§ Tax relief shall be available to all persons who make payments to contractual medical treatment insurance schemes. The relief shall be at the same rates as apply to life assurance policies.—[Mr. Maurice Macmillan.]
§ Brought up, and read the First time.
§ Mr. Maurice Macmillan (Farnham)
I beg to move, That the Clause be read a Second time.
About 20 hours ago I confess that I had a feeling of some disappointment, almost a sense of grievance, but at least some clouds have a silver lining and I therefore begin by expressing gratitude to the Chair for giving me this unexpected opportunity to submit the new Clause. Its object is to attach to payments made to medical treatment insurance schemes the same tax relief, on precisely the same conditions, as now attach to life insurance policies.
I need not weary the Committee with the details, which will be familiar to hon. Members. Suffice to say that if a premium is up to £10, the tax relief is on the whole amount. If the premium is between £10 and £25, the tax relief is on £10 only. If the premium is over £25, the tax relief is on two-fifths of the premium, and there are other complicated provisions which to some extent safeguard the Inland Revenue.
The schemes to which I refer are those mentioned earlier in our debates by my hon. Friend the Member for Somerset, North (Mr. Dean); such organisations as the British United Provident Association, the London Association for Hospital Services and the Western Provident Association.
I hope that the Committee will forgive me for quoting the British United Provident Association or, as it is more commonly known, B.U.P.A. It is by far the largest and the most comprehensive of the schemes and, as a result, has more of the conditions which they all share than do the others.
To give some idea of the size and scope of its operations, it provides assistance towards the cost of serious illness, specialist attention in hospital, nursing homes, and so on. It also provides benefits for out-patients' specialist home nursing, and, as an optional extra, help with the cost of the family doctor. There are 2294 some 550,000 registrations, covering about 1,150,000 men, women and children. It is worth remarking that some 70 per cent. of its membership is in staff or other group schemes. Of those, some 76 per cent. are those in the type of scheme for which the employee pays, some 16 per cent. in the type for which the employer pays, and 8 per cent. in the type for which the employer and employee pay half and half.
The total number of groups is some 6,428, and that includes persons who are covered in the professions and trades, about 250,000; students, 3,800; and, in the school scheme, something over 15,000 children. The types of people included in these schemes are varied in the extreme. I looked down the list of groups at random and found that it included accountants, chemists, printers and stationers, members of Her Majesty's Forces, publishers, I am happy to say, and staffs of Government Departments. There are a number of public boards and nationalised industries which participate in schemes, such as the B.B.C., the National Coal Board, the British Transport Commission, and the National Union of Teachers.
I give those figures simply to show that there is no question of any of the schemes being a method of evading the rigours of the National Health Service rather unfairly, jumping the queue or anything of that sort. They cover people in a wide range of employments and a wide range of income groups. The totals using these organisations show quite clearly a demand for this type of supplement to the Health Service and the need for the type of self-help which they provide.
I should like to put it to the Committee and to the Government that it is a type of scheme which should be encouraged. It provides thrift and self-reliance. We should not be priggish about it; it is worth doing something more than merely not discouraging people from helping themselves. Over the years, we have heard from the party opposite how materialistic our society has become under Tory rule and about the wasteful spending that goes on. If we are to get a more moral tone into our society, we must allow and not condemn those who try to help themselves and, in doing so, choose the private sector 2295 without in any way criticising those who choose the public sector. We should try to encourage the freedom of choice. It is a freedom which only makes sense in the context of plans such as these, which require a contribution from the individual. I hope that hon. Members opposite will accept, as we do, that freedom and responsibility go together.
We accept on this side that the element of competition provided by such plans, and the nursing homes which go with them in some cases, is itself beneficial. When I say "competition", I do not mean commercial competition, but competition in care. I hope that I have shown that there is a large, growing and broadly based demand for medical treatment insurance schemes, and that that demand can and should be encouraged in our type of society.
Secondly, I want to show that B.U.P.A. meets that need efficiently. As I hope the Committee will understand, I include the London Association for Hospital Services and the Western Provident Association and all the others. It is rather long-winded to list thme all every time that they are mentioned. I merely quote B.U.P.A. as an example.
The fact that these plans meet the demand efficiently is shown by the way the main scheme operates. It grows at the rate of some 10 per cent. a year in membership, and the lapses from membership, including those by death, are 3½ per cent. a year. That it is efficient is shown by the fact that its administrative costs, unlike some voluntary organisations, are only 9. 1 per cent. of the subscriptions. I might say in passing that I wish that publishing businesses could operate with an overhead of 9. 1 per cent. of turnover. However, that overhead leaves some 88. 9 per cent. of subscriptions for claims, with 2 per cent. annually going to reserves.
B.U.P.A. is efficient in the way in which it meets that demand, and that is shown by the record of the Nuffield Nursing Homes Trust, which is its daughter organisation providing nursing home beds. Even a cursory glance at the figures shows the success which it has had. Taking those for the month of November, 1965, it provided some 386 beds in 2296 all, with over 78 per cent. occupancy and 784 admissions in the month. There were well over 8,396 patient days, which is a curious phrase.
Lastly, the claim of B.U.P.A. and other similar schemes to meet the need which I have shown is indicated by the contribution which they make to the country as a whole. They encourage and stimulate growth in the total resources available to our National Health Service, both the private and public sectors, and they lessen the burden on the taxpayer. I know that it is sometimes argued that such private plans lead to a turning away of resources from the Health Service. I do not think that that is true. There are many other things which turn away doctors and nurses from the Health Service, and I cannot help thinking that many doctors who now emigrate would probably turn to work under such plans as these if there were more scope available in them than there is now.
Another important aspect of the work of these organisations is in reinforcing shortages of hospital beds in specific areas. The Nuffield Nursing Homes Trust started life for that purpose. Its aim is to meet, and not a desire to compete with, a need which for some reason or another could not be met in any other way. I hope that I have made my second point, that not only is there a need, but that the need is adequately and successfully met by B.U.P.A. and the allied organisations.
I come now to what I am sure the Chief Secretary will regard as the crunch. Why should such plans be encouraged by tax concessions, and why should such tax concessions be built on the pattern of life assurance? As I am addressing the Treasury Bench, I shall quote pre-dents first. Such tax concessions are available to superannuation, retirement, annuities, and occupational pension schemes, as well as life assurance.
I think that I know what the Treasury answer, or perhaps it is more correct to say the Inland Revenue answer, will be—that if there is a precedent it was a mistake to let it happen in the first place, and it is wise to confine it as narrowly as one can now. That is the answer which has repeatedly been given to me when I have tried to extend the tax concession to contractual saving schemes.
2297 Years ago I wrang one concession from the Inland Revenue and I should like to quote it because I think that it is relevant. The concession was that it might possibly be permissible to encourage, through the tax system, savings for a rainy day, for old age, for the education of children—not for the acquisition of wealth—and, lastly, for sickness.
I think that the underlying reason behind this concession was that it was felt that such socially acceptable objectives as putting by for a rainy day, saving for old age, and trying to provide for the education of children, provided a sort of moral equivalent of life cover, because, as the right hon. Gentleman knows, it was the absence of life cover which destroyed the argument for extending tax concessions only to savings in many Finance Bill debates over the years.
I suggest that this Clause meets the conditions, that it is something which is socially acceptable and desirable, that it is not inflationary, and that it has none of the conventional disadvantages which the Treasury and Treasury Ministers quote so frequently when one tries to get concessions from them on these lines.
There is one additional argument this year, that because of the Selective Employment Tax—and I am sorry to have to come back to this after about 33 hours of solid debate on it—one must in fairness admit that through the employment of ancillary staff, the costs of doctors, general practitioners, and specialists will go up, and because of the failure to get my hon. Friend's Amendment accepted yesterday, the expenses of these organisations will increase.
My hon. Friend the Member for Somerset, North said that this tax would mean an addition of £24,000 in a full year to the administrative expenses of these organisations. In 1964 these amounted to about £643,000, and unless my arithmetic has gone awry, this is a direct increase of about 3. 7 per cent., which is quite a lot to bear for an organisation which manages to keep its total administrative costs down to just over 9 per cent. of its income.
The expenses of subscribers to the scheme will go up as prices rise owing to the Selective Employment Tax. I think that there is a practical reason for helping these organisations which 2298 perhaps might appeal to the Chief Secretary more than the previous arguments I have put forward. It is that if something is not done to help these organisations, their rate of growth may well be checked, and when we come a little later to consider the cost of the concessions for which we are asking, I hope that I shall be able to show that any check in growth, or any diminution of the services provided by these organisations, will increase the burden on the National Health Service and on the Exchequer.
I hope to show that although I am asking the Chancellor to make a tax concession, it is one which I believe will save him money. I think that there is a strong case for such a modest tax concession as this, and I suggest that it should be used to encourage those schemes which I have shown have met the proven need of a large number of people.
Finally, I come to the cost. I find it impossible to estimate the total cost, but I have tried to do a somewhat curious sum based on the typical tax saving of the typical life assurance investor set out in a popular Income Tax guide and applied it to the total number of people in B.U.P.A. On a premium of £50, at two-fifths, a £20 reduction in chargeable income at 8s. 3d. in the £ amounts to a loss of actual tax of £8 5s. 0d. If this is multiplied by the 600,000 people registered with B.U.P.A., it comes to just under £5 million. If we add one-fifth for the other organisations, it comes to nearly £6 million. If we call it a £6 million reduction of tax and double it for luck, it will still not break the Exchequer, even in a year like this, when the Chancellor is trying to reduce spending power, because, as I have shown, anything spent through these schemes is spent as an alternative, and not as an addition, to money which would otherwise have to be spent by and through the National Health Service. This point becomes even more valid if we consider the differences in costs between the National Health Service and private organisations.
The total cost of providing a National Health Service bed in a new hospital is about £14,000. Beds provided in conversions of old buildings are cheaper. I want to quote four typical examples relating to the Nuffield Nursing Home Trust.
2299 At Edgbaston the cost is £7,090 a bed; in Hull it is £5,330; in Woking it is £4,280, and in London—most expensive of all—it is £10,220. In respect of the cost of providing new beds in nursing homes or hospitals, on the figures that I have been able to obtain the Nuffield Nursing Home Trust compares very favourably. I should explain that it is not the bed alone that costs £14,000; it is the provision of the full services of a modern hospital for one patient.
The running costs do not show quite such a spectacular difference. If we take the Nuffield Nursing Home Trust and some other hospitals and nursing homes and charge in order to show a surplus of two guineas a week, with an 80 per cent. occupancy of the nursing home, the figure for Edgbaston is 40 guineas a week; for Hull and Woking it is 39 guineas per week, and for London, again the most expensive, it is 48 guineas a week. Those are the running costs as calculated at the Nuffield Nursing Home Trust. The average weekly in-patient cost to the National Health Service in acute hospitals amounts to £39 14s. 5d.; in London teaching hospitals, to £50 13s. 9d. and in provincial teaching hospitals, to £45 6s. 2d. Those are for beds in public wards. I have not carried out the more accurate calculation and added in the extra cost of providing private beds, on which the Nuffield Trust figures are based.
I do not suggest that too much can be made of these figures; they are not a strict comparison, because if the concession for which we are asking causes some growth the cost to the Exchequer obviously rises, but if the concession does not do this there is no cost to the Exchequer. It would be better to regard the concession for which we are asking as being in the nature of an investment tax concession, and I have indicated that its cost is not likely to be too high, because the charges are not altogether onesided.
At best, the cost of the concession—which I have shown to be otherwise worthwhile—even without taking into account the help provided by using available resources, will not be excessive. I have tried to argue this case as closely, quietly and non-controversially as I can, because I believe that it is a valid one. I think that I have shown that these 2300 schemes meet a widespread and diverse need efficiently and economically; that they are worth encouraging for this reason and because they benefit the country, including the National Health Service. They are increasing our total available resources and are taking some, at least, of the burden off the taxpayer. I submit that they are therefore worth a tax concession, which I hope meets the Inland Revenue specification, which is socially as well as economically desirable, and in respect of which the cost to the Exchequer, even without the reciprocal benefits—which could be very significant—is not very great.
I believe that I have demonstrated that to the Committee. I hope that I have convinced the Chief Secretary, and I ask him to consider the Clause with sympathy or, if that is asking too much of a Treasury Minister, at least without prejudice.
§ Captain Walter Elliot (Carshalton)
I support the new Clause. The Government should have no difficulty in supporting it as well, since they tell us, quite sincerely, how, in principle, they are against taxing the sick. They should accept a Clause which offers tax relief to those who make insurance provision for some amenities when they become sick.
One of the principles on which the Treasury often relies to rebut our request, when we ask for concessions of this sort is that when the sheep are shorn they can do what they like with such wool as remains on their backs I hope that the Minister will not put forward that argument tonight, because the principle has been breached. For example, life assurance premiums and mortgage interest payments qualify for tax allowances, so that this is no longer a principle on which the Treasury can stand.
Another argument that the Treasury is very fond of putting forward—it has been done earlier tonight—is, "We recognise what a worthy object this is, but if we give way on it we shall have to give way on an enormous number of other things, and that is out of the question". I hope that the Minister will not put forward that defeatist argument.
It is not beyond the ability of the clever civil servants in the Treasury to differentiate between the essential and valuable things and those that are not 2301 so valuable. I have always thought that an unfortunate thread often runs through Socialist thinking. If somebody wants to pay for something that he could otherwise obtain for nothing, thinking that by paying he will get an improvement, Socialists are suspicious. They think that there is something slightly disreputable about it. They are also inclined to think that if everybody is not in a scheme, if people opt out of it, then, again, there is a trick, and they are up to no good. I hope that in considering this Clause the Minister will free his mind from that sort of idea.
More and more people, as they become better off, prefer to do things for themselves. That is one of the characteristics of this country today. In addition, many people who are not so well off pay their own way, often at great financial sacrifice, and pay for many things that they could otherwise get for nothing. A typical example, apart from health insurance, is people paying for the education of their children. Proposals for tax relief on that are often opposed. It is said that these are the people who can afford to pay, and they should not have tax relief. But that is by no means the case.
When people decide to join a medical insurance scheme they do so because they want some privacy in circumstances of sickness of themselves or their family. Many people want privacy in those circumstances, although others do not. It is a perfectly reasonable object, and they may well, in paying for their sickness insurance, have to give up other things which they might otherwise be able to pay for. What they obtain is, perhaps, some privacy and better accommodation, and part—usually only a part—of the cost is refunded under the insurance scheme.
I suspect that the Minister may well advance the argument that, if this sort of thing is encouraged, the National Health Service will be undermined. I do not accept this for a moment. The Health Service in many sectors, particularly in the hospitals, is greatly overburdened. The practice of some people in insuring themselves tends to take the pressure off the Health Service. The better amenities or a little privacy which they secure for themselves are perfectly reasonable things to want.
2302 It should be our aim to encourage people to do things for themselves, if they can. If it could be proved that this sort of practice undermined the Health Service, I agree that that would be a powerful argument against giving the concession. But I do not believe that it can be proved. Such weaknesses and overstrain as the Health Service shows stem from other causes quite unconnected with this sort of thing.
We encourage people—at least, we on this side of the Committee do—to buy their own houses. We give tax concessions if they take out mortgages. We encourage them to insure their lives, and again we give a tax concession. I would like to encourage them to do many more things by giving a tax concession, to educate their own children, for example. Plainly, a tax concession for health insurance would be excellent, and I hope that the Government will accept it.
§ Mr. Laurence Pavitt (Willesden, West)
The only point of sympathy I have with the hon. Member for Farnham (Mr. Maurice Macmillan), who moved the Second Reading of the new Clause, is in the 24 hours we have spent in the Chamber and the fellow feeling which every hon. Member on either side has towards another who has sat through 7½ hours' debate and been unable to get called. I hope that my right hon. Friend the Chief Secretary will resist this Clause with the utmost power which the Treasury can command. Having been under the pressure of the Treasury in the small hours of this morning, I know what that pressure can be.
I shall not go far into the financial arguments. I look at the Clause purely from the point of view of our health services. The hon. and gallant Member for Carshalton (Captain W. Elliot) was quite right when he said that the main function of the B.U.P.A., the London Provident Society and other similar schemes is to provide a convenience, some privacy and some amenities, nothing whatever to do with sheer health. If a patient in hospital needs privacy, the consultant will give it on health grounds. It is not given for reasons of convenience.
Some of the objects of these health insurance schemes are dangerous for the Health Service, on two grounds. First, 2303 the taxpayer is already paying for most of the services which an insured person will use. For a doctor the taxpayer pays £7,500 in order to educate him over the seven years before he qualifies. As for hospital beds, the B.U.P.A. will, in the main, use beds which are organised under the regional hospital boards or, perhaps, the teaching hospitals—either amenity beds under Section 4 or pay-beds under Section 5—and these, too, are provided by the taxpayer already.
As for professional medical services, the consultant will usually be what is known as a nine-elevenths consultant, that is, giving two sessions for private work and nine for the Health Service. Again, the bulk of his pay is already met by the taxpayer. In the hospital service, what is happening is that the insured person is merely getting a regular extra to which somebody else is equally entitled, but which he cannot pay for out of his own pocket——
§ 8.45 p.m.
§ Sir George Sinclair (Dorking)
Is the hon. Member trying to suggest that members of B.U.P.A. who receive this service are not already paying for the free services which he has cited as part of the Health Service?
§ Mr. Pavitt
That is precisely the opposite. I think that this was made clear. This service is not free. We all pay for it. It is free only at time of illness, but we all pay £1,000 million a year to provide it.
A person with B.U.P.A. is paying a second premium for a convenience. If he has a medical need, as he has already paid for the service, he can have it. Any qualified doctor, whether a consultant in a hospital, a registrar or a general practitioner will give medical care to a person who needs it, irrespective of whether or not he is insured. To say that they would act otherwise would be an insult to the medical profession.
All the B.U.P.A. person is doing is providing some convenience. Here, I have some sympathy with women, because the longest waiting list, as the right hon. Member for Reigate (Sir J. Vaughan-Morgan) will know, as Chairman of the Westminster Hospital, is for gynaecological treatment. The difficulty is that the medical needs between two 2304 ladies who need gynaecological treatment may be precisely the same, because no woman will die from it, but will have six months of acute discomfort because of having to wait. If a woman has some other means of paying, she can get into a bed six months earlier than someone with precisely the same discomfort, but who has not the money to pay the premiums to B.U.P.A. to provide for this need.
This kind of organisation can be used as a means of jumping the queue. In relation to the general practitioner, the position is even worse. He is in the Health Service and is one of 23,000 general practitioners with an average of 2,300 patients each and a maximum of 3,500. If we got to the stage where it was possible to save time through some sort of "opting-out" scheme, we would rapidly reach a situation in which a person would decide that it was easier to opt out so as to be able to go in through the front door and save an hour and a half waiting, perhaps in a crowded surgery, rather than go through the normal machinery.
Of course, the point which the hon. Member for Farnham made and which was similar to a point which I made on an Amendment 24 hours ago, on a different Clause, is that there is a strong need for ancillary services so that G.P.s' time may be used more effectively. The services to the nation of my right hon. Friend the Minister of Health are underestimated. He did tremendous things over the last 12 months when 17,000 doctors in February last year were prepared to resign. This would have made the seamen's strike look like child's play had it happened, yet no resignations have taken place.
The essential thing about the settlement was that it helped to provide the ancillary services which are part and parcel of the B.M.A.s agreement with the Minister. I hope that this point about ancillary services will be covered in the coming months. At present, and in the interim period, the danger is that if one is able to command the doctor's time because he is short of it, he is definitely encouraged to give the worst possible care to non-paying patients. If one has to wait for an hour——
§ Mr. Pavitt
I am saying that there is a cash incentive. No doctor would do this—[AN HON. MEMBER: "Why say so, then?"] There is a cash incentive which might mean that the service which patients get through the surgery lasts a little longer than what they would get if they paid. The College of General Practitioners is giving encouragement to efforts to see that patients have decent waiting-rooms and comfortable conditions. This has been one of the problems of the pool system.
The incentive in the previous system of payment was that the more the doctor paid to help his patients, the more he had to pay out of his own pocket. One of the great advantages of the new system will be that that will no longer happen. It will be made even more redundant if there is any idea of paying for B.U.P.A. or some other insurance scheme. Apart from the very cogent reasons which I am sure the Treasury Bench can put forward, I hope that for health reasons the Government will reject this proposal.
§ Mr. R. H. Turton (Thirsk and Malton)
I am surprised at the hon. Member for Willesden, West (Mr. Pavitt). I heard him last night advocating a special dispensation for co-operative societies because of the advantages they give. This Clause deals with a form of co-operative society, but he is attacking it as venomously as he warmly advocated his own Amendment.
We are in the difficulty that we are discussing what, clearly, is a matter on which only a certain number of people in Government Departments have any close knowledge. That is the administration of the Ministry of Health. As one who held the office of Minister of Health, I think it a great pity that there is no one on the Government Front Bench who represents the Ministry and can advise the Chief Secretary on these problems. I ask that when we are discussing Amendments which affect a Ministry as directly as this does there should be a representative of that Ministry on the Government Front Bench.
T shall try to deal with the arguments of the hon. Member for Willesden, West. He said that the B.U.P.A. was using something without payment for which the rest of the taxpayers have paid. That 2306 was the first limb of his argument and it is absolutely untrue. A great many of the B.U.P.A. hospitals have nothing to do with Health Service hospitals. There is a B.U.P.A. nursing home. As an analogy, we can consider Manor House Hospital. When I was Minister I thought it one of the glories of our Health Service system that we had a hospital outside the Service to which the trade unions had contributed co-operatively and which would provide an additional source of help. That is what B.U.P.A. is doing.
I want to see this insurance for hospital treatment spread far wider. I always wonder at the very small amount of the gross national product divided among Ministers which can be devoted to health. If the country is to have a satisfactory Health Service we have to devote a far greater proportion of the gross national product to health. The only way to do that is to take the example of the trade unions and B.U.P.A. and encourage more people to make their own provision for hospital treatment.
The second limb of the attack by the hon. Member for Willesden, West was his contention that B.U.P.A. patients were using beds which were paid for by the rest of the community. That, I am sure, the hon. Member, for whom I have the highest regard, would wish to reconsider.
§ Mr. Pavitt
Will the right hon. Member say just how many B.U.P.A. beds have been provided distinctly and absolutely separately from the beds it uses in the Health Service?
§ Mr. Turton
B.U.P.A. is building a series of nursing homes throughout the country. This is a project which is in its infancy, rather like the building programme of the present Minister of Health. It will certainly take time, but the hon. Member knows that such projects do take time. Over the last three years, three or four B.U.P.A. nursing homes have been built and the programme is going forward. Just outside my constituency there is the kind of nursing home used by B.U.P.A. patients. It has nothing to do with the Health Service; it receives no money from the Minister of Health; it is provided for by the private patients, principally with B.U.P.A.
§ Mr. Turton
I was trying to quote the argument of the hon. Gentleman the Member for Willesden, West that B.U.P.A. patients were using beds paid for by the rest of the community. He must know that this is completely untrue, because a B.U.P.A. patient is using a private bed.
The cost of a private bed is worked out to include not only the services in the hospital, but the overall cost of operating many other things. When I was Minister of Health I felt that we were making a mistake in making the private bed costs so high, because we were taking into consideration every possible eventuality. No one can say that a B.U.P.A. patient is getting any advantage which is being paid for by anyone else. He is paying the full cost, more than the cost.
If we are to get a better Hospital and Health Service we have to widen our horizons beyond the present limited Government action by which we penalise, through taxation, all those who make provision outside of the Health Service. In the years to come, now that we have a much more affluent society, more people will be making their own contracts for something over and above the Health Service. I am as keen as anyone in this Committee to see that the hospital service is as good as any in the world, and we have to have more and more of the Treasury's money for the development of the service.
I am quite satisfied that it will not be enough and one has therefore to encourage people, not merely those who have a great deal of money, but all people, to try to go in for schemes such as B.U.P.A. The hon. Gentleman the Member for Willesden, West told us that gynaecology cases had the longest waiting list. I am quite sure that he is wrong. I should have said that the E.N.T. waiting list was far longer than the "gyny". My right hon. Friend the Member for Reigate (Sir John Vaughan-Morgan), who has far more knowledge of this than I have, has said that there are certain universal diseases which have an even longer waiting list.
The pressure on the waiting list is tremendous, and if one is to make a success of the Health Service, more accommodation has to be provided. If the hon. Gentleman the Member for 2308 Willesden, West thinks that he can persuade the Treasury to grant his right hon. Friend the Minister of Health sufficient money so as to end those waiting lists in my lifetime, or even in his, I should be happy or even surprised.
§ 9.0 p.m.
§ Mr. Turton
I have watched the hon. Gentleman in friendly appraisal for some time, but his constant endeavours have not had any success.
§ Mr. Braine
Would my right hon. Friend acknowledge that under present arrangements the number of doctors in relation to population is tending to fall, not because of emigration, but because fewer doctors in relation to the increased population are coming in? Unless some steps are taken to increase the total resources going into expenditure on health, the prospects for giving the people a decent Health Service are remote.
§ Mr. Turton
That is true. There is not only the problem of the ratio of doctors to members of the population. I have had personal knowledge of this matter. When one is fighting battles for health and hospitals in the Cabinet, one has many other claims to deal with. I thought that the most successful Minister in dealing with these claims was my right hon. Friend the Member for Wolverhampton, South-West (Mr. Powell), who produced the 10-year building programme. Since then, we have gone back.
There is no argument in morality or justice in penalising a person who makes his own medical provision. This Clause would encourage people to make their own provision and would get a new type of subscriber to B.U.P.A., which I should like to see become a universal organisation, so that emergency cases could go to a central hospital of the Health Service quickly. But if it is a matter of choice, as with an E.N.T. case or with somebody with a hernia, or piles, by his subscription to B.U.P.A. he will be able to get early treatment in one of its homes at no cost to the State. This would encourage the medical profession and would take a great load off the Health Service and would be for the financial benefit of the Treasury.
2309 Those in the Treasury have hearts, and they must be worried about the shrinking proportion of the gross national product being devoted to hospitals and health. Somehow we have to deal with this problem. The only way to deal it is by blending private enterprise with the National Health Service. I agree that the best service must be available for the urgent cases. We have to make better provision. Many people are not satisfied with the long waits in the out-patients department, or the long queues of E.N.T. cases waiting to be dealt with in hospitals. Many people in all income groups and occupations prefer privacy in hospital. This must be provided for.
The B.U.P.A. idea is good. Abroad, in both Germany and Latin America, employers and trade unions are doing this very thing with hospitals. This is why I resented the jeers of the hon. Member for Willesden, West. In Latin America, hospitals are provided by the unions of the employed and by the employers' association.
The best hospitals I encountered when I was touring Germany and Berlin were provided by the Federation of Employers. That is what I want to see in this country if we are to have a really fine Health Service in future. That is why I hope that the Chief Secretary will not pay much attention to the unsound bickering of the hon. Member for Willesden, West but will grant this Clause a Second reading.
§ Sir John Vaughan-Morgan (Reigate)
I must apologise to my hon. Friend the Member for Farnham (Mr. Maurice Macmillan) for not being present to hear his exposition of the case. I am sure that it was a very good one. It was not my intention to take part in the debate, but I was prompted to do so by the remarks of the hon. Member for Willesden, West (Mr. Pavitt)—whom, I gather, I have driven from the Chamber by the mere threat that I might refer to his remarks. Those of use who, like my right hon. Friend the Member for Thirsk and Malton (Mr. Turton) have had the honour of serving in the Ministry of Health or have had some association with the National Health Service, must also resent the argument behind the hon. Member for Willesden, West's attitude.
I share my right hon. Friend's regret that there is no representative of the 2310 Ministry of Health here—not even a P.P.S.—who might have listened to the arguments and at least reported them to the Minister. I am afraid that, although I feel that the Chief Secretary will be able to deal adequately with the reasons from the Treasury point of view why the present situation will not allow this concession to be made, I had hoped that he might have someone at his elbow able to give him some argument from the health point of view.
The hon. Member for Willesden, West—I see that he is back, and I am so glad—started his argument, which I believe that I interpret fairly, by saying that the subscriber to B.U.P.A. had taken all the services of a doctor whose education, costing nearly £7,500, had been paid for by the State. He suggested that therefore the subscriber was receiving, so to speak, uncovenanted benefit from the State.
This applies to almost anything else where education has been provided by the State. Indeed, it applies to the whole community. It is a ridiculous argument. If one wants good 100 per cent. Socialism on those lines, the only logical end to the hon. Gentleman's argument is the abolition of private practice and of private beds in all hospitals. This is a tenable theory, though inhuman and dreary, and it would ruin medicine. Is that the hon. Gentleman's demand?
Mr. Pavitt: I must apologise to the right hon. Gentleman. If this could develop into a debate on the National Health Service I would dearly like to take this up with him. I am prepared to debate at any time with him all the points he is making. What the right hon. Gentleman is seeking to do is to use a preferential call on part of the doctor's time for those people who can pay while the people needing his services on medical and clinical grounds have to wait, as the hon. Member for Essex, South-East (Mr. Braine) pointed out, in the queue.
§ Sir J. Vaughan-Morgan
The logic of the hon. Gentleman's argument is the abolition of private practice, which would be disastrous. I share the view that, far from destroying private practice and abolishing paybeds, we should find a reasonable place for them in the National Health Service—a private sector as opposed to the public sector.
2311 I cannot share the view that this is done at the expense of the public. The hon. Member for Willesden, West suggested that section 5 beds were filled by people who were queue jumping. As the hon. Gentleman knows, the Minister of Health is now having a review of the number of pay beds, but I would be very surprised indeed if, at the end of that review, he decided to do anything about the matter, because, as the hon. Gentleman knows as well as I do, queue jumping amounts to nothing. The queue jumping is in the Manor House Hospital outside the Health Service and not inside the Health Service where it is absolutely minimal. If it were abolished altogether, that would not reduce the important waiting lists by any effective margin.
But it would start to destroy private practice. The hon. Gentleman might say that that was a good thing, but to me it will be a tragedy when the day comes when private practice is abolished. Those who know consultants will know that there is some merit in their hearing what might be called critical voices. In a teaching hospital, the paying sector cannot be disentangled from the other and I do not believe that the patient gets any better service from the consultant by paying for it. I am certain that that is the reverse of the consultants' attitude. But it is a very good thing for the consultants sometimes to have people who argue with them.
§ Mr. Pavitt
The right hon. Gentleman is the Chairman of Westminster Hospital and should know that private patients' papers are given special markings in order that these patients can go more quickly through the radiography department.
§ Sir J. Vaughan-Morgan
If the hon. Gentleman will give me an official note of that, I will look at it, but I doubt whether it affects the service. As he knows, there is a great shortage of radiographers, but if there is any deterioration in the service, I would say that it applied to both kinds of patient. But that is not relevant to the argument, because everything the hon. Gentleman is saying applies to Manor House, which is outside the service. I cannot see why he should allow that and not allow private beds in the teaching hospitals. The present small 2312 sector of private practice should be encouraged for it is to the good of the Health Service as a whole that it should be fostered and should prosper.
§ 9.15 p.m.
§ Sir G. Sinclair
I was deeply shocked by the speech of the hon. Member for Willesden, West (Mr. Pavitt). It is abundantly clear that he would like to see B.U.P.A. wiped out completely. I hope that he and his Socialist colleagues who dislike anything in the medical world being outside the National Health Service will not persuade their Front Bench into taking a similar attitude towards an organisation which is now bringing tremendous and widespread additional benefits to the people of this country.
My hon. Friend the Member for Farnham (Mr. Maurice Macmillan) said that there were already more than I million people subscribing to B.U.P.A. They are not confined to any one income grade. The subscriptions to B.U.P.A. are not very great if they are reckoned out in terms of cigarette money. They are an enormous insurance to families at times of stress and anxiety. More and more families are deciding to use part of their earnings—not a great part, but an important part—to provide facilities in medicine additional to those provided by State medicine.
Will the Government Front Bench stand against this tide of family initiative? This is family initiative deciding to get additional facilities for their own members by paying something out of their earnings, payments well within the capacity of even the lowest earning groups. To provide these extra facilities, to get extra nursing homes built, to attract nursing and medical attention into those homes, is a great additional service to the country. This is what the people themselves are choosing because they are worried by the inadequacies of the Health Service to meet their current needs. This is their own initiative. Why should people stamp on it?
Surely what the country needs is more channels for effective initiative and self-reliance, and B.U.P.A. is one of the finest examples of this that we have today. It is a success story, it is meeting needs, and it is showing the way for the rest of the country. This is what accounts for the fact that there are 1 million subscribers.
2313 This is what accounts for the fact that the membership is rising by roughly 10 per cent. per year. This is a significant social fact. This is the community putting more of its money into something that it wants over and above what the State is prepared to do for it.
I ask the Government spokesman who is to reply to the debate not to stand in the way of something which is becoming more and more broadly based, which is meeting a real need felt by mothers and fathers in families, and which is being appreciated by their elder children as they themselves take on responsibilities. This would be a very dangerous thing to do.
There is an opportunity tonight for the Government to show that on a matter like this, which has the real feeling of the country behind it, they will not be bigoted but will encourage something which is already helping to spread the services of which this country is really greatly in need.
§ Mr. Diamond
The reason why I rise, having listened very carefully indeed to every speech which has been made and recognising that there are other hon. Members who wish to contribute to the debate is that we are having, under your very wise guidance, Mr. Irvine, a wide debate which started with the hon. Member for Farnham (Mr. Maurice Macmillan) dealing in the clearest language with an Income Tax proposal, which was developed by my hon. Friend the Member for Willesden, West (Mr. Pavitt) into the relationship betwen tax and the Health Service, and which was taken up at that point and dealt with by a number of right hon. and hon. Members on the Health Service. Although I have listened with the greatest care, as I always do, and with the greatest interest to what right hon. and hon. Members said, I have not heard the word "tax" for a very long time. Therefore, perhaps it would not be inappropriate for me to give an indication of the Government's attitude on this new Clause dealing with tax.
Can I first clear the ground a little by saying that what the Government are not doing—I am addressing myself to the hon. Member for Dorking (Sir G. Sinclair)—is standing in anybody's way. What the Government are not accepting is a pro- 2314 posal, not a very logical one, by two right hon. Members and supported by several hon. Members, to reduce the amount of money available for the National Health Services. Although they most sincerely want to promote the cause of the National Health Service and recognise, they say, that the National Health Service could well do with further public funds, they nevertheless support an Amendment which would reduce the availability of public funds for the National Health Service and every other kind of public expenditure. That is the logic of what they have said and we cannot accept that logic.
I turn to the essential proposal of the hon. Member for Farnham, who explained the present provision of life assurance relief with complete accuracy. He went on to explain what the associations, for which the new Clause pleads, do. He said that there was a large and growing demand for the services of B.U.P.A. and similar organisations. They were growing at the rate of 10 per cent. per annum, he said. His hon. Friend the Member for Dorking, who spoke with obvious direct knowledge, said that the payments made by contributors were well within the contributors' capacity to pay.
There is a series of organisations which are serving a large and growing demand, growing at the rate of 10 per cent. a year, which exist on payments well within the capacity of the contributors to pay them. I am bound to ask, therefore, "Why is everybody coming to me at the Treasury to ask for some money for these services when they are perfectly capable of looking after themselves?" At the moment I am being neutral about whether the Government should help or hinder the development of these services.
So far the argument has exclusively demonstrated that, whatever else one wants to say about these services, one cannot say that they are in need of public assistance—Treasury help. I accept what hon. Gentlemen opposite have said on this score and, therefore, one must look for entirely different arguments before the new Clause can be said to have been given a footing at all.
§ Sir G. Sinclair
It is the imposition of the new tax, of this new burden, on these services to which everybody is objecting.
2315 It is not a question of giving a dole but of not imposing an extra burden on something which is providing extremely good services to the country.
§ Mr. Diamond
I am prepared to deal with any argument, but the hon. Gentleman will not mind my saying that that leg of the argument was not adduced earlier in discussing this new Clause but relates to an earlier debate. The hon. Member for Dorking is now pleading on the grounds of removing a burden and is talking about S.E.T. He is saying that this burden should not be placed on organisations of this kind. I can only repeat what my hon. and learned Friend the Financial Secretary said yesterday when dealing with Amendment No. 73.
My hon. and learned Friend made it clear that there was no burden which could not be borne most readily and, in adducing that argument, he spoke of the case of the payment of S.E.T. amounting to £12,000 a year which resulted, in effect, in an additional 8d. per contributor per year to cover the cost of S.E.T. which, the hon. Member for Dorking is saying, is a burden which should be removed from these organisations. Thus, to cover the cost of S.E.T., each contributor would have to pay 8d. a year more.
The figures produced by the hon. Member for Farnham showed that S.E.T. would result in a 3. 7 per cent. increase in wages and salaries of the organisations about which he spoke. That is a very likely figure. With wages amounting to 9 per cent. of the total costs and services provided, the tax, therefore, represents 3. 7 per cent. of 9 per cent., or approximately one-third of 1 per cent., which is the sort of figure which would be expected.
On the question of hardship which the hon. Member for Dorking now puts up, the figures produced by the hon. Member for Farnham indicate that Selective Employment Tax represents for the organisation one-third of 1 per cent. of its charges. A £12,000 tax payment in the case of a similar organisation represents an additional contribution of 8d. per member.
§ Mr. Maurice Macmillan
To say that the Selective Employment Tax puts a 2316 burden of 3. 7 per cent. on the wages and salaries, which represent 9. 1 per cent., is a slight distortion, in that 88. 9 per cent. of subscriptions is paid out. The 9. 1 per cent. represents the administrative cost of running an insurance scheme, and it cannot be described as the ordinary cost of providing a physical service. It is the administrative cost of an insurance scheme to which I was referring, and not the running cost of the organisation which is run as a subsidiary activity.
§ Mr. Diamond
One does not know that the subsidiary activity bears an additional penny because of Selective Employment Tax. One does not know the form of subsidiary activity to which the hon. Gentleman is referring. If it is a charity, it does not bear one penny of Selective Employment Tax.
§ Mr. Diamond
Then it does not pay one penny of Selective Employment Tax. I was putting the figures accurately before the Committee and saying that the additional amount which the hon. Member for Dorking is now pleading on the grounds of hardship is 3. 7 per cent. of 9 per cent., or one-third of 1 per cent. In terms of a similar organisation, it represents an additional 8d. per member. The hon. Gentleman cannot say that, because of Selective Employment Tax, which we are not debating, there is a burden——
§ Mr. Braine
Would the right hon. Gentleman address himself to the argument which formed the basis of most of the speeches during the debate? The Health Service, which we all value and wish to see improved, has been in a state of crisis for some years and will be for some years ahead. It has been starved of an adequate share of the national resources, and it is clear under the National Plan that it will get a smaller share of increasing national resources than is probably necessary. If that is so and B.U.P.A. is a means of attracting additional resources to health in the country, do the Government favour or disfavour it? Would they give encouragement to B.U.P.A., or discouragement? That is what the debate is about.
§ Mr. Diamond
Perhaps I may be allowed to come to that point. I was 2317 trying to clear up some of the outside or tangential arguments which had been produced and which I thought did not touch the heart of the matter.
§ Mr. Diamond
What we are discussing is not the proportion of public expenditure which is allocated to the National Health Service. As Chief Secretary, I should be more than delighted to participate in a debate of that kind, when it is before us. What we are discussing is whether a case has been made for an Income Tax allowance of the kind described in the Amendment.
For this purpose, as Chief Secretary to the Treasury, leading with a new Clause on a Finance Bill, I am neutral to all questions of whether I want to encourage or discourage B.U.P.A. and similar organisations. The matter does not arise. I do not have to address my mind to that question. My right hon. Friend the Minister of Health might have to if there were a debate on this issue relating to the Health Service. All that I have to address my mind to is the question, has a case been made for departing from our previous practice, so far as Income Tax allowances are concerned, so as to give an allowance of this kind, namely, Income Tax relief in respect of payments to contractual medical treatment insurance schemes?
There are a whole host of activities which are carried on in this country which are commendable and to which everyone would pay respect and lip-service, but to which I, as Chief Secretary to the Treasury, am not required to subscribe out of the taxes which I collect from every right hon. and hon. Member of this Committee. There are many others of which we could speak in less commendable terms, but this is irrelevant to my responsibility and what we are considering. We are considering whether there should be an Income Tax allowance, and I want to explain to the Committee why this Government share the view of the previous Government that no case has been made for giving an Income Tax allowance of this kind for these purposes.
I can explain it in one sentence. The whole fundamental principle of Income 2318 Tax is involved. The whole basis of Income Tax is that each person is required to contribute on a fair basis out of his income a share of the tax or Surtax which is collected for public purposes, and, subject to the law of the country, to do what he wants to with the rest of his taxed income. It is the individual's money to do what he likes with it, and it is not the problem of the Inland Revenue to define what anybody should do with his money by giving an Income Tax allowance for it. It is within the discretion of every individual to use his own taxed income or capital resources for whatever purpose he chooses within the laws of the country. It has nothing to do with me.
The hon. Member for Farnham moved the new Clause with care and gave all the relevant facts, but there was nothing in his argument which touched on this basic principle. I do not have to be persuaded whether B.U.P.A. is good or bad. I am told that it is prospering. I am told that it does not need Treasury encouragement because it is prospering without it. I am told that it is no burden on its contributors, and I have demonstrated that S.E.T. is no burden on it, so there is no question of any hardship. The only question is, is it within our tax principles to allow a deduction from a person's tax liability of the subscription that he may choose to pay for this purpose?
§ Mr. Paul Dean (Somerset, North)
How does the right hon. Gentleman reconcile his argument with the tax relief for life assurance and for occupational pension schemes?
§ Mr. Diamond
If I am continually interrupted, I shall not be able to get to that part of the argument. I have listened carefully to the debate, and I have noted the points to be answered. There is a simple principle that out of taxed income a person pays for what he wants to pay, and that is the end of that one. This is one of the things for which people pay out of their taxed income.
§ Mr. John Hall
Nothing, but I thank the right hon. Gentleman for giving way.
2319 He says that he will deal with life assurance. Perhaps he will say why the Treasury does not decide whether it is good or bad to get married on taxed income. We get allowances for it nevertheless.
§ Mr. Diamond
I shall answer that, too. I should have thought that the hon. Member realised what the framework of tax allowances was. The purpose is to try to arrive not at what it costs a person to keep a wife, child or dependent relative, but to try to arrive at a graduation of the burden of taxation as a result of which those with heavy responsibilities pay less Income Tax and, as far as can be assured in this unjust world, pay a justly proportionate burden of Income Tax. That is what it is about, and that is why we do not fashion the allowances on what it costs to keep a wife—if the hon. Member for Finchley (Mrs. Thatcher) will forgive me for intimating that keeping a wife is a burden. Perhaps I should refer to the relative joys and responsibilities that family life brings.
So much for the major principle; I am asked how I reconcile this with life assurance relief and mortgage payments. [Interruption.] I hope that hon. Members opposite will contain themselves. Treasury Ministers sit on these benches for 14 hours on end listening with interest and pleasure to hon. Members opposite, including the occupants of the Front Bench opposite; indeed, if it were not for them the lives of Treasury Ministers would be infinitely duller. But since Treasury Ministers sit for 14 hours on end listening carefully to what everybody has to say, I submit that in return hon. Members should listen to Treasury Ministers for 14 minutes at a time.
I am asked how I reconcile this simple principle, which every Government have adopted, with the way in which we deal with the calculation of tax liability and the relief given in respect of life assurance. Life assurance relief is fairly logical, although not completely. But it has been in operation for a century, and anybody who wants to tamper with an allowance that has existed for a century is looking for real trouble. It is not wholly logical, but it is not illogical. Life assurance relief is an encouragement which the State gives to savings. It has nothing whatever 2320 to do with insurance for a period, and with risks, including the risk of accident and ill-health.
One point in the speech of the hon. Member for Farnham completely confused me. Perhaps I misheard him, but I thought he said that on one occasion the Revenue had yielded to his persuasion or to his Ministerial views and had provided a tax concession for sickness. I am unaware of it.
§ Mr. Maurice Macmillan
I cannot remember which Finance Bill debate it was. It was a long time ago. But it was admitted that a case might be made out for such a concession. I did not intend to imply that a concession had been given, but an admission was made that it might be possible to make out a case, very much on the lines which the right hon. Gentleman is arguing with respect to life assurance.
§ Mr. Diamond
I am grateful to the hon. Member. He has completely cleared up the point.
In short, our taxation system does not and never has made allowance, for tax purposes, on payments of this kind. It has provided for over a century an encouragement to saving, and life assurance is one of the most prominent forms of saving. It has never provided an encouragement through tax allowances to any other kind of insurance.
§ Sir J. Vaughan-Morgan
The right hon. Gentleman has dealt very courteously and logically with the argument as regards life assurance. Would he now expand this to cover overdraft interest?
§ Mr. Diamond
Yes, because the hon. and gallant Member for Carshalton (Captain W. Elliot) asked me to deal with mortgage payments, and these and bank interest go together. Neither has anything to do with saving. They are what are called in the trade annual payments, charges on one's income. One pays tax on one's income, but in arriving at its size one deducts from the gross income charges on income, such as bank interest, payments under deed of covenant, and mortgage payments——
§ Mr. Diamond
Insurance payments, I am sorry to tell the hon. Gentleman, are not charges on one's income. They never have been and they cannot be. There is no compulsion to pay them. There is no question of them being charges one can be sued for and have to pay. There is no question of that. I hope that I have made clear why the question of B.U.P.A. and similar organisations is a matter on which I can be absolutely neutral as a Treasury Minister, whatever my views may be. If I were speaking in an entirely different debate I could make a speech about quality of life with which my hon. Friend the Member for Willesden, West would be in 100 per cent. agreement. But at the moment I am concerned with demonstrating that this is a tax principle which has never been breached and it is perfectly consistent with the encouragement that is given for saving.
When we last considered this matter in 1962 the right hon. Member for Birmingham, Handsworth (Sir E. Boyle) resisted an Amendment that was not identical but was very similar. It was right to do so then, and it is right now. I cannot recommend to the Committee that this new Clause should be accepted.
§ Mr. Michael Alison (Barkston Ash)
I thought that there was a smile on the face of the Treasury tiger as the debate became more and more involved in health matters. There he was, lurking in the long grass, waiting to spring out, and he has done just what was expected. He has pawed away all hope for a reasonable and desirable concession, on the basis of his almost aggressive exposition of the pristine purity of Income Tax law which cannot be breached.
Let me remind him of the one or two breaches which already exist, one or two chinks in the armour. He dealt with mortgage payments and life assurance, but what about the allowance which is made, under the Income Tax Act, 1952, of up to £70 to cover the cost of reports, replacements of Halsbury's Law of England for judges, the binding of the same, the maintenance of the same, and a private libary? Or what about the allowance which is made by concession in respect of the performance of judicial functions, as in the case of Her Majesty's judges, to maintain a study at a private residence?
§ Mr. Alison
I shall go on doing so. I think that the Chief Secretary will find that it may turn round and hit him. What about the allowance which is made to journalists to supply themselves with essential reference books? This is a tax allowance which is commonly admitted. What about the annual subscription to professional bodies which can be made an allowance against tax where it is relevant to the occupation of the person who receives the allowance? One could go on indefinitely. What about postage and stationery? What about the allowance to the clergy in respect of domestic service?
§ 9.45 p.m.
§ Mr. F. A. Burden (Gillingham)
What about the allowance granted to businessmen for membership of clubs considered essential for their business?
§ Mr. Alison
The Chief Secretary is trying to dominate, blind and overwhelm us with the monolithic structure of our allegedly invincible Income Tax law. The job of this Committee is to shoot all the weapons it can at that monolithic structure and breach it. This is what the Committee is meant to do, to humanise, change, reform and improve.
The right hon. Gentleman talks about the absence of any need to help the B.U.P.A. because it has grown by 10 per cent. a year. Perhaps he has forgotten that, under another piece of legislation with which the Government are concerned, the Treasury is prepared to throw taxpayers' money, at the rate of 20 per cent. in non-development areas and 40 per cent. in development areas, after manufacturing industry which showed a similar rate of growth, a 9 per cent. increase in investment, in the year 1965. It still qualifies for a huge Treasury grant, in spite of that growth. Perhaps the right hon. Gentleman has forgotten that, under the Industrial Development Bill, the Chancellor is to pour taxpayers' money into one of the most profitable undertakings in the country, Imeprial Chemical Industries, if it happens to invest in qualifying plant and equipment.
It is no use saying that, because B.U.P.A. happens to be growing, it does 2323 not need assistance and it ought not to have any. If expansion in the public interest can be demonstrated in the case of manufacturing industry, the Government are perfectly prepared to throw taxpayers' money after it in order to help it to grow. All we suggest—the health case has been put irrefutably—is that our health services should expand, and be helped to do so, at least as rapidly as manufacturing industry should expand. What is the use of expanding manufacturing industry, with enormous Treasury grants based upon payments from the taxpayer, if the human assets, the human agencies which operate the plant and machinery, are neglected. All we suggest is that the Treasury should take a rational step in this direction. Let them use some of the taxpayers' money in order to increase growth in the health services. It goes hand in hand with plant and machinery.
The right hon. Gentleman cannot convince us by arguing the allegedly monolithic structure of our Income Tax law. It has already been breached in so many particulars. It is so irrational. There is no point in saying that it is a hundred years old and, therefore, only those aspects of our Income Tax law which have lasted for a certain period can be altered. Look at what the Government have been introducing in 1965 and 1966, without any hesitation or respect for precedent.
It is quite clear that the health services should be allowed to expand, with encouragement to the private sector, at least as rapidly as private manufacturing industry towards which the Treasury, apparently, feels quite differently, having no hesitation in dipping into the public purse. We have put a thoroughly rational and irrefutable case for investment in human beings as well as investment in plant and machinery. In fact, the rate of growth is far lower in the National Health Service than it is in the other sectors which the Treasury is prepared to encourage.
Let the right hon. Gentleman look at some of the reliefs which are admissible under Schedule E and remind himself of the anomalies and exceptions which have grown up over the years. Let him take a sensible step and introduce into our law a tax concession which 2324 really makes sense in the present situation and which would get to grips with one of our basic problems. I have reminded him that the judges are allowed concessions for robes, wigs and private studies, the clergy have their concessions for studies, domestic servants, and the rest, the journalists have their concessions for books essential to their trade, when they could easily get them at the public library, being ratepayers like everyone else. These concessions already exist, and the example should be followed through by acceptance of this new Clause.
§ Mr. Patrick Jenkin
Would my hon. Friend care to put to the Chief Secretary the best possible analogy, the allowance made for contributions under a superannuation scheme or pension scheme under Section 379 of the Income Tax Act, 1952?
§ Mr. Alison
I am sure that the Chief Secretary has registered that.
The right hon. Gentleman has referred to the pleasure which he gets from sitting on the Treasury Bench and listening to the argument. If he takes his own words seriously and has listened to the arguments—as, I agree, he has done patiently—and has, on his own admission, been softened by the presence of my hon. Friend the Member for Finchley (Mrs. Thatcher) sitting opposite him, let him add to all this a little commonsense and give us our new Clause, and the whole country will be better off.
§ Mr. Robert Cooke (Bristol, West)
I got the impression from the length of the Chief Secretary's speech and the involvement of it that he probably had a rather poor case and that was why it had to go on so long and had so many ramifications. I put it to the right hon. Gentleman that this is a different century and that perhaps a few new ideas from even the present Government might be acceptable to the Committee. That is why I rise to support the new Clause.
We got the impression from the Chief Secretary's speech that, somehow, all the money belonged to the Revenue and it would be almost immoral for the taxpayer to direct it into a certain field of his choice. If the tax concession is not to be given to people who want to subscribe to B.U.P.A., they could easily prevent 2325 the money from getting into the Chancellor's clutches by giving it to a dogs' home. Surely the right hon. Gentleman would not wish to prevent people spending it on perhaps a more worthy cause than the dogs' home—[An HON. MEMBER: "What is wrong with the dogs' home?"]—which seems to be fairly adequately subscribed for already.
I knew that somebody would say, "What is the matter with the dogs' home?" I do not think that there is much the matter with it. That is why I object to people pouring money into dogs' homes when they might well spend it on something like B.U.P.A., which would probably do them more good in the end.
Money is the key to many of the things that we would like to do and to much of the good that we would like to do. It is not much good the Chief Secretary saying that the cost to this or that organisation would be only £12,000, or 8d., or so many cigarettes per person per week. Think how much good could be done with the extra £12,000 which the Revenue would not claw back. That is a worth-while thought.
We had a formidable team ranged on this side of the Committee, including three former Ministers of Health, two former Parliamentary Secretaries, a host of former Parliamentary Private Secretaries and the chairman of one of London's great hospitals, all people with wide experience. The Treasury Bench merely offers a lot of experts on taxation and cold calculations. We are talking about human beings.
I have been concerned with the medical profession all my life. My father is a surgeon, my mother a highly qualified medical practitioner and one of my grandfathers a doctor. In my constituency I have the finest and largest teaching hospital in the West of England, a host of other hospitals, a private nursing home administered by the Nuffield Trust and another run by the Roman Catholics. I therefore have a real interest in the provisions of the Clause.
I might also say that as far as I can find out the members of my family who trained to become members of the profession did not receive any State aid on the lines suggested by the hon. Member for Willesden, West (Mr. Pavitt). Indeed, many people who are practising 2326 today got there by their own hard exertions and the hard-won savings of their families. It is a futile, feeble and niggling argument to bring out the cost of training a doctor in modern times as though somehow this is all being misused by people who subscribe to B.U.P.A.
I do not want to go in detail over all the niggling speeches which I have heard from the hon. Member for Willesden, West during the years I have sat opposite him in the House, but I wish that he would look at some of the broader principles. That is what the Clause is about.
The hon. Member said something about waiting lists and that it was a terrible thing that, if the new Clause was accepted, B.U.P.A. would go on defeating the fairest way of clearing the waiting list. If however, we were to provide the facilities in the Health Service for clearing the waiting list, as soon as the list had been cleared there would be a whole lot of surplus facilities, which would be an utterly wasteful procedure. That is worth thinking about.
In the case of the consultants on the nine-elevenths basis, the hon. Member for Willesden, West again got it wrong in saying that the bulk of their pay came from the Health Service. Many people who give splendid service to the Health Service get a substantial part—indeed, the majority—of their income from private fees outside it.
The other argument deployed about the waiting list—this is where B.U.P.A. is being attacked whereas it should be helped—is the suggestion that, somehow, there would be circumvention of the waiting list in an immoral fashion through belonging to the scheme. We have heard the phrase, "Time is money". What is wrong with someone who is busy, to whom time is immensely valuable, paying for the privilege to save some of that time and use it more fruitfully rather than in a waiting room? Some other people who have to wait a longer time have less to do with their time. Many people enjoy sitting in a doctor's waiting-room and find it a most interesting——
§ Mr. Eric Lubbock (Orpington)
On a point of order. This is most ghastly drivel. I wonder, Sir Eric, whether we could send for the Government Deputy Chief Whip?
§ Mr. Cooke
I am glad of your support, Sir Eric. Of course, the Committee realises that that is not a point of order. The hon. Member for Orpington (Mr. Lubbock), not having been in the Chamber for most of this debate, would hardly realise what it was all about.
The thing that all of us have been most keen about is that we want to see a greater partnership between private enterprise activities and the State. Hon. Members opposite want to stop private enterprise health activities and the State to take over the lot. How much happier we would be if everyone were in a position to help himself and the State did not have to interfere in people's lives and everyone belonged to some kind of B.U.P.A. organisation. Let people provide their own facilities if they can; that would make for a happy society.
§ Mr. Dean
Rarely have I heard more disappointing and weaker arguments from the Chief Secretary than we heard from him a few moments ago. I hope that before this debate is over he will try to do better.
One of the first points he made in his speech was, why are these schemes coming to the Government for public assistance? To equate with public assistance people who are insuring themselves against ill-health and are taking up contracts thereby and merely asking for tax recognition of this is a most extraordinary notion. I shall return to the arguments by which the right hon. Gentleman tried to convey that there was a fundamental distinction between life assurance and insurance of this kind.
I support this Clause on broad grounds of principle. I think that it will be agreed on both sides of the Committee that there are three things which are basic to the British character: the first is the love of freedom and independence; the second is self-reliance; and the third is thrift. In spite of some evidence to the contrary, these things are still strong in our country, but they need to be encouraged and fostered. There is a danger, if we are not careful and if we attempt to offer the mother's milk of the Welfare State to everybody in all circumstances, that we shall end by making perpetual children of 2328 the British people. This is the broad ground of principle on which I support this Clause.
I turn to some practical points. These are all strictly relevant to the effect that this will have on the Exchequer, and to the finances of the National Health Service. The first practical reason is personal choice. As our society becomes more prosperous, people are becoming better able and more willing to provide for themselves. The abundance of consumer goods to choose from is there to see—cars, television sets, food and the like. No one but a few busybodies would attempt to dictate our personal choice in these goods, yet in things which are absolutely basic to the quality of life, such as health, the choice is very restricted, and, as is quite clear from the speech of the Chief Secretary, this choice is frowned upon by him.
This is a bad mistake from the point of view of our economy and the locking-in of our tax arrangements with our social service benefits. I believe that, equally important, it is contrary to the trend which is growing more powerful every day, of people desiring to provide more for themselves. The survey, "Choice and Welfare", published in 1965, proves this point very clearly.
The figures which my hon. Friend the Member for Farnham (Mr. Maurice Mac-millan) gave about the growth of B.U.P.A. and similar centres shows quite clearly that the demand for this type of self-help is growing not only among the comparatively small section of the community in the higher-income brackets, but among all sections of the community. It is also growing among group schemes, where employers assist their employees to obtain cover.
The second practical argument, and this should appeal to the right hon. Gentleman, is that we are constantly being told by him and other Treasury Ministers that we are spending too much on consumer goods, on trivialities, and that the pressure on demand is too great. The Chief Secretary is perfectly right in telling us these things. If this is true, why is it so? One of the reasons is that we are not sufficiently encouraged to spend our money on things which are basic to the quality of life. In the case 2329 of medical insurance policies there is no tax relief for independent subscribers, and we tend to be accused by the party opposite of queue-jumping, trying to get a better standard of service than the rest of the community. Expenditure in this direction can help to relieve the State services and public money. The more we are encouraged to take out policies of this kind the less likely we are to spend on what the party opposite likes to call "candyfloss".
The third practical point which is directly relevant to the responsibilities of the Treasury is the shortage of resources for the State services. No one can deny that the Health Service, and local health services are short of money, and of doctors and nurses. Hardly a day goes by without some hon. Member drawing attention to accommodation in the Health Service, to shortages and to needs which are inadequately met.
The inevitable answer from the Ministers, and one appreciates that it must be so, is, "We are doing our best, but resources are limited". The National Plan proves this quite clearly. According to the plan we shall be spending in 1970 a smaller proportion of our national resources on health services than we are spending now. Here, then, is a chance for these private groups to help fill a gap which the National Plan clearly foreshadowed.
This point was immensely well put in the survey I mentioned earlier, "Choice in Welfare". It said:In 1965, despite the brave hopes of future economic growth, the Government has felt compelled to hold back expenditure on welfare development which Ministers clearly think highly desirable. Such decisions are dictated by the harsh logic of tax resources confronting ever-growing clamour for Government expenditure on roads, police, administration and foreign aid. The more convincing logic of rising increases and growing preferences for choice in welfare confirms the alternative possibility of turning away from almost exclusive reliance on taxation and attracting more voluntary expenditure into education, health and pensions by encouraging growing numbers to divert a larger proportion of their rising incomes into improved welfare services of their choice.This quotation is very appropriate in making the case for the shortage of resources.
We shall never help the casualties of our society properly if we insist on regard- 2330 ing everybody as casualties. We cannot help the weak effectively unless we encourage the strong. This is not a plea—I say this particularly to the hon. Member for Willesden, West—for the dismantling of the Health Service. It is a plea for welcoming private health services as part of this, so that the Health Service can concentrate more on the job which only it can do effectively.
Finally, I come to the arguments of the Chief Secretary. The first dealt with costs. We do not propose that people who take out medical insurance policies should be able to contract out of their Health Service contributions or their contributions to the general taxation which provides the bulk of the finances for the Health Service. These will remain unaltered. There will be no loss of revenue in either of these respects.
Further, we do not propose that people should present doctored bills and get relief. All we propose is that they should get relief towards the contributions they make to genuine medical insurance schemes. One of the right hon. Gentleman's arguments was that there is no tax relief in respect of this type of insurance. But if this is the case, how does he explain that, where there are group schemes and the employer pays a part or whole of the group or other contribution, he gets tax relief on that?
I hope that, before the debate ends, the right hon. Gentleman will answer this point. I cannot believe that the loss of revenue here would be very great, but it will certainly be more than counterbalanced by the additional health services which will be made available.
Finally, an argument which was used particularly by the hon. Member for Willesden, West was the argument centring on queue-jumping and two standards of service. This was a serious argument which should be answered.
Any hon. Member will recognise that there are many standards of service already in the Health Service. Some hospitals are better than others; some have better facilities than others. There will always be many standards of service and to some extent priorities which are not entirely justified on medical grounds. Can any hon. Member really say that when we ourselves have to go into hospital we do not get some priority in 2331 the Health Service? Of course we do. In an imperfect world this type of thing will always exist.
Finally, what matters is how we can raise standards of service and deal more effectively with mounting needs. Here, in the case of the private sector, one has not only additional resources coming in to relieve pressure on the Health Service, but also in many respects a pace setter for it.
The next argument of the hon. Member for Willesden, West was that the more private schemes of this kind increased the more they would tend to draw off scarce medical resources, including doctors and nurses. I agree that this is not easy to prove one way or the other, but I am doubtful about the validity of the argument. We already have a drain of doctors from the country and one of the reasons is that there is not sufficient variety of work.
Can anyone say that if the private sector were increased we might not find that doctors would be more inclined to stay here and perhaps that some of those now abroad would not return? It is the same case with nurses. I have met, as have other hon. Members, nurses working in private hospitals who, for a variety of reasons, are not prepared or able to work in the Health Service. Were these private institutions not to exist they would probably be lost to nursing altogether. I do not accept the validity of the argument on cost, on two standards of service, or on drawing off of scarce medical resources.
Now, finally—[Interruption.] I am sorry that some hon. Members—they appear to be on the Liberal bench—do not seem interested in life assurance policies. It is as well to get it on record that this should seem to be the case.
§ Mr. R. B. Cant (Stoke-on-Trent, Central)
On a point of order. This is the fifth final point that the hon. Gentleman has made. For the enlightenment of the Committee, could he classify those points before he sits down?
§ Mr. Dean
I am sorry that the hon. Member also does not appear to be particularly interested in this subject. I am 2332 coming to the point the Chief Secretary raised about the analogy concerning life assurance. He said that life assurance has been in existence for a century. From a Treasury Minister that is a poor argument for the rejection of the Clause.
If one looks at it from the point of view of the individual, there is a great similarity between life assurance and insurance for health. The time is rapidly coming when people who insure themselves for life will also take out medical insurance policies as well. The two are coming closer together in the minds of persons concerned, although they do not appear to be in the mind of the Treasury. But no one would deny a man the right of providing for his dependants on the untimely death of the breadwinner over and above the National Insurance Scheme. Indeed, the State encourages it through tax relief. Where is the difference in providing for oneself and one's dependants in the event of illness? It seems a strange logic to encourage insurance for death benefit, but not for life and health.
The tax relief for health services provided by the individual ought to go hand in hand with taxation for the health services provided by the State, so that there is a partnership between the two. If we could extend that partnership, not only would the principle be right, but it would be in the best interests of the Health Service. I hope that before the debate ends the Chief Secretary will deal more effectively with the arguments which have been put from this side of the Committee.
§ 10.15 p.m.
§ Mr. Dance
Most hon. Members will be very grateful when I say that I shall be extremely brief. The Chief Secretary said that life assurance had been going on for a century. It was extraordinary to hear from the Government, who are supposed to be modern in their thinking, that they will not modernise their thinking about another form of insurance, namely, support of B.U.P.A.
It has been said that the private sector of the health services jams the waiting lists. I want to give the Committee some facts about what happened in my own family. On 2nd January, my wife fell down at home and fractured her hip. She was taken to Warwick Hospital 2333 by the ordinary ambulance and she was put in a public ward which was very overcrowded. With the aid of B.U.P.A.—and I certainly could not have afforded it without B.U.P.A.—three days later I was able to get her into a private nursing home. That made that bed available.
Was that not worth while? Was not that a good thing to do? Is it not a good idea, if one is able to pay a certain amount of premium, to help the National Health Service, which is what this was doing? Is there anything wrong with that? I think that it is the right thing to do. The Treasury should give assistance to people who help themselves and in turn try to help the National Health Service. Is there any great argument against that?
The Chief Secretary went on to say that people could spend their money how they liked. I persuaded my children, some of them jolly hard up, to take out a B.U.P.A. insurance. They could ill afford to do so and would rather have had a washing machine or a television set. But because they saw the sanity of taking out one of these policies, they did so, at great hardship to themselves. Why should they not have the some sort of benefit of tax relief as people taking out life assurances?
§ Mr. Lubbock
The hon. Gentleman is suggesting that the choice which his children had was between B.U.P.A. and the washing machine. Why not equally tax relief on the buying of the washing machine?
§ Mr. Dance
I am certain that the Chief Secretary will realise that I am dealing with a serious matter and will not be confused by what the hon. Gentleman has said. This is a form of insurance which should get tax relief as do the endowment policies which can be taken out to help with the education of one's children.
§ Mr. Dance
Thank you, Mr. Brewis. I would not have detained the Committee for as long as his, had it not been for this Liberal nonsense. Does not the Chief Secretary realise that there is a parallel between life assurance, endowment assurance and assistance to people who try to provide for their health and provide for hospital facilities which help the National Health Service? Is there not a very strong argument for giving some tax relief to people who are prepared to look after the future, look after their health, and pay their own contributions? Are not they entitled to some relief?
§ Mr. Maurice Macmillan
We have worked very hard for some time now, but have got very little from the Chief Secretary, who was as negative, doctrinaire and almost theological as most of the arguments made from the Government Benches have been during the course of the whole debate. The Chief Secretary based most of his argument on an Income Tax principle which has been totally destroyed by changing investment allowance to investment grant.
I will not elaborate, because my right hon. and hon. Friends have destroyed the Chief Secretary's argument. All that the right hon. Gentleman could bring to the arguments that were adduced was to give a spirited imitation of Tweedledum and Tweedledee alternately saying "Nohow" and "Contrariwise". Because of the weakness of the case made by the right hon. Gentleman, I must advise the Committee to divide. I ask my right hon. and hon. Friends to support the Second Reading of the Clause.
§ Question put, That the Clause be read a Second time:—2336
§ The Committee divided: Ayes 84, Noes 160.2337
|Division No. 85.]||AYES||[10.22 p.m.|
|Alison, Michael (Barkston Ash)||Gurden, Harold||Osborne, Sir Cyril (Louth)|
|Allason, James (Hemel Hempstead)||Hall, John (Wycombe)||Percival, Ian|
|Atkins, Humphrey (M't'n & M'd'n)||Hamilton, Michael (Salisbury)||Pike, Miss Mervyn|
|Batsford, Brian||Harris, Frederic (Croydon, N.W.)||Pink, R. Bonner|
|Bell, Ronald||Hawkins, Paul||Prior, J. M. L.|
|Birch, Rt. Hn. Nigel||Hogg, Rt. Hn. Quintin||Pym, Francis|
|Black, Sir Cyril||Hordern, Peter||Ridsdale, Julian|
|Body, Richard||Hornby, Richard||Rossi, Hugh (Hornsey)|
|Boyd-Carpenter, Rt. Hn, John||Hunt, John||Sharples, Richard|
|Braine, Bernard||Hutchison, Michael Clark||Shaw, Michael (Sc'b'gh & Whitby)|
|Brinton, Sir Tatton||Irvine, Bryant Godman (Rye)||Smith, John|
|Brown, Sir Edward (Bath)||Johnson Smith, G. (E. Grinstead)||Stainton, Keith|
|Buck, Antony (Coichester)||Jones, Arthur (Northants, S.)||Taylor, Sir Charles (Eastbourne)|
|Burden, F. A.||Joseph, Rt. Hn. Sir Keith||Taylor, Edward M. (G'gow,Cathcart)|
|Chichester-Clark, R.||Kaberry, Sir Donald||Taylor, Frank (Moss Side)|
|Cooke, Robert||King, Evelyn (Dorset, S.)||Thatcher, Mrs. Margaret|
|Costain, A. P.||Kirk, Peter||van Straubenzee, W. R.|
|Crawley, Aidan||Knight, Mrs. Jill||Vaughan-Morgan, Rt. Hn. Sir John|
|Crouch, David||Lewis, Kenneth (Rutland)||Vickers, Dame Joan|
|Dance, James||McAdden, Sir Stephen||Walker-Smith, Rt. Hn. Sir Derek|
|Dean, Paul (Somerset, N.)||Macleod, Rt. Hn. Iain||Webster, David|
|Deedes, Rt. Hn. W. F. (Ashford)||Maxwell-Hyslop, R. J.||Wells, John (Maidstone)|
|Elliott, R. W. (N'c'tie-upon-Tyne,N.)||Maydon, Lt.-Cmdr. S. L. C.||Whitelaw, William|
|Eyre, Reginald||Monro, Hector||Wills, Sir Gerald (Bridgwater)|
|Fisher, Nigel||More, Jasper||Wilson, Geoffrey (Truro)|
|Fletcher-Cooke, Charles||Morgan, W. G. (Denbigh)||Wylie, N. R.|
|Glover, Sir Douglas||Mott-Radclyffe, Sir Charles|
|Goodhew, Victor||Neave, Airey||TELLERS FOR THE AYES:|
|Griffiths, Eldon (Bury St. Edmunds)||Nott, John||Mr. Blaker and Mr. Grant.|
|Abse, Leo||Gray, Dr. Hugh (Yarmouth)||Mackenzie, Alasdair (Ross&Crom'ty)|
|Alldritt, Walter||Grey, Charles (Durham)||Mackenzie, Gregor (Rutherglen)|
|Anderson, Donald||Griffiths, Rt. Hn. James (Llanelly)||Mackintosh, John P.|
|Archer, Peter||Griffiths, Will (Exchange)||Maclennan, Robert|
|Atkins, Ronald (Preston, N.)||Grimond, Rt. Hn. J.||MacPherson, Malcolm|
|Bacon, Rt. Hn. Alice||Hamling, William||Mahon, Peter (Preston, S.)|
|Barnes, Michael||Hannan, William||Mahon, Simon (Bootle)|
|Bessell, Peter||Harper, Joseph||Marquand, David|
|Binns, John||Harrison, Walter (Wakefield)||Marsh, Rt. Hn. Richard|
|Bishop, E. S.||Hazell, Bert||Mellish, Robert|
|Booth, Albert||Henig, Stanley||Mikardo, Ian|
|Boston, Terence||Herbison, Rt. Hn. Margaret||Millan, Bruce|
|Bowden, Rt. Hn. Herbert||Hilton, W. S.||Miller, Dr. M. S.|
|Bray, Dr. Jeremy||Hooley, Frank||Mitchell, R. C. (S'th'pton, Test)|
|Butler, Herbert (Hackney, C.)||Horner, John||Molloy, William|
|Callaghan, Rt. Hn. James||Howarth, Robert (Bolton, E.)||Morris, Charles R. (Openshaw)|
|Cant, R. B.||Howie, W.||Morris, John (Aberavon)|
|Chapman, Donald||Hughes, Rt. Hn. Cledwyn (Anglesey)||Murray, Albert|
|Concannon, J. D.||Hughes, Hector (Aberdeen, N.)||Neal, Harold|
|Cronin, John||Hughes, Roy (Newport)||Noel-Baker, Francis (Swindon)|
|Crosland, Rt. Hn. Anthony||Hunter, Adam||Norwood, Christopher|
|Crossman, Rt. Hn. Richard||Hynd, John||Ogden, Eric|
|Davidson, Arthur (Accrington)||Irvine, A. J. (Edge Hill)||Oram, Albert E.|
|Davies, Dr. Ernest (Stretford)||Jeger, George (Goole)||Orbach, Maurice|
|Davies, Harold (Leek)||Jeger,Mrs.Lena (H'b'n&St.P'cras,S.)||Orme, Stanley|
|Davies, Robert (Cambridge)||Jenkins, Hugh (Putney)||Oswald, Thomas|
|Dewar, Donald||Johnson, Carol (Lewisham, s.)||Page, Derek (King's Lynn)|
|Diamond, Rt. Hn. John||Johnston, Russell (Inverness)||Palmer, Arthur|
|Doig, Peter||Jones, J. Idwal (Wrexham)||Pardoe, John|
|Driberg, Tom||Judd, Frank||Park, Trevor|
|Dunnett, Jack||Kenyon, Clifford||Parker, John (Dagenham)|
|Dunwoody, Mrs. Gwyneth (Exeter)||Kerr, Mrs. Anne (R'ter & Chatham)||Parkyn, Brian (Bedford)|
|Edwards, Robert (Bilston)||Kerr, Dr. David (W'worth, Central)||Pearson, Arthur (Pontypridd)|
|Ellis, John||Kerr, Russell (Feltham)||Perry Ernest G. (Battersea, S.) '|
|Ennals, David||Lee, Rt. Hn. Jennie (Cannock)||Price, Thomas (Westhoughton)|
|Ensor, David||Lester, Miss Joan||Price, William (Rugby)|
|Fitch, Alan (Wlgan)||Lewis, Arthur (W. Ham, N.)||Redhead, Edward|
|Fletcher, Raymond (Ilkeston)||Lubbock, Eric||Roberts, Goronwy (Caernarvon)|
|Fletcher, Ted (Darlington)||Mahon, Dr. J. Dickson||Roberts, Gwilym (Bedfordshire, S.)|
|Floud, Bernard||McCann, John||Robinson, W. O. J. (Walth'stow, E.)|
|Foley, Maurice||MacColl, James||Rodgers, William (Stockton)|
|Fraser, John (Norwood)||MacDermot, Niall||Roebuck, Roy|
|Fraser, Rt. Hn. Tom (Hamilton)||Macdonald, A. H.||Rogers, George|
|Gardner, A. J.||McGuire, Michael||Ross, Rt. Hn. William|
|Gourlay, Harry||McKay, Mrs. Margaret||Rowlands, E. (Cardiff, N.)|
|Sheldon, Robert||Symonds, J, B.||Willey, Rt. Hn. Frederick|
|Short, Rt. Hn.Edward (N'c'tle-u-Tyne)||Thorpe, Jeremy||Williams, Alan Lee (Hornchurch)|
|Short, Mrs. Renée (Whampton.N.E.)||Tinn, James||Williams, Mrs. Shirley (Hitchin)|
|Silkin, John (Deptford)||Tomney, Frank||Willis, George (Edinburgh, E.)|
|Silkin, S. C. (Dulwich)||Wainwright, Richard (Colne Valley)||Winnick, David|
|Silverman, Julius (Aston)||Walden, Brian (All Saints)||Zilliacus, K.|
|Snow, Julian||Wallace, George|
|Spriggs, Leslie||Wellbeloved, James||TELLERS FOR THE NOES:|
|Steel, David (Roxburgh)||W hi taker. Ben||Mr. McBride and Mr. R. W. Brown|