§ Order for Third Reading read.—[Queen's Consent, on behalf of the Crown, signified.]
§ 3.31 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)
I beg to move, That the Bill be now read the Third time.
In our debates on Second Reading and during the Committee stage, we have had a good deal of interesting and helpful discussion on various aspects of the proposed increase in contribution. This is, of course, very useful, but it is important to remember the broad reasons for the Bill. There is a danger that these may have been somewhat overlooked and forgotten, and it might be convenient for me, at this stage, to recapitulate them.
My hon. and learned Friend the Financial Secretary, in his opening speech on the Ways and Means Resolution, and my right hon. and learned Friend, in his Second Reading speech, stressed the rising cost of the National Health Service and the increasing burden falling on the Exchequer. My right hon. Friend the Chancellor of the Duchy of Lancaster, in his speech on Second Reading, gave a full account of the various stages in the increases of cost, and pointed out that it had been the policy of successive Governments to put a limit on the cost of the Health Service actually falling upon the Exchequer. Indeed, in 1950, the late Sir Stafford Cripps, when Chancellor of the Exchequer, said that it was not possible to permit any overall increase in the expenditure on the Health Service.
Again, in April, 1951, the right hon. Gentleman the Leader of the Opposition, when Chancellor, referring in his Budget speech to an increase of about £30 million in the estimated cost of the Service, said that in those circumstances, and with all the other burdens which had to be carried, it was not reasonable to put on the Exchequer, and, therefore, on the taxpayer, another £30 million, and that his Government had decided that the 34 Health Service estimates would have to be brought within a total of £400 million, which, for the time being, would have to be a ceiling.
Although the sums involved are now much larger, the situation facing the Government today is very similar to that facing the Opposition when they were in power in 1950 and 1951. The estimated gross cost of the Service for 1958–59 is £740 million, of which about £555 million would, under present arrangements, fall upon the Exchequer. In 1957, when the National Health Service contribution was increased, the Government considered that £550 million was an excessive burden for the Exchequer to bear and the increase in the contribution would have brought that figure down to £530 million. But, as a result, largely, of continuing inflation, the burden falling on the Exchequer in 1957–58 is now estimated to be £545 million, and, next year, it would, at £555 million, be even higher than the £550 million which, last year, was considered excessive.
The proposed increase in the contribution will reduce the estimated cost to the Exchequer from £555 million to £531 million, a reduction of £24 million, and a figure more in line—in fact, almost exactly in line—with what the Government had in mind as appropriate for last year. There is nothing unreasonable about this, and it does provide the answer to questions as to why the extra £24 million is required.
So it is, Mr. Speaker, that the Government are doing no more than apply here a principle which commended itself to hon. Gentlemen opposite when they were themselves in office—the principle that no service can be allowed to impose a rising, and unlimited, annual charge on the Exchequer. Even with the increased contribution, the Exchequer will still be meeting 72 per cent., or very nearly three-quarters, of the total cost of the Service, and the contributor less than the 20 per cent. that it was thought proper for him to bear when the 1946 legislation was introduced.
As the Government were satisfied that the increase in cost was more than the Exchequer could reasonably be expected to bear, there were three, and only three, alternatives open. It is surprising, I think, that more attention was not paid, 35 during the course of the three debates we have had on this subject, to the other course that might have been open. Let me run, very briefly, through what else might have been done.
The first alternative, of course, was drastically to cut down the Service. If we had done this, it would have fallen especially severely upon sick people, at the time when they were sick, and, therefore, vulnerable—
§ Mr. Frederick Willey (Sunderland, North)
On a point of order, Mr. Speaker. Is it in order, on Third Reading, for the hon. Gentleman to deal with these hypothetical questions?
§ Mr. Speaker
I take it that the scope of the Bill is confined to the increase in charges, but I think that it is allowable to explain how the charges came about, and to make any relevant remarks upon the effect of these charges on the people. I think that that would be in order, in a Bill of this character. I do not want to make a hypothetical ruling in advance, but that is my view.
§ Mr. Eric Fletcher (Islington, East)
Further to that Ruling, Mr. Speaker, which I personally welcome, I take it that it will be in order for those of us on this side of the House to introduce other suggestions as to how these charges might have been made, or to say what other alternatives would have been open to the Government to deal with this problem?
§ Mr. Speaker
I think that it would be in order to argue that these charges are unnecessary or inadvisable, and that any arguments strictly relevant to that would be in order. On the other hand, I rather doubt whether what the hon. Gentleman says would be in order, because the alternative methods are not in the Bill. Therefore, on the Third Reading, I think that they would have to be narrowly restricted.
§ Mr. Albert Evans (Islington, South-West)
Further to that point of order. Would we be in order, in commenting upon the remarks of the Parliamentary Secretary, in dealing with the matters that he has raised in his speech?
§ Mr. Speaker
In a general sense, yes. As long as the Parliamentary Secretary 36 does not himself introduce matter that is not in order, any comment on it would not be out of order.
§ Mr. Thompson
I am obliged to you, Mr. Speaker, for that helpful Ruling. I shall not unreasonably try the patience of hon. Members opposite on matters where they perhaps think that I should not go too far.
Another alternative would have been to impose new charges, and here again this would have involved a fresh burden on the sick which we were not willing to impose. The final alternative—perhaps one should not speak of alternatives when there are three possibilities—
§ Mr. Ede (South Shields)
Mr. Speaker, is this not a breach of the Ruling which you have given? The hon. Member is now discussing alternative methods which are not in the Bill.
§ Mr. Speaker
The Parliamentary Secretary is quite right in justifying the method which he has adduced and which is embodied in the Bill. That is all he is doing. I think his argument is to show that there was no other possible or advisable way of raising the money. That seems to me to be the argument. Of course, it would be out of order to go in detail into these alternatives, which are not before us, but I think that the general argument that this is the only way in which the money can be raised is surely relevant to a discussion on the imposition of charges.
§ Mr. E. Fletcher
With great respect, Mr. Speaker, this places some of us in a difficulty. The Parliamentary Secretary is reading a prepared speech. As I understand the rules of order, a Minister has certain rights of tolerance in that respect, which are not open to back benchers on either side of the House. He has just said that one alternative method would be to impose additional charges on the sick. He has explained that that is one of the alternatives. Surely it places those of us on these benches under a distinct handicap unless we can examine these three alternative possibilities which the Minister is putting before us, in order to challenge his argument on the Third Reading of this Bill.
§ Mr. Speaker
As long as one did not go into too much detail on that point, I think that the argument would be fair and relevant. I think that the Minister's 37 argument amounts to this, that this is the only way in which the money can be found. He is justifying the charges imposed in the Bill on that ground. I think he is entitled to proceed so long as he does not go into too much detail and open up too wide a field.
§ Mr. Thompson
Perhaps I can satisfy the House by saying that the alternative with which I am now about to deal is the one which we have, in fact, adopted—that is to say, a small increase in the contribution. This was felt to be the right course to follow at the present time. It means that people will have to pay a small extra weekly amount while they are fit and at work, knowing, however, that the greater part of the cost of the service available to them when they need it will still fall upon the Exchequer.
Finally, while on this part of what I have to say, I think it would be fair to deal with the question whether this additional cost in the Service, which by increasing the contribution we are striving to offset, could not have been met by economies within the Service itself—not economies of such a drastic character as to alter its whole effect and to cut away essential parts of it, but economies in the Service as at present administered.
Indeed, the right hon. Member for Warrington (Dr. Summerskill) urged during the Second Reading debate that the Minister should satisfy himself that the money spent on the Health Service was being spent to the best advantage. Her chief point was that drastic economies could be made in the pharmaceutical service. My right hon. and learned Friend, in opening the Second Reading debate, had already gone very fully into the question of the cost of drugs and given the House information about the measures to be taken.
As the House knows, we are awaiting with interest any advice we may get from the Hinchliffe Committee. But, in general, as my right hon. and learned Friend said in his Second Reading speech, vague suggestions that large economies in the Service could be effected without detriment to the patient rather missed the point. The main element in the steady increase in costs is the general inflationary tendency in the economy—
§ Mr. R. J. Mellish (Bermondsey)
On a point of order, Mr. Speaker. The hon. 38 Gentleman is now making a point with regard to savings which might have been effected in the pharmaceutical service—a point which was adequately and properly stressed by my right hon. Friend the Member for Warrington (Dr. Summer-skill). That is a good point. But if the Minister can do that, are we not in order in stating why the increase of 6d. in the contribution should not have been imposed and that there are other ways of doing it? The hon. Gentleman has said that the other methods were unacceptable. Can we not explain why other methods ought to have been adopted?
§ Mr. Speaker
I thought that the hon. Member was going a bit wide of the Third Reading possibilities of the Bill. If we are not careful, we shall get into a discussion about the whole of the Health Service such as we had on the Second Reading. That is all right on Second Reading, but not on Third Reading. The House is presented with a Bill which proposes to raise the contribution, and anything that is relevant by way of argument to show either that that is proper or necessary or that it is improper or inadvisable would be in order. But to go into details of administration of the Health Service would be going much wider than is permissible.
§ Mr. Thompson
I will leave the point about the pharmaceutical service. Perhaps I would be in order if I referred to some points which were made on Second Reading by the right hon. Member for Middlesbrough, East (Mr. Marquand), in which he said that he was sorry to hear—and here I quote him—words which sounded like a retreat from Guillebaud"—[OFFICIAL REPORT, 5th March, 1958; Vol. 583, c. 1278.]uttered by my hon. and learned Friend the Secretary to the Treasury when he said that he wondered whether it was right that the proportion which the cost of the Service bears to the national income must necessarily be maintained.
§ Mr. A. Evans
Would the hon. Gentleman tell me the column in the OFFICIAL REPORT from which he is quoting?
§ Mr. Thompson
This report to which the right hon. Gentleman referred analysed the net cost to public funds of the National Health Service in England and Wales as a percentage of the gross national product. The percentage showed a decline between 1949–50 and 1953–54 from 3.75 to 3.24. Although we have no figures for later years prepared on precisely the same basis, it has been possible to calculate percentages based on information in the National Income and Expenditure Blue Book for 1957.
These show for each calendar year from 1950–56 the capital. and current cost to public funds—that is to say, the combined cost falling upon the central and local authorities—of health services in the United Kingdom, and from figures of the gross national product also quoted it is possible to calculate a percentage of 4.11 in 1950 declining to 3.42 in 1954 and then rising slightly to 3.56 in 1956.
While these figures show the same broad trends as the Guillebaud figures between 1950 and 1954, they reveal that the slight downward tendency of which the right hon. Gentleman complained has now been slightly reversed. But, in any case, I am not quite clear what significance can be attached to figures which purport to show that expenditure on the Health Service should be in some fixed proportion to national output.
The Guillebaud Committee itself, if I may pray it in aid at this stage, concluded, in paragraph 98:… in the absence of an objective and attainable standard of adequacy the aim must be, as in the field of education, to provide the best service possible within the limits of the available resources. It is clear that the amount of national resources … which are to be allocated to the National Health Service, must be determined by the Government … regard being had to the competing claims of other social services and national commitments, and to the total amount of resources available".My right hon. and learned Friend illustrated how the Government were doing their best to provide the best Health Service possible within the limit of the available resources and demonstrated the good value for money which the contributor on the present basis receives. He gave several examples of the expansion of the Service in real terms, after making allowance for the fall in the value of money, of progress achieved in return for the extra cost and of the increased efficiency in the Service. I could give 40 many other examples, but I am not sure, Mr. Speaker, whether you would approve—for instance, my giving information on the fall in hospital waiting lists as an example of the better value for money which is now being obtained.
There is also the question of hospital capital development which, again, is related to the kind of good return which we are now getting fox what we spend on this Service. In England and Wales the amount of capital estimated to be spent in 1958–59 is in the neighbourhood of £20 million and £22 million the year after. This compares with only £9 million in 1950–51. Work is proceeding on several major hospital building projects.
§ Mr. Willey
On a point of order. Surely we are going very wide now. We are dealing with the size of the Health Service. The Minister is now raising the question whether the Service, as provided for by the Estimates, is the correct size or not. That is a very wide question and I would certainly like to speak upon it.
§ Mr. Speaker
As long as we do not go into too much detail, I think that the argument is allowable. If I follow the argument aright, what the hon. Gentleman is trying to do is to justify these charges on the ground that the person who pays them gets good value for his money. Surely that is in order. It is all a question of the amount of detail into which hon. Members go. The argument itself is relevant enough.
§ Mr. Ede
Further to that point of order. Are we not now being treated to a general survey of the debates on the Bill, with the Department having supplied the Minister and the Parliamentary Secretary with all the answers that they did not think of at the time when the Committee stage and other stages were being gone through?
§ Mr. Speaker
That is not a point for me. I do not know the source of the hon. Gentleman's information, but so far he has kept in order.
§ Mr. E. Fletcher
Further to that point of order. I was very interested to hear the Minister's reference to education. As I understand, he was trying to justify the Third Reading of the Bill on the ground that, in the sphere of national health as in the sphere of education, 41 there must be some limit to the ability to pay. As I understand the hon. Gentleman's argument, it will be open to us to consider the relative merits of the education service in comparison with the National Health Service.
§ Mr. George Chetwynd (Stockton-on-Tees)
Further to that point of order. The Minister is seeking to justify the Bill on the grounds that people will get good value for money. He is referring, in particular, to hospital buildings and capital expenditure. There are parts of the country where these are inadequate. I, for one, so far as the North-East is concerned, would like to show that we are not getting good value for money regarding new buildings, particularly on Tees-side. Would that be in order?
§ Mr. Speaker
I should not think so. The Minister's argument is of a global character. He is taking the cost of the Service and the contributions as a whole. The distribution of the benefits of the service as between one locality and another would, I think, be entering into a region remote from the Third Reading of the Bill.
§ Mr. Thompson
As you have observed, Mr. Speaker, my arguments in this connection are of a global character. I have been particularly careful not to go in any great detail into all the matters which might or might not be relevant, but which certainly do, in my submission, make up the case, that we are getting good value for money in the expenditure which we now incur on the National Health Service.
I should like to add this point. It is the virtue of this modest Bill that it will enable the development of the National Health Service to continue. That would not have been the case had we refused to spend the necessary additional money on it, nor would it have been the case if we had adopted some of the alternatives to which I alluded earlier in my remarks.
The view has been expressed that the increase in the contribution will cause hardship to those least able to bear it. [HON. MEMBERS: "Hear, hear."] From the assent of hon. Members opposite, I can see that that one statement summarises the whole of the objections which, 42 in one way or another, have been made during the earlier stages of the Bill—that the increase in contribution will cause hardship where hardship can least easily be borne.
§ Mr. Thompson
That may well be so, but I am talking in the global sense, as I said before.
The Government do not share that view. We feel that the increase is very moderate and the contributor will continue to get excellent value for his money. As I have said, nearly three-quarters of the total cost of the Service will still be borne by the Exchequer and hence by the whole community other than perhaps the lowest income groups, with the better-off sections of it paying a progressively greater share of the cost by a higher contribution to general taxation. Surely that is not a proposition with which right hon. and hon. Gentlemen opposite would disagree. Those who are able to pay more do pay more towards the cost of the Service.
For these reasons I believe that the way we have sought to find the additional money by means of a small additional contribution is the right and proper way to do it. It is not inconsistent with the view of these matters which hon. Members opposite took when they had responsibility for these affairs. I confidently ask the House to give the Bill a Third Reading.
§ 3.59 p.m.
§ Mr. H. A. Marquand (Middlesbrough, East)
During the course of his global survey, the Parliamentary Secretary referred to some of my remarks. I am sure, therefore, that it will be in order for me to make some comment upon what he said about my reference to what I called "a retreat from Guillebaud". What I meant by that phrase was to recall to the memory of the House the valuable service which the Guillebaud Committee rendered to us all by reminding us of the real costs of the National Health Service and by showing very clearly that, though during a number of years the money cost had increased, nevertheless the real cost in terms of alternative resources had diminished.
That was one of the outstanding services of the Guillebaud Committee. It 43 is for that reason that we will principally remember that Report long after many of its detailed recommendations have gone. When I used those words, I wanted to draw the attention of the House to the danger contained in the remarks made by the Minister of Health that the Government might forget the importance of these considerations.
The Parliamentary Secretary said that I did not make myself clear and he asked why I suggested that the cost of the Health Service should be in a fixed proportion to the gross national product. He quoted what the Guillebaud Committee had to say, that the aim of the Health Service should be to provide the best service available within those national resources which are totally available to the community. He reminded us, quite correctly, that the Government of the day had to be the judge of what national resources were available.
I fully agree that the Government of the day must be the judge of what resources are available, but I see a great danger if the Government retreat from a reasonable figure such as 4 or 4½ per cent. of national resources for the Health Service. The Government must decide in the light of other claims upon resources. In the opinion of us on this side of the House, however, the Government should have in mind a desirable proportion of national resources which should be held to and below which the resources devoted to the Service should not be allowed to fall.
The example given by the Parliamentary Secretary was germane to my point. He said that in 1951 the provision made for hospital building was £9 million and that today it is £20 million. That represents, I suggest, no more than an adherence to the proportion provided in 1951. In other words, I believe that to buy what £9 million would have bought in 1951 we have today to pay £20 million, or very nearly that figure. The last time I had a comparison worked out for this purpose by the former Minister of Health, he told me that £9 million in 1951 would have bought as much as £15 million at the time he was speaking. Since then, prices have risen still further.
§ Sir Keith Joseph (Leeds, North-East)
If what the right hon. Gentleman is saying is true, why is it that the Socialist 44 Administration did not start any new hospital buildings? Can it be simply that they were dealing with wartime arrears of maintenance, which would be a reasonable answer? The right hon. Gentleman has to face the fact that there is now a very large new hospital building programme as well as the ordinary maintenance programme such as was carried out in the time of the Socialist Government.
§ Mr. Marquand
I shall be delighted to tell the hon. Member. Let me tell him, first, since he represents a constituency in Leeds, which is not far from Sheffield, that next time he is in that neighbourhood he should look at the dental hospital in Sheffield, where he will see who laid its foundation stone.
I remind him that in the very same year as I laid the foundation stone of that new hospital, which now exists, I opened no less than seven extensions of substantial size to existing hospitals. The main reason why a greater real devotion of national resources to hospital building was not possible at that time was the other calls upon resources. I have just admitted that the Government must have some regard to other calls upon resources.
The calls upon resources in 1951 were the calls of rearmament, as everybody knows. What are the other calls on national resources today? My hon. Friend the Member for Stockton-on-Tees (Mr. Chetwynd) has referred to the very bad collection of hospital buildings which we have on Tees-side, a fact which no one can deny. What alternative resources are being used on Tees-side today? On every hand in my constituency, although the Middlesbrough General Hospital remains patched up and inadequate, great new department stores and new blocks of offices are going up. That is where our national resources are going.
I seriously suggest to the Minister that if he wants to fight for his corner for the Health Service within the Government, if he wants adequately to maintain his claims against other Ministers who have claims on national resources, he should try to persuade his colleagues to accept the view that 4 or 4½ per cent., the kind of figure calculated by the Guillebaud Committee for the Service, should remain the figure at which we should aim.
We were all glad to hear the Parliamentary Secretary address us today. We do not hear from him very often and 45 he speaks agreeably. Like the Chancellor of the Duchy of Lancaster, whom we were somewhat surprised to see intervening in our debates on the Bill at a previous stage, the Parliamentary Secretary did not deal very much with the Bill but spent most of his time, like the Chancellor of the Duchy of Lancaster, talking about the past.
It was regrettable that the Chancellor of the Duchy, who could have brought some medical knowledge and who could have given us valuable advice on the progress of the Service during the last year or two, should have felt it necessary to devote all his time to what happened ten years ago. I shall not say that it was regrettable that the Parliamentary Secretary today devoted a great deal of his time to what was not in the Bill. For the sake of my hon. Friends behind me, that was very satisfactory and will enable them to draw attention to many general and constituency problems to which they wish to draw the attention of the House.
§ Mr. Speaker
That statement by the right hon. Gentleman should be received by the House with some modification, otherwise there may be necessity for more intervention by the Chair than I desire.
§ Mr. Marquand
Far be it from me, Mr. Speaker, to suggest or, I hope, to merit interventions from the Chair. If I have erred in any way, in what I said, I apologise; but I still think that it seems fairly clear from the Rulings you have given that a fairly wide interpretation will be permissible to my hon. Friends.
Despite the agreeable way in which the Parliamentary Secretary addressed us, and despite his evident desire to convince the House that he feels that this is the best way to finance the needs of the Health Service, he was the wrong Minister to be speaking on this occasion, as will be his right hon. and learned Friend the Minister if he intends to wind up the debate. It is not the Parliamentary Secretary or the Minister of Health, and still less the Chancellor of the Duchy of Lancaster, whom we want to see at the Dispatch Box. The Third Reading of the Bill ought to have been introduced by the Chancellor of the Exchequer or, if he could not spare the time, by the Financial Secretary to the Treasury.
§ Mr. Marquand
It is, indeed, a finance Bill. It was introduced into the House by a Ways and Means Resolution, as finance Bills usually are. It is concerned with a way of raising finance by imposing a levy on a very large section of the public. The Estimates show that £32 million more is involved—at least, the Explanatory Memorandum mentions £32 million, although the Parliamentary Secretary mentioned £24 million.
§ Mr. Marquand
In a full year, £32 million more will be required for the Health Service.
Normally, such a situation would be taken account of in a Budget speech from the Chancellor of the Exchequer, who, in surveying the total demands upon the public purse, would say that £32 million more will be needed for the Service. He would relate that to the general position of the demands on the public purse and he would go on, after 4.30 p.m., to expound to the Committee of the whole House the ways and means that he thought would be best to meet these various claims on national resources out of taxation. That would have been the normal course to have pursued.
It is, we think, a very serious fact, to be well borne in mind, in dealing with this Bill that that normal course has not been followed on this occasion. An exceptional procedure is followed. A piece of extra revenue which is required is to be financed by a special tax. It is an increase of one particular form of taxation in advance of the Budget, and the House is asked to agree to it while in ignorance of the Budget, so that the House is not in a position to make up its mind, in the light of all the varying claims on national resources, whether this £32 million is a reasonable sum and whether the method proposed for raising it is reasonable in relation to the methods which are to be proposed for raising all the other revenue which will be needed to meet all the other obligations on the Treasury.
We cannot avoid the clear conclusion that this is a tax by calling it a contribution. As my hon. Friend the Member 47 for Sowerby (Mr. Houghton) reminded us in our earlier debates on the Bill, the contribution now to be levied and the increase in contribution now to be imposed are not related in any way to the receipt of any particular benefits, and the failure to pay contribution by evasion or otherwise will not in any way deprive anybody of recourse to the Health Service if he so requires it. This is a tax and nothing but a tax.
We object to it not only because it is a tax omitted from a proper, balanced consideration in the Budget speech, which should survey all the demands which have to be met and how to meet them equitably by a considered and balanced raising of revenue from a great variety of sources. We object to it not only for that reason but because it is a regressive tax in its general incidence and because specifically it is a tax on employment.
§ Mr. Raymond Gower (Barry)
Will the right hon. Gentleman not agree that the criticism which he is now levying against this tax, as he describes it, could also be made against the original contribution which was proposed by his own party when it was the Government—
§ Mr. Marquand
This is a special new tax in addition to what we have had before. In any case, I was addressing my remarks to the contributions which are provided for in the Bill and which were provided for in the Bill we had last year.
We are bound to consider the increase provided for in this Bill, the increase, roughly speaking, of 6d a week, anyway, on the majority of employed persons in this country, not as an isolated 6d.—or 4d. or whatever the figure may be according to the class of the contributor. We have to consider it in relation to the health contribution as it was first introduced by the then Minister of Health, the right hon. Member for Runcorn (Mr. Vosper) and we have to consider it in relation to the charges for National Insurance proper and the increases in those 48 charges which this House made last autumn. We cannot dissociate the 6d. solely, and regard it as an isolated piece of taxation. It has to be considered in relation to—
§ Mr. Marquand
—tax of a similar kind which existed before. It is a regressive tax when it is considered in this way. It will not do to argue that a mere 6d. a week, regressive though it may be in theory, is a very small amount and cannot fall heavily on anybody. That is not the point. The point is that it is 6d. plus what went before it and that it is a flat-rate tax varied only very roughly to meet differences in earnings.
There is a broad difference between the total tax in respect of men as distinct from women, and women as distinct from juveniles, I agree. There is a broad difference in the rate of tax levied in this way on them by their weekly contributions. There is a difference, also, for the self-employed. Though there exists a broad categorical effort apparently to match tax with earnings, within each category there is no differentiation at all. Indeed, to a slight extent such differentiation as already exists between categories of contributions has been modified in a more regressive direction by the new legislation which is now before us.
Within each class of contributor the contribution as it existed originally was undifferentiated according to earning capacity. This would be contrary to wise principles of taxation, and we are now regarding this increase as a tax—we must do—for the reasons I have already given. It is an increase in contribution levied by way of taxation upon the already existing system of contribution. So we regard this increase, levied upon a system of contributions which was already only slightly or poorly adjusted to ability to pay, as a very regressive measure of taxation.
It is, moreover, a tax on employment. The taxation, the extra 6d. which is to be paid, and all the previous contributions which will remain, are paid by employers as well as by employed. We fear that the increases now imposed are so heavy that they will induce some persons to give up employment altogether. The case was argued very powerfully from this side, in Committee, that the 49 extra charge now to be imposed upon persons who have the right to retire from work, who, if men, have reached the age of 65 or, if women, the age of 60, the extra contribution now to be levied upon such people if they have preferred to stay at work, will deter many of them from going on working.
It is in the national interest, we believe, that such an individual, having reached retirement age, and if able to continue work, should continue to do so. Already, of the total number entitled to stay at work the proportion who do is very low, and we fear that the increase of tax thus imposed will make it still more difficult for these elderly people to carry on at work, and that they will decide to take their pension, abandon hope of the increment and give up work, at considerable cost, we suggest, to the community as a whole. It is far better that such people should remain at work and produce than that they should retire and take their pension.
It would be interesting to know from the right hon. and learned Gentleman, at the end of the debate, whether he has calculated what the Exchequer may lose, what the Insurance Fund may lose, if, say, 20 per cent. of such people do decide, as a result of this extra imposition, to claim their pension, instead of staying at work.
Not only that, but the total contribution levied from the employer, not only the extra 5½d. put in here but the total contribution, becomes an incentive to the employer to dispense with the labour of certain types of workpeople. Of course, it cannot be a strong incentive to dispense with many full-time workers, and I do not necessarily suggest that, but I do believe that in the case of part-time workers, of whom very considerable numbers, as we all know, are women, the incentive to employers to dispense with their services will be considerably increased. Even at the time when we had the proposed increase in the National Insurance contributions, employers made representations to the Government through the British Employers' Confederation that these increases in contributions would militate against the employment of part-time workers. Now, we have a further increase.
Let us take what I think would be regarded as a typical case, that of a 50 woman working part-time and earning £3 a week. She now has to pay 8s. in contributions, and her employer has to make an increased contribution as well. I suggest that there is an incentive there to the woman herself to wonder whether it is worth it, and to the employer to try to replace, if he possibly can do, two part-time workers by one full-time worker, thus reducing the opportunities of women to go to work, and, possibly, in marginal cases, putting small employers out of business altogether.
It might also be some incentive to employers, certainly to bad employers—and nobody even on the other side of the House will deny that there are some bad employers—to get rid of old people, whose output in any case cannot be as great as that of younger working people in employment, and to say, "I think that the time has come for you to take your retirement pension; I cannot do with you any longer."
The tax has been justified on the grounds that it lays the burden upon those who are fit and at work, as if the taxpayer was not fit and at work. Taxpayers who earn income pay taxes, and they can only earn their income if they are fit and at work. Taxpayers who have incomes also pay taxes by way of Purchase Tax and other similar taxes not levied on earnings. They can only be able to pay them if they are fit and at work and earning wages. There is no possible point whatever in this argument about being fit and at work. Nobody suggests, and nobody has ever proposed, that revenue should be raised from people who are not fit and not at work.
§ Mr. A. Evans
Has it escaped my right hon. Friend's notice that those who are not gainfully employed, presumably, are not subject to this impost?
§ Mr. Marquand
That, indeed, is true, and we discussed during the Committee stage the position of very lower-paid people, and referred to those who are exempted altogether because their earnings are so low.
If people have very low incomes indeed, from one reason or another, as taxpayers they already have the burden of their taxation adjusted to their ability to pay, at least, to a very large degree—not to such a great degree that we can regard 51 our tax system as perfect, because we raise half the revenue in the form of indirect taxation—but, nevertheless, to a much greater degree than is the case when we select individual groups of taxpayers for a flat-rate additional contribution which is not in any way proportional to earnings.
Right hon. and hon. Gentlemen opposite have taken a good deal of credit as the years have gone by for taking the lower paid sections of our population out of the Income Tax range. Allowances for children have been increased, the reductions in the taxation on some of the lower brackets of income have been increased, and in that way they claim that some very considerable number of lower-paid taxpayers have been taken out of the realm of Income Tax. If that is so, why put them back into a new realm of regressive taxation?
Would it not have been fairer to levy this additional burden on Income Tax payers, even if it involved slightly broadening the band? I do not say that it should have been broadened, but if it was absolutely necessary to broaden the present band in the Income Tax field would it not have been much more equitable to have laid the burden there on the Income Tax payers rather than to have placed an inequitable, flat-rate additional tax upon workers, irrespective altogether of their income?
This is placing the lower-paid worker back into the brackets of taxation from which right hon. and hon. Gentlemen opposite say they have taken him. However many his children and no matter for what reasons he is not brought within the range of Income Tax, no notice will be taken of them and he will now have to pay a tax of 6d. a week, along with every other man in employment. That is clearly inequitable, and, in view of the additional fact that practically all the taxpayers in the country pay on a fairly substantial slice of their income in indirect taxes such as Purchase Tax and others as well, there is no call to make the total tax system more regressive in this way.
As an abstract matter of public finance or as a theoretical calculation of the incidence of taxation and whether it was regressive or progressive, this might not be of very great moment at the present time. What makes it of moment at 52 present is that all sorts of additional burdens have been placed by the Government on the lower-paid workers. It is they who, all the time, have had to bear the chief burden, of the deliberate increases in the prices of bread and milk and in rents of controlled dwellings. It is upon them that these heavy burdens are being laid, at the same time as we are told that they must now pay an additional burden of a regressive flat-rate poll tax as proposed in this Bill.
It is hardly surprising that, in all these circumstances, the lower-paid workers are bound to try to protect themselves, and the only way they have of protecting themselves is through their trade unions. It is not surprising that they go to their trade union leaders and say, "Look at the increase in rent, and in the cost of food, which was done by removing the subsidies and handing a bonus to Surtax payers, while we have to pay another 6d. a week for National Health Service contributions. You must do something to protect us from this."
We have seen already how at least one great trade union has included the additional contributions now to be paid for National Insurance and the Health Service in its list of the reasons for asking for wage increases. Thus, by this ill-timed Measure the Government have given a further incentive to the lower-paid people not merely to feel dissatisfied with the Government and vote against them at the polls, as they are now doing, but to exert trade union pressure for increased wages.
I do not wish to exaggerate the matter, because I agree that the total amount is not much in itself. But when it is added to all these other things then the total effect of the Bill, outside the realm of strictly fiscal considerations, is to add to inflationary pressures.
On all these counts, it seems to us that the Bill falls. We are not objecting in the slightest to the expenditure. There is no need for the Parliamentary Secretary to come here to justify an increase of £32 million in the expenditure on the National Service. He could have asked for twice or even three times that amount, if he had wanted to, and he would have met no objection from this side of the House, though he might have met, quite legitimately, suggestions for pruning here and there to secure reasonable economies. He would have met no 53 objection whatever to his asking for an increased allocation of national resources, if need be, for this Service, certainly not of money for the National Health Service at this time.
What we object to is not that extra money is needed and requested for the Health Service, but the method proposed in the Bill for raising that money. I say, therefore, that the Bill is unnecessary; it is ill-conceived, it is inequitable and it is inflationary, and we hope that even at this last hour the House will decide to reject it.
§ 4.30 p.m.
§ Sir Hugh Linstead (Putney)
The debate on Third Reading is apparently to be considerably curtailed in comparison with the debate on Second Reading. That, perhaps, may be all to the good, because such a curtailment will emphasise that the real difference between the two sides of the House at present is not primarily about the Service itself but about how it is to be paid for. It was interesting to listen to the right hon. Member for Middlesbrough, East (Mr. Marquand) as he developed his argument and to notice the quite substantial change of principle that has taken place on the part of the party for which he speaks. It is not a change of principle to which I object, by any means.
Originally, the National Health Service was conceived of as a universal and comprehensive Service which was to be available to all who needed it. The question of cost, certainly in Lord Beveridge's time, took a secondary place. Now we notice that, since the publication of the Guillebaud Report, the emphasis is placed not on a universal, comprehensive social service but on the allocation of a certain proportion of national resources for this purpose, with the implication that goes with it that if the national resources do not come up to the needs of a universal and comprehensive service, the service may have to be pruned.
That is an interesting difference of emphasis concerning which I make no complaint, but it now makes clear where Lord Beveridge's consideration "B" stands today. It stands where Lord Beveridge left it because, although he said that the National Health Service was to be outside his insurance scheme, his assumption was that it would be paid for out of taxation. 54 In fact, it never was, and he never provided that it should be, because in drawing up the balance for his National Insurance scheme, he straight away allocated £30 million or £40 million as a contribution from the National Insurance scheme to the National Health Service.
The National Health Service, therefore, all through its existence has been partially financed by contributions paid to the National Insurance scheme. In the early days, perhaps, that was obscured, but now it has become perfectly obvious. Certainly, since the transfer in the first days after the National Health Contributions Act, 1957, now reinforced by this Bill, the Health Service is no longer a universal and comprehensive Service paid for by the taxpayer. It is quite clearly an insurance scheme, partially financed out of premiums. It is only by looking at it in this way that we can see the Bill and the development of the Service in future in a proper perspective.
§ Sir F. Messer
Is it not true that the principle was that the contribution should be from the Insurance Fund and not a special Health Service contribution?
§ Sir H. Linstead
If the hon. Member will refer to the Beveridge Report, which I am sure he knows as well as I do, he will see that Lord Beveridge allocated 19 per cent. of the income of the National Insurance scheme towards the cost of the National Health Service.
§ Sir H. Linstead
By a very simple rule-of-three one can allocate a fraction of the contribution to each individual employed person, or to each beneficiary of the National Insurance scheme. It is only a matter of mathematics for one to regard it either as an individual contribution or a lump sum transfer. It is purely a matter of mathematics and not a matter of principle.
I gather that we must be extremely cautious on Third Reading in suggesting whether there may not be other ways in which some of this money should be raised, thereby making the Bill unnecessary. I do not propose to go too close to a question of order in that respect, but my view is that there is practically no more economy to be made. There are a 55 few marginal economies, in one way or another, which could be made. It might be possible to avoid some of the necessity for these contributions if more education of the public about their obligations in a Service of this kind were undertaken by the Ministry, by the hospitals and by the doctors.
In that way some of the demands on the Service might very well be cut down, but, basically, I think that we shall find that with the development of medical practice, with all the new resources and devices that medical science is putting at the disposal of the medical profession, the cost of the Health Service inevitably will steadily go up. Steadily, we shall be faced with the question whether it is to be paid for by the taxpayer out of the general revenue, or whether some attempt is to be made to do what was done, although obscurely, by Lord Beveridge, at the very beginning, and relate the cost in some way to contributions.
It is not out of place to recall to the House paragraph 287 of the Beveridge Report in which this question was discussed. It reads:There remains the third question of the division of financial burdens between the three parties to security. There is nothing sacred about the division suggested in this Report; it is no more than a basis for discussion and argument. It is possible to argue that the contribution of employers should be reduced, at the cost either of the insured persons or of the National Exchequer. On behalf of insured persons it can be argued that even if the contribution proposed is within the capacity of most adult men, it is not within that of persons with low wages, and that these should be relieved at the cost of the taxpayer or the employer; the possibility of adjusting rates of benefit or contribution or both for particular sections of the insured population, after enquiry, is provided for in paragraph 408. On behalf of the Exchequer it may be pointed out that some of the expenditures proposed to be borne wholly or mainly by the Exchequer are for purposes which have hitherto been the accepted responsibilities of individuals, such as the maintenance of children or the securing of medical treatment. It may be argued that it is dangerous to shift too many financial burdens from the citizen as consumer on to the citizen as tax-payer because that may lead to extravagances.After having argued that, Sir William Beveridge, as he then was, came down quite clearly on the side of the need for including some contributory element from those who would benefit from the National Health Service as much as from National Insurance.
56 It is interesting to make a comparison between the social security budget as foreseen at the time of the publication of the Beveridge Report and as it is today. The comparison is this: the total social security budget of the Beveridge Report was £700 million, of which £170 million was the National Health Service. Against that there was to be a contribution of £331 million, of which £40 million was to go to the National Health Service. After this Bill has become law we shall have a total social security budget of £1,400 million, twice the Beveridge figure. We shall have a National Health charge, after allowing for payments made by the patients but excluding contributions, of £700 million. We shall have contributions of £680 million and we shall have allocated to the National Health Service £113 million.
This means that Lord Beveridge allocated 6 per cent. of contributions to the National Health Service, and that element was only 25 per cent. of the social security budget. We are now proposing 7.8 per cent. when the National Health Service is nearly 50 per cent. of the social security budget. On the Beveridge basis, a contribution allocation of 12 per cent., another 4.2 per cent. could be justified on the very arguments that Lord Beveridge used when the scheme was initiated.
We cannot escape from the condition of the National Insurance Fund itself, from which ultimately all deficiencies in the social security budget have to be made up. As the House will know, the Report of the Government Actuary, published last November, indicates the growing liability of the Treasury for future deficiencies in the National Insurance Fund. At the moment, the Fund is more or less self-balancing. Next year, there will be an excess of expenditure over income of £14 million and that will rise steadily. In 1960–61 it will be £126 million and by 1979–80 there will be a deficit of £475 million. The House and the Government could, if they wished, sit back and leave their successors to cope with that problem. It does not seem to me to be good enough, nor the function of this House, that we should allow enormous liabilities to accumulate without making some attempt to meet them.
§ Mr. Walter Monslow (Barrow-in-Furness)
Would the hon. 57 agree that the time has arrived when we might spend less on non-productive and destructive services and more on productive and social services, and that we should make the choice?
§ Sir H. Linstead
Then Jet the hon. Gentleman be precise. Let him make a contribution to the debate and say precisely what are the items in the National Budget he would cut in order to provide more money for the social services.
We know where we are driven by that argument. Always we are driven back to the balance between national security and social security. It is always possible to argue that we can take from national defence and add to social services. Those of us who oppose that, or who try to strike a balance, take the view that social security is of no value unless national security has been provided first. However, that the hon. Gentleman must develop in the course of making his own speech.
My final point is that when we look at the future liabilities of the National Insurance Fund, and we are faced with them as an expenditure that must be met by future Governments, I do not think that we can complain of an extension of the contribution system here to one section of our social service expenditure which, clearly, will add to the total cost of the social service budget in the future. It may be that a national pensions scheme of a more comprehensive kind, related to earnings, will be developed in the course of the next year or so. One does not know. If that were to come about it might change the entire picture of the National Insurance budget for the future. Until that comes above, however, it is only prudent financing and a proper recognition of the needs of the National Health Service to make the provision that the Bill is making.
On that basis, I shall have no difficulty in supporting the Third Reading.
§ 4.46 p.m.
§ Mr. Somerville Hastings (Barking)
The hon. Gentleman the Member for Putney (Sir H. Linstead) has sought to justify this increase in poll tax by reference to the monumental work of Lord Beveridge. I would remind the House that when that work was carried out things were entirely different from what they are today. At that time there was 58 marked unemployment, there was great poverty and there were low wages.
§ Sir H. Linstead
With great respect, that was during the war, when unemployment had completely ceased and wages were probably higher than they had ever been before.
§ Mr. Hastings
But Lord Beveridge was thinking not only of the time of war but of the time which he expected, very rightly, would follow the war. What Lord Beveridge set out to achieve was fair shares in poverty whereas now, under conditions of full employment, wages are much higher and incomes generally are higher. The position is entirely different.
§ Sir H. Linstead
I know that the hon. Gentleman will forgive me for interrupting again, but may I point out that one of the assumptions of Lord Beveridge's Report was an unemployment level of only 8 per cent.? We are nowhere near that 8 per cent, which he took as basic to the economy upon which he was building.
§ Mr. Hastings
That is my point. He based his scheme on a high level of unemployment, and now we have full employment. Conditions are entirely different.
§ Sir K. Joseph
Is the hon. Gentleman maintaining that higher wages, which he himself proclaims, and lower unemployment do not justify a higher contribution?
§ Mr. Hastings
I maintain that conditions are different from those which existed when Lord Beveridge introduced his monumental scheme. I object to this Bill because what it wishes to do is to increase by 6d. the contribution to the National Health Service paid by the man with £10 a week as well as by the man with £30 a week. That seems to me to be unfair, because I look upon health as a national responsibility. I believe that the health of each is the concern of all. We do not pay for education by a poll tax on the individual family. We all pay our share through our rates and taxes according to our income and the rating of the house in which we live. I regard health as more important than education. We are all concerned with the health of every individual.
One reason is that the productive capacity and the welfare of the nation 59 depend on the health in body and mind of the majority of its citizens. We did not always realise that. I remember that at the beginning of the First World War the bankers and some of the economists said that the struggle could not continue for longer than two or three years because there would not be enough money to pay for the war. We soon learned that it was not bank balances but manpower that really mattered and what we learned in war we have found to be true in peace. I maintain, therefore, that the health and well-being of the ordinary man is the concern of us all.
Another reason is that unhealthy people are undoubtedly a public danger, because it is among unhealthy people that disease proliferates and takes on an increased virulence so that it can more easily be spread to all. We see that best when famine is followed by pestilence which can involve a continent.
The Parliamentary Secretary argued that the increase in these contributions was necessitated by the increase in the cost of the National Health Service, but the better Service would also benefit the individuals who paid the contributions. He argued that the man who paid an extra 6d. a week would get a better Health Service because of that payment. With that I entirely agree, but I do not agree that his health will also be improved. That is by no means sure.
I remind the House that in the period of depression between the wars various housing schemes were introduced. At Stockton-on-Tees a slum was cleared and the people were put into a new housing estate which was on higher ground and better situated and in every respect better than the slum. Soon after this, an illuminating report about the new housing estate was written by Dr. McGonigle, who showed that, contrary to all expectations, instead of the health of those people being improved and instead of the mortality rate decreasing, the mortality rate increased. At first, no one could understand that but Dr. McGonigle pointed out that with higher rents to pay on the new housing estate, people had less money to spend on food and other necessities and so, on the whole, the health of the people deteriorated.
At the very same time, I was making similar observations in Hammersmith. I 60 knew the Medical Officer of Health for Hammersmith very well, and he was good enough to give me the names and addresses of the children of unemployed, who, on examination at school, were found to be suffering from malnutrition. With the help of another doctor and a weighing machine and with the agreement of the Medical Officer of Health, I called at the homes of those children and obtained permission to examine their younger brothers and sisters.
I found that as many as 70 per cent. of those younger children were also suffering from malnutrition. I agree that these were not children of average families. They came from the families of the unemployed, large families, in which we knew that there was already malnutrition in the older children at school. What astounded me was that the most under-nourished children came from the well-kept homes where the children were clean, well looked after and well clad, whereas the least under-nourished children came from homes in small tenement slums where the children were clothed in rags, and where, as I learned on inquiry, all the available money was spent on food. Those families were just able to manage, but as soon as any of the money available had to go to other things, cleaning materials, clothes and so on, the children suffered.
My contention is that this reduction in income—admittedly only 6d. a week—may result in a lowering of the standard of life and may, therefore, result not in an improvement of health, through a better Health Service, but in a deterioration of health. In this connection I call in aid some recent observations, published only a few weeks ago, in the Occupation Mortality Supplement of the Registrar-General, based on the census of 1951 and the deaths of 1949–53. I called attention to the figures dealing with tuberculosis and bronchitis.
In both cases, an analysis was made according to occupational groups, from the professional group down to the unskilled labour group. The figures for tuberculosis in males between 20 and 65 in all groups are striking. In the well-to-do group, the mortality ratio was 58, whereas in the unskilled labour group it was 143. There is an even greater difference with bronchitis, the mortality 61 ratio being 34 among the more well-to-do, and 171 among the unskilled labour group, an increase of nearly five-fold.
Bronchitis may be partly an occupational disease, but tuberculosis, except in doctors and nurses, is not; and it was largely a matter of the money available for providing the necessary food and other essentials to provide resistance to disease. Any extra payment which tends to reduce the standard of life, even very little, although likely to improve the Health Service, may result in a reduction of the individual's health.
It has been suggested, and, indeed, was suggested today by the Parliamentary Secretary when moving the Motion for the Third Reading of the Bill, that this is a very small amount, that 6d. is not much and that the individual concerned will, perhaps, spend a little less on tobacco or beer, or some other luxury, so that it will hardly be felt. I maintain, again, that that is not so. When the income is reduced there is a reduction of expenditure not on luxuries only but on most of the ordinary things on which the income is spent.
Again I would like to make my own observations on this. At the time of the great slump between the wars I, living as I did in London, wanted to see for myself what things were like in the depressed areas. I spent a week at Merthyr Tydvil and in the Rhondda Valley where at that time more than two-thirds of the workers were unemployed. I was greatly helped in my inquiry by my hon. Friend the Member for Merthyr Tydvil (Mr. S. O. Davies). I also knew two of the doctors in the Rhondda Valley and they, too, were very helpful to me. To my intense surprise I found in that depressed area that the cinemas were open, though perhaps only for one or two days a week, and that the public houses, although nearly empty, were also still open. I then learned the fact, which I want to stress today, that when for any reason the income is reduced it is not only the luxuries that are done without but that all items of expenditure may be reduced as well.
Because I believe that health is of national importance and, as I have said, the health of each is the concern of all, and because I fear, particularly in the case of the poorly paid worker who has 62 a large family, that this small reduction in income may adversely affect the health of the family, I very strongly oppose the Third Reading of the Bill.
§ 5.3 p.m.
§ Sir Keith Joseph (Leeds, North-East)
We have heard a most interesting speech, based on his personal experience, by the hon. Member for Barking (Mr. Hastings). I shall always agree with him that there comes a point at which money available for the needs of nutrition can be dangerously little, but I would remind the hon. Gentleman that, as he said, the circumstances of today are remarkably different from those of the times of which he was speaking. I would also remind him of what his right hon. Friend the Member for Middlesbrough, East (Mr. Marquand) said earlier this afternoon. The right hon. Gentleman said that he did not want to exaggerate the effect of this extra 6d. a week, which is, of course, only 26s. a year. However, I take the view that this 6d. might be a straw on the camel's back, and, as such, I propose to deal with the matter without referring further to the relative smallness of the amount involved.
I believe that, as it is Tory policy gradually and as fairly as possible to make prices relate as closely as possible to costs, it remains Tory policy to protect those who have relatively little to spend. Probably one-third of the heads of families in the country are still the only wage earners in their households. Some people, whether they are the only wage earner in the household or not, work in industries which for various reasons do not pay high wages or permit of a lot of overtime. It seems to me that it is the responsibility of the Government to make sure that these people have enough money, though, of course, we cannot stop them from spending that money badly.
What, in fact, have the Government done to protect these people? As the right hon. Member for Middlesbrough, East said, we have exempted whole batches of them, numbering millions, from paying any tax at all. When he teases us with putting back with one hand by way of contribution the tax from which we have exempted them with the other, he is comparing a very small nut with a very large apple or orange.
§ Mr. Douglas Houghton (Sowerby)
The hon. Gentleman will recall that that process was merely incidental and that much more substantial tax reliefs were given to the better-off people.
§ Sir K. Joseph
The expert who has just intervened knows very well that, numerically and financially, the benefits to the wage-earning section of the community can be counted in their hundreds of millions whereas the very belated remission of tax to the higher earners has not amounted to more than two or three score million pounds at most. I am not frightened of the hon. Gentleman's argument.
I maintain and believe that the entire wealth of the country on which the Health Service, education and everything depends flows in large measure from managerial skill and initiative. It is true that everyone else has to co-operate—the investor, the inventor and labour—but management must initiate the process. Unless we reward management adequately there will not be any wealth for the country to divide.
I was maintaining that the Government seem to have met the need for looking after the lower paid-and average wage earner in many ways. I would remind the House that on two occasions family allowances have been raised, and they were specific attempts to meet the large family burden. There have been pension increases on several occasions, and increases in contributions. There have been remissions of tax for the elderly. If there is any way of proving that, in fact, the households of the low-wage earners have been protected financially it is by looking at the indices of food consumption and general consumption.
So far as one can draw comfort from this evidence, it appears that the large family and the wage earner's family, and even the pensioner's family, are keeping pace with the general standard of consumption of food and other material benefits. Nevertheless, I must agree that there comes a time at which contributions cannot be raised further without becoming unfair. One is left to ask whether that time has yet been reached. There is no sacred figure. It is a matter of judgment.
The benefits in the Health Service are not graded. Therefore, it seems to me 64 idle to discuss grading the contribution. If the contribution reaches the ceiling fair to the lower wage earner then it seems that there is no alternative but to pay for the rest of the Service out of taxation. Merely to have a social service tax with all the gradations necessary would be to reproduce a duplicate P.A.Y.E. scheme. It would be a great waste of administrative effort.
One is therefore left to ask oneself whether the level of contributions has now reached an unfair height. However much the Opposition may dislike it, it is relevant to remind them that even with the charges imposed by the Government that height is not yet at the level of 20 per cent. with which they started the scheme, in days which, in terms of wage levels, were much more like those referred to by the hon. Member for Barking. It is far more relevant to address ourselves to the question whether the total cost of the scheme is too much.
§ Dr. Barnett Stross (Stoke-on-Trent, Central)
The hon. Member makes comparisons with the past: Does not he agree that in those years there were extensive food subsidies, and that the matter about which people like us are sensitive, namely, the quality of nutrition of those receiving the lowest wages, or the pensioners, tended to be safeguarded by those subsidies? It is not so safeguarded today.
§ Sir K. Joseph
The hon. Member will remember that as and when the food subsidies were reduced, pensions and other payments to similar people were increased. The hon. Member will not need reminding that food surveys have shown that throughout the years the pensioner has maintained, or even substantially improved upon, his standard of living at the time to which the hon. Member referred.
I agree with my hon. Friend the Member for Putney (Sir H. Linstead) who said that we must not imagine that the Health Service is a static or immobile Service. It seems to me to be a most dynamic Service, and we must not be surprised to find, as the years go by, that the standard of expectation of the public, and the standard of capacity of the Service to meet that expectation, inevitably rises and that over the years we shall have to face an expanding cost. No Minister can produce, by any miracle, a method of meeting this expanding cost other than by 65 general taxation. In order that this taxation may bear less heavily upon us two things must exist. First, there must be an efficient Service, and secondly, an expanding gross national product, so that the same rates or lower rates of taxation will produce higher benefits.
On the question of efficiency, we must remember that about two-thirds of the cost of the Service is made up of wages, and I doubt whether anyone would seriously contend that doctors, nurses, or ancillary technicians in the Service should receive lower wages. I maintain, however, that by means of modern managerial techniques their work can be made to go further so that, by reorganisation, in due course it may be possible to spare doctors or nurses for rather different functions, such as chiropody, that we all want to see the Service provide more fully.
If general taxation is the right way to finance the bulk of this Service—and it is financed to the extent of 75 per cent. by taxation now—let us examine the Government's record in this direction. It does not lie with the Opposition to criticise us, when they permitted the contribution to the National Health Service to be allowable against tax. It remained to my right hon. Friends to make this contribution not allowable for tax and therefore much more progressive in its incidence on the taxpayer.
§ Sir K. Joseph
Indeed there were. There has never been a specific sum attached to the Service, but a part of the contribution was dealt with separately, administratively, and was known as the Health Service contribution from the beginning. It fell to this Government to make it not allowable for tax, and therefore a more progressive burden.
§ Mr. Houghton
The hon. Gentleman refers to it being "not allowable to tax." Not allowable to whom? The National Health Service contribution along with the National Insurance contribution is chargeable against taxable profits in the case of people in business. In the case of contributors only that part of the contribution relating to superannuation or death benefits is allowable against tax liability.
§ Sir K. Joseph
Snap! That is exactly what I said. Under the administration of the Socialist Governments both health and superannuation payments, were allowable against tax, so that a person paying Surtax paid it out of gross and not net income. Does the hon. Member deny that?
§ Mr. Houghton
I do. The hon. Member is quite wrong in thinking that the global contribution payable by the National Insurance Fund to the National Health Service formed part of an allowable portion, for tax purposes, of the National Insurance contribution.
§ Sir K. Joseph
The hon. Member has certainly succeeded in muddling me. I hope that my right hon. Friend will arbitrate between us. It was my understanding that the Conservative Government ceased to allow the National Health Service contribution element to be allowable against tax in the hands of the normal taxpayer, thus making this contribution payable from net and not from gross income. I leave it to my right hon. Friend to assess who is right.
Reference has been made to the possibility of raising this sum from the Surtax payer. This is the perennial plea of the Opposition. Whenever they wish to remit a charge, replace a contribution or restore a subsidy, they pray in aid the £50 million which has been remitted to the Surtax payers in the last two years by the Government. But this will not go very far. It will damage initiative, and the managerial skill which has produced Zeta and some magnificent exports—and, quite apart from that, it will go only a small way to plug the enormous gap which the Socialists are always saying they can fill from the pockets of the Surtax payers.
The right hon. Member for Middlesbrough, East urged the Government to allocate a set amount from the gross national product every year to the Health Service.
§ Sir K. Joseph
I beg the right hon. Gentleman's pardon—a proportion. He also argued that we should not be content with this but should put aside 4 per cent. or 4½ per cent. of the gross national product. The half per cent. which he allows himself as a discretion is a very 67 large sum; it amounts to £80 million. He therefore gives himself an opportunity to beat the Government if they are within £80 million of what he regards as an optimum figure. This is a very large discretion. He forgets that, over and above the National Health Service cost to the community, quite a large private medical expenditure still has to be taken into account.
I cannot believe that it is a commonsense approach to the problem to decide dogmatically, academically, and categorically what is the ideal proportion of the gross national product to devote to health. Health is a dynamic concept. We all know the demands made by the public when it hears of something like the Salk vaccine. It is right that as science produces new marvels they should be made available for public benefit, and the public accepts that more should be paid for them. But the proportion of the gross national product needed in order to satisfy the higher expectations of the public must surely dwindle. In a prosperous society there comes a time when the belly of the public is crammed with bread, and we cannot then say, "Not enough money, or a comparable proportion of the gross national product, is being spent on bread." We are making a very rigid approach to the problem if we decide upon some theoretical proportion. We must first decide the best way to serve the public health—and here I am with the hon. Member for Barking—and only then decide how much we can afford.
The right hon. Member also spoke of the discouragement to deferred retirements that this higher contribution would bring, but he must admit that every time an employer is required to make some sort of payment for the benefit of his employee there is necessarily, to that extent, a discouragement to employ excess labour. In fact, there are those of us in business who say that one of the finest incentives to mechanisation and efficiency would be to double wages out of hand. This is what happens in America, where the higher the wages given, the more efficient employers are forced to be. I do not regard it as a serious complaint if it is said that people will not defer their retirement because of this extra 6d. a week burden. According 68 to the best analysis that I have read, people defer their retirement not because of the effect on income but because they enjoy the work. As was shown by the Bethnal Green survey, lack of work is one of the saddest features of our time.
The right hon. Gentleman also spoke of the extra burden of the contribution stopping married women from working. There are two points of view on that subject. There are those who say that the family as a whole would be far better off, were it less easy for married women to go to work. I do not think that the influence of the 6d. a week is such a serious disadvantage as the right hon. Gentleman suggested.
I have the impression that right hon. and hon. Members opposite have been sitting up late at night to find arguments to advance against this modest Bill. They say that we should put the burden on the taxpayer. They do not deny that the Service needs this money, and that it should be paid. I believe that more economies may be made in the Service, but they are long-term economies in what is an expanding cost Service. Surely, hon. Members opposite do not mean to say that the 20 per cent. contribution which was good enough for them to impose when they started the Service has, in the intervening ten years, become a tragic, evil and Draconic burden.
§ 5.21 p.m.
§ Sir Frederick Messer (Tottenham)
I am always interested in the speeches of the hon. Member for Leeds, North-East (Sir K. Joseph) and I agree with a great deal of what he has said. I am surprised, however, that he is unable to see through this Bill. I regard it as a very bad Bill because it is dishonest, and everything dishonest is bad. I agree that we must have more money, but let us get it honestly. This is a dishonest attempt to show that the cost to the Exchequer of the Health Service is not what is really is. It has been demonstrated that this is taxation. We cannot compel people to pay by Act of Parliament without the impost being regarded as taxation.
There is a qualification which fills me with fear; that if it is not paid some benefit will be lost. When the health and unemployment insurance scheme was introduced originally by Mr. Lloyd George, people were entitled to benefit 69 according to the contribution. That scheme broke down and there had to be extended benefits. The Insurance Fund went bankrupt. I remember when Miss Margaret Bondfield, as Minister of Labour, had to go to the Treasury for loans. Here we are saying that a tax shall be imposed because we want more money. No one will disagree with the fact that we want money. What arises from it is that we are now to impose a tax. We shall impose it not in accordance with ability to pay, but in the form of a poll tax.
In my opinion, that is dishonest, because—I de[...]y the Minister to prove otherwise—in reality there is no special benefit to anybody in having a special Health Insurance stamp. If more money is to be paid, there is no reason why we should not go to the Insurance Fund for it. If that situation has to be faced, there is no reason why we should depart from the principle which has existed since the beginning of insurance. Never before have we had a special insurance for a service. The unemployment insurance was for a cash benefit paid when a person was out of work. The supposed health insurance give a benefit while contributions were paid. We did not pay a contribution for the service, we paid it for the sickness benefit. Here, for the first time, we are laying down that people shall pay a special contribution for the benefit of a service.
What is the medical corollary? It is that as the Service becomes more and more expensive, this contribution will be increased. If the contribution reaches the limit to which the hon. Member for Leeds, North-East referred, when he said that there is a limit beyond which we cannot go, what is the next step? We shall begin to have a standard of Health Service for those in benefit different from that for those who are not in benefit. A short amending Act could restore to local authorities some of the powers which they lost when the Service came into being. Among them are powers which could easily be related to the existing welfare powers.
Are we proposing to go back to the days of the old parish doctor; back to the variation in the standards of the Health Service? That is the danger of a Measure such as this. It is not what is 70 happening, but the implications and the possibilities.
What was said by the hon. Member for Leeds, North-East is true, the Service will increase in cost. In company with the hon. Member for Putney (Sir H. Linstead) I heard a speech only a week ago by a prominent member of the medical profession who is an authority on cancer. He said that in this country four machines—we want at least another 12—are employed in connection with the use of cobalt, uranium and other forms of cancer treatment. These machines will cost up to £35,000 each. We cannot afford them, and, at present at any rate, we are not likely to get them. But whether we get them or not, the fact is that the cost of the Service will increase.
We cannot be blind to ideas. We cannot build moral barriers against them. We cannot ignore means of dealing with what at present is the biggest disease scourge, not only in this country but in other countries. In this country there are 60,000 deaths a year, and some of them are terrible deaths. We are bound to increase the cost of the Service, if we do as much as could be done. Notwithstanding that rather terrorising fact, we must remember that there have to be means by which that cost can be met. I do not suggest that the Treasury method is the best way to finance a Service such as this.
While I was chairman of the Health Committee of the Middlesex County Council, we spent in that county, covering a population of 2 million, more in capital than the whole of the North-West Metropolitan Region spends. It may very well be that local authorities could be called upon to play a bigger part in this Service. I am not sure that the responsibility is sufficiently widespread. However that may be, it is a challenge to our intellectual capacity to find a means whereby the money shall be raised, but not unfairly raised. That is the whole point about it.
I want to see the Health Service not only what it already is, but improved, beyond what it is—a monument to the social consciousness of the people. It is one of the finest social services. When we look at what has been accomplished—I shall not go into that too deeply, but tributes have been paid to it—it cannot for one moment be believed 71 by anybody who has any sort of feeling for such a great work as this that it should be limited in any way.
I do not like the Bill because it is spurious. It is an expedient. It is raising just a small sum of money. It is opening the door to a method which, ultimately, will be dangerous. Let the Government find new sources of income if they will, and new methods by which the Service shall be financed, but this is not the way to do it. It is unfair, for the rich pay no more than the poor.
There are the inequalities in life and we cannot help them. Nature, by fitting us in an environment or allowing us to benefit by heredity, equips us for certain things. Others, less fortunate, are less equipped. There are the rich, the poor, the strong and the weak. There are the intellectual and there are the less intelligent. Whatever inequality there is, however, there is no justification for the inequality of treatment of people when they are ill. The same door through which the duke goes when he is ill should be open to the dustman. Because the Bill is inequitable, it is wrong. It is true that we must find the money, but let us find it honestly and fairly.
§ 5.33 p.m.
§ Mr. Raymond Gower (Barry)
We on this side—and, I am sure, Members in all parts of the House—have a very high opinion of the work that the hon. Member for Tottenham (Sir F. Messer) has done, both in Parliament and in local authorities, and particularly in health administration. He was, perhaps, somewhat inaccurate in suggesting that the Bill was solely an unfair way of financing the National Health Service by implying that the rich were paying no more than others. As my hon. Friend the Member for Leeds, North-East (Sir K. Joseph) reminded the House, the preponderance of the cost of the Service still falls upon the Treasury and, ultimately, upon the taxpayer.
The hon. Member for Tottenham also said that the Bill is dishonest, and he proceeded to elaborate that statement. I think, however, that both the hon. Member and my hon. Friend were somewhat at cross purposes in their understanding of the scheme at the time of its inception. Possibly, on reflection, the hon. Member will agree that the proportion of the 72 National Insurance Fund which was earmarked for the National Health Service was in essence just as separate and distinct as the separate fund which is now properly allocated for the National Health Service.
§ Sir F. Messer
Why did the former arrangement not continue? Nobody has ever explained the need for a separate stamp.
§ Mr. Gower
I disagree with the hon. Member. Today, the similarity is far more important than the apparent difference.
The fact that originally the cost of the National Health Service was not paid entirely by the Treasury, as it is not paid entirely today, is far more important than the fact that we now add prominence to this distinction by providing a separate payment or a separate fund. Indeed, if this arrangement, or the Bill, could be regarded as dishonest in the terms described by the hon. Member, it would be fair for somebody arguing against his viewpoint to say, quite pertinently, that it was dishonest in the beginning for there to have been a portion of the National Insurance Fund earmarked for the National Health Service instead of being financed entirely by the Treasury.
The hon. Member said at one stage that this arrangement should not be made, that these contributions should not be levied and that the expense should, if necessary, be passed on to the National Insurance Fund. Surely, the hon. Member will recognise that if that were done, sooner rather than later it would be necessary to have larger contributions to the National Insurance Fund and we would be doing the same thing but calling it a different name.
Most hon. Members will agree that if additional expenditure is necessary and additional contributions have to be collected, it is preferable that they should be contributions or charges payable by persons in work rather than that they should be payable by the person who is ill. To that extent, it can be agreed that 73 the Bill is much more desirable than the form of charge that was made for dentures and for spectacles and which some people thought might have been extended on this occasion. For my part, I deem it far preferable that persons who are well should make a contribution rather than that some new form of charge for a service should have been introduced.
There has been the substantial increase of £288 million in the global cost of the National Health Service in a period of about seven years. Whilst we are having good value and whilst it is, as the hon. Member for Tottenham pointed out, a wonderful service, it must be confessed that the expense of it to the country is far greater than was considered probable at the time of its inception. Indeed, the responsible Minister at that time, the right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) had no idea that we should be faced with expenditure of such magnitude.
Earlier in our proceedings on the Bill, an hon. Member on the benches opposite was not helpful in suggesting that the proposals of the Bill were an abandonment of what he described as a free National Health Service. It never was free—it never could be free—and it is a bad impression for anyone to have the idea that such a service can be free. While we should be proud of the National Health Service and anxious to improve its achievement, it is also important to recognise that long before I and some of my hon. Friends even contemplated coming to this House Parliament decided to institute such a service. We should recognise that this country took on what was, is and will be a very large undertaking. In the nature of our other commitments, it is bound to be a big undertaking.
The right hon. Member for Middlesbrough, East (Mr. Marquand) repeatedly referred to the desirable proportion of the gross national product which should be spent on the National Health Service. I respectfully submit to him that while such a proportion may be a useful guide and from time to time over a long period a useful indication of how we are proceeding, it would be most unwise to make a kind of sacred cow of 4 per cent. or 4½ per cent. In changed circumstances, such a proportion might not be desirable. I can envisage circumstances when public 74 opinion would demand the development of some new welfare services. It is possible, for instance, that this House and a Government from one side or the other might deem it expedient to extend some new service, such as legal aid, on a scale we do not now contemplate. If such new services came into existence it would be unrealistic to say that at the same time the development of every other service shall remain at the same rate and always represent the same proportion of the national product.
I think it reasonable to say that very likely as this country becomes more productive, as we hope it will, and the standard of living increases for all—which I think must be the object and desire of us all—a lesser proportion of our national product may well produce a better National Health Service than we are getting today. I do not think that at this stage we could make the sort of economies of £32 million which would avoid the present charges. I do not think that is practicable in the short run. But it might be possible in the long run, though not over the short term.
§ Mr. A. Woodburn (Clackmannan and East Stirlingshire)
The hon. Member seems to be arguing that a Health Service is settled by the amount of money spent on it. How does he suggest smallpox should be dealt with? Does he suggest we should economise on the treatment of smallpox rather than have the treatment necessary to prevent it occurring?
§ Mr. Marquand
The hon. Member says that in the long period a proportion of less than 4½ per cent. of the gross national product might be satisfactory for the National Health Service. I more or less said the same myself in Committee. My idea of a long period may, however, be very different from his. How long does the hon. Member think it will be before his Government will build a teaching hospital in South Wales such as he and I would like to see?
§ Mr. Deputy-Speaker (Sir Charles MacAndrew)
If either hon. or right hon. Members went further on that subject it would be going rather wide of the debate and would be out of order.
§ Mr. Gower
I agree, Mr. Deputy-Speaker, that it would be out of order. When I speak of a longer period, I do not mean 50 or 100 years but a decade or slightly more. We are dealing with a Bill which is to solve an immediate need. While I agree with my hon. Friend the Member for Leeds, North-East that there is a point beyond which a flat rate contribution cannot and should not be increased, I cannot believe that in the circumstances of the present standard of living and the national position it can be said that the modest charges of this Bill are such as to create the hardship and inequality described by some hon. Members opposite. It may be that if this were on a far larger scale and the process continued they would have a case, but their statements on this Bill today and at previous stages have been vastly exaggerated.
§ 5.45 p.m.
§ Mr. Robert Edwards (Bilston)
I listened with great attention to the remarks of the hon. Member for Barry (Mr. Gower). I should like to follow up some of the points that he made, but I fear that that would be out of order. I was especially interested in his economic arguments, which seemed very illogical. He suggested, and I agree, that our Health Service and our whole system of social security are dependent on the production of wealth. That is a fundamental truth, but he then proceeded to suggest that if we have a fixed percentage of the national product that would limit the whole of the services. If the national product were expanding and the services were dependent on its expansion, the percentage also would increase automatically. It seemed to me that the hon. Member's economic remarks were very illogical.
§ Mr. Dudley Williams (Exeter)
The hon. Member will agree, will he not, that the expansion must be honest and not inflationary?
§ Mr. Edwards
Hon. Members must not address remarks about inflation to this side of the House, because, if ever a Government created an inflationary situation—
§ Mr. Dudley Williams
On a point of order, Mr. Deputy-Speaker, are we allowed to discuss inflation? If so, I should like to make a very long speech about it.
§ Mr. Deputy-Speaker
I think that the hon. Member for Exeter (Mr. Dudley Williams) started it himself.
§ Mr. Edwards
Before the present Government came into power the contribution stamp was only 5s. 1d.; today it is 9s. 11d. That is a 95 per cent. increase. If that is not inflationary, I do not know the meaning of the term. [HON. MEMBERS: "Hear, hear."] Who is responsible for that? Hon. Members opposite are in power and have the means to hold down the cost of living. Surely, if we are to apportion blame, it must rest with the Government in power. The decisions they have taken from time to time, the abolition of subsidies and increases in contributions which the industrial worker has to pay, have constantly led to the worker being compelled, through his trade union, to seek to maintain living standards by demands for increased wages.
These are the fundamental causes of inflation. The root cause is the fiscal political policy of the present Government. [HON. MEMBERS: "Hear, hear."] If hon. Members opposite adopt this attitude, I shall proceed to speak for quite a long time, although that was not my intention. I think that the hon. Member for Exeter (Mr. Dudley Williams) has been having his lunch out of a bottle and that it is the bottle that is speaking, not the hon. Member.
§ Mr. Edwards
It was my intention to make a few modest observations, but I have been provoked by interjections from Government supporters.
I wanted to prove, against this blank wall of unreason, that there has been a great change in the system of financing our services and that our Health Service and other social services, from being the 77 best in the world, are gradually deteriorating. If Bills of this nature are passed without serious criticism the fundamental principles of financing those great services will be undermined.
It is suggested that we are quibbling when we say that the Bill is a confidence trick because it puts 6d. on the contribution of the workers. I do not think we are quibbling. It is my privilege to be the general secretary of a trade union. We have about 4,000 apprentices who are studying to become chemical process workers. These lads get very little money. At 18 years of age they receive from £4 10s. to £5 a week, yet at that age they have to pay an extra 6d. on their stamp. That 9s. 11d. out of £4 10s. means that these lads have about 12 per cent. deducted from their small weekly wages.
§ Mr. R. Gresham Cooke (Twickenham)
If the hon. Gentleman is talking of boys, is not the extra payment only 2d. per week?
§ Mr. Edwards
At 18½ they pay the full rate. I am talking of apprentices in the chemical industry who are training to become chemical operators, and I particularly mentioned the age of 18½ when they are still earning less than £5 a week. More than 12 per cent. of their weekly earnings is to be deducted for these contributions. That is a great injustice, and any Bill that does it is bad because it has not been thought out to its logical conclusion.
These lads do not earn good money until they are 23 or 24. When they are 21 they are conscripted into the Services. They are not allowed to apply their training. If there should be any angry young men it is the 100,000 young National Servicemen who today receive 31s. per week. A married man doing his National Service has, at the end of the week, after deductions for his wife, about 18s., but he has still to pay 5s. 9d. for a contribution stamp. A Bill which fails to deal with these real, human problems should not receive the support of this House.
Government supporters may say that millions of industrial workers pay no Income Tax, and, therefore, should face greater responsibilities by supporting the Health Service. That is a very strange way of arguing. Even the lowest-paid workers are paying increasing sums in 78 indirect taxation. Receipts from Purchase Tax under the present Government have been increasing by about £110 million a year; nevertheless, those workers have to pay indirectly in national taxation. It is all nonsense to suggest that because they pay no Income Tax they do face their responsibilities for national indirect taxation.
It has also been argued that because the percentage of the weekly earnings of workers paid towards the Health Service and social security is very small compared with those of Germany, France and other countries, and that there is a strong case for increasing the cost of the stamp. I noticed in reply to a Question which was asked some weeks ago that the Minister stated that the average percentage of weekly earnings that went in contributions was 3.6. We can never gauge this percentage when we base it upon averages. The average wage is £12 a week, while millions of workers earn less than £8.
The agricultural worker will have to pay between 7 per cent. and 8 per cent. of his weekly earnings towards the Health Service, the road worker's contribution will be as high as 10 per cent., while the male distributive worker will pay as much as 8 per cent. When we talk in percentages of pay for this Service we undermine the whole principle of the relatively free national service which was originally the purpose of our National Health Service legislation.
It would be much better and more equitable to meet by direct taxation this additional £32 million that is required, and not by the underhand conspiracy that goes on every time a Bill of this nature is submitted.
§ Mr. Edwards
That is quite true, but year by year, under this Government, the percentage paid by the National Exchequer is gradually decreasing and the cost of the stamp is increasing. I could produce figures if we had the time—indeed, I did produce figures in a debate in this Chamber on this very point—to show how, year by year, the percentage 79 paid by the contributor was increasing while the contribution was declining from the National Exchequer.
§ Mr. Gresham Cooke
Is the hon. Member aware that the proportion now paid by the national Exchequer is the same as it was in 1948?
§ Mr. Edwards
I should need to look into that, but there are on record a whole recital of figures submitted to the House by my hon. Friend the Member for Ince (Mr. T. Brown) and by myself.
This Bill asks contributors to pay an extra 6d., and industry to accept an extra burden. All industry is not prosperous today. Indeed as a result of the present Government's fiscal policies, many small firms are having great difficulty in maintaining their economy. For instance, a small factory needing a new boiler cannot re-equip its factory in that way, because it cannot borrow the money, because of the credit "freeze" imposed by the Government.
Employers cannot meet the extra responsibilities imposed by the Bill without undermining the economy of their businesses, so they will put the extra cost on to the price of their product, and so on to the consumer. That is essentially inflationary. The very large employers are the local authorities. They, too, will have to face their share of the £32 million. Whence are they to get it? That responsibility will be put on to the local ratepayers.
This is a vicious circle. First, there is created an impulse for industrial workers to get their money back by increased wage demands, and they make harsher demands than otherwise they would. Then we have the additional burdens on the local rates, because local authorities, as employers, have to find this extra money. Then the industrialists pass their share of the burden on to the consumer. We are trying to take £80 million of inflationary money out of the Health Service and, in so doing, are putting, possibly, £100 million of inflationary money right into the economy—
§ Mr. E. Partridge (Battersea, South)
is the hon. Gentleman now arguing that the Health Service should cost no more? If he is saying that it does cost more but that it must not be met by this person 80 or that, or by the local authorities, then it must be met by the Exchequer. If that is what he says, then that is highly inflationary. I should have thought that everyone knew that taxation was highly inflationary.
§ Mr. Edwards
Of course, we are not arguing that this money has not to be found. It has to be found, but the right way to find it is on Budget day, and not by today's slick method of imposing a tax on the contributors without it appearing in the Budget. We believe that the Government should be honest about this, and that the matter should be debated in the normal course of events.
I say, and I am sure that my colleagues would agree, that this extra burden should be met by the Income Tax payers. That is the equitable way of doing it. It is simple logic that an extra 6d. a week is a greater burden to a worker earning £10 a week than it is to a man earning twice as much. We are arguing against the inequality of the whole business. Once start this method, and it continues and continues until the whole principle of the Health Service is completely destroyed.
I have spoken longer and more vigorously than I had intended, but, with my few modest contributions in mind. I hope that the Government will have second thoughts about this Bill; and if they will not I hope that it will be refused its third Reading.
§ 6.5 p.m.
§ The Joint Under-Secretary of State for Scotland (Mr. J. Nixon Browne)
I will leave my right hon. Friend to make appropriate answer to what the hon. Member for Bilston (Mr. R. Edwards) referred to as his "few modest contributions". But I think that it would be convenient if, at this juncture, I said something about the effect of this Bill in Scotland—
§ Mr. Browne
Although this Bill is a United Kingdom Measure, the Scottish Health Service has, under the National Health Service (Scotland) Act, 1947, retained its separate identity with my right hon. Friend the Secretary of State for Scotland as the responsible Minister. In 81 this Bill, we are asking the Scottish people —those employed, and their employers, or self-employed, and those non-employed, except, of course, those who come out of the scheme—to pay more each week towards the Scottish Health Service. We are asking them to produce another £3.2 million. It is appropriate, therefore, to justify the need for this increase in terms of the service being given and the speed at which progress is being made.
I must satisfy those who are being asked to pay more as to what my right hon. Friend is doing to keep down and control the expenditure which, for Scotland, is now running at the rate of £73 million a year. Taking an employed man as an example, his total contribution is being raised from 1s. 4½d to Is. 10½d.—by 26s. per year—to an amount of £4 17s. 6d. For this, as an average citizen, he is receiving services, for himself as a contributor, and also for those members of his own family who are not contributing, which are costing a total of £14 12s. per person a year. As a stamp payer, he will certainly be getting value for money for his increased contribution, and, as a taxpayer, he is providing the balance according to his means and his standard of living.
This is one of many debates on various aspects of the nation's health in which I have taken part. Many are the other discussions I have had with those grand people, the doctors, the nurses, the boards of management and the members of regional boards who run the Service for us. The other day, I had the opportunity of a long and very interesting discussion with the Scottish T.U.C. on Scottish health problems—
§ Mr. Browne
I listen to the comments, the constructive suggestions, the criticisms and the speeches of right hon. and hon. Gentlemen on both sides of the House and, in my heart, I agree with nearly all of them.
These health debates give me a feeling of making history. Our National Health Service is still so young—it is less than ten years old. We are still groping in the dark over so many problems, and we are all genuinely trying to find an 82 answer to them. We all know what needs to be done. Our difficulty, as exemplified by this debate, is to agree priorities, when there is still so much to do. Over all our deliberations is the need to consider the national economy, and the priorities as between the champions of health, and the champions of education and other facets of the Welfare State.
The need for this Bill arises, as the House knows, from the hard fact that the Exchequer is spending as much on health as can be afforded in the national interest, and we need more than that. I think that the Scottish people will gladly pay the added contribution if they feel that we are making progress and that the additional money that they will be finding will not be wasted. I must confess that I disagree with my hon. Friend the Member for Putney (Sir H. Linstead), who is no longer in his place, when he says that no very specific economies are still possible. I agree with my hon. Friend the Member for Leeds, North-East (Sir K. Joseph), who said that he thought economies were still possible. No responsible Government can take the view that no further economies are possible.
Let me tell the House what my right hon. Friend is doing now. He is making a drive to get the best value for money spent on the hospital services. My right hon. Friend the Minister of State recently had a long discussion in Edinburgh on this matter with the chairmen of the regional hospital boards. I myself had a helpful discussion with the chairmen and secretaries of the boards of management of the hospitals in the Western Region, and my right hon. Friend the Minister of State has had similar meetings with the other regions in the last few weeks. I think that all those affected by the Bill would wish me, on their behalf and on behalf of this House, to give a genuine word of thanks to the members of the hospital boards and boards of management who give so much of their time and thought without reward to the Scottish hospital service. It says a good deal for the spirit of our citizens that they, who, in the end, are largely responsible for spending this additional money, should so willingly accept the difficulties and frustrations of having to make the best use of less money than they would wish.
83 We had with the regional boards valuable discussions, especially on improvement of and saving in expenditure on domestic services, and with the boards of management these discussions went into much greater detail. For example, we found that in many hospitals the quality of the food can be improved and savings can be made at the same time. This has actually happened in one hospital, where the saving has been about £15,000 a year. Some hospitals have saved substantial amounts even larger than this, by reorganisation of their cleaning and laundry services. What can be done in one hospital can often be done in another.
§ Mr. Browne
I should like notice of that question.
As I say, what can be done in one hospital can often be done in another. Those who subscribe directly to the health services—those affected by this Bill—are right to ask that the maximum economy should be made, provided always that the patient is not affected. That is our endeavour.
There are other savings more directly concerning the patient which offer important scope for economy. I refer to such things as the over-generous use of expensive bandages, dressings, swabs, etc., and a tighter control on the routine issue of drugs and medicines which are not specifically required by patients.
There is another avenue of economy which must be boldly faced sooner or later. In Scotland, some of our old municipal hospitals have been vastly improved in status under the National Health Service. They can now offer facilities better in some ways than those provided by some of the very small hospitals which were part of the pattern of the years before 1946. New treatments, new drugs, are altering the pattern of illness. We must not be afraid to alter the function of hospitals or even to close them down, or part of them, if we are satisfied that better value for money and better treatment for the patients can be achieved thereby. In Scotland, we rely for these thoughts and policies to a great extent on the regional boards which are near 84 enough the hospitals to know the facts and far enough away to see their area in perspective in a way which would not be possible for the central Department.
Here, then, are the hopes and possibilities of saving money of hospital administration. But what of the drugs used in hospitals for the patients? Will those who are now asked to pay additional contributions be satisfied that their money as spent on drugs is being spent to the best advantage? The nation's rising drug bill and the steps being taken to deal with it are a United Kingdom matter and are not something on which it is appropriate for me to speak tonight, but there is one particular Scottish aspect about which we have grounds for some optimism.
A separate Scottish Prescribing Costs Committee was set up by my right hon. Friend under the chairmanship of Sir James Douglas. The Committee consists of three consultants, three general practitioners, two other doctors, two lay members and one pharmacist. The Committee is not expected to report finally before the end of this year, but it has recently, in response to an invitation from the Secretary of State, submitted valuable interim suggestions designed particularly to ensure more economy in hospital prescribing which has a strong influence on prescribing by general practitioners. These interim suggestions are under close examination and almost all of them will be implemented in' the near future.
In considering, that we must get the maximum value for money if we are to justify this Bill, I think I should give the House these interim suggestions. They are these. They are practical and realistic, and, taken together, I think they will have some effect: first, wall charts showing in graphic form the cost of expensive and commonly used drugs and dressings, these should be put up in all hospitals; secondly, particularly in teaching hospitals; exhibitions illustrating the costs of drugs and dressings; thirdly, the periodic submission to the doctors concerned of samples of individual treatment charts showing the cost of the drugs and the dressings used; fourthly, the regular submission to hospital doctors of information prepared by hospital pharmacists, in association with the hospital accounting staff, showing the drug costs of different wards which vary considerably as between 85 one ward and another doing similar work; fifthly, the issue of prescribers' notes to all hospitals individually; sixthly, authority for hospital pharmacists, with the approval of doctors in charge of the wards, to supply identical standard equivalents for proprietary drugs prescribed unless a special need for the proprietary brand is indicated; seventhly, consultation between doctors and pharmacists at hospital level to reduce as far as possible the numbers of drugs of similar therapeutic effect required to be stocked; then, the issue of general practitioners' prescribing statistics to be speeded up if possible; and, finally, the deans of medical schools to be approached about the need for all those engaged in training students in prescribing to stress the importance of economy in the use of drugs. It seems clear from these suggestions that the Committee is tackling its difficult task in a practical and realistic manner and, as I say, I have hopes for the future.
The additional revenue brought in by this Bill enables us to carry on with our plans for improvement of our hospitals which might otherwise have had to be set aside. As a matter of policy, we in Scotland have decided to devote a large part of what money we have available for hospital building in the next year or two to extending our mental deficiency hospitals. Progress has not been unsatisfactory. In the last four years we have provided 400 more places for mental defectives in mental deficiency hospitals. In the next 12 months we hope to provide about 500 more, making a grand total for five years of 900 places.
§ Mr. Browne
I agree that we have a long way to go, but even beyond what I have told the House there is a substantial programme of work going on, or planned, and it is not possible yet to say when it will be complete. Although money is so necessary, it is not the only factor.
I should like to have dealt at length with the amendment to the mental deficiency laws. But I think it would be in order for me to say thank you to the mental and nursing staff for their untiring devotion and to the voluntary pioneering bodies, like the voluntary association in Paisley, which is such a valuable part of our hospital service. All concerned have 86 been helped in their work by the changing view of the public towards mental deficiency. Again, a word of thanks is especially due to our own Scottish B.B.C., whose programmes on this difficult and delicate subject have achieved just the sort of public reaction for which we had hoped.
As I said, hand in hand with this change of public opinion must come a change in the laws concerning the mentally ill and mentally defective. At present, my right hon. Friend is receiving the views of local authorities and hospital, professional and other interested bodies. Of course, we have the report of the English Royal Commission, the findings of which will be of benefit to Scotland, also. These consultations are well advanced and we shall not delay a moment longer than is necessary.
Perhaps the most compelling reason for revising the law is the position of the aged in our mental hospitals. Changes in the law will help enormously, but so, too, will any increase in the funds available through this Bill. It will help towards the provision of more suitable accommodation by local authorities and by the National Health Service in both mental and general hospitals. There is no easy, short-term solution to our Scottish hospital problems, but the younger contributors under the Bill must be assured that steady progress will be made until the problem is solved.
For all contributors there are two spheres of advancement in which they can be assured that their money now added to by the Bill, is being and will be put to good use. I refer to the chances of a cure for mental patients and those suffering from tuberculosis. During 1956, 29 per cent. of certified mental patients were in hospital for less than three months; 38 per cent. were in hospital for from three months to a year; 11 per cent. were in hospital for between one and two years; and only 22 per cent. were in hospital for over two years. Of certified patients discharged during 1956, 73 per cent. were discharged as recovered and a further 24 per cent. were relieved. Finally, in Scotland we are half way through our X-ray campaign. Glasgow, Fife, Perth, Kilmarnock, Ayr, West Lothian, Port Glasgow, Midlothian, Lanarkshire and Aberdeen have already held campaigns. Edinburgh's campaign is now in progress. Ten areas have still 87 to be tackled. These are, Rutherglen, Greenock, the remainder of Lanarkshire, Renfrewshire, Airdrie and Coatbridge, Dunbartonshire and Dumbarton, Motherwell, Paisley and Dundee. Of course, complete data are not yet available. The notification rate has expectedly increased where the campaigns have taken place, but we can say with satisfaction that every sufferer is getting a bed and that the average stay in hospital is now between four and five months as compared with a year or two only a few years ago.
Seen in perspective, these accomplishments, the progress being steadily made and the many things that still remain undone make this Bill necessary. I cannot believe that anyone can seriously challenge that the Government are right to ask those who are well to pay a few pence more each week towards the provision of better medical care and a quicker cure when they are ill.
§ 6.25 p.m.
§ Mr. A. Woodburn (Clackmannan and East Stirlingshire)
Listening to many of the speeches which have been made on this Bill one would think that the Ministers responsible for it had been sitting in a health conference, deciding what they could do best for the health of the people and that this Measure arose out of their desire to ensure better health for the people. That, of course, is nonsense. Everybody knows that this Bill arose because the Chancellor of the Exchequer wanted to cut his Budget, and that he said to his colleagues, "You must help to cut so much off the Budget". It has nothing whatever to do with health at all.
Whether it is for health or not, the Minister has to make his contribution to the Chancellor of the Exchequer's cuts, whether it is good or bad sense, whether it is in the interests of health or whether it will contribute to more sickness. The only way that he can avoid cutting down on the Health Service to save the Chancellor money is by charging it in some other way to the people than through the Chancellor. That is the reason for the Bill. It has nothing whatever to do with considerations of health.
The Joint Under-Secretary of State for Scotland has told us, in a very interesting speech, what Scotland does for health. I think that in general the Scottish Health 88 Service can show any organisation in the world how to be economical. When we started the Health Service a great deal of its expenses was forced upon it by the more expensive services carried on south of the Border. It had to increase its costs very greatly. Most of the increased cost of the Service, after it started, was due to increased wages for nurses, doctors and others, who work in hospitals. Is any hon. Member prepared to say that to pay the nurses decent wages was extravagant and that the nation ought not to have done that? Therefore, the idea that the expenditure of this extra money on the hospitals was a waste is a caricature of the situation.
§ Mr. J. N. Browne
I am sure the right hon. Gentleman does not want to misquote me. We do not, of course, consider nurses' wages as an avenue of saving. Although there are many things in which we cannot save money, we must still look for avenues where savings are possible.
§ Mr. Woodburn
I will come to that in a moment, but the first point that should be made clear is this. Much of what has been said has inferred that this increased cost has resulted from treating patients in Scotland and throughout the rest of Britain and that it has come from increased prescriptions and from all sorts of extravagances on the Health Service. The fact is that the bulk of the expenditure comes from increased salaries to nurses and doctors and increased wages to those people whose wages, I hope, have gone up commensurate with the rest of the population.
The Government are going into the question of doctors' salaries to see if they should be raised still more. When Ministers talk about this matter they should carefully separate things which have nothing to do with medicine at all and make clear to the public that the great increase in cost is because we are doing our duty to the nurses and doctors by paying them proper salaries. When the Minister of Health is asked to make a percentage cut on the Health Service, he cannot touch the bulk of the expenditure, which is for salaries. This money has to be saved by tackling the cost of Services to the patient.
What are the economies that the hon. Gentleman suggested? Cuts in food—[HON. MEMBERS: "No."] The hon. 89 Gentleman clearly said that £15,000 was being saved in one hospital on food. He says that it now has better, but cheaper food. That may be so. Of course, some would argue that people would be better on porridge and not have any fancy diets. It has become a benefit to cut down the food value of bread nowadays. We now use more of its vitamins to feed cattle, and it has become a so-called benefit not to have vitamins since the war. We know from experience that whenever a Government wish to cut expenditure an expert will show that it is better for the patient that he should not eat so much. We should not accept all that humbug.
The main point to consider is that when the Minister is asked to make a 5 per cent. cut in the Health Service it has to be borne by a very small section of his total expenditure. He has talked about the cuts and the food and cleaning services. Mrs. Mopp is to save the Health Service by using less soap. This is not cutting the Health Service. It is shaving the Health Service. It does not make any cut in the Service at all.
§ Mr. Godfrey Lagden (Hornchurch)
Since the right hon. Gentleman talks about cuts and the saving on soap, may I remind him that when his party was in power there was enormous wastage because the wrong type of soap was ordered, could not be used, and had to be thrown away?
§ Mr. Woodburn
I was in the Government at the time and I can assure the hon. Member that I never chose any soap for a hospital. That was left to the experts.
At that time, we did not have the benefit of I.T.V. and the wonderful advertisements telling us of the right kind of soap to use. Now, everybody knows the value of the different soaps, but in those darkened days when we did not have I.T.V. nobody knew which kind of soap to buy. Now, everybody is well-informed.
Let us come to the question of economising on the Health Service: that is, cutting down on anything which affects the treatment of the patient. That type of economy is rather like the old window tax, when windows were blocked up and the light was cut out. By saving on the treatment to the patient, we would be doing injury to the nation, because if we do not win the fight against disease, it 90 will win the fight against us. It is nonsense, therefore, to talk about economies in the Health Service in the sense of cutting down the necessary services to deal with health and with the treatment of patients.
Are we to cut on water and sanitation? Somebody has argued that the Health Service is not really free. Is water really free? The person who drinks it thinks so. Are we starting to put a percentage payment on the people according to the amount of water they drink, or what is to happen about this new method of charging for the Health Service? What is wrong with having water free and treatment to the patient free?
The whole principle of the Health Service is that a person should be treated according to his illness and not according to the amount of money in his pocket. People should get the treatment that their sickness requires and not be handicapped by and lack of means. Any retraction from this point of view is an attack upon the Health Service, no matter what is said to the contrary.
I agree that we must have national economy and that the Chancellor of the Exchequer may have to cut down. I agree that when a Government's Budget is increasing beyond what is practicable, cuts must be made somewhere. Then, we have to ask where it is possible to get the money if we cannot save it. Where the Chancellor of the Exchequer goes wrong is that he says he will collect the money from those who have the least. At the same time, on television, we are having wonderful pictures of ladies having their dogs dressed in fur coats and getting their hair shaved. There are beauty parlours for dogs who are taken there twice a week by their lady owners to have their hair done. The idea of the Chancellor of the Exchequer putting a "bob" on an old-age pensioner's prescription and allowing all this extravagance to go on and telling us that this is the only place where he can get the money, is ridiculous. No person in his senses believes it.
I am in favour of avoiding waste. Economy is the avoiding of waste. When the Joint Under-Secretary tells us that waste is being eliminated, well and good. I agree that there may be doctors who are over-prescribing. We all know that doctors are still thinking in terms of private enterprise. There are empire 91 builders among them who auction themselves to patients by promising to prescribe more if patients will come to them. That is a bad thing and we had great difficulty in pinning it down on doctors, but it is only a small minority of the medical profession. The medical profession does not approve of that any more than we do. The medical profession must discipline itself in that respect.
I ask the Joint Under-Secretary, on behalf of the Government, to tell me why, if doctors are misbehaving in that way, the patient should have to pay the cost of it. Why should the patient have to pay an extra contribution merely because doctors are misbehaving? Why punish the patient? I can see sense in punishing the doctor, but not in punishing the patient.
The drug question is a serious one. Whether the Chancellor needs to cut expenditure does not arise on the Bill. The Public Accounts Committee, on which sit some of my hon. Friends and hon. Members opposite, watches this matter closely and is always looking for extravagance or waste. Everybody agrees that the Health Service should be run in the most efficient way possible. There should be no waste, either on hospitals or on doctors' prescriptions. Doctors should prescribe properly.
When we talk about expensive drugs, however, if the hon. Gentleman reads this morning's Scotsman he will see a report of medical evidence given to the committee which the Government have set up in which it is pointed out that if, by the use of proper drugs, doctors can treat a person at home and keep him out of hospital, that is a very great economy. Every time a person is taken into hospital the cost of running the hospital mounts up. The more that hospitals can be closed and done away with, the better.
The hon. Gentleman mentioned the X-ray campaign. This has been a splendid effort to make a wholesale attack upon tuberculosis. It is about thirty years since Dr. Robertson told me that if the community was prepared to take these steps, tuberculosis could be wiped out in nine years. Now, we are taking these steps.
§ Mr. Partridge
Did the hon. Member say "thirty years ago?" Streptomycin and the other drugs were not invented then. Was a magic wand to be waved?
§ Mr. Woodburn
Dr. Robertson said that what was necessary was to segregate the patients at the earliest possible moment so that infection ceased to spread. The idea was to have places near towns where people could live and carry on their normal work, but not necessarily be infecting their relatives and everybody around them. Indeed, at the beginning of the war, when we were building camps for soldiers, for evacuation and other things, I suggested the building of huts for this purpose to deal with the segregation of T.B. patients to prevent infection.
Dr. Robertson was right. Streptomycin and the other drugs not only prevent infection, but cure many of the patients. That is a different question. The main attack then was to prevent the infection spreading.
If the hon. Gentleman can carry his mind back, he will remember how, all over the place, we had what were called smallpox hospitals. There was never any talk of economy in providing the smallpox hospitals, because the people who might have grudged the money could have caught it themselves if they did not have the patients segregated. The State made the patient go out to the smallpox hospital, where he was offered a free service then because of the danger to other people.
The smallpox germ could not be kept confined to the houses of the poor. It also went into the rich homes, so everybody took care that the smallpox germs were confined to the smallpox hospitals. A person with a broken leg or appendicitis or almost anything else wrong with him had to wait in the queue to get into hospital.
All these excuses for cuts are humbug. We ought to treat illness as a menace to the nation, and we ought to spend the money which is necessary.
§ Mr. Partridge
Is the right hon. Gentleman suggesting we are not spending the money? I understood that it was agreed on both sides of the House that the money had to be spent. The question is: where it is to come from? The right hon. Gentleman has been talking utter rubbish about economies and cutting 93 down. There is no cutting down, but expansion. The question is where the money is to come from and how to strike a proper balance.
§ Mr. Woodburn
The hon. Gentleman cannot have heard the Minister, who was telling us all about the economies of the Chancellor.
The hon. Gentleman, if he has any acquaintance at all with the subject, will know that the conditions in our big teaching hospitals, especially in Scotland, really are disgraceful compared with conditions in hospitals in little countries like Norway and Sweden. The conditions in which surgeons work in Norway and Sweden are far superior to the conditions in which surgeons work in this great, wealthy country, to the conditions which Britain, it seems, cannot afford.
§ Mr. Farey-Jones (Watford)
I have recently toured a number of hospitals in the three Scandinavian countries, and I can assure the right hon. Gentleman that his statement comparing the Norwegian and Swedish hospitals with our own was a misrepresentation of the facts.
§ Mr. Woodburn
All I can say is that a group of Scottish doctors and surgeons recently studied conditions in the Scandinavian countries and the picture they draw of the teaching hospitals there is one to make us feel ashamed of the conditions we provide in our teaching hospitals.
§ Mr. Woodburn
I am citing what experts have said. Those surgeons have made a report which has been submitted to the Secretary of State, and the Joint Under-Secretary of State can confirm what I have said if he has read it.
In one of our greatest teaching hospitals there is not a common room where the medical staff in the hospital can even have a cup of coffee and can meet to talk together. There are some hospitals where patients waiting to go into the theatre have to sit in conditions which were not worse in the old poorhouses. They have to sit on hard wooden benches. Though these conditions are being steadily improved, they are still rather primitive in many of our hospitals. It is not the fault of the Government. I am not blaming the Government. While the 94 building industry was engaged in building houses, factories and all other constructions which have been built since the war, hospital building has had to be restricted.
However, I would say this to the Joint Under-Secretary of State, that as soon as building labour and money are available there ought to be a great deal more money spent on the Health Service. It is said that we are spending too much on the Health Service. For many years we have been spending too little on the Health Service. I hope the Government will not look at the Service with skimping, economising eyes, but will look upon it as a necessary Service.
I am sure that the Minister of Health does so, but he has to obey the dictum of the Chancellor. He has to cut the Health Service in the same way as other Minister have to cut their services.
Let us come to the real purpose of the Bill. The real purpose of the Bill, since money has to be raised, is to answer the question, where is it to come from?
§ Mr. Woodburn
The Chancellor has broken all the canons of fiscal economy by charging it on the wrong people. The principle of taxation should be, taxation according to ability to pay. The hon. Member seemed to justify the idea that people should pay for their services so much per head; in other words, that a millionaire should pay the same as the old-age pensioner, who is not on National Assistance, for treatment in hospital. Is there anybody who is prepared at this time to justify that system of taxation? It is admitted that they are not paying for the services, but having a poll tax put on them at so much per head. The Chancellor's way of raising this money is quite wrong in principle and it ought not to be done. The money should be raised by general taxation.
As I have said, there is evidence that there is plenty of room for that general taxation. There is a lot of fat which can be taken without touching the lean people. I am a great believer in this, that it is good for the health of fat people that they should have less fat and that it is good for the health of the thin people that they should not have more taken off them. That is the principle of taxation in this country, and the Chancellor is going entirely against it.
95 As I say, there is a very stupid theory that when the Chancellor has to make cuts he has to make every Minister contribute a share. I am admitting that we have done the same thing, when we were in the Government. I know what goes on. The Chancellor says, "We have to save £80 million." The Secretary of State for War, or some other Minister, is not going to give up that expenditure all by himself, so the Minister of Health has to give up so many millions of expenditure to satisfy the Secretary of State for War that he alone is not going to "carry the baby."
There is more fat in the War Office Vote, and a lot of waste in the War Office, as one can see from a study of the Report of the Public Accounts Committee, which has exposed extravagance in the War Office in ordering double quantities of all kinds of things that are not necessary at all. There is a lot of fat which could be scraped off there to save. I object to scraping and skimping on the Health Service, especially when a lot of fat can be saved elsewhere.
§ Mr. J. N. Browne
I hope that the right hon. Gentleman will not assume from my silence that we on this side of the House conduct our affairs in the way in which, according to his description, the Labour Government conducted affairs.
§ Mr. Woodburn
I beg your pardon, Mr. Speaker. The hon. Gentleman can mislead other people, but he cannot mislead anyone who has had this experience.
There is no support for this Bill in Scotland. [HON. MEMBERS: "Nor in England."] The Government have been defeated in Scotland. They are now in a minority in Scotland. Therefore, the hon. Gentleman cannot say they have any authority for proposing this Bill on behalf of Scotland. I know the Scots, and they are certainly willing to pay for health. The hon. Gentleman said people would not grudge this money. I quite agree, and I do not think wealthy people would grudge paying their share either. What I object to is that the Chancellor is not 96 giving them the opportunity to pay their share. He is going to charge them less than their share. I think he should allow everybody to pay his share.
The question is how the money should be raised. The Chancellor could easily do it otherwise than by this business of putting these penalties on people. This is a wrong economy. The hon. Gentleman mentioned the mental hospitals and their wonderful services. I suggest that some of the people who conceived this Bill should go to have some treatment there, because the Bill is not sense at all in logic or economy.
§ 6.48 p.m.
§ Mr. R. Gresham Cooke (Twickenham)
I am sure that we on this side of the House were all edified by the startling revelations the right hon. Gentleman the Member for East Stirlingshire (Mr. Woodburn) made about the financial conduct of the Labour Government, and I was glad to hear my hon. Friend the Joint Under-Secretary of State dissociate our Government entirely from any such goings on as must have happened during the years 1945 to 1951.
The right hon. Gentleman spent a great deal of his time in doing what it is very easy to do and is often done by hon. Members on that side of the House, and that is, poking fun at any economies which may be proposed. That is an exercise which is so often undertaken by hon. Members opposite. When they indulge in such exercise they show their complete ignorance of any large-scale organisation. If there is a large-scale organisation spending £1 million a year and each department is asked to make economies by 5 per cent. and they achieve it, they achieve a total economy of £50,000 a year. Equally, if they are spending £100 million and an economy of 5 per cent. is achieved there is a saving worth £5 million a year. Therefore, if we have a service, as we have today, that is spending over £500 million, and if we achieved an economy of 5 per cent., we should be saving £25 million, which is very nearly the whole of the 6d. increase we are discussing today. It is quite out of tune with the issue facing us today for the right hon. Gentleman and hon. Gentlemen opposite to make fun of the efforts of Ministers in trying to achieve economies in the Health Service.
§ Mr. Gresham Cooke
If the hon. Member had been listening, he would have realised that I am following what the right hon. Member for East Stirlingshire was saying when poking fun at the economies which the Government are trying to make.
§ Mr. John Paton (Norwich, North)
This Bill, of course, has nothing to do with savings. It has everything to do with shifting the burden from the rich to the poor.
§ Mr. Gresham Cooke
I think we are all agreed that the burden need not be so heavy and that we ought to scrutinise the expenditure on the Health Service to see whether we are getting value for money. That, I think, was the point with which the right hon. Gentleman opposite was dealing, although I was sorry that he approached it in the way he did.
The other attack made on the Bill this afternoon was on the question of its honesty. We may say that the Bill is misguided, but it seems to me that it is supremely honest in that it faces the fact that this additional expenditure has to be found, and because it shows the contributor that if he wants the extra services, he must pay for them.
The other day, I elicited from the Chancellor of the Exchequer some information on the value of the services which the average head of a family in this country is receiving from the State, from the taxpayers and from benefits, and some rather startling figures were given by the Chancellor. For instance, the average head of a family, with a wife and two children, if the children are attending a secondary school, receives £150 a year from the education service. Equally, he gets another £19 a year for his council house, and, in addition, he receives services to the value of £48 a year from the National Health Service. That works out at £12 per head per annum. In all, the average man, even perhaps if earning only £10 or £11 per week, is receiving some £237 per year from the State.
§ Mr. Gresham Cooke
Obviously, but not as much as that. The man earning 98 £10 or £11 a week who has two children does not pay Income Tax. The fact is that he only pays by indirect taxation on such things as cigarettes and beer. No one will suggest that he is paying one-tenth of that sum in indirect taxation.
§ Mr. John Diamond (Gloucester)
In terms of real production, who is earning the wealth out of which all this has to be paid?
§ Mr. Gresham Cooke
Everyone in the State is earning the wealth. The point I was making is that it is important for the general public as a whole to realise the great value of the services which they are receiving from the National Health Service, from education, from the subsidies on council houses, and to realise that a man is receiving benefits worth £4 or £5 a week, if he is only earning £10 or £11 per week.
§ Mr. Woodburn
Will the hon. Gentleman allow me? This is very important. Is he aware that before the war the Ministry of Health calculated that this country was losing £375 million a year because of preventable disease, and that if people are prevented from being ill the nation benefits tremendously from uninterrupted production in industry, and that therefore there is no possible way of making a balance-sheet as between one individual and another?
§ Mr. Gresham Cooke
I am not arguing for a moment that the individual or the State does not benefit; of course, they benefit. All I am pointing out is that the average man in the street does not realise the size of the benefit which he receives from all this taxation, direct or indirect, and that this is a most valuable service.
Of course, we have to examine today whether this Bill is necessary, and if we could satisfy ourselves that the £32 million could be found by economies in the National Health Service, the Bill would not be necessary. I was glad when I heard the Joint Under-Secretary of State for Scotland tell us about the research they were making into these matters in Scotland. I think we should examine for a moment whether we could find this £32 million by economies. Earlier today I asked a question about how much the State was finding for the treatment of and operations on foreigners coming to this country, and I was sorry that my right 99 hon. and learned Friend the Minister could not tell us what the sum is, because many people believe that it runs into many millions of pounds.
§ Mr. Gresham Cooke
I am glad to hear the Minister say so. I am saying that the Minister did not tell the House today what the sum was. There is no reason for not knowing, but I am glad to hear my right hon. and learned Friend say that it is not many millions of pounds.
§ Mr. A. E. Hunter (Feltham)
We had a recent Adjournment debate on this matter, and I understand that it is not 1d. per year per head of the population of this country.
§ Mr. Gresham Cooke
I do not know the figures. I asked the Minister only today, and he is not yet in a position to give them to us. All I can say is that I have complaints from my constituents and others that a number of foreigners receive free treatment in this country.
I had an example brought to my attention the other day, concerning a Swiss girl who was over here on holiday, staying with an English family and not earning any wages. While she was a child, she had a rather serious accident, which left a scar on her face. This girl was able, under the National Health Service, to have a small operation and facial treatment to remove the scar or to reduce it. She received very considerable benefit from our National Health Service, but we have no reciprocal agreement with Switzerland, because the Swiss Government have not seen fit to give reciprocal arrangements to people who, for instance, might break a leg when skiing in Switzerland.
Therefore, as taxpayers, we are bearing the burden, which may not be a very much, but which, nevertheless, has to be paid for. I think that, as Members of Parliament, we are perfectly entitled to take up and look into any of the grievances that may be presented to us by taxpayers.
§ Mr. Woodburn
Is the hon. Gentleman aware that, before the National Health Service came into existence, hospitals in this country, like the Royal Infirmary in my own city of Edinburgh, treated everybody without any question, whether they 100 were foreigners or not, free of charge. That was long before the Health Service came in. Does the hon. Gentleman suggest that the nation should now be more mean than the hospitals were before the nation took them over?
§ Mr. Gresham Cooke
I am not suggesting that the nation should be more mean at all. Obviously, if a foreigner has an accident or has a serious illness of an urgent nature it has to be treated, but when complaints are being made—and the right hon. Gentleman has no doubt read them in the papers—that a number of people from foreign countries are coming here in order to obtain treatment, I think we are entitled to examine that position. I have given the House an example that came to my notice the other day.
Another question which has been raised with me recently is whether doctors are as cost-conscious as they ought to be. I have had examples given to me of mobile cases—that is people who are quite able to walk—who have to go to hospital for treatment who are demanding ambulances when they could easily go by bus. I am sorry to say that in one or two cases which have been brought to my attention doctors, perhaps because they are overworked, have given these people a certificate authorising them to be taken by ambulance. This is a matter which should be closely examined by the regional committees and the Minister.
§ Mr. Gresham Cooke
Other economies could be made by means of work studies. One of my daughters works as an almoner in a large and busy London hospital. I also have had the advantage of going over St. Thomas's Hospital, where there is an enormous organisation with a great many different departments and a very large staff. I have had some experience in industry, as no doubt have many other hon. Members, and we all know that by means of research and work study it is possible to lighten the burden of work on people and thereby cut down the number of people required.
In a department of six, for example, it is quite feasible to make such economies in manpower through work studies as to reduce the number in the department by two—from six to four. [Laughter.] 101 There are many examples in London where that can be done to the benefit of the workers themselves. If hon. Members opposite do not wish to see the burden of work lightened in our factories, perhaps they will get up and say so.
In my experience in industry, it is in the interest both of employer and employee to see the burden of work lightened and, if possible, to see the job done by fewer people, because more economic methods can be put into operation in that way, and it is often possible to pay the remaining workers bigger wages. I invite the Minister, therefore, to say whether it is not possible to find the £32 million required in this case by economies in the short-run. I do not suppose it is possible, because if it were the Bill would not be necessary and we could all go home.
I hope, however, that the Minister will tell us that he has looked into the matter and that he hopes to find economies in the future. It would be a useful exercise throughout the National Health Service. A large number of people write to Members of Parliament and to newspapers under the impression that serious economies can be made throughout the National Health Service. I am not in a position to say whether that is so or not, but I am bound to raise the point because it is put to me by so many of my constituents.
§ Mr. Gresham Cooke
There are twelve almoners in the hospital in which my daughter works, which is more than there were before the war. She is very busy, and she tells me that the other almoners are also very busy. I dare say that is true. In a large building of that kind there is an enormous amount of running about to do. It might be possible for more work to be done, not by running about but by—
§ Mr. Gresham Cooke
More work could be done, not by running about, but by 102 installing an automatic internal telephone system. I will not make any definite suggestion, but it might be possible for the work to be done by ten almoners instead of twelve, though I am sure that my daughter would not lose her job.
Payment by the contributors of only 20 per cent. of the expenditure on the National Health Service is surely extremely small. If the Government said that it was fair that the State should pay one-third, the employer one-third and the contributor one-third, there might be a logical case for it. Indeed, the Beveridge Report originally envisaged that the contributor might pay one-third of the expense of the Service. The present payment of 20 per cent. is very modest, and I am surprised that hon. Members opposite should cavil at such a small sum.
§ Mr. Willis
The contributor includes every insured person. Every insured person also pays tax. Therefore, he is really paying the lot. What we are deciding today is not who pays the money but how it should be paid.
§ Mr. Gresham Cooke
If they do not smoke and do not drink, they pay very little taxation at all. I believe that the contributors, who after all are the people who will get the benefit, should pay a fair proportion of the cost. In my view, a 20 per cent. contribution is quite low.
§ 7.8 p.m.
§ Mr. Walter Monslow (Barrow-in-Furness)
I am sure the hon. Member for Twickenham (Mr. Gresham Cooke) will forgive me if I do not dilate on the arduous and responsible duties his daughter performs. I would not be so ungenerous. The Bill has undoubtedly been made necessary by inflationary pressure resulting from governmental policy. It is fair to say that the sums necessary to run the hard core of the National Health Service, by which I mean the hospital service, the consultant service and the general practitioner service, are certainly due to rising costs. I agree that it is necessary to have an expanding National Health Service. Many features of the Service are not what we would 103 consider adequate in the present century, and I agree with my right hon. Friend the Member for East Stirlingshire (Mr. Woodburn) that facilities and equipment in certain hospitals are quite obsolete and out-of-date.
I recall the difficulties which confronted the Labour Government in 1951 when the National Health Service charges were increased, due to increasing expenditure which was then running at approximately £400 million. That expenditure has since increased by about two-thirds. At that time we on this side of the House said that we did not seek authority to impose charges. We called what was then done a readjustment. We said that charges for dentures and for spectacles were not necessarily to be regarded as a permanent feature of the Service and that by Order in Council we could revoke or modify those charges. But it has been my experience as a Member of Parliament that whenever a Government, of whatever party, impose a tax it is never repealed.
§ Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)
The charges were definitely prescribed to come to an end on a specified date.
§ Mr. Monslow
I thank my hon. Friend. I am satisfied that there has been no wild abuse of the National Health Service, and it would have been a grave reflection upon the medical fraternity if there had been any abuse of it. I think the profession has lived up to its ethical standards, and it would certainly have the guts to resist any attempted abuse of the Service.
I have never accepted the view that the flat rate contribution is a satisfactory arrangement. Frankly, I think we ought to have a graduated scale, with the higher income groups paying a higher contribution. This would relieve many of the poorer sections of our community from a charge which is becoming intolerable. In my judgment, a deduction of 10s. is more than ought to be expected from the wages of our lower-paid workers. I am thinking particularly of those in the railway industry who receive under £8 a week.
§ Mr. Anthony Fell (Yarmouth)
I am grateful to the hon. Gentleman for allowing me to interrupt. Surely his argument would only make sense if the 104 contribution to the National Health Service were somewhere near 100 per cent. As it is, the other four-fifths of it must be on a graduated scale, as is the case now.
§ Mr. Monslow
I do not accept the argument adduced by the hon. Member. As I want to give way to my colleagues who wish to speak, I will only add that this additional 6d. is nothing more nor less than a poll tax. Although to hon. Gentlemen opposite it may appear to be infinitesimal, I do not take that view. In addition to this increased contribution the cost of many commodities has been rising, and the general situation has been responsible for the trade unions making incessant demands for increases to keep pace with rising prices.
§ Mr. Roderic Bowen (Cardigan)
May I interrupt to say that it also falls heavily upon many self-employed persons?
§ Mr. Monslow
I agree with the hon. and learned Member that this is affecting adversely the one-man business.
The hon. Member for Twickenham asked where else could the £32 million be found? We must take a retrospective view as well as a prospective one of this Bill. In 1955 the Chancellor of the Exchequer reimbursed Income Tax payers by £100,000, and in 1957 Surtax payers received £35 million. That second figure could certainly have relieved the lower Paid workers of this additional contribution.
§ Mr. Gresham Cooke
The hon. Gentleman would be the first to admit that the lower wage earners have also benefited by the increase in the allowances and by the reduction in Income Tax.
§ Mr. Monslow
The hon. Gentleman is correct in that there have been certain reductions which must have benefited the lower income groups. I want to remind him, however, that these were long overdue and that many of the lower income groups at present are in a parlous plight because of the ever-rising cost of commodities and increased rents, so that the imposition of a further 6d. is more than they can be expected to meet.
I have been saying for ten years that unless this country decides to spend less on non-productive and destructive services it will not be able to spend more on productive and social services. We 105 shall have to make a choice. If I want any testimony in support of this, I have the striking example of the ex-Chancellor of the Exchequer, the right hon. Gentleman the Member for Monmouth (Mr. P. Thorneycroft). I recall that in his resignation speech he said in this House that Governments have moved over the last twelve years from crisis to crisis.
I say to the House that we cannot meet our present commitments, particularly those for non-productive or destructive services, out of our limited resources, neither can we maintain a stable economy. Although 6d. may not appear to be very large, it must be looked at in the light of the other rises in costs which have occurred in the lifetime of this Government. I am convinced that there is another means by which we could find this sum. This further imposition upon the wage-earning section of our community will result in further inflation and, no doubt, in further wage demands. Obviously we cannot ask the poorer sections of the community to accept wage restraint in circumstances which are the result of Government action.
§ 7.16 p.m.
§ Mrs. Eveline Hill (Manchester, Wythenshawe)
I listened carefully to the speech of the hon. Member for Barrow-in-Furness (Mr. Monslow) and one thought which occurred to me was, what use would there be in our health and welfare services if we had not some protection as well? It is no use having one without the other. I have noticed that during our discussions this afternoon speaker after speaker has referred to what is being paid out of the weekly wage packet, whereas nothing has been said about what can be received in return for what we are paying. What we are doing by paying our contributions is something we were taught to do many years ago: we are putting something away for a rainy day. Granted we have to do it because the Government say so, and it is a given amount, but if there is severe illness in the home we do not have to think of all the relevant costs that may ensue. To that extent our National Health contributions give us peace of mind.
From the start of the National Health Service I have noticed in talking to people how little they have known about the actual amount contributed. Men were astonished when they learned that 106 only 10d. out of their insurance contribution went to the Health Service, and this really became known only as a result of the increase in contributions provided for in the 1957 Act. It cannot be denied that there was a run on the Service in the early days. Many people thought along these lines, "I have been paying all this time and now I will get something back."
Now we know how much of the total contribution goes towards the National Health Service, and we also know that those with the lowest incomes are paying least. As has been pointed out, a very large percentage of the addition will come out of taxation. Frankly, that is as it should be. It has always been our philosophy that the strong should help the weak, and the strong are already paying by virtue of additional taxation.
I have always marvelled that the Health Service has functioned so well, because in those early days of 1948 there was a tremendous upheaval in the method of procedure and management and it was all done at one swoop. It says much for the people in the services at that time that those services continued to function without interruption.
Since then, all Ministers of Health have wanted more capital expenditure. I believe that if we had had more money for capital expenditure in the early days, we would probably have had more economies by now. We all know that the hospital service takes by far the greatest proportion of the money spent on the Service as a whole. Much has been said about economies there. I hope that with the extra money being voted to him and being raised by the new contributions, the Minister will be able to put that house in order, because there are many things which need to be done.
We all want to hurry to improve standards. We have been doing that all the time, even before the Health Service. Local authority hospitals were considerably improved in the days of the boards of guardians up to the time of the Health Service. As a member of a hospital committee, I can recollect the great changes which took place.
More needs to be done for the chronic sick, because it is always difficult to have to take what might be a chronic case out of a bed required for an acute case.
107 I want it to be made possible to get these cases transferred more quickly, because we do not want to spend a great deal of money on accommodation for acute cases if accommodation can be made available by providing in some other way for the chronic sick. I do not like to think that a person who is very ill and who cannot be cured has to be turned out of his hospital bed and sent home to pass away. Those are matters with which we want to deal more quickly.
We are building new hospitals, but the design of those hospitals should be flexible, so that the hospitals do not occupy an enormous area which will not be needed when conditions change. Indeed, they have already changed, as we all know. Fever hospitals no longer house fever cases, except in a few instances, because infectious diseases have been controlled so much; and in many parts of the country a similar argument applies to sanatoria.
I hope that we will spend our money wisely. Whether it comes from taxation or contributions, it is public money which ought to be spent carefully and for which full value should be obtained. I know that the Minister is anxious, with the money available to him, to produce the best possible Service, and I hope that he will bear in mind what I have been saying.
The mental health services have been mentioned. More responsibility is to he placed on local authorities for mental and other services. All the time the emphasis must be on prevention so that we attain that for which we have hoped ever since the Service first came into being—a need for fewer and fewer hospitals and less and less illness, for the benefit of all.
Many economies have been suggested. I have a special interest in hospitals. Economies in hospitals cannot be enormous without cutting services. Hospitals can be improved by various organisation and method examinations, but there are not enormous economies to be made. Drugs are frequently mentioned in these debates. I do not suggest that hospitals are extravagent in the use of drugs. People who would not be extravagant with their own money are not likely to be extravagant with other people's money.
I know of a tuberculosis hospital which spent about £600 a year on drugs before the war. It now spends between £20,000 108 and £25,000 on drugs. That means that whereas before the war people felt that, although that was a good hospital, there was not much hope for those who went into it, today they can be treated with drugs and sent home earlier, back to their everyday lives to play their part in industry. It is very important that many people should be treated in their own homes, where the surroundings are reasonably good. That represents a saving to the Health Service. While we might be able to evaluate what we spend on drugs, we cannot measure in cash terms what we save in creating greater human happiness and health. We should not quibble too much about these amounts which we are being asked to contribute. They are not very much.
I am glad that we have had this debate and glad that the facts have been brought out. I sincerely hope that the Minister does not have to return to ask for more money, and I am sure that he, too, shares that hope. I hope that, by our action tonight, we shall support him in maintaining the Service, and that in future we will all bend our efforts to improving that Service.
§ 7.29 p.m.
§ Dr. Barnett Stross (Stoke-on-Trent, Central)
I am very fortunate in being able to follow the hon. Lady the Member for Wythenshawe (Mrs. Hill), because I found myself agreeing with most of what she said and it was a pleasure to listen to her. It is not surprising that hon. Ladies who are Members of this House are always at their best when speaking on a subject of great importance to humanity. That is because their sex is more realistic than mine and they have a sense of values which, on the whole, are rather better than men's. I say that as a medical man who, after a fairly long life, has learned that the values which women hold dear are probably correct.
It was interesting to notice how the debate was enlivened when the Scots intervened. It had been comparatively placid before that. I am very glad that the right hon. and learned Gentleman is in his place, because there were one or two matters which have been raised and which I have found interesting.
The Joint Under-Secretary of State for Scotland gave us a careful study of the techniques which will be used in Scotland 109 to teach students and doctors how to prescribe, what they are prescribing for, and to be economical without disregard of the interests of their patients. I did not find anything with which to disagree. As much teaching should be done on this subject as possible.
When I was a student there was literally no teaching. One learned what the drugs, as we knew them then, were and what they did, but it was not considered important to teach us what they cost, how to prescribe them or what vehicle they should be in. We were expected to learn that on our own, and we did, as best we could. I do not think we did any harm. In those days, apart from opium, morphine, codeine, cocaine and strychnine, we were dealing with simple drugs. We did not pretend to ourselves when we had a case of pneumonia that what we had available was worth anything at all; we might just as well have thrown it away. We knew that only careful nursing of the best type could give the patient the best chance of life. Even so, we lost forty patients out of every hundred.
Today, one must know not only what quantity of antibiotics to use and how to apply them, but when to switch them, because they do not always work. As we are now literally saving lives we always used to lose, it is most important that students should be taught adequately and well, and while they are being taught they might as well know what the stuff costs. They must learn in the first place to save life irrespective of cost, and having learned that, to be reasonably economical through knowledge and not to be extravagant from ignorance. That is putting the matter fairly.
The Joint Under-Secretary of State also told us very proudly about Scotland and how far the mass X-ray of the population was getting on. That interested me immediately, because I am responsible to some extent for causing expenditure in the English service. The hon. Lady who is Joint Parliamentary Secretary will remember that I was very interested that there should be a mass X-ray at the North Staffordshire pitheads. The Ministry of Health, some eighteen months ago, agreed that this should be done.
The survey is now complete, and it is fascinating to see what the expenditure 110 of money can do. It confirms very strongly the thesis that the hon. Lady the Member for Wythenshawe was making, that we cannot tell how much we can save because we are saving so much for which we cannot pay. No money can pay for it because it is so valuable. It is fascinating to know that out of 22,000 miners 16,000 volunteered for the X-ray. That must have cost some money. It has been done very economically, let me tell the Minister, and much too economically in certain respects.
There is only one X-ray machine available, the old 30 mm. type. It has done yeomen service for many years and must have had many fragments replaced. As in so many other matters, an inferior weapon can do good work in the hands of someone who is trained to use it. We know that there are better machines than this 30 mm. X-ray, and I am pleading for a more costly machine to be installed in this area, a new one, preferably of the 100 mm. type.
Let me return to the X-ray survey. If the Minister of Health is restive, I beg him to stay for a minute or two longer. I know he has been very patient and has sat here for a long time. Out of the 16,000 examinations 59 cases of active tuberculosis were found. The Minister does not have to use his imagination to know what we have done for the mining community in North Staffordshire by finding those 59 cases of active tubercle. The way to kill your neighbour when working in the pit with him is to infect him. Many men have tiny traces of pneumoconiosis which will never do them any harm if they do not become infected. Once tubercular infection is superadded to minimal pneumoconiosis there is very rapid deterioration. In a year or two, or at the most in three years, there will be total loss of faculty and, without treatment, premature death, due to massive pulmonary fibrosis.
All those 59 cases of tuberculosis have been taken out of the mines so that they can no longer harm themselves, their neighbours or their own families. There were also 200 cases of different types of massive fibrosis discovered and the lives of those 200 men will be saved. We can save them today, again through the expenditure of money. We shall put them into a sanitorium and treat them with expensive drugs for nine months to eighteen 111 months. We can save them and give them an almost normal expectation of life. The mass X-ray unit has gone into every family among the miners where there was any question of doubt in order to give them protection.
§ Mr. Dudley Williams
Would not the hon. Member agree that these great benefits justify the small increase of contribution proposed in the Bill?
§ Dr. Stross
I am coming to all that. I was saying that the families are examined, the wives and children. This is a very interesting example where an increase in expenditure can bring about tremendous benefit which none of us knows how to estimate in terms of money. If we must try to estimate it in terms of cash, let us take this apparently extravagant bill for drugs. I do not know who will ever be able to give a true assay on the matter or a true account of what has happened. I can only guess at it, as a medical man who worked before the new and expensive drugs were available. I know what we can do today and what we could do years ago, before the war.
Seeing what we can do today, I am prepared to state that, despite the carelessness in prescribing which probably exists in a number of instances, despite the fact that there is over-prescription which causes waste, and despite the gross pressure, which can never be supported, on medical men by some of the manufacturers of the newer drugs with expensive glossy advertisements and the constant expensive sending of representatives to them, there has been great advance. I ought to declare an interest here, because I have some inside knowledge of this matter. I am associated with a firm of manufacturers who do research into drugs of the newer types. It is possible to declare that modern science and modern invention are saving much more every year in this country than the total cost of the drug bill; a good deal more than that. I am not being sentimental; I am being as realistic as I can be.
If persons dear to us are ill and only a very expensive drug will save them, it is a fine thing to know, a thing to boast about and that we are all happy about, that there shall be no bar to their getting it except this miserable 1s. on the prescription, nothing standing between the most 112 expensive drug and the need of the patient.
We are dealing with a very moral type of service. It is ethically so good that it is apparent that although the Opposition in 1948 did not seem to have much enthusiasm for it, there are plenty of supporters for it on the Government side now. I am not saying that in any inimical sense.
Certain countries in Europe which also boast of a health service—I am thinking of one I know more than others, Czechoslovakia—have used another method of trying to economise. It is one which we must never follow or imitate. It would be a great mistake to do so. They assume that the consultant knows a great deal more than the family doctor. Centrally, methods and types of treatment for different diseases are laid down and put into print. The family doctor must carry them out generally. That, I think, is a very bad way; it is a wrong way. It does not by any means follow that people with a higher qualification, on paper, know very much more, or any more, than family doctors as a whole.
In those countries they do not leave therapeutic freedom to the family doctor. They have taken some initiative from him and do not give him very much chance to be a good doctor. I do not say that lazy, inefficient doctors would not be helped by that technique and that method, but the average medical man would find it irksome. It would take away all his interest in learning. The family doctor can learn all his life, and tends to do so.
The hon. Member for Exeter (Mr. Dudley Williams) asked if I did not believe that a small added cost was justified and that we should all pay 6d. a week extra in view of the services we were getting. I am pleading, quite frankly, for a bigger total expenditure, but I am absolutely against that method of doing it, and I am going to say why. All agree that this is a poll tax. It is a very much better method than that of charging the sick, of course. It would be absolutely and utterly inexcusable to place the burden on people who are ill, when they are ill, of finding the extra money. The third method, nor which we are pleading—
§ Mr. Dudley Williams
I think I am right in saying that the hon. Member's party first put the charge on the health system.
§ Dr. Stross
I am not sure whether the hon. Member was in this House at that time. We took power to impose a 1s. charge on the prescription, but we never implemented it. That was the first step. Then we imposed a charge on dentures and on the lenses of spectacles. I remember this well, for I moved an Amendment that it should cease after one budgetary year. My right hon. Friend accepted it, but declared that it would have to last for two budgetary years. It would then be removed and no further charges put on. I hope that satisfies the hon. Member on that score.
I come to the third method which we would have preferred to see employed. We may be on a narrow point about this extra 6d., but it is not narrow when the principle is concerned. It is here that we tend to divide and are not in agreement. We want the Treasury to provide it, so that it comes from taxation in such a way that those who can pay most will pay most. The right hon. Member for Woodford (Sir W. Churchill), speaking during the war, described the type of health service he hoped, expected and declared would be instituted after the war. He likened it to a fire service and said that whether it was a palace or a humble cottage the same service should be available in order to put out the "fire". If that be the case and we accept the spirit of what the right hon. Member said, surely it is wrong to use a poll tax.
Eighty per cent. comes from the Treasury, and this would have meant 80 per cent. plus another 5 per cent. from the Treasury. That is where we differ, and I will give reasons why I think in principle we are right and hon. Members opposite are wrong. Between the wars we had calamitous figures for unemployment. If people were not really hungry physically through lack of bread, they were hungry because they lacked the essential nutriments for a healthy diet, and many of them died prematurely for that reason. Those who did not die fell sick from time to time. I will give two examples to show how important it is that we should never allow any section of people to pass over that demarcation line. If it is gone over we literally allow our 114 brothers and sisters to die unnecessarily and prematurely. One example is, I am sure, well known to everyone in this House. It concerns the work done in Stockton-on-Tees by the medical officer of health, Dr. McGonigle. He found that unskilled labourers and their families and unemployed and their families, or old-age pensioners, when they moved from slums and were rehoused to two housing estates where they lived in clean, fresh air and brand new houses, fell sick and died, although when they had lived in slums they had appeared to be more healthy. That so disturbed him that he investigated the matter carefully and scientifically. His conclusion was one which we easily understand.
The extra 5s. or 6s. a week that had to be paid in rent had to "come off the table". The table had been sparsely laid before, but when they had to find another 5s. or 6s. for rent, plus fares for travelling three miles from the housing estate to their place of work if they were working, which was not necessary when they lived in the centre of the town, men, women and children died more easily than when they were in the slums. Not only the death rate, but morbidity rates increased. That is common knowledge to everyone.
There was another example of the demarcation line. I speak from memory. I think it was in 1932 when it was noted that workers in one of the greatest copper mines in Africa fell sick and were not able to turn out to do their shift work. It looked as if the whole process of manufacture would break down for that reason. The African workers were recruited in the prime of life. Most of them were about 30 years of age. In this country men of 30 years of age have almost no death rate, but it was found that the death rate among those men had risen to 60 per 1,000 and the morbidity rate was correspondingly high. As a result, this multi-millionaire concern was faced with an almost insuperable difficulty as it could not use its labour. The labourers could not crawl out of their tents and huts to work.
A very sensible thing was then done by the employers. They brought in physiologists, doctors and nutritional experts who pointed out what was wrong. I shall not bore the House with details 115 as the whole story is in the Colonial Reports for those years. When the problem had been carefully looked at it was noted that the men were sick and dying because of a variety of malnutritional conditions, one of which was the way in which their food was cooked. The employers took over, supplied cooks and nutritional experts, and out of their own money spent 4d. a day to feed each man. That was all that was needed.
By 1936 the death rate instead of being 60 per thousand was eight per thousand. That very great copper mining concern had no difficulty and no problem in breaking all production records within a year or two of having started to spend 4d. per day per man scientifically and accurately.
The demarcation line today can affect only a small percentage of our people, but I do not care if it is only 1 per cent. or 2 per cent.—it is still important. I am thinking now not so much of the old-age pensioner as of the unskilled worker who cannot make up his wages on overtime today because of the economic situation, who has more than three children and who, in spite of family allowances, is a poor man. I venture to suggest that he is in danger. He cannot feed himself or his wife or his children as adequately as we feed ourselves.
I hope that no hon. Member will say that we are interested only in minimal standards and not in optimal standards. Indeed, I hope that the House will never again speak of minimal standards of nutrition as being all that is needed, as the House spoke in 1935 when it received the Report on Food, Health and Incomes by Sir John Boyd-Orr. Its reception of that Report was disgraceful. I was not here, but some hon. Members now listening to me may have been here in those days. For about £200 million the standard of everyone in the country could have been raised to optimal levels, but all that we heard from Sir Thomas Innskip at that time was that the Government were interested only in minimal and not in optimal standards and therefore were not interested in the Report.
I would remind hon. Members that 6d. a week means two eggs a week, which means about 104 eggs a year.
§ Dr. Stross
There are plenty of poor people of the type of whom I am thinking who do not smoke. If the hon. Member thinks that the kind of people I have been describing, who are vulnerable today—and he will agree that there are some—smoke 40 cigarettes a day, he is wrong. I know that he did not mean that at all. Moreover, 6d. a week means a herring a week.
§ Dr. Stross
It means a kipper a week or nearly 50 pints of milk a year. Does that mean nothing? To the people of whom I am thinking 100 eggs or 50 pints of milk a year can mean a very great deal. I was taught by experts in nutritional matters and I knew a little about such things myself during the war, when I lectured all over the country on behalf of the Ministry of Food. But I knew that all that was needed in order to protect a person completely against any shortages during the war of vitamin A or vitamin D was that he should eat two kippers a week. Here we are denying people one kipper a week.
I am referring specifically to the 1 per cent., 2 per cent., or 3 per cent of people in the country who today are vulnerable and are beyond the demarcation line. If from families of that type we cut out 50 pints of milk or its equivalent in essential food value each and every year, we should do them great harm. That is why I have no hesitation in saying that because some people are vulnerable, we should have found this money in other ways. There may not be many of them; it way not be more than 500,000 or a million or possibly even less. But we know that there are some today who are vulnerable. For their sake we should have seen to it that this money, and a great deal in addition, should have been obtained through taxation in another way.
§ 7.55 p.m.
§ Mr. E. Partridge (Battersea, South)
I am glad to follow the hon. Member for Stoke-on-Trent, Central (Dr. Stross) because at all events he has adduced arguments in support of his present view. I am bound to say that that is more than a good many other hon. Members opposite have done today. Unfortunately, I could not quite follow him in his last argument, although his last few words put a rather different aspect on it. The logic 117 of his argument would be that people should pay nothing at all for their Health Service or unemployment or pension stamps, because that would give them more kippers and more herrings. By the same token it would give them more cigarettes. I hope the hon. Member understands that I did not make the interjection in his speech in a jocular spirit, but the fact is that for most of the working population I believe that two cigarettes is a better standard by which to judge than is a kipper a week.
§ Dr. Stross
We all know that people should economise on tobacco, because we know today how bad smoking is for them. If the hon. Member believes that people should smoke less because they could save 6d. a week, presumably he will join us to force the Minister of Health to a more rapid and more constructive action to educate people not to smoke.
§ Mr. Partridge
I should be out of order if I pursued that argument for too long. I am one of those who for medical reasons cannot themselves smoke, but I do not seek to tell other people what they should do or what they should not do. I very strongly hold the view that they must judge for themselves. If I were asked to go one stage further I should be bound to say, again emphasising that I do not smoke, that if I were a smoker I should not be convinced that smoking necessarily leads to cancer of the lung or any of the other diseases. I am, however, confident that it makes one short of wind—
§ Mr. Partridge
I agree with the hon. Member for Stoke-on-Trent, Central that we need an expanding Health Service. I have heard nobody on this side of the House who wants the Service to be any smaller than it is now or believes that the cost should somehow be held down. Many hon. Members opposite talk about the rising cost of wages. That is undoubtedly the case, but we do not want to economise on the remuneration of those members of the healing profession who do yeoman work for us all.
§ Mr. H. Butler
Would the hon. Member include in this argument the administrative staff who have been refused the 3 per cent. increase agreed by the Whitley Council?
§ Mr. Partridge
I will not be drawn into that, because they will get their just deserts as a result of the Noel Hall Report. That is a difference in classification. I should include administrative staff in my remarks, but if I am asked to go further along that road, I would say that it is in administration that the greatest economies could be made—economies which would be of great benefit to the Service itself and to the people who have to subscribe to it.
I am quite sure that hon. Gentlemen opposite will have met, not once but many times, people who say—whether rightly or wrongly does not matter for the purpose of my argument now—that there is a tremendous amount of waste in the Health Service. If they really believe that, there is no incentive for them to make their own personal economies. Likewise, people in the healing professions, in our hospitals and elsewhere, have not the incentive to be efficiently economical if they see what they consider to be waste going on all round them.
Without going into parsimonious economies, I believe that, as a result of work study, economies can be made to the benefit both of the Health Service costs and of those concerned in the department that is the subject of the work study. The reason is that it lightens their load, and, for the most part, makes their work more interesting. Even though the economy may be on a menial side of our hospital administration—in the laundry or in the kitchens, for instance—nevertheless, if an economy is made efficiently I am sure that it is for the benefit of the Service and for those working in the department concerned.
I am glad that the hon. Member for Stoke-on-Trent. Central advocated more expenditure on the Health Service where it arises from the greater use of drugs, vaccines and the like, which are so beneficial. I was not quite so glad to hear him say, as a member of the profession—or even thinking for a moment that there was an abuse by doctors or others in the form of over-prescribing, or not caring whether or not what they did prescribe was essential—
§ Dr. Stross
The hon. Gentleman must not put into my mouth words on something that is a matter between myself and my medical colleagues, but I think that 119 it is fair to say that all of us in the profession know there is pressure brought to bear on doctors by the public. They hear about things—their neighbours tell them—and they demand those things. We know that that is true, and we also know that a small percentage of doctors—we think about 5 out of every 100—do give way rather more easily than we would like. That is as far as I am prepared to go—and it is far enough.
§ Mr. Partridge
I would not argue with the hon. Gentleman, because I am not a doctor, although I come from a family that has produced a large number of doctors, and I am a son of a doctor, and proud of it. Would not he agree, however, that if a person honestly and sincerely has real faith in a certain specific—and that is a prerequisite—and, because of that great faith, asks a doctor to prescribe it, the psychological aspect might appeal to the doctor? Might not the doctor, although he himself had no very great faith in the specific, think that it was a good thing to prescribe it because of the great faith his patient had in it? I do not know, but I do say that I would not be the one to look grudgingly on expenditure on these new and, very often, expensive drugs and vaccines.
I have tried not to intervene in these debates on National Health Service contributions because I am one of those very fortunate people who have benefited so much, not only from the Health Service but from hospitals and medical science even before the Service came into being. If I may, I should like to pay my tribute to the healing profession here and now. Of course, hon. Members opposite might not think that it is a good thing that I am here today, annoying them—if I am —because of the skill of those who both prescribed for and used the knife on a tuberculous patient, who was not very much more than a hulk, washed up with the tide. However, whatever hon. Gentlemen opposite may think of me and my conduct, they certainly cannot decry my physical condition. [HON. MEMBERS: "Hear, hear."] I must say that I do not like fogs or diesel-engine fumes, but, apart from that, I have a pretty good time.
If we are to have these advances in medical science, and in drugs and vaccines, we have to nay for them somehow. 120 In this country, the insured is really getting a very good bargain—and I will come back a little later, if I may, to the point made by the hon. Member for Stoke-on-Trent, Central. Taking it on the whole, our average citizen today gets very good value for his direct contributions to the cost, and gets a service very much more cheaply than do many people on the Continent and elsewhere. Judged by that standard, we are doing very well indeed.
I do not agree with the argument that this increased contribution amounts to a poll tax. What it means is that people are being asked to pay a proportion of the cost of the Service. Personally, I think that that is right, and most of us—and certainly those who can afford to do it—pay willingly and gladly. There is the small proportion, admitted by the hon. Member for Stoke-on-Trent, Central to be small, who cannot really afford to pay this 6d.
I would not have thought that there were a great many nowadays, or that it was likely to make any real difference to the nutriment that they and their families should have; but, if it does, I do not think that it is an argument against the provisions of this Bill. It is an argument for doing something whereby, as my right hon. Friend the Member for Woodford (Sir W. Churchill) proclaimed during the war, there should be a level below which no one should fall.
If that level is now too low, it is not the fault of anything in this Bill, but of something very much different—
§ Mr. Partridge
I do not know that it does. It might accentuate the problem, but it certainly does not make the level lower. It might make it all the more necessary for us to devise some means of helping those people who are right at the bottom, but I would not think it an argument against the provisions of the Bill.
The hon. Member for Stoke-on-Trent, Central said that it was a small proportion, and I do not hold it against him that he said that he did not know whether it was 1 per cent., 2 per cent. or 3 per cent. It may well be only ½ per cent. or ½ per cent.—we do not know. I am willing to accept his argument in principle; but, if that is true, I say that there is a better 121 way of dealing with it than by letting too great a proportion of the cost of the Health Service come out of taxation, either direct or indirect.
§ Dr. Stross
I know that in 1935–36 the figure was nearer 20 per cent. in this country, and I am pretty sure that it is well below 5 per cent. now, but I do not think any of us could be sure without the most careful estimation.
§ Mr. Partridge
I must leave the matter there, but I would remind the hon. Gentleman that my father was a medical practitioner in the Old Kent Road where I saw the most terrible poverty—poverty that I hope never to see again in this country or anywhere else. But that was not to be held against any Government or any party. The fact is that we were insufficiently educated about what could and should be done. Therefore, I would not point a finger of accusation at anybody. I know what poverty was in those days. I do not mean that I experienced it, but I saw it; my father tried to alleviate suffering and that is what I have been trying to do ever since.
I therefore do not come to this House and speak in any spirit of superiority, nor do I speak in ignorance of the subject as the right hon. Member for East Stirlingshire (Mr. Woodburn) accused me. I know quite a good deal about the subject—in fact, too much for my liking. I certainly know too much about the insides of hospitals—another matter about which the right hon. Gentleman said I knew nothing.
When we agree that it is right that the Service should expand and that we should pay large contributions, would it not be better if everybody felt that he had as great a stake as possible in the efficient running of the hospitals and the Health Service generally? I should have thought it would have made for more efficiency and economy.
The right hon. Member for East Stirlingshire spoke of cuts in the Service. I think it is agreed on both sides of the House that the Service should not be cut. The whole essence of this debate is not to see how much we can cut the Service but, assuming that its cost is so much, how we are to pay for it. If that be the case, as I have said before, I have no doubt that this is the right way of doing it, and if it bears too hardly on any 122 single section of the population, however large or small, we should find a different and better means of alleviating their suffering.
§ 8.14 p.m.
§ Mr. Herbert Butler (Hackney, Central)
The hon. Member for Battersea, South (Mr. Partridge) said that there is a tremendous amount of waste in the Health Service.
§ Mr. Partridge
If I allowed those words to slip from my lips it was certainly a lapsus linguae. I did not say that. I said there was room for economy in all spheres of the Service, but I did not say there was tremendous waste. If I did, I apologise and withdraw.
§ Mr. Butler
The hon. Gentleman may apologise, but that is what he said. He said that there is a tremendous amount of waste in the Health Service. If he now desires to withdraw that statement, who am I to stand between him and his withdrawal?
It is quite obvious that in this debate the hon. Member for Battersea, South, like myself, has been a sort of "fill-in" as on the music halls. The conjuring act comes on first. Then we get the crescendo, and during the enjoyment of the dinner we fill in.
The hon. Gentleman suggests that there is a tremendous amount of waste in the Health Service and that there should be an examination of the Service because tremendous economies can be exercised. But I am bound to remind the hon. Gentleman that while he lauds the Service that is provided, his party was opposed to the original Act.
§ Mr. Butler
If the hon. Gentleman consults the records he will find that his party was opposed to the Act when it first came before the House as a Bill.
§ Mr. Partridge
I do not mind the hon. Gentleman maligning me, because I can stand up for myself. Incidentally, I have asked my hon. Friends on the benches round about me, and they all agree that I did not say there was any waste. What I ask the hon. Gentleman not to do is 123 to say that my party voted against the Second Reading of the Measure. There was a reasoned Amendment, and I happened to be here at the time—not on these benches, but on other benches to which I am not supposed to allude.
§ Mr. Butler
I do not want to take up too much time, but the hon. Gentleman will probably remember that during the period of office of the Labour Government we suffered the criticism that people obtained wigs under the Health Service. I did not want one, although the hon. Gentleman may have wanted one. It was suggested that people went to dentists to have their teeth out for the pleasure of extraction so that they might have false teeth.
The stack music hall joke was based on the fact that the doctors' surgeries were full of people who were taking advantage of the National Health Service. Even today in the House we have heard the criticism that people come from other countries and dare to seek medical attention when they are here. I assume that the argument is that if a person gets smallpox here we should not treat him because he does not happen to he a British subject.
One remembers the stories that used to go around about the voluntary hospitals. We know why the voluntary hospitals were established. It was to segregate the poor people who had infectious diseases so that they were not able to infect other people. Then we reached the stage where the Labour Government brought in the National Health Service.
Today, we are discussing means of finding money for the Health Service, and it is proposed that the money should be taken from people who are least able to afford it. The hon. Member for Cheadle (Mr. Shepherd), who spoke in the Second Reading debate but who is not now in his place, told us how much the railway workers earned. My hon. Friend the Member for Newcastle-upon-Tyne, West (Mr. Popplewell) was at some pains to point out that the basic rate for a porter was between £7 10s. and £7 14s. and that of a ticket collector about £8 10s. a week. My hon. Friend the Member for Newcastle-upon-Tyne, West said that 6d. a week out of this sort of wage was of considerable importance. We find that the Government have decided, once again 124 in accordance with their policy, to pass over the responsibility for financing the Health Service to the poorest section of the community.
We are discussing whether, in fact, the Health Service should be based upon the desire to keep the people healthy or whether it should be a Service for which the people have to pay direct. That is the issue involved in this Bill, and we have to consider whether that is the right way to do it. In spite of the praise that comes from hon. Members opposite about the Health Service, we have to decide the right way to carry out this Service. I have been a member of a regional hospital board since the appointed day. I have served on a regional board and on a management committee, and in my own way I have attempted to utilise public money in the most efficient way possible. On that board and management committee there are men and women of all sorts of political ideas and interests. Those men and women seek to serve the community in their own particular way.
I regret that the Minister is not present. The Parliamentary Secretary has recently addressed a letter to the chairmen of management committees telling them what they have to do in view of the financial stringency in the country. It is a two-page letter occupying three sides. So far as I am aware, the Minister has not seen fit to sign that letter, but has stuck a rubber stamp on it.
§ Mr. Butler
It is very significant. The Minister ought to understand that men and women who are giving a voluntary service like to feel that a Minister in charge of a Department recognises that they should not be addressed by rubber-stamped letters. The hon. Member for Exeter (Mr. Dudley Williams)—who may be a rubber stamp member supporting the Government—should understand that people feel that there should be a little more interest taken in their activities than by sending them a rubber-stamped letter.
I now come to the question of how far we might be able to do something about economies in the Service instead of levying this 6d. on the stamp. This point has been mentioned before. Due to the system of Treasury control, every management committee and regional 125 board, at the conclusion of every year, has to face the question of what it will do with any money that is available. I realise the difficulties. I understand that because of Treasury control we cannot carry over any money that happens to be left. I seriously suggest that it is about time that we looked at the question of how our Estimates can be used in any particular year and whether it is not possible to devise a method by which we can carry over the money which is allowed to us in particular years.
The Parliamentary Secretary will realise that careful people are very keen about utilising the money which is allocated to them in the best possible way and feel a sense of frustration if, at the end of the year, they are either worried about being over-spent or, alternatively, worried about being under-spent. Therefore, we often get a situation, both in management committees and regional hoards, where we have to either start cutting down or find an avenue in which to expend the money available to us. I seriously suggest that that is not the most effective way in which to conduct the finances of this huge undertaking.
I wish to say only one thing more, which I think my hon. Friend the Member for Barking (Mr. Hastings) touched upon on a previous occasion. Some people who have been active in the Health Service since the appointed day have felt that more attention should be given to the amalgamation of management committees. I realise that difficulties arise. Local interests have to be served. Local features of hospital administration and local vested interests have to be overcome.
I therefore hope that the Minister will look at these two matters. One is the question of the carry-over of money. The other is that more attention will be given to the question of amalgamating management committees. Then we may possibly see some of the power of regional boards, which, at present, are tending to become more and more like post offices, devolved on to the management committees.
§ 8.26 p.m.
§ Mr. Dudley Williams (Exeter)
I am grateful to have the opportunity of addressing the House upon this subject. I do not propose to say a lot about the speech of the hon. Member for Hackney, Central. (Mr. H. Butler). I was glad to 126 hear from him that the Minister of Health has not spent the whole of his time signing letters which can be better turned out on a Roneo duplicating machine. I do not think that a member of a management committee who receives such a letter, unless he is unduly sensitive, will be worried because the Minister does not spend a great deal of his personal time in signing the letter himself.
The hon. Gentleman gave us a graphic history of the development of the voluntary hospitals before they were taken over by the State. He drew a picture of how those hospitals were set up to keep the infectious away from those who were healthy. He went on to say that the Labour Government brought in the National Health Service. But there were a lot of developments in hospitals before the Service was brought into being. It will not be denied—and I am sure the hon. Gentleman did not wish to mislead the House or the public—that up to the time when the National Health Service was introduced a tremendous amount of work was done in voluntary hospitals, both for private patients and for patients who could not afford to pay a charge. They certainly were not sent to these large hospitals, many of which are well known to hon. Members. They were not kept for people suffering from infectious disease.
I thought that the hon. Member for Stoke-on-Trent, Central (Dr. Stross) would start off the same old rumour that the Tory Government were against the National Health Service.
§ Mr. Williams
We had all that during the 1950 Election. We voted against certain Amendments, and the hon. Members knows it, because the principle was wrong and we were trying to preserve a better relationship between the doctor and the patient, but we were not against the National Health Service in principle. It was my right hon. Friend the Member for Woodford (Sir W. Churchill) who got Lord Beveridge to draw up his plan on which the National Health Service was founded. Members on this side have more right to what credit there is from the National Health Service than hon. Members opposite, who certainly would not have had the nous to have had a report drawn up in the first place.
§ Sir F. Messer
It is quite true that the whole conception of the idea was not the Labour Government's. Does the hon. Member remember Mr. Henry Willinck's study of a National Health Service, which was very different to this one?
§ Mr. Williams
The National Health Service has been considerably improved since my right hon. Friend the Member for Woodford took over the Government of the country in 1951. There have been considerable improvements, and I will relate some of them later in my speech.
§ Mr. Williams
If the hon. and learned Member regards more nurses as imagination, he should get up and make his speech to ventilate his ignorance properly instead of making remarks from a sedentary position.
The hon. Member for Bilston (Mr. R. Edwards) made great play of the fact that apprentices were to be charged the extra 6d. if they were over the age of eighteen, and he said how calamitous this was for young men who were paid only £5 or £6 a week. What the hon. Member should have said at the same time is that they are paid about double as much as cadets in the Air Force who risk their lives in aeroplanes. I do not think that the apprentice has anything whatever to grumble about. He is well looked after and can well afford to pay the extra 6d. for the facilities that he will get from the National Health Service.
I want to take up a few minutes in considering which ways—[Interruption.] I thought that the right hon. Member for South Shields (Mr. Ede) was coming in to enlarge on the crack he made to my hon. Friend the Member for Twickenham (Mr. Gresham Cooke) when he asked whether my hon. Friend would advise a reduction in the number of almoners at the hospital at which his daughter worked as an almoner if it meant throwing her out of work. That is the sort of out-of-date conception that we always associate with the right hon. Gentleman. It is the sort of Luddite idea which has kept the country back against the onset of production which is typical of the United States. I only hope that the right hon. Gentleman will not make any more 128 remarks like that, because they are unhelpful, out of date and typical of the past generation—typical almost of the Victorian era, with which, I have no doubt, the right hon. Gentleman is associated.
The three methods by which the extra cost of the National Health Service can be met are by increased contributions, the method which we are considering tonight; by increased charges to those who are sick or by some form of increased taxation. I shall develop in due course my argument in support of the proposed increased contributions. I take it that nobody on the benches opposite is suggesting that we should increase charges and that the sick should pay more for the facilities they receive. The proposal which seems to be most popular with the Opposition is that there should be increased taxation.
Hon. Members opposite avoid saying where the extra taxation should fall. One hon. Member, whose constituency I forget but who is very vocal at Question Time, said that it should fall on the Surtax payers. I can speak with feeling about this, because I do not have a large income. It is most important that we should give added incentives to the people who are Surtax payers. We have had enough trouble trying to keep young men in this country because of the already heavy taxation of people earning over £2,000 a year. Any increase in the burden of taxation which falls on that section of the community is liable to drive them into the United States of America, with calamitous results to this country.
§ Mr. Williams
If the hon. Member knew a little more about the U.S.A., he would know that unemployment does not fall upon the creators of new devices. I agree that there is considerable unemployment, but one has only to look in the advertisement columns of our great national papers to see the advertisements for jobs for scientists and so on in the U.S.A., and also, of course, in Canada.
§ Mr. Cyril Bence (Dunbartonshire, East)
Surely, the people who are migrating from this country are not the Surtax payers but those in the low income groups.
§ Mr. Williams
The hon. Member is quite wrong. The advertisements to which I refer, and which he can look up in the papers in the Library today, are for scientists and people like that.
We cannot afford to lose people like that. If we lose them, then inevitably the standard of living here will become lower as a result.
§ Mr. Williams
The hon. Member has had his opportunity to make his contribution, and I have no doubt he is learning a lot from the remarks I myself am making.
§ Mr. A. S. Moody (Gateshead, East)
Is the hon. Member aware that there are no scientists in the super-tax class; they are very badly underpaid? Does the hon. Member realise that his policy means giving incentives to the super-tax payer, which is the old Tory policy of "unto him that hath"?
§ Mr. Williams
I thought we were to have a better intervention than that. If the hon. Member reads the newspapers he will see there are many jobs even in this country for scientists which are well in the super-tax class. I do not know what I can say to convince the hon. Member. He astonishes me. The Atomic Energy Commission itself is constantly advertising for scientists well in the super-tax class. I think it advertises jobs at from £2,500 to £3,500 a year. The hon. Member can see for himself if he will read the newspaper. I believe there are advertisements in today's paper to that effect, but I am not sure.
§ Mr. Williams
I do not think the Daily Worker is in the newspaper class. Anyhow, it is not a responsible newspaper. I did say "responsible newspapers."
Contributions to the National Health Service, as a result of this increase in payment of 6d., still represent only about 20 per cent. of the cost of the National Health Service. Having regard to the average wage packet today, I think that 130 the contribution is exactly the same proportion now that it was in 1948 when the National Health Service was first brought into operation.
§ Mr. Williams
It proves that the same proportion was taken away from a man's wage packet in 1948 when the Labour Government were in power.
§ Mr. Bence
I sometimes become rather fed up when these sorts of remarks are made by hon. Members opposite. The year 1948 was only three years after the most devastating war in which Britain has ever been engaged. Is the hon. Member suggesting that the ratio of certain contributions and burdens on the individual should appertain for all time because that was the ratio in 1948?
§ Mr. Williams
I am not suggesting that the National Health Service should bear the same relation to the national income as it did in 1948. I am going to develop that argument later if the hon. Member will permit me to go on with my present remarks.
My fear is that if the proportion of the contribution by each individual to the National Health Service is whittled away or is reduced to an insignificant amount some people will begin to say that people really have no right to the Service at all. It is important that people should know what is the cost of the Service. They should make a reasonable contribution, and I do not think this extra 6d. on the contribution is an unreasonable proposal.
The argument we get from the other side of the House is that the proportion of the national income which is devoted to the National Health Service is declining. While this may be so, we still spend considerably more in terms of real money under the present Government than was spent under the Socialist Government in 1949. It is true that we are paying about £80 million more per year on the National Health Service and that the Exchequer contribution amounts to about £35 million more. I do not understand 131 this argument which we constantly hear put forward from the other side, in particular by the hon. Member for Stoke-on-Trent, Central (Dr. Stross), that we should spend a greater proportion of our national income on the National Health Service. I think that this attitude shows a dismal regard for the effectiveness of the Service.
I understood that one of the great advantages of having such a Service was that it would be preventive, and that by getting people to have their teeth attended to at an early age, for example, they would lessen the demands on doctors and dentists. I think this attitude shows a serious lack of faith in the effectiveness of the Service generally, and particularly the prophylactic services.
I mentioned earlier that, in my opinion, we have a better Health Service today than we had in 1951. We also have a lower rate of infant and maternal mortality than ever before, and it is steadily declining. I am not saying that that is because we have a wise Government; that is not the only reason. True, we have been spending the money rather more wisely than did hon. and right hon. Gentlemen opposite; but, in fact, tribute must also be paid to the skill of the doctors and nursing staffs. We have more nurses today than we had in 1951, and, automatically, it is a better Service. There are fewer patients per doctor than there were in 1951, and that is a very real gain. There is not the slightest doubt that the Service is considerably better than it was.
§ Mr. Weitzman
Is the hon. Gentleman really saying that there is a change in the maternal mortality rate because we have a Tory Government?
§ Mr. Williams
I said that the Service had improved and that one of the reasons why it had improved was that we had spent more money on it, in real terms, than the hon. and learned Gentleman's Government did in 1950 and 1951.
The next point I wish to make is on the total cost per person of the Service. I do not believe that people realise what exactly they get for their contributions. It is about £30 per person which is available to each individual under the Service. I must say that this is a pretty heavy sum for the taxpayers of this country and all sections of our society to find, and I 132 wonder whether we should not have some examination to see whether, by altering the incidence of taxation or some other method, we can provide a Health Service possibly through private resources.
What I am now referring to are such institutions as the British United Provident Fund, which has an enormous number of members. When I joined, and I must declare my personal interest, it was something like 500,000 contributors. There are various other funds and insurance companies, which provide additional comforts for people when they are ill. If patients want private rooms and so on, they pay for them. I have no doubt that many hon. and right hon. Gentlemen opposite receive additional benefits in the event of illness. Most of them go to the Manor House Hospital, which I understand is a most effective organisation.
I wonder whether my right hon. and learned Friend could give some attention to this sort of scheme, and whether encouragement could be given to people, through the remission of taxation or some other technique, to join these institutions and thereby make more adequate provision for themselves and their families. In relation to the present contribution, the Bill is right. It faces the cost of the Service, and everyone in the country, in making the additional contribution, maintains his or her right to partake of the Service.
§ 8.45 p.m.
§ Mr. Douglas Houghton (Sowerby)
Things have changed a great deal since I first came to the House. We now hear hon. Members opposite claiming credit for the National Health Service. When I came to the House in 1949, I listened to nothing but nagging criticisms and denunciations of the teething troubles of the Health Service. There were wild allegations of patients coming out of chemists' shops with arms full of cotton wool and large bottles of medicine which they would never take, and there were other extravagant charges of that kind. It is reassuring to us on these benches to know that at long last hon. Members opposite recognise that the National Health Service was a bold, beneficent and revolutionary social change, brought about by the Labour Government. There is no getting behind that.
We all want to make the Health Service better, and I am sure that any 133 way in which both sides of the House can co-operate in achieving that will be for the benefit of the public. The hon. Member for Exeter (Mr. Dudley Williams) fell into error in thinking that we on these benches believe that a fixed proportion of the national income should be spent on the National Health Service, come what may. That is not our point of view.
§ Mr. Houghton
The hon. Member was very free in giving way to interruptions when he need not have done so. That delayed the course of his speech. I am working somewhat against time and, if he will permit me, I will explain what is the real attitude of my hon. and right hon. Friends.
We do not believe that a fixed proportion of the national income should be spent on the National Health Service, come what may. We believe that while there is much to be done for the Health Service we can at least afford to maintain a steady proportion of the national income in expenditure on the Health Service. That is the difference between the two.
We all hope that the time will come when the expenditure on the Health Service will be a diminishing proportion of the national income. We hope to have more experience of preventive medicine and treatment. We also hope that the rising standard of life of the people will be reflected in better health, especially if we can all become wiser in our eating, drinking and smoking, and not ourselves, by our own folly, encourage some of the illnesses and diseases which afflict mankind.
I want to put myself right with the hon. Baronet the Member for Leeds, North-East (Sir K. Joseph), because I was mistaken in an intervention which I made in his speech earlier today. I find that I fell into the same error as did the right hon. Gentleman the Minister of Pensions and National Insurance, who similarly misled the House inadvertently on 19th March last year but corrected himself in a Written Answer on 17th April last year.
The hon. Member for Leeds, North-East was reciting the achievements of the Government and bestowing much praise upon his right hon. Friends. He said 134 that among the Government's achievements was the remedying of the unjustified concession given to taxpayers in respect of the National Health Service element of the National Insurance contribution. He said that the Government were right in withdrawing the tax concession on the Health Service element in that contribution. I challenged him on that and I said that it had not been the subject of a tax concession. On going into the matter, I have since discovered that it had.
I remember criticising some of the proposals in the original Act on the taxation question. It is still true that the business man may charge against his taxable profits the whole of the contributions he pays on behalf of his employees, and the National Health Service contribution—the new one and the increased one—is included in that process. As regards the employer not in business, the principal Act last year took way from the employer of, for example, a domestic servant the right to charge against his, the employer's, tax liability the National Health Service contribution paid on behalf of his employee. That was a worsening of the Income Tax position of the employer not in business, and I wish to apologise to the hon. Baronet for having made an intervention which proved to be wrong. However, it leads me to the following point, which is fundamental to the Bill.
What the hon. Baronet was talking about was the global contribution of £40 million a year made by the National Insurance Fund to the National Health Service. Beveridge thought that, in view of the savings which the National Health Service would make on the expenses of sickness benefit of the National Insurance Fund, it was only right that the Fund should make a contribution to the expenses of the National Health Service. A round figure of £40 million a year was payable out of the National Insurance Fund to the National Health Service as a result. That was worked out as amounting to about 8d. a week per contribution, and that was the National Health Service element in the combined contribution, though it was never separately stated and never separately collected.
The Government have used that principle, turned it round, and converted it into a direct charge on the contributor to the National Health Service. I see no merit in that. I see no justification. The 135 Government have taken a round sum contribution out of the total resources of the Fund and have converted that—because they have removed that contribution altogether—into a flat-rate tax on the National Insurance contributors.
I see no justification for that, and much of the discussion has been of the hardship to the lower-paid worker. What I have challenged all along, however, is the principle of this matter. This is a shedding of the load from the general Exchequer to a form of flat-rate taxation on a specified area of the population, namely, those who make contributions under the National Insurance Scheme. There is no more real justification for linking a contribution to the National Health Service with the National Insurance contribution than there would be for linking a defence contribution with the contributors under the National Insurance Scheme.
That is where I quarrel with the principle. This is an adoption of a new form of taxation. I do not agree that the National Insurance contribution is a poll tax, because it is directly related to benefits, and money benefits at that. This certainly is a poll tax because it is not related to benefits. Not only is it a poll tax but it is discriminatory, because only those who pay National Insurance contributions pay this contribution, irrespective of claims upon the National Health Service itself.
That is our real opposition to this Bill. This is an extension of the Act of last year and we have never had any reasonable explanation why it is necessary to shed the load from general taxation to this form of taxation.
It is wrong to say that the Government are faced with unlimited expenditure on the National Health Service. That is no more true than that the Government are faced with unlimited expenditure on defence. Expenditure is limited by Budgetary provision, and it is a matter of on what the money is to be spent and how much is to be spent on development or maintenance of the Service and so on.
Therefore, the Government could make provision within the framework of the Budget and general taxation for a reasonable expenditure on the National 136 Health Service in any particular year, in just the same way that they make provision for defence, roads, education and so on. My approach remains what it has been from the beginning, not concentrated on the hardship aspect, but on the fact that this is wrong financing and a mistaken approach to the financing of the Health Service.
I conclude by saying that it is a great pity that so much Parliamentary time has been taken up with an extension of last year's Act when the Government themselves admit that there must be a reappraisal of the whole approach to social security expenditure. There was no need to foist this £24 million on National Health Service contributors this year. It could have been borne by general taxation. There is no reason for it, except that there was a rumpus inside the Cabinet which led to the resignation of the three Treasury Ministers.
That is where this Bill comes from. We might just as well fix it fairly and squarely on Cabinet troubles and disunity. It is a shame that we are confronted with the Bill when a reappraisal which is already overdue will have to be made and when it is time that the Government produced their comprehensive proposals and stopped fiddling about with additional increases of 4d. and 6d.
§ 8.57 p.m.
§ Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)
I am sorry to have to intervene so early, but I promised that the right hon. and learned Gentleman would have a full opportunity to reply to the debate. I am very glad that my hon. Friend the Member for Sowerby (Mr. Houghton) made such vigorous and sharply pointed comments on the Bill. It was refreshing to return to the Bill after a fairly lengthy tour around it. At times it seemed that we were discussing matters with which the Bill does not deal. I do not complain, because if we had been too narrowly confined we should not have had some interesting speeches.
I am very glad that the Minister of Health is to reply to the debate. We had thought that it might be his right hon. Friend and more senior colleague, the Chancellor of the Duchy of Lancaster, who is now entering the Chamber. Some of us have always expected that the right hon. Gentleman's rôle was that of Minister of Health, together with some 137 unspecified duties which we could never quite understand. It has now been made quite clear in the Press this morning that the Chancellor of the Duchy of Lancaster has assumed the complete rôle and we shall be very interested to await developments. This will no doubt be another Cabinet problem, but I shall not elaborate on this subject now, although I am sure that we shall all want to know more about it on a more suitable occasion.
At this stage, I can only wish the Minister well and hope that he may have an opportunity of taking part in health debates in the future. We wait with baited breath to see what happens and we will leave to another occasion a fuller investigation of the comments which, we understand, the Chancellor of the Duchy of Lancaster has made about the Minister of Health, and hope that the matter will be settled amicably.
This is a Chancellor of the Exchequer matter. There is no doubt, as my right hon. and hon. Friends have made clear, that it is a tragedy that the Ministry of Health should have anything to do with it. The representative of the Treasury should be here to explain it. If we could not have the Chancellor, who may be busy with other matters, the Financial Secretary to the Treasury might have come here to deal with the Bill. It is extraordinary how the roles have been crossed. Urgent health matters like the Slaughterhouses Bill have been dealt with by Ministers who are not Ministers of Health, although the measures are clearly health measures, while a matter which is clearly a Treasury affair, is being dealt with by the Minister of Health. It is very unfortunate.
We regard the Bill as being forced upon the Minister of Health by the Chancellor of the Exchequer. As my hon. Friend the Member for Sowerby pointed out, this is a miserable, shoddy little Bill. One would have thought that as it is a financial Measure introduced on a Ways and Means Resolution at least we should have had information about its financial background. Yet right up to today we have not had the Health Service Estimates on which any proper decision should have been based.
It is curious that although nearly all the other Estimates are out, these are not in the Vote Office, as I found by inquiry. It is as though the Minister of Health 138 and the Chancellor of the Exchequer were determined that we should not know the detailed figures for the Ministry of Health and the Health Service, although the proposals in the Bill are presumably based upon them.
This is an extraordinary situation. If we were to examine this proposal effectively, to decide whether this was the way to go about it, we should know something more about the Budget. Presumably the Bill fits into the design of the Budget. How can we be told? We cannot expect the Chancellor of the Exchequer to breach his silence and tell us about the Budget in advance, but what was to prevent the right hon. and learned Gentleman introducing the proposal after we had seen the Budget proposals and the Health Service Estimates? Why should not the Bill be regarded as a Measure flowing out of the Budget?
It is a fair criticism that we ought to know what the Chancellor is proposing. Is the Chancellor proposing a Budget intended to deal with an inflationary or a deflationary situation? This question has some point for this debate. We have been reading some very interesting articles in the Manchester Guardian recently by Professor Meade who was discussing the use that could be made of insurance contributions. He suggests, for example, that in a deflationary situation—some people suggest that we are coming towards such a situation now—it would be wise for the Government to cancel contributions either in whole or in part.
If this Bill is being seriously argued and put forward by a person of some eminence it is crazy to be discussing the proposals in the Bill without the background information that we ought to have. We have no idea of the Chancellor's general proposals or of the details of the Health Service Estimates.
It might be that if the Chancellor of the Exchequer were to follow the advice of Professor Meade and to decide that we were moving rapidly, rather uncomfortably, into a deflationary situation he might make suggestions for a remission of the very contributions now being put into force. What a ridiculous situation this is. This is an ill-conceived and not very carefully thought out proposal which has been rushed in in a panic to try to heal a Cabinet split which, as we all know, occurred some little time ago.
139 As many hon. Friends have said, we cannot regard the Government's proposal in isolation from the many other changes which the Government have introduced in the contribution pattern over the last few months. Hon. Members opposite talk about administrative costs, but what could be more wasteful in administrative labour and expense than the continuous alterations and changes of the past nine months? Who knows how many more are to come? There have been three major changes in National Insurance and Health Service contributions. This is an extraordinarily stupid method of dealing with the problem.
We have the right to ask, as has been pointed out by my hon. Friend the Member for Sowerby and others: what are the real intentions of the Government? Are they proposing to place the Health Service to a much larger extent on an insurance basis? When I raised this matter on a previous Government Bill, I was told that that was not so, that they had no such intention. Yet, within a few months, they come back to the House and increase the insurance proportion. We cannot easily be put off by hon. Members opposite saying it is not their intention to put the Health Service on to an insurance contribution basis, for that is what we are confronted with month by month. We have the right to press the right hon. and learned Gentleman to make the position of the Government clear. Is this a once-for-all? Are we now finishing with repeated approaches to the House for further additions to the level of contributions?
My hon. Friend the Member for Sowerby and my hon. Friend the Member for Tottenham (Sir F. Messer) pointed out how ill the two Services assort with each other. This attempt to forge some kind of link between the insurance principle and Health Service financing is a very unsatisfactory one. It is quite clear that no real thought has been given to the question. The insurance contribution has always been regarded as a contribution for a specific benefit, but hon. Members in all parts of the House agree that it does not apply in this case.
In this case there is no proposal to disenfranchise the person who is not making an insurance contribution. There is no 140 such proposal yet, but we do not know whether it will come. We are assured that they will still get their Health Service benefits. It may be, logic notwithstanding, that the right hon. and learned Gentleman will come forward with proposals to wipe that out.
This is a poor, botched-up effort. We have not had any sort of reply as to whether, if the Government intend to introduce more of this insurance principle into our Health Service—with which we disagree, as we see no relation between the two—they will continue to levy the charges on the Service as a whole.
Hypocritical comments have been made about the Labour Government introducing charges for spectacles and dentures. With their hands on their hearts, hon. Members opposite have said, "It is terrible to impose charges upon the sick and the ill." In fact, right hon. and hon. Members opposite have been imposing charges upon the ill and the sick through prescription charges, treatment charges, dental charges and all the rest. Broadly, all the charges which we have today upon the sick are those which right hon. Gentlemen opposite have introduced. Not only have they itnroduced them, but they have swept aside the recommendations of the Guillebaud Committee and, in certain cases have increased them, in spite of the fact that the Guillebaud Committee recommended their abolition in some cases and clearly insisted that there should be no increase.
That is the faith which we can have in the protestations of right hon. and hon. Members opposite about the future. It is fair that I should ask whether they have any proposals for the abolition of the charges or for their absorption within this form of insurance charge, as some hon. Members opposite have suggested.
Some of my hon. Friends have made it clear that the charges which the Labour Government introduced were temporary, and I should like to know why there is no provision in the Bill for a review of the present proposals. If these are proposals to meet a particular financial difficulty in this year—although we see no reason why that should be the case—why is there no arrangement for the review or termination of this extra contribution and for a reconsideration such as we provided? Why have not the Government provided for the position to be reviewed 141 next year or the year after that, if that is the period of financial emergency which they are considering?
My hon. Friends have rightly insisted upon the effect of these proposals, not alone but together with the pattern of past Government proposals, upon working people and the claims which they are inevitably making for increases in wages. They have pointed out the dangerous effect which this could have upon the economy. It is no use right hon. and hon. Members opposite saying that it is only 6d., because this is 6d. in addition to the other charges imposed a few months ago, and in the minds of the great body of working people they will all be classed together.
We are trying to make clear to right hon. and hon. Members opposite that it is the cumulative effect of these charges which could be so serious. Moreover, it is difficult to think of any other time which could have been chosen which would have been less apt for the proposals. We know that a great deal of the overtime which has previously been worked has now ended.
In many parts of the country there are anxieties and fears about the security of work, and with some justification. I do not propose to exaggerate the difficulties, because we all hope that we shall rise out of them, but we are seriously concerned about the increase in the amount of unemployment and the particular effect which it is having in certain areas.
Very real anxiety has been created in those areas. Surely this is the very worst moment for any proposal for increasing contributions to be paid by the individual workers. Half the earnings figures quoted by hon. Members opposite relate, of course, to some little time past, and have no bearing on the present conditions, or the future conditions that we may well have to face.
Therefore, there is a very logical case for asking the Government at least to postpone and reconsider the Bill. I seriously ask right hon. and hon. Gentlemen opposite to think very carefully indeed before there is further progress with the Bill through another place. This is our last opportunity, possibly, to consider it in this House. As I was saying, it is a botched, quickly trumped-up Measure that bears no relation to the economic situation of today, so that I 142 very much hope that the party opposite will, even now, make a gesture towards us and the working people by withdrawing this present proposal.
The debate has run surprisingly widely, perhaps, and in the course of the discussion on what I might fairly have called Clause 3 of the Bill, had it been there, some interesting comments have been made upon the activity of the Labour Government in developing a Health Service as contrasted with the work done in more recent years by the present Administration. We have again had trotted out the argument that during its tenure of office the Labour Government did not build any new hospitals, and the impression was created that there were no real health developments in that period.
What utter nonsense all this is. As everybody knows, there was the most rapid expansion we have known in the hospital service not, it is true, by means of building new hospitals but by the development of the existing ones, by the increase in the number of beds, and by the enormous improvement in their quality.
The official figures will tell anyone who cares to inquire that between 1949, and 1951, when the Labour Government went out of office, there was an expansion of 14,000 beds. From 1951 to the end of 1956 and those are the latest figures that I have—there was another expansion of 14,000 beds. That is to say, we managed to do in two years what the Conservative Government have been able to do in four years. One could quote any number of figures to show the tremendous expansion there was in those early days in the provision of additional specialist advice and all the rest of it, and the real reorganisation that went on.
I do not for a moment claim that that has ended. We all, I hope, take pride in the development of the Service, but what I rather despise is this attempt to suggest that because no new hospital, as such, was built in those years, the Health Service was neglected, and not developed. Everybody who has any contact with the Service at all knows that that is not true.
Another matter which has been referred to and which comes into our consideration of the Bill on Third Reading, is that if we do not approve of this method 143 of raising the finances what do we propose? Some hon. Members seem to have the impression that extra money is required to enable a new expansion of the Health Service to take place. I think the Minister will agree with me that that is not the case. He might wish it were. But this is not a question of finding means to provide additional services. In fact, we may find when we come to discuss the Estimates, which, I repeat, we have not got, and consider them in detail that in very many cases there have been quite serious cuts in provisions in hospitals and elsewhere.
No, this is merely an attempt to maintain in some fields existing expenditure—and not wholly that either. This is a treasury dictate, in effect. Therefore, we must try to disabuse the minds of hon. Members opposite who think that this is a capital way of trying to enable the Health Service to expand and provide even more valuable service than it did before.
What other methods are there? We say, as many of my hon. Friends have said, that we would think it much preferable to raise the finances necessary for the Health Service through the ordinary Exchequer receipts. We can see no reason why this cannot be done, particularly in view of what, in our view, are some forms of wasteful expenditure. To give one example, there is the level of interest charge payments which the Government have imposed upon us, placing some hundreds of millions of pounds more upon the Exchequer in payments than would otherwise have been the case. There are not only the examples of extravagance which my hon. Friends have made clear, but we could quote many examples of the results of the Government's policy which we feel should have been altered before being asked to approve a proposal of this sort.
I was very glad to hear the comments of the hon. Lady the Member for Wythenshawe (Mrs. Hill), who brought a refreshing and realistic view of some of the problems of our Health Service expenditure. If the hon. Lady looks at certain comments that I made in the House on a rather similar subject, about the use of drugs for the treatment of tuberculosis, she will find that our ideas are not very far apart on that matter. I hope that I can recruit her support in trying to secure 144 some economy or some further examination of this problem of tranquillisers. I mention that in passing, because we have had quite a bit of discussion already about drugs, and I do not want to overdo it, but I am still worried about the situation.
The Chief Medical Officer of Health, in his Annual Report, has expressed anxiety about this matter, and it seems to me curious that the Government cannot produce figures to show what we are spending in this field. Many doctors are concerned about this, and would like to see some investigation made. They are anxious about it not merely from the point of view of the expenditure of money, but also from the point of view of what are proper medical controls.
We must all have been worried by the attitude that many hon. Members opposite seem to have adopted. Many of us are left with the feeling that this proposal of the Government's is only one step presaging a very doubtful future. This is a proposal which takes a second step, moving us away from the concept of financing the Health Service which we wish to see. I wish we could get back to that concept which my hon. Friend the Member for Barking (Mr. Hastings) movingly and sincerely referred to, and which was in our minds when the Health Service was started, that the health of each is the concern of all. That is the true definition of our concept of the Health Service. It is because we believe that this is a step away from that concept that we resist this Bill so vigorously.
§ 9.25 p.m.
§ The Minister of Health (Mr. Derek Walker-Smith)
I agree with the hon. Member for Newcastle-upon Tyne, East (Mr. Blenkinsop) that we have succeeded in having a very interesting discussion on Third Reading in spite of the fact that the Bill has been so heavily and closely debated over the last two or three weeks. I also agree with him to a not inconsiderable extent that we are indebted for the interest of the discussion to the liberal attitude taken by the Chair. I have certainly heard many points of great interest, upon some of which I should like to comment.
I am spared from what would have been a most difficult task which I was asked to undertake. I was asked by my 145 hon. Friend the Member for Leeds, North-East (Sir K. Joseph), in his admirable speech, to arbitrate on a technical issue of taxation between himself and he hon. Member for Sowerby (Mr. Houghton). However, I am glad not to have to do that. After research into the matter, I was preparing to give judgment in favour of my hon. Friend, but the hon. Member for Sowerby has, in a handsome way, admitted error, which, of course, on a matter of taxation, is a most unusual thing for him. It may be of comfort to hon. Members who, like myself, find these technical matters by no means free from hazard and difficulty, that even Homer can nod in the person of the hon. Gentleman in the sphere in which he is very expert.
At the conclusion of this interesting final debate, the case for the Bill still rests on three clear basic propositions. First, the total cost of the National Health Service is growing, and I cannot, as I explained on Second Reading, guarantee any immediate reduction in, or even any immediate containment of, the total cost of the Service. I hasten to reassure my hon. Friend the Member for Twickenham (Mr. Gresham Cooke), and other hon. Members who spoke about the economies in the Service, that in the long run I take a more hopeful view, as I explained in detail on Second Reading.
We are, of course, as I then explained, already pursuing the question of organisation and methods and work study and the various techniques to which both he and my hon. Friend the Member for Manchester, Wythenshawe (Mrs. Hill) have referred this evening. But in the immediate context, as it is not possible to guarantee a reduction or curtailment, we must have more money. That is the first proposition.
The second proposition is that we on this side of the House cannot accept the principle of an unlimited Exchequer liability. That being so, it follows that if we reject the concept of cuts in the Service we must either increase contributions or increase charges for prescriptions, appliances and the like. As has been explained in the earlier debates on the Bill, we have preferred an increase in contributions to an increase in charges, because of the principle that it is better, if take we must, to take from those who 146 are earning and well rather than from those who are anxious and sick.
Those are the three basic propositions upon which the case for the Bill rests. The Bill cannot be opposed logically except on one of these three grounds. Either first, we should cut the Service; or, secondly, we should increase charges rather than contributions; or, thirdly, we ought to accept the principle of unlimited Exchequer liability. In the course of these debates, no hon. Member opposite, as far as I can recollect, has advocated either of the first two courses. And it has been significant that the Opposition have been very coy about announcing any acceptance of the third principle: that is to say, unlimited Exchequer liability. The right hon. Member for Middlesbrough, East (Mr. Marquand) got very near to it this afternoon when he said that hon. Members on his side of the House would gladly accept an increase of two or three times the £32 million in the Bill so long as the method of getting it was not the present method. Whether the right hon. Gentleman meant that to be an unqualified acceptance of the principle of unlimited Exchequer liability for the National Health Service, was not very clear.
The right hon. Gentleman and his hon. Friend the Member for Newcastle-upon-Tyne, East both described the Bill in harsh terms as ill-conceived, unjust and inequitable. I may not have got all the epithets quite right, but they gave a clear indication between them that they did not like it very much. Therefore, I address myself first to the question whether there is anything inherently unjust, inequitable or improper in what is essentially a modest increase; and I say that there is not.
To answer the question, we have to look at various factors—at who is paying this modest increase, at the general pattern of consumer expenditure in relation to it, at the allegation that this is a regressive tax, which has run so much through the speeches of hon. Members opposite, and last, but by no means least, the point stressed by my hon. Friend the Member for Wythenshawe in her admirable speech, at what the contributors are getting in return.
On the point of who is making the increased contribution, the important thing is who is not paying it. It does 147 not involve people in receipt of retirement pensions or of unemployment benefit, nor does it involve, for example, people in receipt of National Assistance. Thus, it does not affect those who are normally considered to be the most vulnerable sections of the community in matters of this sort.
We have debated, more particularly in Committee, whether various categories have any proper claim to preferential treatment or to exemption. The hon. Member for Newcastle-upon-Tyne, East has put some wide questions about our future thinking on this matter. These matters have to be looked at in the broader National Insurance picture. As the hon. Member knows, and as my hon. Friend the Parliamentary Secretary told the House earlier, the Government are engaged in reviewing the financial basis of National Insurance.
§ Mr. Blenkinsop
If the Minister is saying that the Government are engaged in a review of this matter, does that mean that in all probability we shall have another set of proposals concerning the Health Service contributions within a few months?
§ Mr. Walker-Smith
It would not be for me to peer into the crystal in this context. I am engaged with the modest increase embodied in this National Health Service Contributions Bill. It would, obviously, be quite wrong and impracticable in the context of a modest adjustment to what is only the minor element in the weekly contribution to embark upon any variations of the traditional pattern. The review is going on and, for the purposes of this modest increase, we have—properly. I would say—followed the traditional pattern.
I think that the right hon. Gentleman the Member for Middlesbrough, East and the hon. Gentleman the Member for Barking (Mr. Hastings) and, of course, some of my hon. Friends have agreed that this is a modest increase in terms of money, and it is certainly a very modest increase in terms of the proportion which this amount bears to total earnings. Take average earnings for as recently as October last; the average men's earnings were £12 11s. 7d. a week. This increase of 6d. is only one-fifth of 1 per cent. of that amount, and the whole National 148 Health Service contribution is only three-quarters of 1 per cent.
§ Mr. Blenkinsop
This is just the point I tried to make. Why is the right hon. Gentleman going back to October last year when we all know that there are all the anxieties about the present position and about the future dangers of a fall, in the amount of overtime and even dangers to the retention of employment?
§ Mr. Walker-Smith
I think the hon. Member realises that I take that month because those are the latest official statistics available to me, and it would be quite wrong to conjecture and to go beyond what actual statistics there are.
When we look at the smallness of the percentages it is obvious that, even if we take a lower wage, for the reason the hon. Gentleman has suggested, or if we look at people who are earning less than the average, even then the percentages will be tiny in relation to total earnings. No amount of exaggeration—and hon. Gentlemen have scraped the barrel on this, and with great ingenuity, during our debates—no amount of equivocation, no amount of ingenuity can get away from those figures, which show beyond a peradventure what a very small percentage this is of average earnings or even of earnings less than average.
§ Mr. Marquand
When we were talking about the regressive nature of this we said—I know I did myself—that we had to take the National Health Service contribution into account with the big increases in National Insurance contributions, and those are a quite considerable proportion.
§ Mr. Walker-Smith
But the National Insurance contributions, which are not in issue here because they are not part of this Bill, are for benefits. They are for benefits in cash. Here we are considering this modest increase in what, I submit, is a modest total health contribution, which is paid by the contributor on the insurance principle in return for the great benefits he gets through a National Health Service unequalled in any other country in the world.
Before I come to the right hon. Gentleman's point about the regressive nature of the increase, let me put before the House the amount of the increase in the 149 context and pattern of the trend of consumer spending. There has been a great change in consumer spending in the years since the Labour Party went out of office. There is far more consumer spending, illustrating the higher standard of life which the people of this country have attained under the Conservative Government. [Interruption.] I think the right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) should be a little more careful in citing by-elections, because we are not nearly at the end of the road yet. I think that the right hon. Gentleman will find when we arrive at the General Election that the result will be much more favourable to us than he is at present inclined to think and to hope. If the right hon. Gentleman will stump a little more often in by-elections himself, then we shall get an improvement all the quicker. We shall do a little better presently.
Taking the figures at 1948 steady prices, there has been an increase in consumer expenditure between 1951, when the Labour Government mercifully went out of office, and 1956 of no less than £1,067 million. In 1957, for the three-quarters of the year for which figures are so far available, there has been a continued steady increase in consumer spending. The hon. Member for Barking mentioned tobacco and drink. In real terms, there was an increase in that year of 2.8 per cent. in expenditure on alcoholic drinks, of 3.2 per cent. on tobacco and of 10.9 per cent. on durable household goods. Is not it reasonable in that pattern of increased consumer expenditure, that some tiny proportion, such as we here propose, should be spent in return for the most precious commodity of all?
To come to the right hon. Gentleman's point about the regressive nature of this increased contribution, we are here concerned, broadly, only with those who are earning, because the retired and the unemployed do not have to pay the contributions. Therefore, I think I could summarise the Opposition's case on this point not unfairly in this way. The lower-paid workers would be better off if the extra cost were borne on taxation, because they do not have to pay taxes, or, if they do, they do not pay very much. I think that that is not an unfair précis of the case as put by hon. and right hon. Gentlemen opposite.
150 Then, of course, the question immediately arises: why do not the lower-paid workers pay any tax, or why do they pay so little? The answer, of course, is that they have been exempted from tax by the actions of Conservative Chancellors of the Exchequer. [Interruption.] Certainly. Perhaps the right hon. Member for Ebbw Vale may not be interested in these figures, but the right hon. Member for Middlesbrough, East, who, we know, does not always see entirely eye to eye with his right hon. Friend, may find them of some interest.
In the 1951 Budget—the Budget of the present Leader of the Opposition—a single man came into tax liability when he received £2 12s. 11d. per week. Now, he does not come into tax liability until he gets £3 9s. 3d. An hon. Member mentions the cost of living. I expected that, and adjusted the figures as a precaution, thinking that an hon. Gentleman might put that question. Adjusted, it is £2 16s. 9d., which is still appreciably above the 1951 figure.
A married man with a child between the ages of 11 and 16 came into tax liability under the Labour Budget of 1951 at £6 5s. per week. Now, he does not come into tax liability until he receives £9 Os. 6d. a week. A married man with two children, under the Labour Budget, came into tax liability at £7 18s. 8d. a week. Now, under a Conservative Budget, he does not come into tax liability until somewhere between £10 17s. 7d. and £13 7s. a week, according to the ages of his children.
Finally, a married man with three children—an especially deserving class in the community—came into tax liability at £9 12s. 4d. under the Labour Budget, and, as the result of Conservative Budgets, does not come into liability now until between £13 7s. and £17 Is. 2d. [Interruption.] I am not surprised that hon. and right hon. Gentlemen opposite do not like these figures. What they show is that where Labour Chancellors have bound, Conservative Chancellors have loosed; where Labour Chancellors have taken away, Conservative Chancellors have restored.
I would ask this question against the background of their action when in power. What are we to think of the sincerity of the protestations now made by hon. and right hon. Members opposite for 151 the welfare of the lower-paid workers when they, when they had the opportunity, extracted taxation unto the uttermost farthing? Against the background of their previous conduct, what are we to think of their good faith in making allegations of harsh treatment against this Government? Their accusations, in the face of their previous conduct, are about as convincing as if the Artful Dodger made charges of petty larceny against Mr. Pickwick.
§ Mr. Blenkinsop
I was hoping that the right hon. and learned Gentleman would go on. We do not want to stop him. I was hoping that he would give us also figures for the Surtax payers, to round off the picture.
§ Mr. Walker-Smith
Right hon. Gentlemen opposite had their hands in every taxpayer's pocket quite indiscriminately. I appreciate that, but I am facing the case made by right hon. Gentlemen opposite in respect of the lower-paid workers, and I have demonstrated quite clearly and conclusively on statistical evidence what a very poor, hypocritical argument theirs is.
The contributors here are getting very good value in return for their contributions, not only in relation to other countries but in relation to what they were getting under the Labour Government. Comparing what they get now with what they got then, the number of hospital beds and of hospital doctors, and the number of patients treated have all gone up under Conservative administration. The mortality rate, hospital admission lists, and the time taken for treatment have all gone down. There are more sight tests, there is more dental treatment, there are more health visitors and more home helps.
The hon. Member for Newcastle-upon-Tyne, East, in one of the more brazen parts of a not particularly modest speech, actually had the effrontery to enter the lists about hospital building. In the days of the Labour Government there was no hospital building. There was hospital building in the five continents of the world, but there was none in Britain. 152 There was hospital building for Europeans in Switzerland and for Africans in Swaziland, but no hospital building here in Britain for the British under a Labour Government.
§ Mr. Blenkinsop
Really, the right hon. and learned Gentleman should not get away with this again. I correctly gave a perfectly fair account of the situation and the actual figures of the extra beds we had provided in that time. The right hon. and learned Gentleman cannot get away from that.
§ Mr. Walker-Smith
The hon. Member claims to have provided more hospital beds, without providing more hospitals, and in the next breath he makes allegations of the overcrowding of hospitals. Today we have fourteen major hospitals in progress or approved. New wards, new out-patient departments, new casualty departments, new operating, theatres, have come and continue to come into being. In money terms, in 1949 £91 million only were spent. This year we are spending £20 million on hospital construction, next year £23 million, and in the year after that we shall spend £25 million. [An HON. MEMBER: "You will not be there."] If, by any mischance, the Conservative Government were not there then, of course, my figures would not hold good and we should no doubt revert to £9½ million.
I believe that the Government have made their case on this Bill, and it is clear that the Opposition have not made theirs. They have not even informed the House whether or not they accept the principle of unlimited Exchequer liability, because the right hon. Gentleman did not take the opportunity to explain when I gave him the chance. If they do not accept that principle then they should not be opposing this Bill. If they accept the principle of unlimited Exchequer liability then perhaps in the closing minutes of this long debate somebody will answer the question, which has not yet been answered by the Opposition, why it was necessary to impose the ceiling on Exchequer liability in 1950 and again in 1951? [An HON. MEMBER: "The Korean war"?] Did I hear somebody say, "The Korean war"? I think I did. Sir Stafford Cripps imposed the ceiling in April, 1950, and the Korean war did not start 153 until June, 1950. Hon. Gentlemen opposite have more ingenuity than accuracy when they try to put that forward as a reason.
Nobody has yet answered the conundrum which I ventured to put in the debate on the Ways and Means Resolution: when is a ceiling not a ceiling? I must try to answer it myself. I suppose it is when there is a change of bench. We have the advantage of the presence here of the right hon. Gentleman the Member for Ebbw Vale but we have not got the advantage of the presence of the right hon. Gentleman who might be expected to give an answer to this question. Where is the Leader of the Opposition?
§ Mr. Walker-Smith
No. It was the right hon. Gentleman who imposed the telling in 1951. Does he think now that discretion is the better part of valour in this delicate matter? Does he think that perhaps the reasoned and statistical processes which brought him to impose the ceiling in 1951 might, in the new partisan atmosphere of Labour Party politics, lead to a comparison with a desiccated calculating machine?
§ Mr. Walker-Smith
I see that the right hon. Gentleman remembers the quotation though he does not seem now to relish it as much as he did.
§ Mr. Aneurin Bevan (Ebbw Vale)
On the contrary. I do not know what expression I was wearing, but I was highly amused by the performance of the right hon. and learned Gentleman. He is far better in his part at the hustings than as Minister of Health.
§ Mr. Walker-Smith
I know it is embarrassing to have these skeletons brought out of the Labour Party's cupboard. I know it is particularly difficult for the right hon. Member for Ebbw Vale and for the right hon. Gentleman the Leader of the Opposition now that they are in this period of reconciliation and friendship. Of course I understand that, having had their modern Labour Party equivalent of the Field of the Cloth of Gold, it is not very nice to be reminded of the bad old days of the Hundred Years War.
§ Mr. Walker-Smith
The Opposition do not make their position clear on the economics of the National Health Service and we are now in the quandary whether to judge them by past performance or by present protestations. If the Opposition now take the view, as they did not in those days, that we can insulate the cost of the National Health Service from the general economic position of the country, then I believe that it bodes ill for the future of the social services in general, and for the National Health Service in particular, if ever the Labour Party again gets back to power.
If it is the belief of the Labour Party that these services can be continued irrespective of any weakening of our general economic position, then the sort of policies which right hon. Gentlemen opposite would introduce, according to their present thinking in these matters, would be such that it would not be a case of our living beyond our means, but of being in great danger that we would die beyond our means.
§ Mr. Woodburn
The right hon. and learned Gentleman seems to be arguing that if the country is in danger, what we have to do is to find economies in the Health Service. He says that if we cannot afford these services, we have to cut them down and that means that the first thing to be cut is the Health Service.
§ Mr. Walker-Smith
No, Sir. I have said that as we cannot guarantee a reduction or containment in the immediate future of the total cost of the Health Service, we have to find more money and this is the best method of finding it. That is the argument I have been putting forward. What we do not know from the right hon. Gentleman is what would be the attitude of the Opposition towards these contributions, if the electorate gave them the chance.
The Opposition have said that they would remove charges, if elected, but they have not said what they would do about the contributions. It would not be any surprise to me if they gave this added hostage to fortune in addition to all the promises they have already made, because it would be just one more piece of evidence that their desire for power is eroding their sense of responsibility. 155 Some of the promises we have had have been such that if they are made by the Opposition without knowing their effect on the national economy, then their ignorance is a public danger. If, on the other hand, they make these promises while subordinating their knowledge to their desire for power, then their bad faith is a public crime.
The Government have sought to do their duty by submitting this Bill. We have sought to do our duty to both the general economy and the National Health Service, because we believe that we can
§ maintain the full strength and scope of the National Health Service and the social services generally only in the context of a sound national economy and strong sterling. The Government have done their duty, but the Opposition have failed in theirs. They have a bad case, a bad record, a bad policy, and should have a bad conscience and I ask the House to decide between us now.
§ Question put, That the Bill be now read the Third time:—
§ The House divided: Ayes 307, Noes 237.159
|Division No. 75.]||AYES||[9.58 p.m.|
|Agnew, sir Peter||Crowder, Sir John (Finchley)||Harvey, Sir Arthur Vere(Macclesf'd)|
|Aitken, W. T.||Crowder, Petre (Rulslip—Northwood)||Harvey, Ian (Harrow, E.)|
|Allan, R. A. (Paddington, S.)||Cunningham, Knox||Harvey, John (Walthamstow, E.)|
|Alport, C. J. M.||Currie, G. B. H.||Harvie-Watt, Sir George|
|Amery, Julian (Preston, N.)||Davidson, Viscountess||Hay, John|
|Amory, Rt. Hn. Heathcoat (Tiverton)||D'Avigdor-Goldsmid, Sir Henry||Heald, Rt. Hon. Sir Lionel|
|Anstruther-Gray, Major Sir William||Deedes, W. F.||Heath, Rt. Hon. E. R. G.|
|Arbuthnot, John||Digby, Simon Wingfield||Henderson, John (Cathcart)|
|Armstrong, C. W.||Dodds-Parker, A. D.||Hesketh, R. F.|
|Ashton, H.||Donaldson, Cmdr. C. E. McA.||Hicks-Beach, Maj, W. W.|
|Astor, Hon. J. J.||Drayson, G. B.||Hill, Mrs. E. (Wythenshawe)|
|Atkins, H. E.||du Cann, E. D. L.||Hill, John (S. Norfolk)|
|Baldock, Lt.-Cmdr. J. M.||Dugdale, Rt. Hn. Sir T. (Richmond)||Hirst, Geoffrey|
|Baldwin, A. E.||Dunean, Sir James||Hobson,John(Warwick & Leam'gt'n)|
|Balniel, Lord||Duthle, W. S.||Holland-Martin, C. J.|
|Barber, Anthony||Eccles, Rt. Hon. Sir David||Hope, Lord John|
|Barlow, Sir John||Eden, J. B. (Bournemouth, West)||Hornby, R. P.|
|Barter, John||Elliot,R.W.(Ne'castle upon Tyne,N.)||Hornsby-Smith, Miss M. P.|
|Baxter, Sir Beverley||Emmet, Hon. Mrs. Evelyn||Horobin, Sir Ian|
|Bell, Philip (Bolton, E.)||Errington, Sir Eric||Horsbrugh, Rt. Hon. Dame Florence|
|Bell, Ronald (Bucks, S.)||Erroll, F. J.||Howard, Gerald (Cambridgeshire)|
|Bennett, F. M. (Torquay)||Farey-Jones, F. W.||Howard, Hon. Greville (St. Ives)|
|Bennett, Dr. Reginald||Fell, A.||Howard, John (Test)|
|Bevins, J. R. (Toxteth)||Finlay, Graeme||Hughes Hallett, Vice-Admiral J.|
|Bidgood, J. C.||Fisher, Nigel||Hulbert, Sir Norman|
|Biggs-Davison, J. A.||Fletcher-Cooke, C.||Hurd, A. R.|
|Bingham, R. M.||Forrest, G.||Hutchison, Michael Clark (E'b'gh, S.)|
|Birch, Rt. Hon. Nigel||Fort, R.||Hutchison, Sir Ian Clark (E'b'gh, W.)|
|Bishop, F. P.||Foster, John||Hutchison, Sir James (Scotstoun)|
|Black, C. W.||Fraser, Hon. Hugh (Stone)||Hyde, Montgomery|
|Body, R. F.||Fraser, Sir Ian(M'cmbe & Lonsdale)||Hylton-Foster, Rt. Hon. Sir Harry|
|Boothby, Sir Robert||Freeth, Denzil||Iremonger, T. L.|
|Bossom, Sir Alfred||Galbraith, Hon. T. G. D.||Jenkins, Robert (Dulwich)|
|Bowen, E. R. (Cardigan)||Gammans, Lady||Jennings, J. C. (Burton)|
|Boyd-Carpenter, Rt. Hon. J. A.||Garner-Evans, E, H.||Jennings, Sir Roland (Hallam)|
|Boyle, Sir Edward||George, J. C. (Pollok)||Johnson, Dr. Donald (Carlisle)|
|Brains, B. R.||Gibson-Watt, D.||Johnson, Eric (Blackley)|
|Braithwaite, Sir Albert (Harrow, W.)||Glover, D.||Johnson, Howard (Kemptown)|
|Bromley-Davenport, Lt.-Col. W. H.||Godber, J. B.||Jones, Rt. Hon. Aubrey (Hall Green)|
|Brooke, Rt. Hon. Henry||Gomme-Dunean, Col. Sir Alan||Joseph, Sir Keith|
|Brooman-White, R. C.||Goodhart, Philip||Joynson-Hicks, Hon. Sir Lancelot|
|Browne, J. Nixon (Craigton)||Gough, C. F. H.||Kaberry, D.|
|Bryan, P.||Gower, H. R.||Keegan, D.|
|Bullus, Wing Commander E. E.||Graham, Sir Fergus||Kerby, Capt. H. B.|
|Burden, F. F. A.||Grant, W. (Woodside)||Kerr, Sir Hamilton|
|Butler,Rt.Hn.R.A.(SaffronWalden)||Grant-Ferris, Wg Cdr. R.(Nantwich)||Kimball, M.|
|Campbell, Sir David||Green, A.||Kirk, P. M.|
|Channon, Sir Henry||Gresham Cooke, R.||Lagden, G. W.|
|Chichester-Clark, R.||Grimond, J.||Lambton, Viscount|
|Clarke, Brig. Terenee (Portsmth, W.)||Grimston, Hon. John (St. Albans)||Lancaster, Col. C. G.|
|Cole, Norman||Grimston, Sir Robert (Westbury)||Langford-Holt, J. A.|
|Conant, Maj. Sir Roger||Grosvenor, Lt.-Col. R. G.||Leather, E. H. C.|
|Cooke, Robert||Gurden, Harold||Leavey, J. A.|
|Cooper, A. E.||Hall, John (Wycombe)||Leburn, W. G.|
|Cooper-Key, E. M.||Hare, Rt. Hon. J. H.||Legge-Bourke, Maj. A. E. H.|
|Cordeaux, Lt.-Col. J. K.||Harris, Frederic (Croydon, N.W.)||Legh, Hon. Peter (Petersfield)|
|Corfield, Capt. F. V.||Harris, Reader (Heston)||Lennox-Boyd, Rt. Hon. A. T.|
|Craddock, Beresford (Spelthorne)||Harrison, A. B. C. (Maldon)||Lindsay, Hon. James (Devon, N.)|
|Crosthwaite-Eyre, Col. O. E.||Harrison, Col. J. H. (Eye)||Lindsay, Martin (Solihull)|
|Linstead, Sir H. N.||Nicolson, N. (B'n'm'th, E. & Chr'ch)||Stanley, Capt. Hon. Richard|
|Llewellyn, D. T.||Noble, Comdr. Rt. Hon. Allan||Stevens, Geoffrey|
|Lloyd, Maj. Sir Guy (Renfrew, E.)||Nugent, G. R. H.||Steward, Harold (Stockport, S.)|
|Longden, Gilbert||Ormsby-Gore, Rt. Hon. W. D.||Steward, Sir William (Woolwich, W.)|
|Low, Rt. Hon. Sir Toby||Orr, Capt. L. P. S.||Storey, s.|
|Lucas, Sir Jocelyn (Portsmouth, S.)||Orr-Ewing, Charles Ian (Hendon, N)||Stuart, Rt. Hon. James (Moray)|
|Lucas, P. B. (Brentford & Chiswick)||Osborne, C.||Studholme, Sir Henry|
|Lucas-Tooth, Sir Hugh||Page, R. G.||Summers, Sir Spencer|
|McAdden, S. J.||Partridge, E.||Sumner, W. D. M. (Orpington)|
|Macdonald, Sir Peter||Peel, W. J.||Taylor, William (Bradford, N.)|
|McKibbin, Alan||Peyton, J. W. W.||Teeling, W.|
|Mackie, J. H. (Galloway)||Pickthorn, K. W. M.||Temple, John M.|
|Maclay, Rt. Hon. John||Pike, Miss Mervyn||Thomas, Leslie (Canterbury)|
|Maclean, Sir Fitzroy (Lancaster)||Pilkington, Capt. R. A.||Thomas, P. J. M. (Conway)|
|McLean, Neil (Inverness)||Pitman, I. J.||Thompson, Kenneth (Walton)|
|Macleod, Rt. Hn. Iain (Enfield, w.)||Pitt, Miss E. M.||Thompson, R. (Croydon, S.)|
|MacLeod, John (Ross & Cromarty)||Powell, J. Enoch||Thorneycroft, Rt. Hon. P.|
|Macmillan,Rt.Hn.Harold(Bromley)||Price, David (Eastleigh)||Thornton-Kemsley, Sir Colin|
|Macmillan, Maurice (Halifax)||Price, Henry (Lewisham, W.)||Tiley, A. (Bradford, W.)|
|Macpherson, Niall (Dumfries)||Prior-Palmer, Brig. O. L.||Tilney, John (Wavertree)|
|Maddan, Martin||Profumo, J. D.||Turner, H. F. L.|
|Maitland, Cdr. J. F. W, (Horncastle)||Ramsden, J. E.||Turton, Rt. Hon. R. H.|
|Maitland, Hon. Patrick (Lanark)||Rawlinson, Peter||Tweedsmuir, Lady|
|Manningham-Buller, Rt. Hn. Sir R.||Redmayne, M.||Vane, W. M. F.|
|Markham, Major Sir Frank||Rees-Davies, W. R.||Vaughan-Morgan, J. K.|
|Marlowe, A. A. H.||Remnant, Hon. P.||Vickers, Miss Joan|
|Marples, Rt. Hon. A. E.||Renton, D. L. M.||Vosper, Rt. Hon. D. F.|
|Marshall, Douglas||Ridsdale, J. E.||Wade, D. W.|
|Mathew, R.||Robson Brown, Sir William||Wakefield, Edward (Derbyshire, W.)|
|Maude, Angus||Rodgers, John (Sevenoaks)||Wakefield, Sir Wavell (St. M'lebone)|
|Maudling, Rt. Hon. R.||Roper, Sir Harold||Walker-Smith, Rt. Hon. Derek|
|Mawby, R. L.||Ropner, Col. Sir Leonard||Wall, Patrick|
|Maydon, Lt.-Comdr. S. L. C.||Russell, R. S.||Ward, Rt. Hon. G. R. (Worcester)|
|Medlicott, Sir Frank||Scott-Miller, Cmdr. R.||Ward, Dame Irene (Tynemouth)|
|Milligan, Rt. Hon. W. R.||Sharples, R. C.||Watkinson, Rt. Hon. Harold|
|Molson, Rt. Hon. Hugh||Shepherd, William||Webbe, Sir H.|
|Moore, Sir Thomas||Simon, J. E. S. (Middlesbrough, W.)||Whitelaw, W. S. I.|
|Morrison, John (Salisbury)||Smithers, Peter (Winchester)||Williams, Paul (Sunderland, S.)|
|Mott-Radclyffe, Sir Charles||Smyth, Brig, Sir John (Norwood)||Williams, R. Dudley (Exeter)|
|Nabarro, G. D. N.||Soames, Rt. Hon. Christopher||Wilson, Geoffrey (Truro)|
|Nairn, D. L. S.||Spearman, Sir Alexander||Wood, Hon. R.|
|Neave, Airey||Speir, R. M.||Woollam, John Victor|
|Nicholls, Harmar||Spence, H. R. (Aberdeen, W.)|
|Nicholson, Sir Godfrey (Farnham)||Spens, Rt. Hn. Sir P. (kens'gt'n,S.)||TELLERS FOR THE AYES:|
|Mr. Oakshott and Mr. Wills.|
|Ainsley, J. W.||Clunie, J.||Greenwood, Anthony|
|Allaun, Frank (Salford, E.)||Coldrick, W.||Grenfell, Rt. Hon. D. R.|
|Allen, Arthur (Bosworth)||Collick, P. H. (Birkenhead)||Grey, C. F.|
|Allen, Scholefield (Crewe)||Collins, V.J.(Shoreditch & Finsbury)||Griffiths, David (Rother Valley)|
|Anderson, Frank||Corbet, Mrs. Freda||Griffiths, Rt. Hon. James (Llanelly)|
|Awbery, S. S.||Cove, W. G.||Hale, Leslie|
|Bacon, Mist Alice||Craddock, George (Bradford, S.)||Hall, Rt. Hn. Glenvil (Colne Valley)|
|Baird, J.||Cronin, J. D.||Hannan, W.|
|Balfour, A.||Crossman, R. H. S.||Harrison, J. (Nottingham, N.)|
|Bellenger, Rt. Hon. F. J.||Cullen, Mrs. A.||Hastings, S.|
|Bence, C. R. (Dunbartonshire, E.)||Dalton, Rt. Hon. H.||Hayman, F. H.|
|Benn, Hn. Wedgwood (Bristol, S.E.)||Darling, George (Hillsborough)||Healey, Denis|
|Benson, Sir George||Davies, Ernest (Enfield, E.)||Henderson, Rt. Hn. A. (Rwly Regis)|
|Beswick, Frank||Davies, Harold (Leek)||Hewitson, Capt. M.|
|Bevan, Rt. Hon. A. (Ebbw Vale)||Davies, Stephen (Merthyr)||Hobson, C. R. (Keighley)|
|Blackburn, F.||Deer, G.||Holman, P.|
|Blenkinsop, A.||de Freitas, Geoffrey||Houghton, Douglas|
|Blyton, W. R.||Delargy, H. J.||Howell, Charles (Perry Barr)|
|Boardman, H.||Diamond, John||Howell, Denis (All Saints)|
|Bottomley, Rt. Hon. A. G.||Dodds, N. N.||Hoy, J. H.|
|Bowden, H. W. (Leicester, S.W.)||Donnelly, D. L.||Hughes, Cledwyn (Anglesey)|
|Bowles, F. G.||Dugdale, Rt. Hn. John (W. Brmwch)||Hughes, Emrys (S. Ayrshire)|
|Boyd, T. C,||Ede, Rt. Hon. J. C.||Hughes, Hector (Aberdeen, N.)|
|Braddock, Mrs. Elizabeth||Edelman, M.||Hunter, A. E.|
|Brockway, A. F.||Edwards, Rt. Hon. Ness (Caerphilly)||Irvine, A. J. (Edge Hill)|
|Broughton, Dr. A. D. D.||Edwards, Robert (Bilston)||Irving, Sydney (Dartford)|
|Brown, Rt. Hon. George (Belper)||Edwards, W. J. (Stepney)||Isaacs, Rt. Hon. G. A.|
|Brown, Thomas (Ince)||Evans, Albert (Islington, S.W.)||Jay, Rt. Hon. D. P. T.|
|Butler, Herbert (Hackney, C.)||Evans, Edward (Lowestoft)||Jeger, George (Goole)|
|Butler, Mrs. Joyce (Wood Green)||Finch, H. J.||Jeger, Mrs. Lena(Holbn & St.Pncs,S.)|
|Callaghan, L. J.||Fletcher, Eric||Jenkins, Roy (Stechford)|
|Carmichael, J.||Fraser, Thomas (Hamilton)||Johnson, James (Rugby)|
|Castle, Mrs. B. A.||Gaitskell, Rt. Hon. H. T. N.||Jones, David (The Hartlepools)|
|Champion, A. J.||George,Lady Megan Lloyd(Car'then)||Jones, Elwyn (W. Ham, S.)|
|Chapman, W. D.||Gibson, C. W.||Jones, Jack (Rotherham)|
|Chetwynd, G. R.||Gooch, E. G,||Jones, J. Idwal (Wrexham)|
|Jones, T. W. (Merioneth)||Noel-Baker, Francis (Swindon)||Soskice, Rt. Hon. Sir Frank|
|Key, Rt. Hon. C. W.||Noel-Baker, Rt. Hon. P. (Derby, S.)||Sparks, J. A.|
|King, Dr. H. M.||O'Brien, Sir Thomas||Steele, T.|
|Lawson, G. M.||Oliver, G. H.||Stewart, Michael (Fulham)|
|Ledger, R. J.||Oram, A. E.||Stonehouse, John|
|Lee, Frederick (Newton)||Oswald, T.||Stones, W. (Consett)|
|Lee, Miss Jennie (Cannock)||Owen, W. J.||Strachey, Rt. Hon. J.|
|Lever, Harold (Cheetham)||Padley, W. E.||Strauss, Rt. Hon. George (Vauxhall)|
|Lewis, Arthur||Paget, R. T.||Stross,Dr.Barnett(Stoke-on-Trent,C)|
|Lindgren, C. S.||Paling, Rt. Hon. W. (Dearne Valley)||Swingler, S. T.|
|Lipton, Marcus||palmer, A. M. F.||Sylvester, G. O.|
|Logan, D. G.||Pannell, Charles (Leeds, W.)||Taylor, Bernard (Mansfield)|
|McAlister, Mrs. Mary||Pargiter, G. A.||Taylor, John (West Lothian)|
|McCann, J.||Parker, J.||Thomas, George (Cardiff)|
|MacColl, J. E.||Parkin, B. T.||Thomas, Iorwerth (Rhondda, W.)|
|MacDermot, Niall||Paton, John||Thomson, George (Dundee, E.)|
|McGhee, H. G.||Peart, T. F.||Thornton, E.|
|McGovern, J.||Pentland, N.||Timmons, J.|
|McInnes, J.||Plummer, Sir Leslie||Tomney, F.|
|McKay, John (Wallsend)||Prentice, R. E.||Usborne, H. C.|
|McLeavy, Frank||Price, Philips (Gloucestershire, W.)||Viant, S. P.|
|MacMillan, M. K. (Western Isles)||Probert, A. R.||Watkins, T. E.|
|MacPherson, Malcolm (Stirling)||Proctor, W. T.||Weitzman, D.|
|Mahon, Simon||Pryde, O. J.||Wells, Percy (Faversham)|
|Mainwaring, W. H.||Randall, H. E.||wells, William (Walsail, N.)|
|Mallalieu, E. L. (Brigg)||Rankin, John||West, D. G.|
|Mallalieu, J. P. W. (Huddersfd, E.)||Redhead, E. C.||Wheeldon, W. E.|
|Mann, Mrs. Jean||Reeves, J.||White, Mrs. Eirene (E. Flint)|
|Marquand, Rt. Hon. H. A.||Reid, William||Wigg, George|
|Mason, Roy||Robens, Rt. Hon. A.||Wilcock, Group Capt. C. A. B.|
|Mayhew, C. P.||Roberts, Albert (Normanton)||Willey, Frederick|
|Mellish, R. J.||Roberts, Goronwy (Caernarvon)||Williams, David (Neath)|
|Messer, Sir F.||Rogers, George (Kensington, N.)||Williams, W. R. (Openshaw)|
|Mikardo, Ian||Ross, William||Williams, W. T. (Barons Court)|
|Mitchison, G. R.||Royle, C.||Willis, Eustace (Edinburgh, E.)|
|Monslow, W,||Shinwell, Rt. Hon. E.||Wilson, Rt. Hon. Harold (Huyton>|
|Moody, A. S.||Short, E. W.||Woodburn, Rt. Hon. A.|
|Morris, Percy (Swansea, W.)||Shurmer, P. L. E.||Woof, R. E.|
|Morrison, Rt.Hn.Herbert(Lewis'm,S.)||Silverman, Julius (Aston)||Yates, V. (Ladywood)|
|Mort, D. L.||Silverman, Sydney (Nelson)||Younger, Rt. Hon. K.|
|Moss, R.||Skeffington, A. M.||Zilliacus, K.|
|Moyle, A.||Slater, J. (Sedgefield)|
|Mulley, F. W.||Snow, J. W.||TELLERS FOR THE NOES:|
|Neal, Harold (Bolsover)||Sorensen, R. W.||Mr. Pearson and Mr. Simmons.|
|Bill accordingly read the Third time and passed.|