry.
One of the most alarming features about the whole of this trend is the emphasis which is placed more and more on the extension of the principle of the means test. We have heard it said—and it has been said already in the debate several times—that the poorest classes will be able to recover prescription charges from the National Health Service and that they will get the welfare milk free. The Minister of Housing and Local Government, when answering Questions at Question time recently about interest rates and the withdrawal of subsidies as they affected the housing programmes of local authorities, said that if local authorities introduced differential rent schemes they would find it easier to continue their housing programmes—again, an extension of the means test principle. If this is to be the policy and if this is the way in which payment for the social services is to be extended, it will cut fundamentally at the root of the whole principle of the social services, because people quite rightly regard the means test as being an humiliation and compelling 264 them to turn to charity for something which they regard as being their right.
The principle of the social services is opposed fundamentally to this notion of charity. The principle, of course, is that everyone contributes either through taxation or through insurance contributions to the services and that everyone is entitled to the benefit of them. If it is to be the policy of the Government to say that more and more people must pay directly for the services as they get them, and if the burden becomes too heavy on them they must turn to the National Assistance Board, then they are striking at the whole principle. It is this trend which, I respectfully suggest, is one of the reasons which is leading people to feel that the Government in their actions and in their policies are getting fundamentally out of touch with the situation as it affects the ordinary people of the country.
I should like to conclude with one instance, although I promised not to weary the House with particular instances. I remember vividly calling at the prefabricated bungalow of one householder and asking how she intended to vote. Her answer, given in a rather weary voice, was, "The last time I voted Conservative, but this time I will vote for you." Then she added, "They just do not seem to understand; they do not realise what life is like for people like us." I only quote that because I believe that that woman, in those simple phrases, expressed what very many people in this country are feeling today, and it helps to explain why it is that the Member for Lewisham, North now sits on this side of the House.
§ 5.53 p.m.
§ Sir Spencer Summers (Aylesbury)
I have been in this House for a considerable time, but I have never had the honour to be called immediately after an hon. Gentleman who has delivered himself of his maiden speech. I have always been rather concerned lest when that occasion arose I should find some difficulty in expressing sincerely the traditional congratulations from the next speaker, but I should like to say to the hon. Member for Lewisham, North (Mr. MacDermot) that the speech that we have heard from him this afternoon relieves me of all anxiety, because I can with the utmost possible sincerity congratulate him on the 265 way in which he has discharged his responsibility. I noticed that he appeared to have considerable notes to fortify him for the task, but I was not aware that he looked at them at all. Indeed, I think everyone would agree that as we listened it was very hard to imagine that he had not already spoken on many occasions in the House. He obviously has thought much about the subject and I am sure that we shall all look forward with the greatest interest and find it an agreeable occasion when next he feels disposed to try to catch Mr. Speaker's eye.
In the speech of the hon. Member for Lewisham, North and in other speeches there was regret that there seemed to be a tendency to move towards the element of direct charges, and in that I include contributions, and away from taxation for the financing of a number of these social services. The hon. Lady the Member for Leeds, South-East (Miss Bacon) went to the length of saying that this tendency frightened her very much because she feared that the day might come when only those who were in compliance, so to speak, would have the benefits of the National Health Service if so much stress was increasingly placed on the contributory element in the situation.
I think that the hon. Lady could not have listened very attentively to the speech of the Minister earlier in the debate because he made it quite clear that even after the increases in recent times which are challenged in this Motion, the proportion derived from the taxpayer to finance a number of the services is at least as great and in most cases greater than when the system was first started. We learned that the proportion in the National Health Service had gone up from about 72 per cent. to about 75 per cent., and that the proportion of public help for welfare milk and school meals was still not less than 50 per cent. There is, therefore, no evidence to support the suggestion that there is a trend away from the taxpayer to the contributor in the relative proportions in which those services are financed.
I want to draw attention to one particular point which seemed to be in marked contrast to the views that we have heard from the other side, notably from 266 the hon. Member for Sowerby (Mr. Houghton), on this question of the contributory element. The hon. Lady to whom I have referred feared that if the individual personal contribution became too significant there was a fear that the beneficiary would be asked if he was in compliance. The hon. Member for Sowerby, on the other hand, feared the absence of the contributory factor from the individual in retirement pensions and that only those who deserved the pension would, in fact, be entitled to it unless the element of contribution, carrying with it the element of right, was forcibly maintained. I think that it is therefore quite appropriate for me to call in evidence against the hon. Lady the evidence of the hon. Member for Sowerby, namely, the importance which the element of contribution must play in ensuring that the benefits shall be available for all.
§ Dr. J. Dickson Mabon (Greenock)
Surely that is not a fair compromise when we consider that both these matters are quite different. The hon. Lady was arguing in relation to the Health Service where there is supposed to be the idea of giving services in accordance with needs, irrespective of the moneys available or of cash payments, whereas the hon. Member for Sowerby was arguing the case in relation to old age pensioners and the contributions linked thereto. These are two entirely different principles. That was the whole point of the hon. Lady's interruption.
§ Sir S. Summers
The hon. Gentleman might choose to regard them as quite contrary, but the principle to which I am drawing attention is namely, that the element of contribution which is inherent in the Health Service as we now know it enables the system to dispense with a means test and it is the element of contribution in the retirement pensions which enables us to dispense with the means test there also.
§ Mr. J. Griffiths
This is a rather important matter which we expect the Minister to say something about. As the hon. Members knows, the cash benefits of the National Insurance scheme are related to contributions directed to the National Health Service with all its provisions financed out of taxation. Is the hon. Member suggesting that the right 267 to have service under the National Health Service is to be conditioned by the contributory provisions?
§ Sir S. Summers
Evidently I have not succeeded in making myself clear. If we swing the pendulum in the direction which the hon. Lady appears to wish it to go, to finance the Health Service entirely out of taxation, there would be a genuine fear in my mind at any rate that it would become so expensive that one of these days the benefits of that Health Service would be denied to certain people on the grounds that they could well afford to pay for it themselves.
I want to take up the time of the House for a very few minutes on two points. Firstly, we have to look afresh at the whole system, for a variety of reasons. We have found that providing help under the Health Service in modern conditions is becoming increasingly expensive, because science is providing increasingly expensive ways of helping the sick. We are finding that pension benefits are becoming increasingly expensive, because in the years that lie ahead, the number of old people who will draw benefit will increase.
Whichever direction we look, it seems that there is an ever-growing range of additional expenditure in the social services. We must be very careful that we do not allow the whole system to break down by going on exactly as before, without ensuring that those who in the name of common sense ought to derive benefit from our social services are denied it, because they cannot get proper benefits if everybody is dealt with exactly as before.
The broad principle which should guide us in these matters is that the normal running expenses of life should fall upon the people individually concerned and that they should, by insurance and joining together, protect themselves from the major hazards of life, be it old age when they can no longer earn wages. a serious operation which would be a calamity for people with modest incomes, or matters of that kind. In those ways people should feel assured of protection against life's major hazards, but the ordinary running expenses, and I include spectacles and the like, should be the responsibility of the individuals concerned.
268 I qualify that in one respect, a notable one to which our attention was drawn by my hon. Friend the Member for Leeds, North-East (Sir K. Joseph). It is that those who are just above subsistence level, and so denied the benefit of National Assistance, should be helped to cope with some of these situations. It may be that something is needed in that respect in keeping with the point I am making.
If I am justified in arguing that the normal running expenses of life should properly fall upon the individuals concerned, then a major mistake was made when the system of family allowances was introduced in the form in which we now know it. I have always supported the principle of family allowances on the grounds—no doubt similar to those which commended themselves to Lord Beveridge—that unless there were some system for helping people with large families, it would not be possible to make a commonsense plan for sickness, unemployment and old age. When the system of family allowances was started, it was decided to exempt the first child. I do not believe that that decision can be justified.
I want to argue that it is perfectly reasonable to tell parents that they ought to be capable, through their own skill and the wit of the breadwinner, if necessary assisted by his wife, to look after two children without assistance from other folk. If that were done, there would be at the disposal of the social service system as we know it, with one qualification to which I shall refer in a moment, no less than £70 million annually. That is what is provided by the taxpayer for the second child of every family.
It is, I think, a most unwise use of a system of social service to spend so much within the system in that way. If the benefit of 8s. for the second child were discontinued, the benefit for the third and subsequent children should perhaps be greater than it now is. It is now 10s. If it were increased to 12s., about £8 million would have to be deducted from the £70 million to which I have referred. One other deduction would have to be made. If one is to have a sense of perspective, it is only right that this should also be mentioned. That deduction would be in respect of those who are sick or unemployed and who, quite properly, have the right of additional benefits for their children.
269 That benefit is now graduated to take account of the present system of family allowances. If the system of family allowances were drastically changed, as I am recommending, by no longer paying benefit for the second child, there would have to be increases for the second child of people who are unemployed or sick to take account of that change. I am advised that the cost of so doing would be about £4 million annually.
Therefore, between £55 million and £60 million would be available for other purposes in the social services. It is not very long since the House had a debate, the essence of which, at any rate as put from the other side of the House, was that too little is being done for old people. No doubt the hon. Member for Ince (Mr. T. Brown) will echo that sentiment. If people who are now drawing about £70 million from funds provided by the taxpayer could be persuaded in the name of justice that they should go without that until they are old—when it would be much more appropriate that the taxpayers' money should be accorded to them than it is when they are in the prime of life—it would be much easier to put across this plan.
§ Mr. George Craddock (Bradford, South)
Is not the hon. Member making an argument for large families rather than family allowances?
§ Sir S. Summers
I do not think that anything I have said is in favour of large families, though I have always regretted that I was not a member of a larger family. What I am saying is that a large family should be considered to be one of more than two children, instead of more than one child, which is the present position.
If my suggestion were adopted, the sums released by the change could be deployed for the benefit of the old. I have made certain calculations, which may need adjustment, but which show by and large that, if the sums thus released were made available for only retirement pensioners, it would be possible to increase the retirement pension by nearly 6s. a week, which is a really significant figure. On the other hand, if it were thought more appropriate, particularly in the name of those who need it most, to use the phrase of the Motion, to devote the money to an improvement in the position of those on 270 National Assistance, it would be possible to increase the present figure by about 10s. a week. The point I should like hon. Members on both sides—and especially on the Front Benches—to take note of is that there is a great deal to be said for withholding the benefit now paid to families for the second child and using the resources made available to better advantage in the field of social services.
§ 6.10 p.m.
§ Mr. Donald Wade (Huddersfield, West)
This has been a very interesting debate, and some very valuable and sincere contributions have been made, but I feel that there has been an atmosphere of unreality about it. The Motion which we are discussing makes no reference to one of the main causes of our difficulties, and of our failure to make the improvements in our social services which most of us would desire. I refer to inflation.
The major issue is not between those who support the social services and those who are against them, or between those who are anxious not to place an increasing burden upon those least able to bear it, and those who do not care. If that were the main conflict I should spend my time in advocating wholehearted support for the maintenance of the social services. As I see it, however, the main problem is the effect of inflation and the decline in value of money upon our attempts to uphold and improve the social services.
A leading article in The Times today says:British social payments, our Correspondent showed, are low by international standards—and so are insurance contributions. Inflation continually whittles away the purchasing power the nation intended the pensioner to command. The challenge this presents has so far been faced by neither party nor has the experience of other nations trying to meet It been examined.There is a great deal of truth in that. Inflation works adversely in two ways. First, it results in an inevitable increase in total Government expenditure, because everyone who is employed has to be paid more, and all materials cost more. At the same time the benefits, in terms of cash, are worth less to the recipient.
There is a danger that the whole edifice will be undermined. It was with that consideration in view that my right 271 hon. and learned Friend, my hon. Friends and myself tabled an Amendment which, I understand, will not be called. Its purpose was to draw attention to the failure of all post-war Governments to prevent the undermining of our social services by continuous inflation and, at the same time, to call for a comprehensive review of the functions and scope of social services, the modern needs which they should cover, and the economic requirements to meet them.
I know that hon. Members are placed in a difficulty in this matter. I am aware of the pressure which is continually put upon them. Every week, if not every day, I receive letters from one or other body appealing for support. It is very difficult not to say "Yes" to every appeal, but if the Government did, the burden placed upon the taxpayer and contributor would be so great that the whole structure of our social services would break down. That is the problem which must be faced. We must examine the whole question of the essential functions of social services.
I wish that the Government had thought fit to take a somewhat unorthodox course and support the Amendment to which I have referred. It would have involved admitting that this Government, as well as previous Administrations, have failed to check inflation, but had that course been adopted, when members of the general public opened their newspapers tomorrow morning they would have said, "For once we have a Government which is 100 per cent. honest". Alternatively, if the Opposition had accepted the Amendment the same remark might have been applied to them. That would have helped to meet some of the prevailing cynicism which unfortunately exists about Parliament and Members of Parliament in particular.
§ Mr. Wade
We have asked for a review partly in order that we might be given an objective answer about the minimum below which no one should be allowed to fall owing to sickness, unemployment or old age. The principle was set out very clearly by Lord Beveridge in his famous Report. I have been reading it again. The material words are: 272The fourth fundamental principle is adequacy of benefit in amount and time. The flat rate of benefit proposed is intended in itself to be sufficient without further resources to provide the minimum income needs for subsistence in all normal cases.Unfortunately, inflation has played havoc with the proposals set out in the Report. It is a little sad to recall the enthusiasm and hope which the publication of that Report aroused throughout the country and then to reflect upon the difficulty which many old people experience today in trying to make ends meet.
I have also been reading the report of the speech made by the right hon. Member for Llanelly (Mr. J. Griffiths) when he moved the Second Reading of the National Insurance Bill. He said:The House will be aware that the Chancellor of the Exchequer has expressed the Government's intention to hold the cost of living at about 31 per cent, over the September. 1939, level. We have decided, therefore, to review the leading rates proposed in the White Paper and in the Beveridge Report on the basis of an overall addition of 31 per cent. instead of 25 per cent. The result was to establish a basic rate of 42s. for a couple living together, with 26s, for a single adult …. I believe that we have in this way. endeavoured to give a broad subsistence basis to the leading rates, within the framework of a contributory insurance scheme."—[OFFICIAL REPORT, 6th February, 1946; Vol. 418, c. 1742.]Unfortunately, all that has gone by the board as a result of the changing value of money. Money values have fallen faster than the rate at which basic rates have increased. The cost of living figures have been quoted many times, and I do not propose to burden the House with saying much about them. I believe that hon. Members are well aware of the fall that has taken place in the value of the £. Taking its value as 20s. in September, 1946, it was worth only 12s. 7d. in December, 1956. But I have tried to ascertain the extent to which the cost of the social services generally has gone up. While I will not weary the House with a lot of figures, I have taken some calculations from the Blue Book on National Income and Expenditure, 1956.
If one takes housing, education and child care, school meals, milk and welfare foods, health and National Insurance Pensions and Assistance, one arrives at a total of £1,932 million for 1950. The corresponding figure for 1955 is £2,692 million. But I have deducted housing, as, there is an element of dispute about whether that should come under the 273 heading of social services. I have also deducted the proportion paid by local authorities which has increased considerably. That leaves a figure of £490 million difference between 1950 and 1955.
I think it fair to say that the cost of the social services has risen at the rate of approximately £100 million a year. Yet, in spite of that, we have many people who are feeling the pinch, particularly among the old people who are unable to manage on the amounts they receive. That is a tragic state of affairs. It is largely due to the failure to check inflation. I suggest that we have to attempt to make a new start. We have to consider what is now the minimum below which no one should be allowed to fall as a result of unemployment, ill-health or old-age, that is, a review of the minimum proposed by Lord Beveridge in his Report.
Secondly, we have to consider as objectively as possible what are the essential requirements which on no account must we allow to be dispensed with. In saying that, I am not suggesting that we should not endeavour to improve the social services.
Thirdly, I think we should consider to what extent we may encourage self-help. Lord Beveridge in his Report made clear that he favoured the encouragement of self-help. He never intended that the effect of the social services should be to discourage saving, for example. I have discussed that subject with him personally and I know that is his view. If time permitted, I should like to elaborate on this to show how I think the minimum could be calculated; how inflation might be checked and self-help encouraged, but it would take a long time to do that adequately.
Turning from the general to the particular, may I refer to one aspect of self-help, namely, the various voluntary schemes for superannuation. I admit that this is only one aspect and I know that in some quarters voluntary superannuation schemes are criticised. I think they are criticised wrongly on one ground and rightly on another. It is sometimes said that the State gives away a lot in the shape of tax remission and that that is unfair. I take the view that that is outweighed by the advantages. In the first place, the effect is to draw a certain percentage of people out of the category of potential recipients of National Assistance. Secondly, it encourages saving, and 274 thirdly, it makes large funds available for investment.
Whether the right people have those funds or whether they are rightly invested is another matter which I should be happy to discuss on another occasion, but, on balance, I think that voluntary superannuation schemes are of value to the community as a whole. There is another criticism which I think is justified, that is that the benefits are not easily transferred, and mobility of labour is in many cases deterred because of that. The scheme is so drawn that there is a discouragement to people to move from one form of employment to another. In fact, obstacles are put in the way.
I could give quotations, but I do not propose to take up the time of the House in doing so. The opinion expressed by the Working Party of the Council of the Institute of Actuaries and the Faculty of Actuaries in Scotland and other highly responsible bodies shows that the Inland Revenue, no doubt under the authority of the Treasury, intentionally or otherwise makes it difficult to draw up schemes whereby the insurance benefits might be easily transferred when a person moves from one form of employment to another.
I mention that as a specific example. I believe that there are many ways, by legislation and otherwise, whereby one could increase and encourage the amount of self-help, and therefore lessen somewhat the very heavy burden falling on the community. One thing I think is clear—that there will be no encouragement to save unless people have faith in the value of the £. If we can tackle this problem of inflation, I think we may look forward to the future with a reasonable amount of hope. If not, I am convinced that when historians look back on our generation they will not congratulate us on having upheld or improved the finest of social service systems, but will rather condemn us for having been responsible for a tragically disappoining failure.
§ 6.27 p.m.
§ Mr. John Eden (Bournemouth, West)
I propose to refer later in my speech to certain remarks of the hon. Member for Huddersfield, West (Mr. Wade) about self-help. I have one or two points to advance for the consideration of the House.
First, I must say that I find it particularly tiring, when the subject of social 275 services is raised, to hear hon. Members opposite still labouring the point that they are a sort of "fairy godmother" of the Welfare State; that they alone have built up this thing; that with their own hands have they created it and that the general public should turn to them in gratitude for what they have done. If, in fact, that were so, no doubt the general public would have turned to them in gratitude in 1951 and again on a more recent occasion.
Hon. Members opposite are only too happy to use such phrases as, "The Tories never like the social services." As I understand it, the Motion on the Order Paper is directed principally at the recent changes which have been made by the Government in an endeavour to try to effect certain savings to the Exchequer in the cost of these services. It was just because right hon. and hon. Members on this side of the House are every bit as anxious to maintain the social services as are right hon. and hon. Members opposite that it was necessary to introduce these measures, and try to bring to sensible proportions the amount of expenditure which is taking place.
If hon. Members think that the vast sum of money that we are spending on the social services can be allowed steadily to increase without our considering where it can best be directed, where it is most needed, and whether it is absolutely necessary in the first place, they are deluding themselves. It is most important, if we wish to maintain these services, as we all do, that the economy of the country must be secure and able to bear the burden of them.
The charge levied against the Government by the Opposition is that we are undermining or cutting the social services. I shall deliberately weary the House with one or two figures about the general cost of the social services. Some hon. Members would do well to take note of them. In the year 1953–54. the increase in social services cost over the previous year was £32 million. In 1954–55, the increase over the previous year was £82, in 1955–56 the increase was £90 million and in 1956–57 the increase went up to £113 million.
The estimated increase for the coming year is £146 million. The total estimated civil expenditure will thus be £173 million over the original Estimates. The main 276 items in these overall figures are for education, in which the increase is £63 million, and health, in which the increase is about £49 million. The increase is largely accounted for by increased wages and salaries, the increased cost of maintaining services and increased usage.
§ Mr. Tom Brown (Ince)
The hon. Gentleman has given the figures of the rising costs of the social services. Will he give us the-increase in the number of old people who are claiming pensions and the number who have been forced to go to the National Assistance Board? These increases in the cost of our social services are due to the inflationary stage through which we are passing.
§ Mr. Eden
It is well-known that the number of old-age pensioners is increasing the whole time. One of the major problems that we shall have to face over the next twenty-five years is that the proportion of old-age pensioners to wage earners is increasing rapidly. Although I have not the exact figure, which my hon. Friend the Parliamentary Secretary may be able to produce towards the end of the debate, I can say that the number of pensioners claiming National Assistance has gone down and not up.
§ Mr. Eden
I have no doubt that the hon. Member for Ince (Mr. T. Brown) will recognise that the problem of the old-age pensioners and how best to help them has now to be considered very carefully. It cannot be put right simply by giving increases of money. We have to 277 find ways of giving them assistance more indirectly. Later in my remarks I shall have a proposal to put forward in this respect.
Neither I nor anybody else is anxious to see the system of social services, or the Welfare State, curtailed or cut into, but I wish to see that it is kept to some kind of proportion. I do not believe that any amount of State assistance can replace individual responsibility. I fear that the vast sums of money spent by the Government on those in need and on everybody else in general will lead the rising generation not fully to appreciate its individual responsibility to family and children. That is a definite danger. People are brought up nowadays to think in terms of a "fairy godmother" State. If anything slightly unhappy occurs to them they think they can always go to the State for assistance.
Those who are genuinely In need should get assistance, and I am not complaining that this assistance operates. welcome it. I am condemning the possibility that growing in the minds of the younger people is the belief that they have no responsibility whatsoever of their own and can rely entirely upon the State for help. That is bad and is not to be welcomed at all.
§ Dr. Horace King (Southampton, Itchen)
The hon. Member has made some criticism of the youth of the country. I know that he wants to be fair. Does he not realise that every one of the young people he is talking about is voluntarily giving two years' National Service, and that the remarkable thing is that very few of them grumble about giving that service to the State?
§ Mr. Eden
I accept that, but I am not talking of National Service but am emphasising personal, individual responsibility. There is a real danger of encouraging the tendency for people to rely more and more upon the State for assistance. They thereby lose the ability to live up to their own personal responsibility. It is important to emphasise it.
The vast expenditure that is now taking place for the national services should, in certain respects, be put to better use, provided that the emphasis is placed where the assistance is most needed. In this context I want to bring out a point about helping old people. My hon. Friend the 278 Member for Aylesbury (Sir S. Summers) put forward one or two solutions and spoke of the possibility, if such a scheme were carried forward, of allocating a considerable sum of money, about £55 million or £60 million.
I would like to see an extension and an encouragement given by the State to voluntary bodies who are dealing with these problems. They already get assistance from local authorities, who have power to help them. I would like to see this power extended so that grants to voluntary bodies were increased and made more direct so as to assist those most in need within each local authority area. I am aware that this might well take away from the National Assistance offices some work they are at present called upon to do, but I do not think that that would be a very bad thing.
If the work could be done through voluntary organisations which could be encouraged by some form of financial assistance to develop this work, that would be a direction in which I should like to see an increase taking place. People in voluntary bodies who are on the spot are probably in a far better position to find who in their area are most in need. I also believe that the older people would be more likely to go to voluntary bodies than to National Assistance.
That is one way in which, possibly, we can overcome the natural and very understandable dislike many people have of going to the National Asisstance Board. They think that there is some kind of stigma attached to getting assistance. They think it wrong that they should be subjected to 'a means test, although in every walk of life everyone is subjected to a means test of one kind or another. The matter may be put right to some extent by encouraging them to go to voluntary bodies to seek the help which at present they do not like to seek—although they are entitled to get it—from National Assistance.
Although I mention these things, I am aware that I am asking for a greater expenditure to take place in certain directions in which I am interested at the moment, but I do not think that that necessarily should increase the total expenditure on our social services. I want to see that kept under control as far as possible and also to see that certain things 279 which, to my mind, have not received their due share can have a little more attention. One of those is the great problem today of mentally retarded children, or children who are mentally handicapped in some way.
The figures I shall quote are from the Journal of the National Society for Mentally Handicapped Children. I understand that there are between 7,000 to 12,000 children now awaiting attention. They are classified as educationally subnormal. It is estimated that every year about 3,000 children are classified as ineducable. These are two problems which are among the hardest of all the problems we have to solve. They are the most personal and most human problems.
Obviously, a dividing line has to be found, but the mere drawing up of that division is in many cases causing considerable hardship. The dividing line I have in mind is between the child classified as just educable and one who is just ineducable. In many cases, great distress is caused to parents of children classified as ineducable. Naturally, a parent thinks that there is a great future for the child provided that it can continue to receive the benefits of education by being improved and put right.
In my constituency I have been able to see some of the work which is being done for mentally handicapped and ineducable children under the auspices of the local authority and the medical officer for health. They are doing admirable work, but, as I suppose is the case in a large number of areas, they are handicapped through lack of the necessary occupation centres. Many occupation centres are in old-fashioned buildings and dreary surroundings, which are not exactly conducive to helping a child who is already facing such difficult mental problems. This is a matter on which we could focus attention. The need is very apparent.
There are now nearly 300 occupation centres in the country. My hon. Friend the Member for Leeds, North-East (Sir K. Joseph), who made an excellent speech, mentioned that this number has increased. It used to be about 100, but now it is about 300. Obviously, it is still nothing like enough. Somehow, we have to increase the number of homes and of 280 trained people to look after these children.
In the Bournemouth area there are now plans to go ahead with a new home which is to cater for all those in the area likely to need it. That will probably be one of the most advanced homes of its kind in the country. There still remains, however, the problem of children in other areas. For example, there are more than 20 counties where there is no sort of occupation centre. I should like my right hon. Friend to pay particular attention to this matter. If, in replying to the debate, he can add any further undertakings to those which have already been given in the House recently in this connection, I am sure that they would be very much welcomed.
The Bournemouth Medical Officer of Health has been trying to investigate other possible ways of helping children of this kind, particularly those classified as mentally defective. He has been discussing the possibility of running hostels by local health authorities acting as agents of the Ministry. There the homeless defective could live within his own community and later enter employment, perhaps based on the hostel in the same way as patients are now allowed out on licence when they have been placed in a home.
These are one or two directions on which perhaps more emphasis could be placed and they certainly need attention. I am not calling for a vastly increased expenditure in the total amount of expenditure by the State. I am asking for the redeployment of these amounts, concentrating on those directions where help is most needed today. I have listed two of those directions, the problem of some of the old persons and the problem of mentally defective children, as examples of what I have in mind.
§ 6.49 p.m.
§ Mr. Somerville Hastings (Barking)
We have all listened to the speech of the hon. Member for Bournemouth, West (Mr. J. Eden) with very much interest. He complained of the increasing cost of the social services, but everything else has been increasing in cost.
What the hon. Member did not tell us, and what is really significant, is whether the proportion of the national income spent on the social services has gone up or not. Even if it has gone up, 281 I am not sure that I should much regret it because there are certain services which can be purchased more cheaply and efficiently if they are purchased collectively. Moreover, national considerations as well as personal considerations are involved. We have decided that in the national interest uneducated children and unhealthy people are a disaster, and we have, therefore, provided social services to avoid these.
I want to speak briefly about the cost of the National Health Service. The Minister of Health and several other hon. Members have mentioned it. It is, no doubt, a very high cost, and I suggest that there are perhaps two particular reasons for this. In the Preamble to the National Health Service Act, the Minister of Health is bidden to provide a service for the prevention, diagnosis and treatment of illness. What has been done so far has been done mainly in the diagnosis and treatment of illness. I do not complain of that; clearly, it should be attended to first. But when the Minister of Health can give more attention to the prevention of illness then I, at any rate, am hopeful that the cost of the Service may be reduced.
When the hospitals and allied services were taken over under the National Health Service Act, in 1946, they were in a very bad state. The voluntary hospitals had been starved for money for years. The Poor Law hospitals had been removed from the Poor Law authorities by the 1929 Act, but the Poor Law authorities had long realised that this would happen and for many years had spent very little on their infirmaries. Between 1930, when that Act came into operation, and the war there was not a very long time during which the local authorities could do much about these hospitals. As a result, when the National Health Service Act came into operation many years of neglect had to be dealt with.
I suggest to the Minister that in the hospital service a good deal can be done by wise spending and that expenditure now may save money in the future. For several years I was closely associated with the Board of Management of the Hammersmith Hospital. At one stage we decided to put in a fresh stoking plant for the heating apparatus, and the saving in fuel covered the cost in two 282 years. I suggest to the Minister that if he pays cooks a little more and thus is able, particularly in the smaller hospitals, to get more efficient officers, in competition with industry, the food will be much more appetising and better cooked and there will be much less wasted in hospitals. The right hon. Gentleman can save money by wise spending.
I wish to speak briefly about milk and the prescription charges. I regret the increased charge to be made for welfare milk and I regret even more that the Government are now prepared to pay their contribution for only one-third of a pint of milk in the nurseries instead of two-thirds of a pint as in the past. We must remember that milk is a very valuable food. In reply to a Question, only a few days ago, I was given the information that the consumption of milk per individual in this country had fallen slightly every year between 1951 and 1955. I look upon that as a disaster, because I am as proud as is the Minister of Health of the children. In the Library of the School of Hygiene and Tropical Medicine there are photographs of schoolchildren of thirty and forty years ago. To compare these with the children of today is most encouraging. We can then understand why children's hospitals have been closed. To compare the appearance of our children today with the children of other countries, as I have done, is also very cheering.
We want this to be maintained, and it will be maintained, I think, by providing for these children an abundant supply of milk. I do not like any possibility of the consumption of milk being reduced and of less being drunk in schools, particularly among children under five years of age, because I realise that milk is such a valuable protective food. It is said that milk contains no fewer than 20 different food substances. The cow synthesizes these with the help of bacteria, although some were not in the food it had to eat.
These food substances can easily make up for any deficiencies in a child's diet. Particularly in winter a child may not be getting enough of an essential food substance, perhaps owing to a deficiency in fresh green food or fruit in the winter, either because of expense or because it is difficult to obtain; but that can very 283 well be made up by the milk which the child gets.
I should like to say a few words about the prescription charges. which both my right hon. Friend the Member for Warrington (Dr. Summerskill) and the Minister of Health have mentioned. I felt that the Minister was not very enthusiastic when he was supporting these increased charges and I thought that he would be as glad as any of us to abolish them altogether. They are very undesirable for many reasons. First, I feel that anything, real or imaginary, which prevents a patient from getting advice as soon as possible is a disaster not only for the patient but for the society as a whole. Often a man has some slight trouble and wonders whether he should consult a doctor. It may be nothing, but it may be the beginning of an infectious disease which needs isolation and treatment as soon as possible.
A year ago at a residential nursery in Kentish Town 70 children became suddenly ill one morning. The National Health Service was involved, and teams of doctors and nurses from nearby hospitals came forward and looked after them. When the cause was sought and found, it was that one of the cooks had had a septic finger which had not been treated. That demonstrates the danger of not seeking medical advice and treatment as soon as possible.
So much can be done nowadays with drugs. I remember when pneumonia was a fatal disease. Now. with the antibiotics that are available much can be done, and, therefore, in the interests of all, as well as the person concerned, I do not think that we want to place any barrier between the patient and the seeking of advice as soon as it may be necessary. Again, as I think my right hon. Friend the Member for Warrington pointed out, it is very likely that we shall need more drug treatment in the future than we have needed in the past, because the population is getting older, and older people are more subject to illnesses. More people live to a ripe old age nowadays, but at that period of life all sorts of illnesses, not necessarily fatal illnesses, may occur.
I have here a letter, of which I think I have sent a copy to the Minister of Health, which comes from one of my 284 constituents. She points out that she lives with her husband and that in one week she had to pay nine separate shillings for nine separate prescriptions for her husband and herself. I think that the Minister has seen the letter. This constituent is not very poor, she is not on National Assistance, but she found this expense very heavy indeed, and I cannot help feeling that anything that might tend to drive into hospital a patient who could be treated at home is a disaster. Only when it is absolutely necessary should people be sent to hospital. I feel that this prescription charge may operate in such a way that people may be more ready to go to hospital than perhaps otherwise they would be.
As I have already pointed out, the National Health Service has done most in the direction of treatment and not the prevention of disease. What the Service has done, and done most efficiently, is to keep alive people who otherwise would have died long ago. We remember that in 1952 there was a bad smog, and that nearly 4,000 Londoners died. In January of last year, there was another smog, which lasted only about a day, which I and. I think, most of us hardly noticed, but it is said that 1,000 people died. Why did they die? I remember much worse fogs when I was a young student, working in a hospital in London. The reason is that we are keeping alive now, by means of drugs and medicines, people who would have died twenty or thirty years ago. I know many people, and every doctor does, with chronic tuberculosis who are being kept alive today by the drug P.A.S.
I suggest that we shall need more prescriptions—I regret to say so—in the future than we have had in the past, and I am, therefore, particularly sorry to find that the people who will need these prescriptions most, particularly the old people, will have to pay more for them. I have dealt only with one or two points. which, I think, are personal points that affect the lives of the ordinary people, but it is for such ordinary people that I wanted to speak tonight.
§ 7.6 p.m.
§ Dr. Donald Johnson (Carlisle)
In my intervention in the debate tonight, I am anxious to concentrate what I have to say in talking about a social service that 285 saves money rather than one that costs money, and to some extent I shall be echoing in particular terms what the hon. Member for Barking (Mr. Hastings) has just said in general terms. I also hope that what I have to say will help rather than hinder my right hon. Friend the Minister of Health in his financial difficulties.
It is now a year since I put a Motion on the Order Paper, which I did not have the opportunity to move, pointing out the need for a domiciliary psychiatric social service. Many hon. Members asked me at that time what I meant by those long words. The phrase means, of course, the extension of a preventive service in the sphere of mental health. The financial figure that is, so to speak, the target for tonight in what I have to say is approximately £50 million annually. The last exact figure which I was given was £47 million, but that sum has probably increased since then, as it dated back two years. It is the amount spent on keeping 150,000 patients. the mentally ill and mental deficients, in our mental hospitals, 90,000 of these being mentally ill and another 60,000 mentally deficient.
We know that the accommodation is inadequate for these people. There is a pressure on space leading to overcrowding to the extent of about 16 per cent., and it is quite clear that relief of this situation can only come about in one way. Relief from overcrowding and from the financial situation can only be provided by the promotion of an adequate social domiciliary and home service that will keep people at home, rather than rush them into hospital, and which will screen and support our mental hospitals.
We like to think, and, indeed, over the vast sphere of social services we think rightly, that our social services are the most advanced in the world, but in this particular respect it is far from true. We are quite a long way behind certain countries. It is as long ago as the early 1930s that the municipality of Amsterdam, in circumstances not dissimilar from our own at present, started a service of this character. Over the years, that has developed into a highly efficient unit of social service which is giving much relief to human distress and also much relief to hospital finances. I had the opportunity of seeing that social service in operation 286 when I visited Amsterdam last year. Before describing it in outline, however, perhaps I can deal with the cost.
In Amsterdam, the most recent figures are that this service costs £25,000 a year for a population of almost 1 million people. One must, of course, make adjustments in salaries and other matters when translating that figure into terms of finance for this country, but in doing this and making all allowances, one can say that for the whole population of England and Wales we could establish a service of this character for not more than £1½ to £2 million a year at the outside.
Next, what would we save? We can get some idea of this, too, because there are certain places where, by local initiative, a service of this kind has been established. One of those is the County Borough of Oldham, where a similar service was started five or six years ago. The report of the Medical Officer of Health for Oldham shows what the effect of the service has been upon hospital admissions.
In 1951, the number of mental hospital admissions in Oldham was 169, which is about the national average for mental illness. By 1954, however, the number had dropped to 128. As a result of this service, therefore, in three years there had been a reduction of one quarter in admissions to mental hospitals.
In terms of the overall picture for the country as a whole, it being a fair assumption that our hospitalised mental patients cost about £30 million a year, a reduction of that order in admissions would save £7 to £8 million a year simply as a start within three or four years; and that is only the immediate effect in the first few years. As the service developed, the effect on finance would be incalculable and there is a possibility of saving £10, £15 or even £20 million.
I should like to say a word about the service as it is working in Amsterdam and as I understand it works in Oldham. When an acute episode in mental illness occurs elsewhere, there is the tendency for the duly authorised officer to come in and for the patient to be almost immediately certified and rushed straight to hospital. It is not until he gets to hospital that the patient finds any skilled help or attention or any attempt to diagnose his condition properly by skilled help.
287 Instead, in the service which I am describing, the patient is seen by a psychiatrist in his home and, if possible, diagnosed. At least, an attempt is made to settle him down in his home surroundings and to ensure that he has adequate attention not only from his local practitioner, but with the help of a social worker, so that the home and social surroundings are concentrated on the problem that may have caused the breakdown. The problem of environment is often dealt with by a social worker and in that way a patient can be tided over and, perhaps, be kept at home and treated as an out-patient, thus saving a valuable hospital bed.
Suppose, however, that in the end it is necessary for the patient to go to hospital. He still has an eye kept on him by the local authority service during his time in hospital with a view to his eventual rehabilitation when he has recovered from his illness. The rehabilitation of mental patients is an extremely difficult and complicated job and one that completely stymies us in most parts of the country at the present time.
A service of this nature would assist actively by keeping in touch with the patient while in hospital and in preparing the way to his discharge by continuous contact with relatives, the employment exchange and, if necessary, the housing officer and all the other necessary social services that are essential.
With this one service, therefore, it is possible to cure the two main causes of overcrowding in mental hospitals. The first of these is the hurried admissions. I must take this opportunity to refer to a letter which I have received from the medical superintendent of a large mental hospital, in which he gives me his opinion. He says:In mental hospitals, the greatest problem is the improper admission of patients.He cites the case of somebody who was taken into a mental hospital, having taken barbiturics or attempted suicide in a similar manner, and who, perhaps, even before being treated for his physical condition, was placed on an Order and detained. That kind of thing—either admission direct from a general hospital or hurried admission from home, as frequently takes place—would be quite impossible if we had a proper psychiatric 288 service in the homes of the people so that they could be cared for in the proper fashion.
By the same token, the second and probably equally great cause of overcrowding is the difficulty of the rehabilitation and the discharge of patients. Again, one can refer to the words of a medical superintendent, Dr. Bickford, in an article in The Lancet a year ago, in which he stated quite clearly that at his hospital, the Willerby Hospital, Hull, he could discharge one-fifth of his female patients straight away if they had anywhere to go. That is why these patients are accumulating in mental hospitals. There is difficulty in their resettlement, and without help——
§ Dr. Johnson
Particularly the old people—without help in the form of a rehabilitation service, there is nowhere for them to go.
This applies with particular force to the old people, who are tending to accumulate in this unfortunate fashion in our mental hospitals. It is staggering that one-third of the certified patients entering hospital today are over 65 years of age.
§ Dr. Johnson
Yes, the old people. One-third of our certified patients are over 65 years of age. They go into hospital and, because of the failure of rehabilitation in this way, they stay there.
One cannot pass over this question without commenting, by way of compliment, on the splendid work being done in the geriatric unit at Oxford by Dr. Cosin, by which he has rehabilitated old people by getting them into hospital in time. They have been rehabilitated quickly and have been returned to the community quickly. He is setting an example that might well be followed in other parts of the country. This is by no means a novel conception even in this country, because there are powers available in Section 28 of the National Health Act, to any local authority to put a service of this kind into action straight away.
289 The Macintosh Committee sat from 1948 to 1951 with the special purpose of considering social workers in the mental health services, but by the time that the Committee had reported and made its recommendations, in very similar terms to what I have been describing, a working party on health visitors had been set up under Sir William Jameson. That working party took another three years to consider the matter and apparently action had to wait until it was seen how the social workers in the mental health services would fit into the general picture of social workers.
One cannot help pointing out that three years went by before we had exactly three paragraphs in a Report, which was the sum total that seemed to deal with mental work. By the time that Report had been issued there was a further working party—the Younghusband Committee on social workers, whose report we are still awaiting. One cannot avoid saying that we seem to develop our social services by fits and starts. We have a big upheaval overnight, as we did in 1948, and now we have been waiting nearly ten years for further development of this small part of the National Health Service.
We know that these matters are being considered, but it is important that we should have some idea of what is happening at present. in contrast with the kind of service that I have visualised. I will read to the House a letter from a former mental patient, describing what happens when a patient is considered to be mental and is taken to hospital. It shows what happens in contrast to what should happen—the patient being seen by a tactful and trained psychiatric social worker and a skilled psychiatrist.
This man, in a letter to me, describes, first, how he was certified as a result of a sudden and unexpected visit by a doctor, a duly authorised officer and a justice fo the peace. He continues:After the aforesaid meeting in my house, and the departure of the four visitors, there was an interval. Towards 12 noon there was an amazing scene. Two uniformed policemen (an inspector and a constable) arrived art the door, demanded admission, and an ambulance drew up outside. My removal was effected in the best traditions of the old Nazi Gestapo. Without explanation, without a moment's notice, I was bundled into the ambulance. An attendant inside hugged and held on to me as though a murder had just been committed. I had to tell him to desist, and even the policeman sitting opposite smiled290 That is the sort of thing that happens today. It is only one instance and I quote it because it has been better described than a number of others which have been brought to my notice.
It shows how the mental services in the country are getting into a quite unnecessary disrepute, because this man was not in the least violent. It was completely unnecessary to bring a policeman in this case, just as it is unnecessary in any case of mental illness that can be tactfully and skilfully handled. I submit, therefore, that the service which I have described to the House all too briefly is urgently needed.
§ Mr. Shurmer
I cannot let the hon. Member's statement pass. I have been a member of a mental hospital committee for thirty years and I have never known a policeman attend such cases, unless the person has been brought from a prison where he had been confined and certified. This man must have had hallucinations. Two policemen could not have been sent to fetch him. and even the uniforms of our male nurses would not suggest that they were policemen. I have never heard of such a case.
§ Dr. Johnson
I assure the hon. Member that this is one of several cases where policemen are employed. I will give him particulars later if he wishes.
§ Mr. Christopher Mayhew (Woolwich, East)
I have warmly sympathised so far with the speech of the hon. Member for Carlisle (Dr. Johnson), but may I ask whether, in fairness to the mental staff and the nurses concerned, he checked the facts with an independent source?
§ Dr. Johnson
Yes, I checked them with a relative. The best check that we can have is the fact that one has more than half-a-dozen such stories from different sources, where there can be no possible collusion. This is only one case out of a number.
§ Mr. Mayhew
I, too, have received a number of letters of this kind, but one has to realise that they are not all of equal validity—that is, the letters one receives from former patients at mental hospitals. We must be fair to the people who have this hard job which the hon. Member has described. I wish that he had 291 been able to assure us that he was not merely quoting a letter, but had made independent inquiries himself.
§ Dr. Johnson
I can quote another incident. I was talking earlier about Amsterdam. This is the effect that our mental services have on people abroad. I went round hospitals in Amsterdam with a psychiatric worker. She came over to London to see our mental health services here and she went out with a duly authorised officer.
§ Dr. Johnson
No, a duly authorised officer. These officers are known as mental health officers. The identical thing that I have just described happened when this visitor was over here. A patient would not go into a hospital and a policeman was sent for. The psychiatric worker I have mentioned expressed her complete horror to me at that incident. That is just another example.
§ Dr. Johnson
Oh, yes they have. Apparently the hon. Gentleman does not know the Act of 1890, where that procedure is laid down. He should know his law in this respect. May I ask him to look at Section 16 of that Act, under which people are moved to mental hospitals? It provides for a constable to be sent for. That is the legal procedure at present, and that is why I am intervening in this debate, because I want a social service which avoids that kind of thing.
§ Mr. Shurmer
They may have done those things in years gone by, but today things are very different.
§ Dr. Johnson
If the hon. Gentleman will meet me afterwards, I can give him perhaps half a dozen cases of the police being called for, and he can see the people himself. They are not figments of my imagination. I have met and talked to these people and I should he glad to introduce the hon. Gentleman to them. Perhaps we can arrange that.
Now, if I may continue where I was interrupted, may I say that the public attitude at present towards mental illness is one of uncertainty and hesitation. It 292 can only be allayed by a service such as I have talked about. I think this would need three things. First, an integration of effort between the regional hospital boards and the local health authorities. Secondly, the recruitment of personnel, which, I understand, is one of the difficulties today, particularly for the psychiatric social worker's course. One is not altogether surprised that there are insufficient recruits coming forward when one reads the case quoted by the Macintosh Committee, where an advertisement of a local authority for a qualified worker actually offered a lower salary than for an unqualified worker. Thirdly, and not the least important, is a general change of attitude on the part of the authorities and public towards mental illness.
I am pleased to be able to say that there are signs of these things happening. We are looking forward to the Royal Commission reporting. and it is hoped that its report will be followed not only by legislation, because legislation is only a part of the solution, but by the development of a social service of this kind which, as I have said, will make completely out-dated and unnecessary the compulsive legislation which has been such an unfortunate and prominent feature of the treatment of mental illness in the past.
§ 7.33 p.m.
§ Mrs. Harriet Slater (Stoke-on-Trent, North)
I am sure that the hon. Member for Carlisle (Dr. D. Johnson) will forgive me if I do not follow his argument on the subject on which he felt he must speak. I want to bring the debate back to the terms of the Motion before us. I find it extremely difficult to reconcile the claim of the Government that the recent measures they have introduced have not in any way undermined the social services, since that is what has happened, and what will happen even more as a result of some of those Measures.
The claim has been made today that there has been an increase in the £s. d. spent on our social services, but I suggest to the Government that much of this increase is due to their deliberate policy during the last few years of increased interest rates, which add charges to any new buildings erected, to any new schools, to any new hospitals and to any new 293 health centres. The policy of the Government of taking off controls on essential commodities, which has resulted in the prices of essential foods rising, has again affected the hospitals because of the food consumed there. Similarly, the policy of the Government has affected our education services.
I want the House to realise that the provision of social services is very young. It is only about eighty-two years since the first major Public Health Act was introduced, and only twelve years since the Labour Government started to measure up to the need for such services in this country. So we are by no means at the stage of having accomplished a complete social service, but are merely in the teething stage of learning how much is needed and how far we have to go.
One speaker today suggested that we could perhaps spend less on certain services and increase grants to voluntary services. I am not by any means decrying voluntary services, particularly those which care for old people, but I have a real fear that when this suggestion is made, particularly by members of the Tory Party, it may be a desire to hark back to the old days before we had any real social services, and when we depended on the Lady Bountifuls and folk with a little money, much of which had been collected on flag days in coppers from the folk they were eventually going to help.
The hon. Member for Bournemouth, West (Mr. J. Eden) tried to advance the argument that there was a decrease in the individual sense of responsibility. Surely we are not going to take a few individuals as the yardstick for the community. There will always be some people, and they are not confined to working-class people, who will not measure up to their individual responsibilities, but, on the whole, our people realise their responsibilities to their family and to the community. Nowadays we have a different conception. We have a community responsibility based, I hope, on a humanitarian approach. If we accept this, it means that we need not stand still or cut down on the services provided for the community, but we must look at them repeatedly to find out how far we are falling short of the real needs of the community.
294 We have heard many arguments about who should pay for our social services. For the moment, I will not deal with that point, but, later, I will make one suggestion for extending rather than cutting down these services. Now, however, I want to make the plea that social services should not only be looked upon as a community responsibility on a humanitarian basis, but should be regarded from the preventive point of view. I say that because, if we can prevent illness and need, it means that more money can be spent on further preventive measures. I maintain that some measures introduced by the Government recently are not only not preventive, but actually undermine preventive measures undertaken in the past.
Let us look at the question of welfare milk, the increased charges for milk and the removal of the subsidy. I remember when in most working-class homes the only milk bought was that bought on a Sunday to make a milk pudding for the Sunday dinner and when the cheapest milk to be obtained was a tin of condensed milk. Then came realisation that children were suffering from malnutrition and rickets and that there were people who were not able to measure up to their work because they were not getting this essential food, and welfare and school milk was introduced. As a result, we have seen a considerable improvement in the health of children and mothers. That was a preventive measure, and I consider that to cut that in any way would be a disgrace to any Government in the present age.
Let us look at maternity and child welfare services. I have spent a long time as a member of a local authority. In the early days of my service as a local councillor, we had in cities like Stoke-on-Trent very high maternal and infant mortality rates. In many cases that was because mothers, owing to poverty, did not get the necessary food. It was also because there were no ante-natal clinics and there was very little maternity and child welfare provision. Much of that had been left to voluntary organisations to do, and very little had been done. When I first became a councillor, there was one maternity and child welfare clinic in Stoke-on-Trent.
Because of maternity and child welfare work and ante-natal clinic work we have 295 considerably reduced maternal mortality, and we have done much through our social services to decrease the infant mortality rate. That is another preventive measure and one which I am sure we should not like to undermine. Yet the increase in the price of milk and the cutting down of extensions in maternity and child welfare clinic work will ultimately, perhaps in an indirect way, undermine our service in respect of preventive medicine.
As to prescription charges, we are repeatedly told that people who cannot afford to pay can go to the National Assistance Board. But they cannot go there until they have bought the medicine. To these people 2s., 3s. or 4s. a week represents a very real burden. Some of them are asking doctors not to put as many items on the prescription sheet. Some are not even going for the medicine which they have been told they must have.
I am concerned about not only the old people—that is a very real concern—but the woman with a family and the widow living on a very small amount of money. I remember when working-class women did not dare go to the doctor because they could not afford to go or to pay for the medicine. One great feature of the National Health Service has been that it has brought the women and children into the scheme. Women in working-class homes have been able for the first time to go to the doctor before they really became ill. They have been able to take their children to the doctor before they really became ill.
Now a woman taking such a child will have to face a charge of 2s. or 3s., and there may also be another member of the family who is not well. What will the mother do? She will take the child to the doctor, but she herself will not consult him. We shall then return to the days when the mother became ill in middle life because she had been unable to get medical attention when she most needed it.
Like my right hon. Friend the Member for Warrington (Dr. Summerskill), I hope we shall face up to the provision of a chiropody service, especially for old people. To return to the voluntary idea, we in Stoke-on-Trent have been told that we can make a grant to the meals-on-wheels service for it to carry out a 296 chiropody service, but that we cannot run such a service for ourselves. That sounds queer to me. The meals-on-wheels service is able to carry out the chiropody service only for the very few people with whom it is in contact, and so for the mass of the old people in the city there is no real chiropody service at all. I have always said that if we could keep the old people on their feet by means of a chiropody service we should not only make them happier, but we might be able to prevent them having to go into hospital through becoming upset and ill because of the effect upon their general health of their bad feet.
I am also concerned about the care of the mentally deficient, and particularly of the children coming between the real mental defective and the subnormal child. I am concerned that there may be in some large mental colonies young boys and girls who ought not to be there but are there because there is no other place to which they can go. There ought to be some form of intermediate hospital where they could be trained to live among the general community rather than be condemned to live among mentally deficient children.
On the subject of education, a recent measure which upset me was the increase in the charge for school meals. My hon. Friend the Member for Leeds, South-East (Miss Bacon) has mentioned two of her experiences. I remember as a very young teacher having to take children from one of the poorest schools in Stoke-on-Trent to what was literally a barn for them to have a bowl of soup and a chunk of bread. I also remember children having to go to a shop, which was in a condemned area even then, and they walked in through the door, received 3 pork pie and a piece of slab cake, and then had to go out by another door and consume the food as they went along.
A few weeks ago I went to one of our county modern secondary schools and had lunch with the girls there, a school meal, in a dining-room which was cheerful and where there were decent tables, crockery and cutlery. The girls not only had a good, well-balanced meal, but they had it under good social conditions. I have always felt that if the children had their meals at decent tables, with decent cutlery and crockery and in a family spirit, we should remove from the minds of many of them when they grow up a 297 fear of eating in public and we should also train them to live together and to eat together as a community.
The Minister of Health said this afternoon that he agreed that the school meals service was not only valuable in so far as we could be sure that the children taking it would have at least one decent meal a day, but also from its social aspect. I suggest to the Minister of Health that to save £31 million in that way is a paltry way of saving money in this country. In the first place, it is paltry that we should save it at the expense of the school meals, and, secondly, it is paltry that we should save it at the expense of the social training that the school meals service is able to give to the children.
I have seen the school meals service make a considerable difference to the physique and general attitude of our children, and the increase up to 1s. will be a very real burden on the mother with two, three or four children. What will happen will be that either none of them will have a school meal or that some of the family will have to take it in turns not to have school meals. I hope that the Government will have another look at this economy from both the aspect of school meals and that of the social services.
Then there is the question of the education grant. I am very worried about the fact that the education grant is now to be thrown into the melting pot. We have not many instances of local authorities which have not really considered that to spend money on education was a valuable service which they ought to give. We still have some local authorities which give very much less than others in grants to university students. We still have some local authorities which are not prepared to expand, for instance, their further education services and which are not very worried about a cut in the school-building programme and whether their own dirty, unhealthy, badly-lighted schools will either be done away with or modernised. In the main, those local authorities are Tory-controlled.
I do not want us to go back to the time when we had the scramble as to whether education should be a Cinderella service or a service which was considered essential. I fear the fact that our educa- 298 tional grant will be lumped together because I know that many councillors look upon this as an opportunity to get more money for some little thing which they have ideas about and who would be the first to consider that what they call the frills and fancies of education, but which I would call the essentials of education, should go by the board, with the result that our children and young people will suffer as a result.
Then there is the question of playing fields, new buildings, the bulge which we shall have in our secondary-modern schools, the still far too many large classes which we have in many of the large industrial areas and the need that we may have to hold back the three-year training period for teachers, which enables them to have a much higher and much better training, and, therefore, a much higher standard.
Finally, I come to another matter which I think is undermining the wellbeing and preventive attitude to ill-health and bad conditions. That is the Government's attitude to housing, which has only been mentioned in passing today. I consider that the cut in subsidies for general housing and increased interest rates are a deliberate attack by the Government against the people who really need houses.
My local authority and many other local authorities of large industrial areas are at this very moment considering the question of whether they will say at their next council meetings, "No more houses are going to be built for the general applicants; only houses for slum clearance will be built."
I remember the time when the Prime Minister introduced the Housing Repairs and Rents Act, 1954, and talked about a crusade in housing. Much of the propaganda at the elections of the Tory Party has been about this great crusade in housing. It has come to an end, and it has had its feet cut from underneath it. Young people who are getting married just cannot find the deposit which is necessary to buy a house in the region of £2,000. They are finding fewer building societies prepared to lend them the money to buy their houses. Even when they can face up to both of these problems, the burden of high interest rates which they are condemning themselves to pay over the next twenty years is one 299 which most young people simply cannot face up to. So we are condemning them to go on living with their families and to begin to rear their own families in overcrowded conditions.
Many of them are living in bad houses already. We are laying the foundations not only of a feeling of frustration in the minds of these young people. but of ill-health because we are condemning them to live in overcrowded conditions. I want to see these slums cleared, but I also want to see the time come when we shall have houses for those people who are in need of decent houses. So long as we have a Government which puts up interest rates and cuts subsidies from the general housing of the people of this country, we shall have a Government which really does not understand the problems of the majority of the people.
The Minister of Health said that we do not want to tax people too much for our social services. But the people who will benefit most are old people, widows and people with large families who do not pay taxes and yet, by the increased contribution, will be called upon to pay the heaviest amount in relation to their needs. That is a further unjust burden on the people whose need is greatest.
I should like to see more preventive medicine and the building up of those services which will prevent ill-health and the mental disturbance of which the hon. Member for Carlisle (Dr. D. Johnson) was speaking. Many old people become mentally ill because of the fear of old age and because, perhaps, they cannot get the bare necessities of life. All this becomes a burden on old people when they are least able to stand the increasing nervous exhaustion.
There have been many suggestions as to where the money should come from. I may be accused of being naïve, but if the Government would face up to a suggestion which has been repeatedly put to the Prime Minister during the last few weeks of abandoning the hydrogen bomb tests, of cutting down armaments in this country and doing away with unnecessary National Service, we could find much of the money for which we are crying out at the present time. We should thereby be providing not only increased and improved social services, but contributing 300 to a more humanitarian outlook for the future of the people of this country and the rest of the world.
I therefore ask the Government to look again at what they have done in the last few months and to consider whether they can honestly say that they have not undermined the social services, and to realise that to cut essential social services is to attack those people whose need is greatest and inevitably to store up greater problems for future Governments.
§ 8.0 p.m.
§ Mr. R. P. Hornby (Tonbridge)
Anyone who, like myself, has listened to the whole of the debate must be, aware of the immense scope of social services in this country. On both sides of the House we can all take a good deal of pride in that. We should also all be aware of the immense claims on the country's resources made by social services.
The hon. Lady the Member for Stoke-on-Trent, North (Mrs. Slater) covered a great deal of ground and I hope that she will forgive me if I do not follow the whole of her speech. The hon. Lady demanded a great deal of expenditure on a great many subjects and suggested where the necessary economies should be made. I do not propose to stray into the paths of a defence debate, but she knows as well as I that the Government have stated that they are looking searchingly at all that matter That is all I shall say about it.
I want to concentrate on the Health Service and its finances, about which the hon. Lady said much. I was glad in particular that she mentioned preventive medicine and preventive measures. Most of us would agree that there are two aspects of the Health Service with which we are mainly concerned. We are concerned with providing diagnosis, treatment and cure of such sickness and disease as we find, and with trying to find resources for research and preventive work.
In doing that, we have to recognise that we are working within the context of a limited budget. When the hon. Lady referred to education and the Health Service, and when other hon. Members talked about mental sickness and old people, they should have realised that all those services, admirable in themselves, all cases for which we should like to do 301 something as soon as we can, compete for the country's resources.
I am glad to see that the hon. Member for Huddersfield, West (Mr. Wade) has returned to his place. He was quite right in saying that if we allow our enthusiasm for all or any one of these cases to outrun itself, we shall land in inflation and overstrain the country's resources, thus becoming worse off than we were when we started. In all probability, those people who can least afford to defend themselves will be paying the price for that inflation.
In other words, we are faced not with just the problem of the Health Service, but with an economic problem arising out of that Service. I want to concentrate my remarks on that problem. We have to ask ourselves whether what we are spending on health is adequate for our needs, whether we can afford to pay it, and whether we are spending it in the right way. We cannot possibly divorce the problems of any one of our social services from the economy in which we live and out of which we have to draw the resources for the things we want.
I want to return to deal with the methods by which we finance our Health Service today. We are all aware that the cost of the Health Service has caused repeated concern to successive Chancellors and Ministers of Health on both sides of the House. We know that the estimated cost of the total Service today is £690 million. We know that the steadily increasing proportion of that cost is drawn year by year from the Exchequer. We know that there are two other main sources of revenue for the Health Service, charges applied to the users of the Service and National Insurance contributions.
Those are the three elements with which we are dealing. As has been rightly observed, if we do not like one method of payment, we have to look at the others. In the same way, if we want more for one social service, or one part of the national economy, we have to consider where we are prepared to do with less. That is the framework in which we have to consider the subject.
We have to remember that the charges are carefully chosen selective charges applied to a very few individual items 302 —prescriptions, dentures, dental treatment, spectacles, and one or two more. In fairness, we must also remember that there is a very carefully drawn-up list of exemptions from those charges. No one who receives National Assistance has to pay the full cost of prescription charges—there is a refund process. All children are excluded from the spectacle charge and anyone under 21, or a woman who is expecting a child, or who has had a child in the last 12 months, is exempt from the dental charge.
We must remember all those things, if we are to see the picture in its right context. We must remember that the insurance contribution is at present one-seventeenth of the total cost of the health bill. After my right hon. Friend's new proposals are brought into effect it will be raised to only one-ninth, while Sir William Beveridge, as he then was, recommended that it should be one-fifth.
I come to the main criticisms of the present proposals and the present methods of financing the Health Service. They largely fall under two headings. The first is that the Exchequer is niggardly in its general treatment of the Health Service, and the second that the arrangements which have been made and which are being made bear hardly on those who can least afford to pay. As to the first, I expect that many hon. Members have read the 1955 Report of the International Labour Organisation on the financing of social security. They will have found it interesting on this subject when they see that the Exchequer in Britain is paying for social services.
The Report reveals that the cost of the Health Service borne by public funds is far greater in Britain than in any other country in Europe. The figures are: roughly 90 per cent. of the cost borne on public funds in this country, as against 32 per cent. in Belgium; 30 per cent. in Sweden; 30 per cent. in Denmark; and between 20 and 25 per cent. in Norway. The discrepancy is enormous. Seen in that general European context, the figures completely refute the suggestion from the other side of the House that my right hon. Friend the Chancellor is not playing fair by the Health Service. It is a very different story.
Secondly, emerging from that same Report—and it applies to the new proposals 303 for the increased insurance contribution—there is the fact that in Europe the trend over the last few years has increasingly been that the burden of health costs should be moved away from the State or public authority contribution in the direction of the insurance contribution. Until now the trend in this country has been entirely in the opposite direction. The Exchequer has borne the burden to an ever-increasing extent, and less and less has come from other sources. My right hon. Friend the Chancellor now proposes to halt that trend to some extent, and I believe that he is right to do so.
It is an absolutely sound policy, both socially and economically, so to legislate that insurance plays a bigger part in the financing of our Health Service. I am not suggesting that it should play a predominant part, or go further than Lord Beveridge originally suggested. but I submit that it has been playing too small a part hitherto. What are my reasons for saying that? First, the Health Service would gain considerably if its demands were insulated to a greater extent from other demands made upon the Exchequer. The Health Service will have a rather large chunk of money which would be in a separate contributory fund, and I think that its future would be the more secure for that. It has a large sum of money which would be definitely and undeniably its own.
Secondly, I believe that the alteration would be beneficial economically, because of the effect that a slightly larger insurance aspect would have upon the users of the Service. When I speak to my constituents I frequently find that they have the illusion that the weekly stamp pays for the Health Service. That is a dangerous illusion. People think that they are paying for the whole thing when they are paying only one-seventeenth, as I have previously mentioned. A good deal would be gained if people realised what is involved in the financing of the Health Service, and it is quite a sound policy, both economically and socially, that those in work should contribute something towards the dangers and risks involved in sickness.
The hon. Member for Leeds, South-East (Miss Bacon) talked about the unfairness of a contributory system. When I say that I should like to see the insur- 304 ance principle emphasised I would point out that I also recognise that if these contributions were considerably increased—as I think they might be—they would impose a burden upon the lowest paid workers. This is a problem which can be faced with advantage.
I would ask my right hon. Friend to consider whether some advantage is not to be gained in pursuing the insurance principle further while, at the same time, seeing whether two rates of contribution could be instituted—a standard rate, and a lower rate to be paid by those below an agreed level of income.
That might meet some of the points which the hon. Lady mentioned, and I believe that it would preserve considerable advantages. First, it would enhance the contributory factor, which I regard as a useful one, and, secondly, it would help to relieve the burden upon the Exchequer. At the same time, it would safeguard some of the lower-paid workers.
§ Miss Bacon
Does the hon. Member realise that when he talks about the Exchequer he is talking about the taxpayers? Does not he agree that to take money from the Exchequer, or from the taxpayer, is much more equitable than putting a burden upon everyone, including the lower-paid workers?
§ Mr. Hornby
I am glad that the hon. Member has raised those points. It seems to me that there are two points to be considered there. I believe that the idea of taking the national income as a whole and distributing it among different sections leads to bad budgeting and extravagance. I believe that a better management of funds can be obtained if they are subdivided and set aside for specific purposes.
Secondly, I do not think that her argument is quite fair. I believe she said earlier that the taxpayers were getting off unduly lightly under the contributory system, or words to that effect. We must remember that the taxpayers are playing an enormous part in the financing of the Health Service. So long as that is true it does not seem unreasonable that both the taxpayers and the insured persons should play their respective parts in the system.
§ Mr. Sydney Silverman (Nelson and Colne)
The hon. Member says that taxpayers are playing too large a part. I 305 rather thought from his previous argument that that was exactly what he wanted. He wants the National Health Service to be financed by contributions, and he wants the contributions to be graded according to capacity to pay. While the rate is borne by the Exchequer, which means the taxpayers, that is exactly what he gets.
§ Mr. Hornby
I was trying to make the case that there was an enormous claim for an extension of the insurance principle. I also pointed out earlier that the taxpayer had been playing a very large part in financing the Health Service.
§ Mr. Hornby
I am quite happy about it.
I now come to the question of charges, and whether they bear hardly upon individual users of the Service. My right hon. Friend mentioned an article appearing in The Times of 14th March, which referred to the standards of living of the average wage earners in this country in the last few years. That article pointed out quite clearly that the average spendable incomes of those people had increased since 1948 by between 18 per cent. and 20 per cent.
In her speech, the right hon. Member for Warrington (Dr. Summerskill) said that "the average wage earner" was a dangerous and often misleading term in the consideration of social problems, because we are particularly concerned with those below the average. I accept that argument, but I do not think that it can be used against the measures which have been taken by my right hon. Friends in this and the preceding Government.
It seems to me that it is an argument for preventing extravagance wherever it occurs, for developing our services within our budgets and without creating inflation, and for paying special attention to provisions whereby we can exempt from payment those who need exemption, or can give refunds, or special aid, to those who fall below certain levels.
We must also remember that some of the charges which have been criticised have been imposed for very special reasons. Many hon. Members opposite, 306 before my becoming a Member of this House, have commented upon the vast volume of medicine which is being poured down British throats. We should also remember that dental charges have been specifically introduced because of the dangerous shortage of dentists, and that the Guillebaud Report is by no means certain that the charges for spectacles have not had a useful influence in preventing extravagant demands for replacements.
In considering these charges we must remember why they have been imposed. They are there to prevent extravagance, which is something we must avoid if we are to do all the things we want to do in the Health Service. The contributory principle offers a valuable line for our consideration. I suggest, therefore, that the social policy of my right hon. Friend is right. The insurance charges have been criticised and I would argue that in that respect we have been moving in the right direction. Incidentally—though this is not necessarily obvious proof that we are right—we have been moving in the same direction as the rest of Europe.
I would argue that on all the figures that I can find the taxpayers and the Treasury are being extremely generous to the Health Service by comparison with any other country in Europe. I maintain that the curb on extravagance represented by the charges is a perfectly legitimate way of trying to keep within our budget, as just one way in which we can curb inflation. Unless we do that, unless we realise that all the things we want in a social health policy must fit within the framework of our existing resources as earned by industry and by our own capacity as a nation, then, as the hon. Member for Huddersfield, West said, we shall bring the whole framework of the social services down in ruins about us.
§ 8.21 p.m.
§ Dr. J. Dickson Mabon (Greenock)
No doubt the hon. Member for Ton-bridge (Mr. Hornby) was genuine in his comments on how to try, by economies here and new taxation on the Health Service there, to get our social services in balance and use what money is available better and more wisely for the benefit of the community. That seemed to be the argument of the hon. Gentleman. It is a pity that he did not read 307 the opposition Motion which seeks to draw attention to theundue and increasing burden on those least able to bear it.and the Government's recent changes in the social services. After all, that is what we are debating. We are discussing what the effect has been. The hon. Member has argued how desirable it is that we have taken these measures in a general sense, without applying that to his constituents.
One of the feelings I had during the last debate in the House on old-age pensions was a sense of the lack of social indices to which one could refer. We have one report which goes back to 1954, and which was published in April, 1956. That is the best information available to hon. Members. From my own experience, I know of one or two medical teams which have done service in the last year and brought forward facts that do not conform with the claims of the 1954 Report. In other words, we cannot argue in terms of general social indices.
§ Miss Margaret Herbison (Lanarkshire, North)
My hon. Friend will remember that in the debate to which he refers, although the only statistics available to backbench Members on either side related to 1954, the Parliamentary Secretary was able to quote statistics relating not only to 1955 but to 1956 as well. It seems to me that if these figures are available at all, they should be available to every hon. Member.
§ Dr. Dickson Mabon
As a matter of fact, I was very irritated by that and the undue debating advantage which the Minister had over Private Members. I wrote to the Minister of Agriculture. Fisheries and Food and complained, and asked whether he could supply every hon. Member with such information for a forthcoming debate. I have as yet only had an acknowledgment, and so I should not like to take the point further now. I agree that it seems to be unfair.
The point I am trying to argue is on the question of how we assess the value of the Motion on the Order Paper with the social indices that are available. I suggest that there are not very many in the general context, but we can look at our own constituents and find examples to which we may refer. In my own 308 borough, for instance, what better could I do than ask the local co-operative store manager, or some other major distributor of milk, by how much his distribution of milk had fallen in the last few months. That is a fair question. I found, depending on the area, because there are differences in the effect, that the changes in the price of milk have resulted in substantial changes in the volume of milk consumed in the poorer areas. I submit that it is not unreasonable to say that by increasing milk prices we are depressing the demand of some people who consume milk. We are creating a bias against those who have less money.
From the general figures we find that there has been a decrease in the volume consumed in Great Britain. I ask each hon. Member to look into his heart and say, "Is this a homogeneous drop? Does this apply to every single individual in Great Britain, or is it possible that it may apply to only a certain class of people? If it does apply to only a certain class, is not that a shameful thing?" At least it should be recognised in the intellectual arguments in this Chamber as being a valid point to be considered, quite apart from the humanitarian aspect.
There is another interesting feature, that of school meals. I find on visiting families in my constituency, particularly the larger families, that when I ask how many children have stopped taking school meals in consequence of the charge being raised, it is, of course, the larger families and the poorer families who have to send children back to the dreadful practice of going to school with a "piece," a sandwich, for their lunch. That is a practice which I thought we had managed to overcome by the introduction of school meals at the end of the war. That provides another indication which is surely a fair one to refer to when we are considering whether it is a good thing to impose this increased charge.
Since I have not much time in which to speak, let me address myself to the major argument, that of prescription charges. I cannot think of a more lamentable change in the social services which has been made in the last few years than this one. Taking again the example of my own constituency, I can say that chemists have asked me into their back shops—of course I go as 309 a politician, as a Member of Parliament, and not a doctor, because the ethics of our profession do not allow us to compound with pharmacists—and showed me the E.C. 10 forms on which doctors prescribe their medicines. I have seen one or two which have been obliterated with pencil or ink marks. They have been obliterated because the chemist has advised the customer that the obliterated items are not the most important. The customer has asked, "What is the most important medicine on the prescription?" Sometimes the most important item is the most expensive, so the patient says, "I shall not buy the others because I cannot afford it." It reminds me of Thomas Carlyle, who once handed a bottle of medicine to a friend and said, "This cured me. It will cure you." That was his logic and the same type of logic of which I am complaining will cost the country more in the long run. If we treat people sensibly it is sometimes less expensive.
People who are in the marginal class just above National Assistance are finding it very difficult to meet the new cost of prescriptions, especially in the seasons in which they get their chronic, recurrent illnesses which demand perhaps four or five small medicines per week to keep them going in reasonable health and comfort. Take the case of the so-called "multiple pack" that we were promised. We have not got any of them, even for the colostomy people, who suffer from having to treat themselves daily, after one of the most awkward surgical procedures in modern medicine. At any rate, these packs have not yet managed to percolate over the Border, although they may be already a rousing success in England and Wales I haven't heard.
We might well say that the prescription charge has been a deterrent. The Minister's figures tend to prove that, because they dropped 25 per cent. by December, after one month's trial, and by January they dropped a further 18 per cent. It is clear that the charges are a deterrent. Does the hon. Member for Tonbridge really think that the deterrent represents the squeezing out of the margin of abuse? Or does it represent a corroding of the area of genuine illness? I am sure that hon. Gentlemen will see a very great danger here of depriving people of medicines which they need because the charges for them are substantially heavier than 310 was ever intended, even by the 1949 National Health Service (Amendment) Act.
The hon. Member for Tonbridge quoted the Guillebaud Report, which was quite against the National Health Service charges; even the one shilling per prescription was regarded as highly undesirable. Yet the hon. Gentleman says that we ought to have a few more of those taxes and a higher insurance contribution, so as to reduce the National Health Service burden upon the Treasury. I would advise the Minister of Health that, if he wishes to find economies on the pharmaceutical side of the Service, he should look at the American proprietaries which are now coming in.
I am still a registered medical practitioner and, when I go home at the end of this week I shall find like any other doctor, from twelve to two dozen highly-coloured catalogues waiting for me and advising me in the most seductive terms to use various medicines. Often these medicines have been so well placarded in the public Press that patients come in and ask the G.P. to prescribe them. Doctors, like other human beings, are influenced by advertisements and so are their patients. This conspiracy is engineered by the advertisers, the pharmaceutical firms, to get more and more proprietary drugs used in prescriptions.
§ Mr. Hornby
I shall be interested to know from the hon. Member, as he is a doctor, whether he wants the Ministry of Health to tell him what he may or may not prescribe?
§ Dr. Dickson Mabon
I thought the hon. Gentleman would come forward with that argument. I have the answer, which is perfectly simple. We should ask our experienced seniors, as we do with any other important drugs, to apply these proprietary medicines on scientific terms to a restricted number of individuals and, after having assessed not only their effects but their side effects, to say whether it would be wise to use the medicines in our practice. We have done that for generations.
Can it not be done by the Medical Research Council? It could take each new proprietary drug and submit it to a scientific test to find out whether or not there is some equivalent already in existence, and to determine its pharmacological value. Then we could find out its 311 worth financially and the Ministry could get into direct negotiations with the firm concerned. There have been remarkable examples in recent history of firms cutting their prices by half, after the Ministry has made representations to them, and still being able to sell their drugs at a reasonable profit. American companies are having a wonderful time in this field. Some of these firms are the pharmaceutical Al Capones of medicine.
Much money is being spent on these medicines that ought to be used to better purpose. We must cut down expenditure on them so that we can use the money more sensibly elsewhere. One saving would be to abolish the prescription charges right away. They have done a great deal of damage to the practice of medicine.
Talking about the finances of the National Health Service, the hon. Member for Tonbridge argued that we ought to have a larger National Insurance contribution. There we get closer to the fundamental difference between the two sides of the House on the question of the National Health Service, and, indeed, of the larger issue of the social services. The fundamental difference is that we believe that a common Health Service should be provided to every citizen. In the main that should be provided by general finance. There should be no discrimination between one section of the population and another. One section should not be given a better service than another as has been suggested from time to time.
I do not worship Lord Beveridge as the god of the Welfare State. I acknowledge that he did a great deal in thought and in converting many people to the idea of extended social services in this country. I was surprised that the hon. Member says that Lord Beveridge propounded a fraction so high as one-fifth of the cost of the National Health Service which had to be borne by National Insurance contributions. My understanding was that it was continued from 1948 until the present Government at a rate of £40 million, that £40 million being derived from National Insurance Fund as part of the cumulative moneys from benefits in a society in full employment.
If we had anything between 6 per cent. or 8 per cent. unemployment, the actuarial
312 position in the Unemployment Fund would mean that these would be no money to go to the National Health Service. The presumption would be that the moneys could come from the National Insurance contribution only in a state of full employment. If the Government are to raise it by one-fifth, what possible reason would there be in five or ten years time—the Lord preserve us from that if there were a Government of this texture in office—to say, "Let it be one-third or even one-half ". Until such time as they have turned the clock back to 1911? A famous statesman once said that the Conservative Party was in favour of reform, but of the last reform, not the next. In this case it is in favour of the last reform but two.
§ Miss Herbison
The Government have turned the clock much further back than the position under the Lloyd George legislation. The majority of my constituents could always get their prescriptions free of charge, even before 1948, but they cannot now. This has gone back beyond 1911.
§ Dr. Dickson Mabon
I am indebted to my hon. Friend for underlining that point. This seems to extend the National Insurance contributions, as apparently is the intention, very far from the original concept of the Service. It may be nearer to the concept of the Service which the Conservative Party has in mind. It is entitled to that so long as it recognises and declares that that is so.
The hon. Member for Tonbridge skated over the arguments about the contribution. Of course, I say that respectfully. He did not say in his remarks about the contribution of one-fifth that there were to be charges for prescriptions, which is the exact point made by my hon. Friend the Member for Lanarkshire, North (Miss Herbison). If he had said that Lord Beveridge declared it to be one-fifth with no charges, probably that would be nearer the accurate position, but the fact is that charges exist. Is the hon. Member saying that the National Insurance contribution should be increased, but that that should be accompanied by the abolition of National Health charges? If so, I would agree with him because I want to see the prescription charge abolished in the near future.
313 The hon. Member really squirmed when he was asked about the lower paid worker. He wanted two rates of National Insurance contribution and wanted the Minister to look at that question. Apparently, the suggestion was that we should have two rates of National Insurance contribution, one for the poorer worker and one for the better-off worker. That system might be worth while, but the hon. Member is being driven to it solely because it has become part of this major idea of fortifying the Health Service.
I should like to draw the attention of hon. Members in all parts of the House to the fact that in the Opposition's Motion we have argued that these changes in the social services, whether hon. Members opposite think them desirable or not. have caused a great deal of suffering and difficulty to the ordinary people. Consequently, this is no advancing, progressive democracy, constantly widening its welfare facilities and seeking to enlarge the national Budget towards that end.
I am glad that the hon. Member for Bournemouth, West (Mr. J. Eden) is back in the Chamber because I want to refer to his argument about the expansion of the social services. He gave a stream of figures showing how the social services have increased and he concluded with the words, "No honest man could say otherwise." Surely he realises that the figures must be related not only to the national Budget, but also to the national income. We have only to turn to the Guillebaud Report to see that the proportion spent on the National Health Service has tended to drop in the last four or five years, which means that we are spending less, proportionately, on the social services than we ought to be spending, assuming that the basis of our earlier budgetary pronouncement was correct. I have still to hear an argument from the Government that those pronouncements were not correct.
The usual argument is, "Labour did this and the Conservatives have done that", the argument being that what we did was good and if they can improve it they must he better. Surely the hon. Member can apply that argument to this case. If Labour is the touchstone, the reality of good judgment, then the changes which have been made in the 314 social services do not correspond to an advance. I put it to him that we have had cuts in the services—perhaps not absolute cuts, but relative cuts.
As for the effects of these cuts, which all hon. Members have seen in their constituencies, and the hon. Member's arguments about them, I very much doubt whether even the Minister who is to reply can so attune his debating powers to overcome a case which shows that the lower income groups. the old, the sick, the lower-paid workers, the mothers of large families and the children have suffered very much more in the last three months than they have suffered for very many years.
§ 8.43 p.m.
§ Mr. William Shepherd (Cheadle)
The hon. Member for Greenock (Dr. Dickson Mabon) has delivered a moderate speech. I am prevented by time front dealing with one or two of the points which he raised, but I shall refer to one or two others.
The political attack on the Government today has failed abysmally. I rejoice in the fact that today the Opposition's attack has so entirely failed, and I do so not for party political reasons but because I want to feel that the interest in our social services and their progress is to be a bi-partisan policy. I look with regret upon those who attempt to attack the social services, on the one hand, and those who, on the other, say that there should not be any alteration in the pattern which was set in 1948. It is wrong to take the view that in 1948 we were possessed of all wisdom and that under no circumstances can we make changes which will be of benefit.
We have a common purpose in our social services, and I am very proud of the achievements of the nation in leading, to some extent although not in entirety, in social services. I hope that what we have done in the last ten years will provide us in later years with a very material dividend.
As some hon. Members have said, the Health Service and the social services generally do not take a much larger proportion of the total national product than they took before the war, but we must realise that we have many other burdens, too. I will come in a moment to the question of payment for the services.
315 I should like, first, to deal with the argument of those who say, and I understand that one hon. Member on this side of the House said today, that the social services as at present administered diminish the sense of responsibility of our people. I believe that that is absolute nonsense.
§ Mr. Shepherd
My hon. Friend the Member for Bournemouth, West (Mr. J. Eden) says that he said it. I think it is absolute nonsense.
§ Mr. Shepherd
I agree that the social services and the Health Service may have the effect of diminishing responsibility among certain elements in our community, both among the recipients and among those who administer them. It has had a bad effect, for example, on some doctors, hut. I think, very few, and it has certainly had a bad effect on a very limited section of our community which receives these services, but it is little short of arrant nonsense to declare in general terms that the social services have had the effect of diminished responsibility.
§ Mr. Eden
Will my hon. Friend allow me to intervene? What, in fact, I did say was that there was a grave danger that over-reliance upon the system of social services provided by the State might encourage in the youth of the country—and I think I was taken up on this point—the feeling that there is no longer the same necessity for individual responsibility; and that, I think, is a dangerous trend.
§ Mr. Shepherd
I do not altogether agree with that. I do not find that youth today is as bad as it is painted, and I am very sorry to see a relatively young man like my hon. Friend the Member for Bournemouth, West sharing this rather out-of-date view. When considering the question of the effect upon morale of the Health Service, I look to what happened in the inter-war years. How much more rotting of the fibre took place through unemployment? There was more rotting of the fibre in one week, I would say, than in the whole period since 1948, during which we have had the enhanced social services.
316 The time has come to abandon the idea that the social services diminish responsibility. The poor types in our society, who exist in the upper, middle and lower strata, will take advantage, as they do of other things in our country, but, on the whole, I think that the majority of our people are good, decent people who will respond to their duties and not attempt to take advantage of these services.
I want to use what time I have left to me to deal with one or two points, and the first is that I feel that a mistake we have made in the health and social services is perhaps in not taking as much advantage as we should have done of voluntary service. There was a feeling in 1948 that an end had come to voluntary service, because of the all-pervading assistance of the State, vet there is still a vast field for voluntary service—a tremendous field—and I hope that in the next year or two we shall do what we can to encourage the further use of voluntary effort.
§ Mr. Shepherd
My hon. Friend says that he said that. I am very glad that he did, and that I agree with some of the things he said.
It is perfectly true that the voluntary services can supply some things which cannot be supplied by the payment of money or by paid service. I hope we shall, particularly in the care of aged people, use to an increasing extent the voluntary services which are readily available, and for which I believe many people would volunteer to help, if we showed them the way.
I want now to say a word about the method of payment, because I think that there has tended to develop in the House tonight a difference of opinion between one side of the House and the other. My hon. Friend the Member for Tonbridge (Mr. Hornby) pointed out something which I should have liked to develop at length if I had the time, that Continental countries had become accustomed to providing much more of the revenue for social services by direct charges than is the case in the United Kingdom. I hope that right hon. and hon. Gentlemen opposite will not be too dogmatic in looking at this question, because we are faced with a very real problem.
317 It is no good our saying that we are not overburdened and that initiative is not being discouraged by too heavy a level of taxation. Most of us are agreed that some lightening of the load of taxation is essential, yet these services will demand more and more. Consider, for example, the hospitals themselves. If we are really to provide proper hospital buildings, how many millions of pounds should we spend in the next twenty years? It is a tremendous sum of money, on top of the already rising level each year of health expenditure. We really must consider taxation not as a bottomless pit, but from the point of view that we must try to condition our affairs to the state of our economy.
I do not see anything wrong in causing the weekly payment to bear a larger share of the Health Service than it does now, but I would say this as a concomitant. I think that if that were done, the prescription charges ought to go. I must declare myself to be an utter opponent of the prescription charges and I will explain why.
If it were the case that the first 1s. prescription charge had succeeded in halting the vast cataract of mainly useless medicines which people put down their throats, I would have been a supporter of it because the cost of the medicines, the bottles and all the time involved is a waste of national resources. We see, however, from the figures that after a year or so, despite the prescription charge, the cataract did not dry up; in fact, it increased in volume.
Although my right hon. Friend the Minister is now able to say that there has been a diminution in prescriptions following the additional charges, I feel that it is not permanent. One hon. Member has said that the consumption of milk is falling, and so it is, but I am convinced that in another six months' time it will start to go up to the original level, and so will medicine. When people face an increased charge, as sometimes happens, for example, with tobacco in the Budget, sales go down for a varying period, and then they resume their normal level.
If I had a choice, I would readily increase the charge for the weekly stamp rather than impose the prescription charges, because the prescription charge is a thoroughly bad charge. It does not 318 achieve its purpose and, on the whole, it is a hardship for those who can least afford it. It involves a cumbersome method of recovery for those who cannot afford it. I would say without hesitation that the weekly payments by workers and employers could bear a larger share of the cost of the Health Service and the prescription charges should be abolished altogether.
There are some who say that people cannot afford to pay for these things, but that is nonsense. What do we spend each year upon drink, tobacco and entertainments? It is about £2,000 million a year—and Sir Bernard and Lady Docker do not spend it all. All kinds of humble people, in varying circumstances, spend part of this immense total. I do not think that there is any argument for saying that people cannot afford to pay more for the weekly stamp, because I believe they can.
I had intended to refer to one aspect of medicine which disturbs me considerably, and about which little is done or very little discussion takes place. That is the extent to which we lose nationally because of absence from work through illness. When we have 2 or 3 million working days lost in a year from strikes, we get very excited. Some people, in fact, get more than excited, but we look with apparent unconcern at the 281 million days that are lost each year by absence through illness.
A great deal of that absence is really avoidable. I cannot go into details now. It is a very complicated and interesting subject. We have to apply ourselves in the next year or so to finding out more about this problem and to finding out means by which we can reduce the incidence of absence through sickness. Some of the sickness is not genuine. Sometimes paid absence encourages longer absence from work. There are all kinds of factors, but surely a great deal of work on the preventive side can be done.
There is work to be done on better ventilation and forms of heating, more agreeable conditions, the right places for people in the right kind of jobs, and attention to the various neurotic conditions that arise in factories. I know of firms which, by enlightened policy, have reduced absence from work, which, I am 319 sorry to say, is generally about 3.5, down to 1.5,
I know that everybody cannot do that, but I am sure that by proper application and study of the problems involved, and by adopting the right kind of methods, we can make a tremendous contribution towards our industrial production.
§ Mr. Ronald Bell (Buckinghamshire, South)
Would my hon. Friend explain whether by 3.5 he means 3.5 of the days, or a percentage?
§ Mr. Shepherd
I meant that 3.5 of the working days are lost through absence from work, which amounts to the work of almost 1 million workers a year lost by absence through illness. Therefore, this is a problem which we must tackle. Preventive medicine can do a great deal, and I hope that my right hon. Friend the Minister of Health will try to direct more attention to this problem than has been directed to it in the last ten years.
I hope that we all share the desire to maintain and improve the health and social services. This is a duty which civilised people accept as an obligation. We ought not to make it too much of a party issue. It is far beyond being a party issue. If we are to secure better health for our people in the future it is something that we must do irrespective of party. We have a long way to go. Hon. Members will have noticed that when people leave their work at our great factories they do not look healthy. There is a great deal to be done to improve their health. I hope that we shall try to accept this as a joint responsibility, although we may quarrel about the methods adopted.
Finally, we must not be too fixed in our ideas. We did something in 1948 and it may not necessarily be the best thing to have done. We must look at these things in the light of our own experience and experience abroad. If we find that we can improve these services by this or that change, or we find that one method of financing is better than another, I hope that neither side of the House will be too dogmatic and that we shall do our best in the interests of the nation.
§ 8.59 p.m.
§ Mr. James Griffiths (Llanelly)
I am sure that we have all listened with interest and pleasure to the thoughtful and constructive speech of the hon. Member for Cheadle (Mr. Shepherd). During the course of the day we have had a number of speeches in which hon. Members, with a deep knowledge of. and wide experience in, one or more of the social services, have made constructive suggestions for their improvement.
As I am sure all right hon. and hon. Members in all parts of the House would like to do, I should like, in particular, to join in sincerely congratulating my hon. Friend the Member for Lewisham, North (Mr. MacDermot) on his maiden speech. He spoke well. My hon. Friend came to us from Lewisham after a signal political victory. I thought that my hon. Friend, from his own experience in that by-election, put the fears that are being felt and expressed by an increasing number of the people of our country. Indeed, it was those fears which were responsible for his return as the Member for Lewisham. North.
The fear is, first, that the Government, by the trend of their recent policy, are departing from some economic and social policies which have come to be regarded by a majority of our people as an essential part of our national life. This country has now accepted that it is the duty and responsibility of any and every Government to pursue financial and economic policies that will maintain full employment. I believe that that is accepted as part of national policy, and that any Government which is believed by the electorate to be departing from these policies will be defeated in the country.
Secondly, as the hon. Member for Cheadle said, I think that there is almost universal assent that those already comprehensive measures of social insurance and social services which we have developed, and which we expanded considerably after 1945, and which we now call the Welfare State, are regarded by the mass of our people not as a luxury to be dispensed with if we meet with difficulties, but as an essential part of the life of a civilised community.
The fear expressed by my hon. Friend the Member for Lewisham, North of the people there, and elsewhere, too, was that 321 the Government, by their policies, are slowly but surely undermining those measures; that they are curtailing and restricting the scope and the cover of our social insurance services; and that, by their recent measures in particular, they are pursuing policies which tend to put the greatest burden on the shoulders of those least able to bear it.
It is not fear of one particular thing but, in effect, of a large number of measures which this Government have brought before us in recent months. I will list them, for I would remind the House that it is the cumulative effect of all these changes which is causing deep concern in the country and which, indeed, is behind the Motion which we have moved today.
First, there is the increased charge for welfare foods. We shall save, what? A paltry few million pounds. I should have thought that it was beyond argument that the money spent on welfare foods is one of the best investments that this country has made and is making. When the Minister of Health spoke, earlier, I intervened to ask a question. I do not think that the right hon. Gentleman made a real attempt to justify the increased charge for welfare foods on grounds of social policy, but we expect from the Minister of Health a balanced estimate of the gains and the losses.
Let us look at the immense gains as a result of the development of our welfare food services. Let us look at the tremendous reduction in the maternal mortality and the saving of the lives of mothers. Let us look at the great reduction in infantile mortality. These are all of enormous importance to the well-being of the country, to its prospects, to its future, because the children of today are the men and women of tomorrow. Indeed, the gains of the last fifty years, owing to the progressive development of welfare services and, in particular, what were referred to as the nutritional services, represent some of the greatest progress made by this country in the last half century.
Now we are to cut this service. There can be no mistake that the increase in the payment will mean a cut in the service. It cannot be justified on grounds of social policy. The United Kingdom has a national income of £16,000 million and 322 a Budget running into thousands of millions. We shall jeopardise the gains, that we have made in this sphere to save' a paltry few million pounds.
The same applies to the school meals and to the prescription charges. None of these recent charges can be justified on grounds of social policy. They are niggardly economies, amounting to a few million pounds in an enormous budget. I have listened to and taken part in numerous debates of this kind and I have not yet heard anyone justify the prescription charges. Hon. Members and people outside the House who have the widest experience and the greatest right to speak about these problems are unanimous in completely condemning the step that has been taken.
There are also the changes which have taken place in housing and rent policy, another attack upon what has become well-established social policy. Two things are happening. First, for forty years tenants have been protected by law, but that protection is now going, and the consequences will be very serious, not least perhaps in the field of industrial relations. Secondly, it is now clear that, apart from slum clearance, it is the policy of the Government to abandon housing as a social policy and to return to the old days of speculative building. That will be a tremendous setback to our people. It is already arousing intense bitterness and opposition.
It is fear of the cumulative effect of these policies which is behind not only the Motion but the successive defeats, which the Government have sustained in the country. There will be further defeats, because the country is making up its mind that the Government, though they render lip service to the Welfare State, are increasingly, in niggardly ways—not making a frontal attack—chipping away at the Welfare State and undermining its effectiveness and scope.
There is another matter on which both the Minister of Housing and Local Government and the Chancellor have recently spoken. It will be a very big change. In the field of social services, responsibility is shared between the central Government and local government for certain services, and among the most important of these is education. The Minister has said that the Government 323 propose to discuss, and eventually, presumably, to present to the House, a proposal by which the present distribution of responsibility between the central Government and local government is to be fundamentally changed by the introduction of a new block grant formula.
The Chancellor used what I thought were rather ominous words when commending it to the House. He said that what he and the Government hoped to achieve by the block grant which it is proposed to substitute for the present percentage grant is a stabilising influence in the central Government's contribution to local expenditure. I have discussed this matter with hon. Friends of mine who are engaged in or associated with local government administration, and they are all afraid of it and have grave apprehensions.
I am proud to live in a county where, through Labour administration in the last fifteen or twenty years, we have built up, on the basis of Education Acts, and particularly the 1944 Act, provision for education to a level which is equal to anything in the United Kingdom. There is now concern that the new formula will chain and handicap progressive authorities and keep them down to the level of the most backward and most reactionary authorities. It is felt that as a consequence one of the most sinister attacks is upon our social services and particularly our expenditure on education, and also in the very wide and important field which is provided for by Part III of the National Assistance Act. One consequence will be a serious reduction in the provision of social services in so far as they are administered by local authorities. All this, added together, seems to us to show the emergence of a pattern of policy by the Government which, in our view, is bound seriously to handicap and reduce the effectiveness of our social services, and it is for that reason that we tabled our Motion.
I now come to a subject which I want to deal with in some detail, because it is of the greatest importance. There is, for example, the Measure, already announced, by which the Government propose to increase the insurance contribution in order to provide for an increased contribution to the Health Service. Perhaps the Minister of Pensions and 324 National Insurance will tell us, because the Minister of Health referred to this, whether there is to be any provision to earmark this for certain purposes.
The flat rate of contribution was commended by Beveridge. I accepted that recommendation and embodied it in the 1946 Act. When I introduced the Bill, the level of contributions for the contributor of 18 years of age and over was 4s. 11d. for National Insurance and the National Insurance (Industrial Injuries) Act, with provision for an extra 2d. or 4d. shortly afterwards. I realised from the beginning that the strongest argument for flat rate system of contributions was that for a generation or more the country had been used to an insurance system based upon a flat rate contribution and flat rate benefits. If hon. Members read the Beveridge Report, they will see that that was the strongest argument in its favour. I also realised that a point might be reached in the future where the flat rate contribution would have two consequences.
First, it would become a kind of regressive taxation, putting the biggest burden upon those least able to bear it, and. secondly, it would become the biggest obstacle to the expansion of social services because the contribution fixed on the flat rate all the time would depend upon the capacity to pay of those least able to bear it. It will now go to 7s. 5d. when this extra 8d. is added to the contribution which is paid by all male adult contributors of 18 years of age and over. But it is paid by all of us? Let me deal with the problem.
Since 1946, there have been very great changes. The fact is that the only person who now pays the full insurance contribution is the person who does not earn enough to pay Income Tax. That is the truth and the Minister knows it. There are in this country 5 million, 6 million or 7 million people, most of them contributors to the National Insurance scheme who do not earn enough to pay Income Tax. All hon. Members are insured under the National Insurance Scheme and our contributions are deducted from our pay each month, but the part of the contribution which we pay towards retirement pension we are allowed to set off against the claim for Income Tax. The result is, therefore, that that part of the contribution which we 325 pay for our retirement pension is sub-vented by the State as it is, indeed, for most kinds of superannuation.
The man who does not earn enough to pay Income Tax bears the whole of the burden. Let us realise what we are doing by adding this new 8d. to the insurance contribution. The heaviest burden will fall upon the contributor who earns the least, who has the least income That is what we are doing.
§ Sir S. Summers
Surely the right hon. Gentleman will agree that those who have their contributions subsidised, as he claims, by the fact that it is a charge against tax, themselves contribute additionally through the very tax they pay.
§ Mr. Griffiths
The Minister of Health posed a question and I will answer him at once. He asked whether it was better for people to pay for the Health Service, for example, in part through their contributions, or through their tax, the assumption being that everybody pays in some form or other. But that is not true. That is why I say that by adding these contributions towards the cost of the Health Service we are putting the extra cost of the Service on those least able to bear it. Therefore, it is a regressive tax and unfair.
When I introduced the National Insurance Bill we incorporated 10d. a week in the payment as a carry-over of the contributions under the old scheme. One of the benefits which contributors received under the pre-1946 Act scheme was a Health Service for himself completely free, including free prescriptions. The Government are now making him pay increased contributions and an increased charge for prescriptions, so that relatively the insured contributor is in a worse position than under the old Act of 1911.
§ Sir K. Joseph
Is the right hon. Gentleman complaining because Tory Governments have removed tax from those wage earners who were paying tax when the system was introduced?
§ Mr. Griffiths
What I am saying is that the tax system relates to what is earned by those who pay and that the flat rate system, which has now reached 7s. 5d., has become regressive taxation and we must reconsider it. If, in a few months' time, the Minister of Pensions and 326 National Insurance brings forward proposals for increasing insurance contributions, the contributions may be increased to 8s. We have reached the stage, as the hon. Member for Cheadle said, at which we must review the whole matter, including the financing, in the light of the experience we have gained. The flat rate contribution has definitely reached a stage at which it is regressive and an obstacle to progress. We must think again about financing the schemes.
There is another reason. What we have been discussing is the basic service of preventing destitution. There have been many changes in social services, particularly in social insurance services, since 1948. One of the most important—and I can refer to it only briefly—has been the development through negotiations, collective bargaining and other ways of what the Americans call fringe benefits.
The whole trend of thinking about social policy has moved away from Beveridge's conception of a subsistence level. We accepted Lord Beveridge's subsistence concept during and immediately after the war. We were thinking entirely in the context of our experience of the 1920s and 1930s—mass unemployment, low wages, the means test, and all the tragedy of those years. What we were concerned to do was to impose a definite platform below which no one would fall.
In every field we are departing from that principle now. We have now reached the stage when we have two types of old-age pensioner, one of which, in addition to his basic pension, has his superannuation. There are now between 8 million and 9 million of these, and they are increasing all the time. In his Report, Lord Beveridge envisaged a country in which there would be uniform provision for everybody by one comprehensive insurance scheme. What we now have is a rapid development of all kinds of supplementary provisions to the insurance scheme.
Miners have a special scheme relating to industrial injuries—I believe that the mining industry is the only one that has it—and they are now looking forward to a separate scheme of sickness benefit, by which they will receive full pay for a period and half pay for another period when they fall sick. They have also developed a superannuation scheme.
327 Partly as a consequence of full employment and partly owing to the development of a social conscience, what was at one time regarded as the prerogative of the white collar and supervisory grades of workers is now becoming the demand of everybody in industry. There is a tremendous demand for a rise in status. and that brings with it a new conception.
The important thing to remember is the relationship between the benefits provided during adversity and the earnings obtained during work. The fact is that the gap between earnings and benefits is increasing, and not lessening.
The Minister of Health quoted from a very interesting article by a special correspondent in The Times the other day. But he quoted only part of the article. He knew perfectly well that the writer applied this test to the present position in regard to social insurance benefit and showed quite clearly—there is no time for me to give the actual figures—that as a proportion of earnings benefits are now lower than they were in 1946 and 1948.
The International Labour Office has laid down its own standards and has said that for married people without children the benefit should be equal at least to half their earnings while in work and that for a married couple with two children it should be at least two-thirds of those earnings. This new concept is developing.
In a very short time the Labour Party will be presenting the result of its survey and review of the whole of our social insurance services. We are convinced that we have reached a stage in which to continue the flat rate contribution would mean an almost complete halt in the development of those services. The Labour Party therefore proposes that the important consideration now is to ensure that those people who meet with adversity should not be subject in future, as they are now, to a terrifying adjustment and a big drop in their standard of living.
Further, we must raise the basic scales and regard them as a platform below which no one shall fall. I have indicated that the successive measures adopted by the Government, taken together, have made life harder and more difficult for the poorer sections of the community. In that respect the Government have departed from the essential principles of 328 the Welfare State. I am proud of the Welfare State. Families are better off because of it. Now they live in council houses, and I would infinitely prefer to bring up a family in a council house than in the "rabbit hutches" which were called company houses, and which were provided in the old days.
The father is better off. He has full employment and the security and dignity which that brings. He is becoming an increasingly responsible partner in industry and not a servant. The children are better in health and in physique and they have better opportunities. The sick, the maimed, the injured and the old people are better than they were, but still how poor they are. What a restricted, miserable life they have.
We say that in view of the enormous resources available to us the provision of social services should be one of the first priorities on our national resources. We protest against the measures adopted by the Government. We protest against the trend which shows a clearly emerging pattern of an attack on these services and the placing of the burden on the weakest and those least able to bear it.
§ 9.26 p.m.
§ The Minister of Pensions and National Insurance (Mr. John Boyd-Carpenter)
When the right hon. Member for Llanelly (Mr. J. Griffiths), with an eloquence which few of us can attempt to emulate, came to his peroration he really condemned the substance of the Motion. Because the very eloquent, the very moving way, in which he described the steady improvement in our social service arrangements which has taken place over recent years, and the great progress in human well-being which has resulted from it, completely contradicted the attempt made by one or two of his hon. Friends to suggest in this debate, to which I listened practically throughout, that for years a Conservative Government has been wrecking the social service system.
The right hon. Gentleman cannot have it both ways. He cannot pay the eloquent tribute which he did pay to our present system of social services, and the result it has produced, and, in the same breath, say that the Government responsible for administering the social services for the last six years have been engaged in wrecking them. But I will say this for the right hon. Gentleman. I think 329 he was the first speaker to try to argue the case for the Motion.
We have had an extremely wide debate which has covered virtually the whole scope of the social services. From speeches made from both sides of the House there has emerged—as also emerged from what was said by the right hon. Gentleman when he came to the end of his speech—an admission, a view, that we need not necessarily accept that the last word in social service arrangements was said in 1948; that Lord Beveridge sprang fully armed from the head of the right hon. Gentleman—or the other way round—with a perfect social service system which it would be blasphemous to seek to modify as experience developed.
Indeed, the right hon. Gentleman himself said that he and his right hon. and hon. Friends had been giving some thought to a possible variation in the system. Therefore, we can surely continue our discussion on the basis, not that it is the duty of any Government meticulously and automatically to preserve every detail of the existing system, but that it is the duty of the Government, from time to time, to modify the system, to expand it in some directions, and, perhaps, in that same operation, to modify and reduce it in others. Therefore, I hope that we can discuss what the Government have been doing in recent months on that basis.
I must take up one or two of the things which the right hon. Gentleman said. He became very indignant about the extra 10d. proposed on the price of the stamp on the grounds, he said, that as a result of taxation arrangements, the extra charge would fall more heavily on the poor than on the rich. I think that the right hon. Gentleman has misapprehended the position. The only part of the National Insurance contribution which is an allowable deduction for tax is that in respect of the retirement pension, for the good reason that the retirement pension is taxable when it is paid. The extra 10d.—or, indeed, the present 10d.—for the stamp is not an allowable expense for tax. Therefore, it is wrong to suggest, as the right hon. Gentleman undoubtedly did, that the 10d. will be paid less tax by those who are better off and therefore subject to Income Tax. [Interruption.] If the right hon. Gentleman did not say it, I will give way. If he did not, I 330 cannot see the relevance of introducing the tax question at all.
§ Mr. J. Griffiths
I said that the part of the flat-rate contribution which is devoted to the pension is allowable as a charge against Income Tax, and that the consequence was that the only people who now pay the charge in full without any assistance from the State were those who did not earn enough to pay Income Tax.
§ Mr. Boyd-Carpenter
The right hon. Gentleman now acknowledges that we are not altering that part of the contribution which is allowable for tax. The right hon. Gentleman seems to be in a little confusion of mind in introducing this question of Income Tax when this is a matter in which the question of an allowance of tax simply does not arise.
The right hon. Gentleman also said that he was going to list what the Government had been doing in connection with the social services, but he did not in fact do that. I do not think it is possible for the House or for people outside to form a clear judgment on the Government's recent measures in connection with the social services unless not merely one or two items but all of them are considered together. As anyone with experience of social-service administration—the right hon. Gentleman has had more, perhaps, than anyone—knows perfectly well, these services act and interact on each other and it is not fair to say that people are worse off because some downward modification has been made unless, at the same time, we take account of—to use the right hon. Gentleman's own phrase—the list of what the Government have been doing in recent months. Let me supplement what the right hon. Gentleman gave in his unduly abbreviated list. I would ask the right hon. Gentleman whether, in the terms of the Motion, he and his hon. and right hon. Friends deplore these changes in the social services which the Government have made.
There has been the increased provision in National Insurance for widowed mothers and their children to a level for the child more than double that which was started in 1948. Is that to be deplored? There are the improvements in family allowance both in the amount for the third and subsequent children and for older children who are at school or are apprenticed, Are 331 they to be deplored? There is the improvement in the earnings limit with retirement pension and the increased provision for the older war pensioners, which came into effect only a few weeks ago. Are they to be deplored?
Is the improvement in the comforts allowances for the seriously disabled war pensioner, which came into effect only a few weeks ago, to be deplored? There is the supplementation from the Industrial Injuries Fund for old Workmen's Compensation cases, which came into effect a few months ago, and the additional provision for sickness and unemployment benefit for widows. This, too, came into effect earlier this year. Are they among the proposals which, it is suggested, should be deplored? There is the better provision for widows brought about by reducing the qualifying period of marriage from ten years to three. It came into effect only a little time ago. Is that deplored?
If the right hon. Gentleman is going to deplore the social service measures taken by the Government and is going to say, as he did at the Dispatch Box, that he will list these measures, it is not quite fair to ignore these changes, made in the last few months, because they are all part and parcel of the pattern of improved provision in the direction of the greatest need. They must be looked at if the House is to form a fair judgment on the other changes to which the right hon. Gentleman devoted his speech.
§ Mr. J. Griffiths
The Minister will know that for most of those changes seven-eighths of the cost is not found by the Government at all but by contributors, leaving only one-eighth to be found by the Government as a deliberate piece of Government policy.
§ Mr. Boyd-Carpenter
The right hon. Gentleman will know that, first, the Government make a very large contribution to the National Insurance Fund. Secondly, in the present position of the Fund acceptance of increased liabilities imposes a very serious contingent liability on the Exchequer. Thirdly, the Family Allowances changes fall directly on the Exchequer. If the right hon. Gentleman is criticising these proposals I take it that he is now criticising them on the rather unusual ground, not that the changes are not beneficial, but that they do not impose 332 sufficient liability on the Exchequer to please him. That is a very remarkable proposition. I do not believe the people who benefit—the large families, the widows, the old casualties of war or industry—will take quite such a detached view as the right hon. Gentleman appears to take.
The difference, as I see it, between the kind of social policy for which the right hon. Gentleman stands and that which is exemplified by the changes to which I have just referred and the other changes with which I shall deal in detail in a moment, is that we have been concentrating the resources on the areas of greatest need and have taken into account the fact that for the great bulk of the population there is a higher standard of life and a higher degree of prosperity than there has ever been. We must take into account the general state of the population and the general state of their wellbeing if we are to have a sensible social policy.
I often think that hon. Members opposite, in this matter as in others, are back thirty years ago, in the 1920's. There is nothing so static on earth as the so-called Labour movement. It is solemnly advocating a kind of Speenhamland social policy for the subsidisation of everybody, whether in full work or not, in a manner which might have been appropriate when right hon. Members opposite were forming their ideas thirty years ago, but which is completely irrelevant to the quite different circumstances of today, with high wages, high consumption and a high standard of life—in the society with which at present we have to deal. For example, we cannot take into consideration whether it is reasonable to increase the price of the stamp or not unless we take into account the average level of earnings of the great mass of contributors.
§ Mr. Sydney Silverman (Nelson and Colne)
I wonder if the right hon. Gentleman would like to explain what is puzzling a great many of us listening to this extremely rosy picture of Tory social legislation? Could he explain to us why the Government find it so difficult to convince the electors of the benefits of their policy?
§ Mr. Boyd-Carpenter
The hon. Member had better not count his chickens before they are hatched. [HON. MEMBERS: "They are hatched."] He might 333 remember, if he is worrying about by-elections, that the Edmonton by-election in 1948 showed a bigger loss of votes for the then Government than any by-election since and despite that the then Government was returned to power at the following General Election.
If I may distract the hon. Member for Nelson and Come (Mr. S. Silverman) from his predilection for electoral activities. I will return to the Motion his right hon. Friends have put on the Order Paper. As I was saying when the hon. Member intervened, it is relevant, although not a word of this fell from the right hon. Member for Llanelly, to a consideration of whether or not the increased contribution in respect of health imposes overall an excessive burden—to view that against both the general standard of living and the general standard of earnings.
I do not think that the right hon. Gentleman fully appreciates that whereas the National Insurance contribution containing the original 10d., proposed in 1948, represented 3.6 per cent. of the then average level of earnings, the new contribution, including the further 10d., will amount only to 3.2 per cent. of the average earnings at the latest figure. I say to the right hon. Gentleman with the greatest respect that it is essential to have clearly in mind the sort of community and the standard of life which we have if we are to consider how to adjust our social services.
§ Mr. J. Griffiths
The right hon. Gentleman says that the contribution is only a certain percentage of the average income but he realizes, of course, that it is not an average contribution related to earnings; it is a flat rate contribution. I have made the point to him that by adding this 10d. to the flat rate contribution he is presenting an obstacle to further progress in the Social Services because the time will come when the contribution will become unbearable to lower-paid men. I hope he will deal with that point.
§ Mr. Boyd-Carpenter
If by taking a stamp of 3.2 per cent of average earnings we are constituting a barrier to future advance, we are at least doing so in somewhat less measure than did the right hon. Gentleman when he initiated a stamp at 3.6 per cent.
334 If I may proceed to deal with the matter which the right hon. Gentleman himself mentioned—the stamp—I would point out that there is nothing new in the principle behind it, which is that some contribution should be made by National Insurance contributors for the benefit of the Health Service. The right hon. Gentleman himself fixed it at 10d., and such has been the rise in earnings since then that this additional 10d., doubling the original rate, represents broadly the same proportion of earnings fixed as the Health Service contribution as was fixed by the right hon. Gentleman himself and his right hon. Friend the Member for Ebbw Vale (Mr. Bevan) in 1948. We are therefore not dealing with any great question of new principles. We are dealing purely with a practical question whether the figure fixed in 1948, amounting then to one-fifth of the total cost of the Health Service, should be allowed to remain as at present, at one-seventeenth of the total cost of the Health Service, or whether some adjustment such as is proposed, not the whole way back to 1948 and to one-fifth but about half-way there, to one-ninth, should be effected.
In considering that the House will wish to face the alternatives, as my right hon. Friend the Minister of Health said so well earlier. No Government is prepared to allow any particular service to impose a completely unlimited charge on the economy and on the Exchequer. Certainly right hon. Gentlemen opposite did not permit it. As the House will remember, the late Sir Stafford Cripps imposed, or sought to impose, a ceiling of £400 million in 1949–50. The present cost of the Service on next year's Estimates is £690 million. It is therefore not unreasonable for any Government to say that an unlimited increase cannot be permitted.
If one accepts that, there are three courses open; to restrict the scope of the Service—in other words, to deny the sick of this country the treatment which it is technically possible to give them; to increase charges, which has the disadvantage which several hon. Members have most eloquently stated about the present charges, that they impose a charge on a person when he is sick; or to do what we now propose, which is to impose an additional charge on the stamp, which, the House will recall, is paid only when a man is well, because when he goes on 335 sickness benefit he ceases to pay his contribution. Before the right hon. Gentleman and his friends allow themselves to become too indignant I would therefore ask them to address themselves to this practical problem. Faced with the need, which they themselves accepted at a lower figure, to secure that there is not an unlimited expansion in the cost of the Health Service, which of the three courses would they themselves prefer—increased charges, a cut in the Service or the addition to the stamp? That is the question which has to be faced.
§ Miss Herbison
Before the Minister leaves that point—[HON. MEMBERS: "Answer."] He made great play about the proportion of the National Health Service that will be financed by this additional contribution and the previous contribution. Has he added to that proportion not only the additional contribution which people will have to pay, but also the proportion they pay through prescription charges, the charges for surgical appliances and the charges for teeth and spectacles, because that is very important in this matter?
§ Mr. Boyd-Carpenter
Of course, I have taken that into account. I have given the House the total, which, of course, includes the various directions from which it is made up. I am bound to say that I thought the hon. Lady the Member for Lanarkshire, North (Miss Herbison), with the courage which always distinguishes her in debate, was going to answer the question which I put to the right hon. Gentleman.
§ Mr. J. Griffiths
Let me gather what the Minister has said, so that we can get it clear. He has asked which do we prefer—is it increased contributions or prescription charges? Is he now proposing to the House that these are alternatives? Is he therefore proposing that if we increase the contribution, he is now proposing to reduce or remove the prescription charge or any charge of this kind? I thought I indicated the policy which we believe this country ought to have. We must find a way by which payment of all kinds included in National Insurance must be more closely related to the ability to pay and not to a flat rate contribution.
§ Mr. Boyd-Carpenter
With very great respect, that means absolutely nothing, as the right hon. Gentleman, as an old Parliamentarian, knows perfectly well. It is not good enough for the right hon. Gentleman or for those who share that Bench with him, and who regard themselves as an alternative Government, to criticise every change that we make and never offer, as he has conspicuously refused to offer today, an alternative.
The News Chronicle, which is, after all, not a Conservative paper, as the hon. Member on the Liberal benches knows, said this, which I think is relevant:It is all very well for Labour Members to shout, 'Resign, resign' at the Chancellor when he makes some unpopular announcement of higher charges for Welfare Services. What the country wants over the whole field of Labour policy is a sign of a genuine alternative. So far, the Labour Party has shirked the financial implications of its policies.The House and the right hon. Gentleman must face the financial implications of their policies. I have made it as clear as I can that our policy with the limited resources that clearly are and always will be available to the community, which in work is now enjoying the highest standard of living it has ever known, is to try to concentrate the resources where they are most needed—on the old, the sick, the large families and those who need it most—and not to spread social benefits, in the form of general subsidies, whether they be on food or rent, over the population, the great majority of whom do not need them.
I do not think that right hon. Gentlemen opposite deny the high standard which the great mass of wage earners now enjoy. Certainly, the Daily Herald acknowledges it—[HON. MEMBERS: "They have earned it."] Certainly, and worked for it, and it is an admirable thing, but it is a factor to be taken into account when right hon. Gentlemen opposite suggest that people in that position require a large number of subsidised commodities in their budgets. It is a fact which the Daily Herald acknowledges in its advertising if not in its editorial columns and it is a fact which the Co-operative movement has triumphantly proclaimed in the bumper sales which it claims to have achieved—and good luck to it—last Christmas. Therefore, the House must have in mind that 337 we are dealing with a community that is able to pay increasing amounts for the various thing that it needs and does not require budgetary additions such as hon. Gentlemen opposite are getting very excited about.
It is not fair to suggest, as has been suggested, that this Government have made an attack on the social services. That is very far from the truth. Opinions can vary, and properly so, as to the precise emphasis to be placed on one service rather than on another and as to which at any particular moment it is better to develop and which it is less necessary to develop. That is a matter on which there can be legitimate differences of opinion, not only between the two sides of the House, but among hon. Members. What is unfair and what is not borne out by the facts is to say, as the hon. Lady the Member for Stoke-on-Trent, North (Mrs. Slater) said, and as several hon. Members sought to say, that the Government have made an attack on these social services.
Let me remind the House of the increases which have been made in some of them since we came into office. In education, there has been an increase in the Estimates provision of 94 per cent. during the lifetime of this Government. Does that look like attacking the social services? In National Insurance benefits, the increase under the present Government has been 78 per cent.
§ Mr. Boyd-Carpenter
The right hon. Gentleman knows perfectly well that the Government make a big contribution.
§ Mr. Boyd-Carpenter
And in family allowances, there has been an increase under this Government of 95 per cent. What we have said is that a population able, as the published figures show——
§ Mr. Griffiths
To get the balance clear, will the Minister set against these the reductions made in subsidies in other ways by this Government which have increased the cost of living?
§ Mr. Boyd-Carpenter
If the right hon. Gentleman has followed my argument, I have been trying to say—and I have been trying to be fair about this—that we do, as a matter of clear-cut policy, 338 tend to reduce or eliminate the general subsidies which benefit all, rich and poor alike, and which benefit a population the vast majority of whom do not need them and to use the money saved thereby to help those who are economically vulnerable. If I have not explained that clearly to the right hon. Gentleman, I am sure the fault was mine.
§ Mr. A. Woodburn (Clackmannan and East Stirlingshire)
I think the right hon. Gentleman is perfectly right in saying that people ought to pay according to their ability. If it is put on as a poll tax without question of their ability to pay, is that not a much less fair method of charging than to put it on in taxation, which people pay according to their ability?
§ Mr. Boyd-Carpenter
If the right hon. Gentleman had followed what I was saying, he would know that I dealt with that some minutes ago. I was dealing with the exact converse of it—that is to say, the giving of benefits where they are most needed.
The question of a flat-rate contribution was settled in the first place by right hon. Gentlemen opposite when they introduced the National Insurance Act, 1946. It is a little late in the day for them now to come back and say that a flat-rate contribution is unfair, particularly when, as I pointed out earlier, the new flat-rate contribution will represent a smaller proportion of average earnings than did the original contribution in 1948.
The House and right hon. Gentlemen opposite must face the fact that the amount of money available for the social services is clearly not unlimited. It never has been under this or any other Government. I have tried to put our more selective approach as far as the benefits which are based on taxation are concerned. What I have said does not apply, clearly, to the great contributory scheme of National Insurance, whose great merit is that its benefits are paid to all as a right and without a means test. I am sure that the House and people outside will appreciate——
§ Mr. Boyd-Carpenter
The hon. Member might think less about by-election results and a little more about the social services of the country.
§ Mr. Boyd-Carpenter
I think that the House will accept that the worst betrayal of our social services and the beneficiaries would be to allow their foundations to be eroded by financial strain, to allow too heavy a load of expenditure to be accumulated so as to cause the whole system to collapse through excessive strain. That would be a real betrayal of
§ the social services, because it would mean that the real impact of the disaster would fall heaviest on those who depend upon these social services for their wellbeing—upon the poorest of the poor. We shall, as we have done before as trustees of the social services of the country, administer them to the full benefit that the economic situation of the country is able to maintain.
§ Question put:—
§ The House divided: Ayes 247, Noes 311.343
|Division No. 79.]||AYES||[9.57 p.m.|
|Ainsley, J. W.||Edwards, W. J. (Stepney)||Lipton, Marcus|
|Albu, A. H.||Evans, Albert (Islington, S.W.)||Mabon, Dr. J. Dickson|
|Allaun, Frank (Salford, E.)||Evans, Edward (Lowestoft)||MacColl, J. E.|
|Allen, Arthur (Bosworth)||Fienburgh, W.||MacDermot, Niall|
|Allen, Scholefield (Crewe)||Finch, H. J.||McGhee, H. G.|
|Awbery, S. S.||Fletcher, Eric||McGovern, J.|
|Bacon, Miss Alice||Forman, J. C.||McKay, John (Wallsend)|
|Baird, J.||George, Lady Megan Lloyd||MacMillan, M. K. (Western Isles)|
|Balfour, A.||Gibson, C. W.||MacPherson, Malcolm (Stirling)|
|Bellenger, Rt. Hon. F. J.||Gooch, E. G.||Mahon, Simon|
|Bence, C. R. (Dunbartonshire, E.)||Gordon Walker, Rt. Hon. P. C.||Mainwaring, W. H.|
|Benn, Hn. Wedgwood (Bristol, S.E.)||Greenwood, Anthony||Mallalieu, E. L. (Brigg)|
|Benson, G.||Grenfell, Rt. Hon. D. R.||Mallalieu, J. P. W. (Huddersfd, E.)|
|Beswick, Frank||Grey, C. F.||Mann, Mrs. Jean|
|Bevan, Rt. Hon. A. (Ebbw Vale)||Griffiths, Rt. Hon. James (Llanelly)||Marquand, Rt. Hon. H. A.|
|Blackburn, F.||Griffiths, William (Exchange)||Mason, Roy|
|Boardman, H.||Hale, Leslie||Mayhew, C. P.|
|Bottomley, Rt. Hon. A. G.||Hall, Rt. Hn. Glenvil (Colne Valley)||Mellish, R. J.|
|Bowden, H. W. (Leicester, S.W.)||Hamilton, W. W.||Messer, Sir F.|
|Bowles, F. G.||Hannan, W.||Mikardo, Ian|
|Boyd, T. C.||Harrison, J. (Nottingham, N.)||Mitchison, G. R.|
|Braddock, Mrs. Elizabeth||Hastings, S.||Monslow, W.|
|Brockway, A. F.||Hayman, F. H.||Moody, A. S.|
|Broughton, Dr. A. D. D.||Healey, Denis||Morris, Percy (Swansea, W.)|
|Brown, Rt. Hon. George (Belper)||Henderson, Rt. Hn. A. (Rwly Regis)||Mort, D. L.|
|Brown, Thomas (Ince)||Herbison, Miss M.||Moss, R.|
|Burke, W. A.||Hewitson, Capt. M.||Moyle, A.|
|Burton, Miss F. E.||Hobson, C. R. (Keighley)||Mulley, F. W.|
|Butler, Herbert (Hackney, C.)||Holman, P.||Neal, Harold (Bolsover)|
|Butler, Mrs. Joyce (Wood Green)||Holmes, Horace||Noel-Baker, Francis (Swindon)|
|Callaghan, L, J.||Houghton, Douglas||Noel-Baker, Rt. Hon. P. (Derby, S.)|
|Carmichael, J.||Howell, Charles (Perry Barr)||Oliver, G. H.|
|Castle, Mrs. B. A.||Howell. Denis (All Saints)||Oram, A. E.|
|Champion, A. J.||Hoy, J. H.||Orbach, M.|
|Chapman, W. D.||Hubbard, T. F.||Oswald, T.|
|Chetwynd, G. R.||Hughes, Cledwyn (Anglesey)||Owen, W. J.|
|Coldrick, W.||Hughes, Emrys (S. Ayrshire)||Padley, W. E.|
|Collick, P. H. (Birkenhead)||Hughes, Hector (Aberdeen, N.)||Paget, R. T.|
|Corbet, Mrs. Freda||Hunter, A. E.||Paling, Rt. Hon. W. (Deame Valley)|
|Cove, W. G.||Hynd, H. (Accrington)||Palmer, A. M. F.|
|Craddock, George (Bradford, S.)||Hynd, J. B. (Attercliffe)||Pannell, Charles (Leeds, W.)|
|Cronin, J. D.||Irvine, A. J. (Edge Hill)||Pargiter, G. A.|
|Crossman, R. H. S.||Irving, Sydney (Dartford)||Parker, J.|
|Cullen, Mrs. A.||Isaacs, Rt. Hon, G. A.||Parkin, B. T.|
|Dalton, Rt. Hon, H.||Janner, B.||Paton, John|
|Darling, George (Hillsborough)||Jay, Rt. Hon. D. P. T.||Peart, T. F.|
|Davies, Ernest (Enfield, E.)||Jeger, George (Goole)||Pentland, N.|
|Davies, Harold (Leek)||jeger, Mrs. Lena (Holbn & St. Pncs, S.)||Plummer, Sir Leslie|
|Davies, Stephen (Merthyr)||Jenkins, Roy (Stechford)||Price, J. T. (Westhoughton)|
|Deer, G.||Jones, David (The Hartlepools)||Price, Philips (Gloucestershire, W.)|
|de Freitas, Geoffrey||Jones, Elwyn (W. Ham, S.)||Probert, A. R.|
|Delargy, H. J.||Jones, Jack (Rotherham)||Proctor, W. T.|
|Dodds, N. N.||Jones, J. Idwal (Wrexham)||Pryde, D. J.|
|Donnelly, D. L.||Jones, T. W. (Merioneth)||Pursey, Cmdr. H.|
|Dugdale, Rt. Hn. John (W. Brmwch)||Kenyon, C.||Randall, H. E.|
|Dye, S.||Key, Rt. Hon. C. W.||Rankin, John|
|Ede, Rt. Hon. J. C.||King, Dr. H. M.||Reeves, J.|
|Edelman, M.||Lawson, G. M.||Reid, William|
|Edwards, Rt. Hon. John (Brighouse)||Ledger, R. J.||Rhodes, H.|
|Edwards, Rt. Hon. Ness (Caerphilly)||Lee, Frederick (Newton)||Robens, Rt. Hon. A.|
|Edwards, Robert (Bilston)||Lever, Harold (Cheetham)||Roberts, Albert (Normanton)|
|Roberta, Goronwy (Caernarvon)||Stonehouse, J. T.||Wheeldon, W. E.|
|Robinson, Kenneth (St. Panoras, N.)||Stones, W. (Consett)||White, Mrs. Eirene (E. Flint)|
|Rogers, George (Kensington, N.)||Strachey, Rt. Hon. J.||White, Henry (Derbyshire, N.E.)|
|Ross, William||Strauss, Rt. Hon. George (Vauxhall)||Wigg, George|
|Royle, C.||Stress, Dr. Barnett (Stoke-on-Trent, C.)||Wilcock, Group Capt. C. A. B.|
|Shinwell, Rt. Hon. E.||Summerskill, Rt. Hon. E.||Wilkins, W. A.|
|Short, E. W.||Swingler, S. T.||Willey, Frederick|
|Shurmer, P. L. E.||Sylvester, G. O.||Williams, David (Neath)|
|Silverman, Julius (Aston)||Taylor, Bernard (Mansfield)||Williams, Rev. Llywelyn (Ab'tillery)|
|Silverman, Sydney (Nelson)||Thomas, Iorwerth (Rhondda, W.)||Williams, Ronald (Wigan)|
|Simmons, C. J. (Brierley Hill)||Thomson, George (Dundee, E.)||Williams, Rt. Hon. T. (Don Valley)|
|Skeffington, A. M.||Thornton, E.||Williams, W. R. (Openshaw)|
|Slater, Mrs. H. (Stoke, N.)||Timmons, J.||Williams, W. T. (Barons Court)|
|Slater, J. (Sedgefield)||Tomney, F.||Willis, Eustace (Edinburgh, E.)|
|Smith, Ellis (Stoke, S.)||Ungoed-Thomas, Sir Lynn||Wilson, Rt. Hon. Harold (Huyton)|
|Snow, J. W.||Usborne, H. C.||Winterbottom, Richard|
|Sorensen, R. W.||Viant, S. P.||Woodburn, Rt. Hon. A.|
|Soskice, Rt. Hon. Sir Frank||Warbey, W. N.||Woof, R. E.|
|Sparks, J. A.||Weitzman, D.||Yates, V. (Ladywood)|
|Steele, T.||Wells, Percy (Faversham)||Zilliacus, K.|
|Stewart, Michael (Fulham)||Wells, William (Walsall, N.)|
|Stokes, Rt. Hon. R. R. (Ipswich)||West, D. G.||TELLERS FOR THE AYES:|
|Mr. Popplewell and Mr. Pearson.|
|Agnew, Sir Peter||Crowder, Sir John (Finchley)||Harvey, Ian (Harrow, E.)|
|Aitken, W. T.||Crowder, Petre (Ruislip—Northwood)||Harvey, John (Walthamstow, E.)|
|Allan, R. A. (Paddington, S.)||Cunningham, Knox||Harvie-Watt, Sir George|
|Alport, C. J. M.||Currle, G. B. H,||Hay, John|
|Amery, Julian (Preston, N.)||Dance, J. C. G.||Head, Rt. Hon. A. H.|
|Amory, Rt. Hn. Heathcoat (Tiverton)||Davidson, Viscountess||Heald, Rt. Hon. Sir Lionel|
|Anstruther-Gray, Major Sir William||D'Avigdor-Goldsmid, Sir Henry||Henderson, John (Cathcart)|
|Arbuthnot, John||Deedes, W. F.||Hesketh, R. F.|
|Armstrong, C. W.||Digby, Simon Wingfield||Hicks-Beach, Maj. W. W.|
|Ashton, H.||Dodds-Parker, A. D.||Hill, Rt. Hon. Charles (Luton)|
|Astor, Hon. J. J.||Doughty, C. J. A.||Hill, Mrs. E. (Wythenshawe)|
|Atkins, H. E.||Drayson, G. B.||Hill, John (S. Norfolk)|
|Baldock, Lt.-Cmdr. J. M.||du Cann, E. D. L.||Hinchingbrooke, Viscount|
|Baldwin, A. E.||Dugdale, Rt. Hn. Sir T. (Richmond)||Hobson, J. G. S.(War'ck& Leam'gtn)|
|Balniel, Lord||Duncan, Capt. J. A. L.||Holland-Martin, C. J.|
|Barber, Anthony||Duthie, W. S.||Hope, Lord John|
|Barlow, Sir John||Eccles, Rt. Hon. Sir David||Hornby, R. P.|
|Barter, John||Eden, J. B. (Bournemouth, West)||Hornsby-Smith, Miss M. P.|
|Baxter, Sir Beverley||Elliot, Rt. Hon. W. E.||Horobin, Sir Ian|
|Beamish, Maj. Tufton||Emmet, Hon. Mrs. Evelyn||Horsbrugh, Rt. Hon. Dame Florence|
|Bell, Philip (Bolton, E.)||Errington, Sir Eric||Howard, Gerald (Cambrideshire)|
|Bell, Ronald (Bucks, S.)||Erroll, F. J.||Howard, Hon, Greville (St. Ives)|
|Bennett, F. M. (Torquay)||Farey-Jones, F. W.||Howard, John (Test)|
|Bennett, Dr. Reginald||Fell, A.||Hughes Hallett, Vice-Admiral J.|
|Bevins, J. R. (Toxteth)||Finlay, Graeme||Hughes-Young, M. H. C.|
|Bidgood, J. C.||Fisher, Nigel||Hulbert, Sir Norman|
|Biggs-Davison, J. A.||Fletcher-Cooke, C.||Hurd, A. R.|
|Birch, Rt. Hon. Nigel||Forrest, G.||Hutchison, Sir James (Scotstoun)|
|Bishop, F. P.||Fort, R.||Hyde, Montgomery|
|Black, C. W.||Foster, John||Hylton-Foster, Rt. Hon. Sir Harry|
|Body, R. F.||Fraser, Hon. Hugh (Stone)||Iremonger, T. L.|
|Boothby, Sir Robert||Fraser, Sir Ian (M'cmbe & Lonsdale)||Irvine, Bryant Godman (Rye)|
|Bossom, Sir Alfred||Freeth, Denzil||Jenkins, Robert (Dulwich)|
|Boyd-Carpenter, Rt. Hon. J. A.||Galbraith, Hon. T. G. D.||Johnson, Dr. Donald (Carlisle)|
|Boyle, Sir Edward||Garner-Evans, E. H.||Johnson, Eric (Blackley)|
|Braine, B. R.||George, J. C. (Pollok)||Johnson, Howard (Kempton)|
|Braithwaite, Sir Albert (Harrow, W.)||Gibson-Watt, D.||Jones, Rt. Hon. Aubrey (Hall Green)|
|Bromley-Davenport, Lt.-Col. W. H.||Glover, D.||Joseph, Sir Keith|
|Brooman-White, R. C.||Godber, J. B.||Joynson-Hicks, Hon. Sir Lancelot|
|Browne, J. Nixon (Craigton)||Gomme-Duncan, Col. Sir Alan||Kaberry, D.|
|Bryan, P.||Gough, C. F. H.||Keegan, D.|
|Bullus, Wing Commander E. E.||Gower, H. R.||Kerby, Capt. H. B.|
|Burden, F. F. A.||Graham, Sir Fergus||Kerr, H. W.|
|Butler, Rt. Hn. R. A. (Saffron Walden)||Grant, W. (Woodside)||Kershaw, J. A.|
|Campbell, Sir David||Grant-Ferris, Wg Cdr. R. (Nantwich)||Kimball, M.|
|Carr, Robert||Green, A.||Kirk, P. M.|
|Cary, Sir Robert||Gresham Cooke, R.||Lagden, G. W.|
|Channon, Sir Henry||Grimston, Hon. John (St. Albans)||Lambert, Hon. G.|
|Chichester-Clark, R.||Grimston, Sir Robert (Westbury)||Lancaster, Col. C. G.|
|Clarke, Brig. Terence (Portsmth, W.)||Grosvenor, L.-Col. R. G.||Langford-Holt, J. A.|
|Conant, Maj. Sir Roger||Gurden, Harold||Leather, E. H. C.|
|Cooke, Robert||Hall, John (Wycombe)||Leavey, J. A.|
|Cooper, A. E.||Hare, Rt. Hon. J. H.||Leburn, W. G.|
|Cooper-Key, E. M.||Harris, Frederic (Croydon, N.W.)||Legge-Bourke, Maj. E. A. H.|
|Cordeaux, Lt.-Col. J. K.||Harris, Reader (Heston)||Legh, Hon. Peter (Petersfield)|
|Corfield, Capt. F. V.||Harrison, A. B. C. (Maldon)||Lennox-Boyd, Rt. Hon. A. T.|
|Craddook, Beresford (Spelthorne)||Harrison, Col. J. H. (Eye)||Lindsay, Hon. James (Devon, N.)|
|Crouch, R. F.||Harvey, Air Cdre. A. V. (Macclesfd)||Lindsay, Martin (Solihull)|
|Linstead, Sir H. N.||Ormsby-Gore, Rt. Hon. W. D.||Stanley, Capt. Hon. Richard|
|Llewellyn, D. T.||Orr, Capt. L. P. S.||Steward, Harold (Stockport, S.)|
|Lloyd, Rt. Hon. G. (Sutton Coldfield)||Orr-Ewing, Charles Ian (Hendon, N.)||Steward, Sir William (Woolwich, W.)|
|Lloyd, Mai. Sir Guy (Renfrew, E.)||Orr-Ewing, Sir Ian (Weston-S-Mare)||Stewart, Henderson (Fife, E.)|
|Longden, Gilbert||Osborne, C.||Stoddart Scott, Col. M.|
|Low, Rt. Hon. A. R. W.||Page, R. G.||Storey, S.|
|Lucas, Sir Jocelyn (Portsmouth, S.)||Panned, N. A. (Kirkdale)||Stuart, Rt. Hon. James (Moray)|
|Lucas, P. B. (Brentford & Chiswick)||Partridge, E.||Studholme, Sir Henry|
|Lucas-Tooth, Sir Hugh||Peyton, J. W. W.||Summers, Sir Spencer|
|McAdden, S. J.||Pickthorn, K. W. M.||Sumner, W. D. M. (Orpington)|
|Macdonald, Sir Peter||Pike, Miss Mervyn||Taylor, Sir Charles (Eastbourne)|
|Mackesen, Brig. Sir Harry||Pilkington, Capt. R. A.||Taylor, William (Bradford, N.)|
|McKibbin, A. J.||Pitman, I. J.||Temple, J. M.|
|Mackie, J. H. (Galloway)||Pitt, Miss E. M.||Thomas, Leslie (Canterbury)|
|McLaughlin, Mrs. P.||Pott, H. P.||Thomas, P. J. M. (Conway)|
|Maclay, Rt. Hon. John||Powell, J. Enoch||Thompson, Kenneth (Walton)|
|McLean, Neil (Inverness)||Price, Henry (Lewisham, W.)||Thompson, Lt.-Cdr.R. (Croydon, S.)|
|Macleod, Rt. Hn. Iain (Enfield, W.)||Prior-Palmer, Brig. O. L.||Thorneycroft, Rt. Hon. P.|
|MacLeod, John (Ross & Cromarty)||Profumo, J. D.||Thornton-Kemsley, C. N.|
|Macmillan, Maurice (Halifax)||Raikes, Sir Victor||Tiley, A. (Bradford, W.)|
|Macpherson, Niall (Dumfries)||Ramsden, J. E.||Tilney, John (Wavertree)|
|Maddan, Martin||Rawlinson, Peter||Turner, H. F. L.|
|Maitland, Cdr. J. F. W. (Horncastle)||Redmayne, M.||Tweedsmuir, Lady|
|Maitland, Hon. Patrick (Lanark)||Rees-Davies, W. R.||Vane, W. M. F.|
|Manningham-Buller, Rt. Hn. Sir R.||Remnant, Hon. P.||Vaughan-Morgan, J. K.|
|Marlowe, A. A. H.||Renton, D. L, M.||Vickers, Miss Joan|
|Marples, Rt. Hon. A. E.||Ridsdale, J. E.||Vosper, Rt. Hon. D. F.|
|Marshall, Douglas||Rippon, A. G. F.||Wakefield, Edward (Derbyshire, W.)|
|Mathew, R.||Roberts, Sir Peter (Heeley)||Wakefield, Sir Wavell (St. M'lebone)|
|Maude, Angus||Robertson, Sir David||Walker-Smith, Rt. Hon. D. C.|
|Maudling, Rt. Hon. R.||Robson-Brown, W.||Ward, Rt. Hon. G. R. (Worcester)|
|Mawby, R. L.||Rodgers, John (Sevenoaks)||Ward, Dame Irene (Tynemouth)|
|Maydon, Lt.-Cmdr. S. L. C.||Roper, Sir Harold||Waterhouse, Capt. Rt. Hon. C.|
|Medlicott, Sir Frank||Ropner, Col. Sir Leonard||Watkinson, Rt. Hon. Harold|
|Milligan, Rt. Hon. W. R.||Russell, R. S.||Webbe, Sir H.|
|Moore, Sir Thomas||Sandys, Rt. Hon. D.||Whitelaw, W. S. I. (Penrith & Border)|
|Morrison, John (Salisbury)||Schofield, Lt-Col. W.||Williams, Paul (Sunderland, S.)|
|Mott-Radclyffe, Sir Charles||Scott-Miller, Cmdr. R.||Williams, R. Dudley (Exeter)|
|Mott-Radclyffe, Sir Charles||Sharpies, R. C.||Wills, G. (Bridgwater)|
|Nabarro, G. D. N.|
|Nairn, D. L. S,||Shepherd, William||Wilson, Geoffrey (Truro)|
|Neave, Alrey||Simon, J. E. S. (Middlesbrough, W.)||Wood, Hon. R.|
|Nicholls, Harmar||Smithers, Peter (Winchester)||Woollam, John Victor|
|Nicholson, Godfrey (Farnham)||Smyth, Brig. Sir John (Norwood)||Yates, William (The Wreldn)|
|Nicolson, N. (B'n'm'th, E.& Chr'ch)||Soames, Christopher|
|Noble, Comdr. A. H. P.||Spearman, Sir Alexander||TELLERS FOR THE NOES:|
|Nugent, G. R. H.||Spence, H. R. (Aberdeen, W.)||Mr. Heath and Mr. Oakehott|
|O'Neill, Hn. Phellm (Co. Antrim, N.)||Spens, Rt. Hn. Sir P. (Kens'gt'n, S.)|