§ 2.35 p.m.
§ Order of the Day for the Second Reading read.
§ BARONESS GAITSKELL
My Lords, I feel very privileged to introduce this National Health Service (Family Planning) Bill into your Lordships' House, for two reasons: the first because I am a comparatively new Life Peer, and the second because I have always been in favour of family planning, quite apart from the effects of the population explosion on vast poverty-stricken areas of the world.
This short Bill is concerned only with family planning in England and Wales. I have always believed that one of the basic human rights for a woman was the right to have as many, or as few, children as she wanted, and personally I have never accepted any moral objection to this right. It seemed to me that in this day and age women should not be at the mercy of a relentless fertility, and that they should have the right and the means to control their maternity and plan their families. I also believe that only the State can give the necessary universal service of education and information, particularly to the poorer members of the community—the women so often harassed by more children than they can adequately care for, who thus become the 154 responsibility of the State. This Bill, in short, helps women to have some control over their fertility, helps them to space their families and so to avoid having unwanted children.
There are three milestones on the road to this Bill extending over forty years. In 1926 Lord Buckmaster moved a Resolution in this House which sought to remove all obstacles to the introduction of birth control in maternity and child welfare centres. The Resolution was passed—an early example of the sometimes overlooked progressive character of this House, which is not always matched by the other place. Then in 1930 there was a circular under which local authorities could give family planning advice where the health of the mother would be endanged by another pregnancy. Thirdly, there was the circular of February, 1966, sent to local authorities by our enlightened Minister of Health, which was inspirational in its encouragement about family planning. It asked local authorities to make arrangements for advice and treatment without charge for those women whose health would be endangered by a further pregnancy.
The Minister also encouraged local authorities to give financial and other assistance to voluntary bodies working in this field, particularly the Family Planning Association, and for publicising information about places and times of voluntary clinics. But this circular, though a step forward, still authorised advice and treatment only for women whose health would be endangered by further pregnancies. Now there is this Bill, a short Bill, clearly drafted in reasonably penetrable legal language, to make family planning by local health authorities part of the National Health Service.
Clause 1 covers the provision by local authorities of services in connection with contraception. The present position with regard to family planning is that local health authorities have powers to provide, and in fact do provide, advice on contraception and prescribe or supply appliances, and more recently substances, to expectant or nursing mothers under Section 22 of the National Health Service Act 1946, or more widely under Section 28(1) of that Act. The scope of the powers and of the services given is, however, limited to women likely to suffer detriment to their health as a result of pregnancy.
155 Clause 1(1) confers on local health authorities a general power, with the approval of the Minister of Health, to make arrangements for the giving of advice on contraception, the medical examination of persons seeking such advice, and the supply of contraceptive substances and appliances. This power can be converted into a duty so far as the Minister may direct. The object of Clause 1(1) is to give power to a local health authority to provide, or arrange for local voluntary organisations to provide, advice on contraception and supplies for any persons who need them on social grounds, and not only for women at medical risk in the event of pregnancy. The new clause thus goes beyond the present powers limited under Section 28 to the prevention of illness, and constitutes a new and entirely separate provision replacing the powers under that section.
Clause 1(2) empowers a local health authority, subject to the Minister's approval, to recover from persons of any class or description such charges for the provision of advice or the supply of substances or appliances as the authority consider reasonable having regard to the means of the recipient. The power to recover charges is wide enough to enable an authority, within the scope of the Minister's approval, to use its discretion in deciding what charge, if any, should be made, and to exempt necessitous cases. For example, it may be decided to make no charges for advice or supplies in medical cases, and in non-medical cases to charge for supplies or prescriptions but not for advice.
Clause 2 contains the supplementary provisions. Subsection (1) provides that the Act of 1946 shall have effect as if Clause 1 were included among the provisions of that Act and the services under it were provided under Part III of the Act. The effect of Clause 2(1), therefore, is that the services to be provided under the Bill will be treated as local health services, and will be subject to a number of provisions of the 1946 Act. Clause 2(2) brings Clause 1 within the scope of Section 46(1)(a) of the Local Government Act 1958, thus ensuring that a scheme of delegation to a county district council of the health and welfare functions of a county council made under Part III of that Act will operate as though it in 156 eluded a reference to the provision of services in connection with contraception.
Clause 3 deals with expenses and receipts by the Minister. Subsection (1), paragraph (a), provides that any increase in the expenses incurred by the Minister in the exercise of his functions—that is, of his default powers—under the Acts of 1946 and 1958 which are attributable to the provisions of this Bill shall be defrayed from the Exchequer. Subsection (1)(b) provides that any increase in rate support grants to local authorities necessitated by increased local authority expenditure under the Bill will also be met from the Exchequer. Subsection (2) requires the payment into the Exchequer of any sums which may be received by the Minister in consequence of exercising his default powers in relation to services provided under the Bill.
My Lords, there is no distinction drawn in this Bill, for advice on contraception on social grounds, between married and unmarried women. Where the health of an unmarried woman would be endangered by a further pregnancy, a local authority is already empowered to give contraceptive advice and treatment. Personally, I feel that in a free society like ours one simply has to take a risk. Freedom always carries with it a modicum of licence. Knowledge in the use of contraceptives by the young can tempt some of them into promiscuity. I had not noticed that ignorance did not do that already. It is a question of balance. Let us balance the illegitimacy figures—68,000 in 1965—against the risk of laxity and abuse. It cannot be thought that ignorance is really a good basis for morality, although I heard a speaker on "Any Questions?" on Sunday declare that a good deal of morality was based on fear and compulsion. Even if that were true, fear in sex is due only to ignorance, and young people today can neither be compelled nor kept in ignorance about sex.
There is a smart remark going about that the best contraceptive for a woman is, "No". I wonder how many males take "No" for an answer, particularly among married people. We know that the number of children in community care to-day belies this adult ideal of restraint. Meanwhile, the Brook Advisory Centres for the unmarrieds are courageously meeting a very real social 157 need. I know, my Lords, that innocence has long been a masculine fetish, just as excessive adulation of motherhood has merely served as a cover to keep women in subjection. It seems to me that the need for these Brook Advisory Centres must go on growing.
The aim of this Bill is to secure the provision of adequate local family planning services. Thus the Minister can convert the power of a local authority into a duty, and this power of direction cannot be excluded. But there is little ground for thinking that this power will need to be invoked, as we see that out of the 174 local authorities in England and Wales, with one or two exceptions all 156 authorities who replied to the Minister's circular already provide a family planning service, 70 per cent. of them through voluntary bodies and 23 per cent. of them through direct service supplemented by voluntary bodies, and that 94 per cent. of authorities assisting voluntary bodies assist the Family Planning Association alone. Here I should like to pay homage to the Family Planning Association. Whenever in the General Assembly I champion the work of voluntary bodies (particularly because the Russians are always denigrating them) I think of the Family Planning Association.
This Bill, if and when it is passed through Parliament, will stand as a monument to a handful of dedicated pioneers and their ceaseless endeavours. The long-term results from this Bill can only mean fewer abortions, fewer poor children. There are 2½ million children classified as "poor" in this affluent society of ours. Proper sex education, which must include a knowledge of contraception, can only help increase social responsibility. I commend this Bill to your Lordships with enthusiasm, and beg to move that it be now read a second time.
§ Moved, That the Bill be now read 2a.—(Baroness Gaitskell.)
§ 2.50 p.m.
§ LORD SANDFORD
My Lords, we too welcome this Bill and are grateful to the noble Lady for introducing it. My Lords, sexual intercourse within marriage is right and good, and the use of responsible forms of family planning make it better; sexual intercourse outside marriage is wrong, and the lack of 158 contraception makes it very much worse. As I believe those two relatively simple propositions, I, too, welcome the comprehensive family planning service for all that will be made possible by this Bill when it is enacted. I hope that as soon as it becomes law the Minister of Health will encourage all concerned to give full effect to its intentions.
I must confess that I share with the noble Lady, and with Mr. Brooks, who introduced this Bill in another place, a good deal of impatience with those who in the past have sought to hinder the spread of knowledge about family planning: not that your Lordships are guilty, for, as the noble Lady reminded us, it was in 1926 that we became the first legislative Assembly in the world to try to make family planning the concern of the public service. When the local health authorities come to set up their family planning services in the light of this Bill, I hope that no further attention will be paid to those who seem to think that virtue can be built up by ignorance of sex and that good morals can be sustained by fear of conception. I hope that when he follows me in a few moments the right reverend Prelate the Bishop of Chester can assure us that we have nothing further to fear from the Churches, or any part of the Churches, in that respect. It is good to know that those who have the future of young people at heart are now approaching these matters in a more positive way and in a broader context.
I was told the other day by the General Secretary of the National Marriage Guidance Council that whereas a year ago their educational department was in touch with three local education authorities, they are now in active co-operation with no fewer than 27, teaching teachers how to teach their children the facts of life and the fuller understanding of personal relations between the sexes. If contraception is learned in that context, I feel that we have not much to fear from an increase of promiscuity.
May I now turn to certain aspects of this Bill? The Title is addressed to local health authorities, and I have no quarrel with that, but I imagine that your Lordships would agree that hospitals, particularly maternity hospitals and post-natal clinics, are also especially favourably placed to give family planning advice, not 159 only where it is required on medical grounds—because this they already do—but on general social grounds as well. I think we should like to hear from the noble Lord, Lord Beswick, exactly what guidance will be given to the hospital service by the Minister to keep that arm of the National Health Service in line with the local health services when this Bill becomes law. We should also like to know what steps are to be taken to ensure that medical training is given at appropriate stages in order to keep the medical profession in line with these developments. If the noble Lord cannot tell us now, perhaps we may be told about it at the next stage.
In Clause 1(1) we find a reference to England and Wales but there is no reference whatever to Scotland. Perhaps it is in the nature of our legislation that there should be this omission. I think it is one which will certainly bring couples who have gone to Gretna Green back South again. Perhaps it is necessary to have a separate Bill for Scotland, but we should like to know at this stage who will bring it in, when and in which House. So far as I can see, there is no case whatever for the exclusion of Scotland for more than a temporary period from the provisions of this Bill.
As was said by the noble Baroness, Lady Gaitskell, Clause 1 is widely drawn and it is not yet certain how local authorities will use the powers conferred upon them by it. I was glad when I read the report of the Second Reading debate in another place on February 17 [OFFICIAL REPORT, Commons, column 1006] that, to start with, at least, the Minister does not intend to use his powers of direction but to leave it to local health authorities to develop their family planning services in their own way. I am sure that this is wise, and this approach is welcomed by noble Lords on this side of the House. I hope it is the only approach which will be necessary. But the uncertainty at this stage about how the new service will develop makes this yet another occasion when we sadly miss the presence of the late Lord Brain, who was President of the Family Planning Association. I am sure that had he still been with us he could have told us exactly how he saw the future of this service developing. That is something for which we shall now have to wait.
160 I hope that there will be nothing in the working of this Bill that will upset the status of the Family Planning Association as a charity, for if it did I could picture the Association tending towards becoming a subsidiary part of the National Health Service; and that, I submit, is the last thing we want to see. It is essential that in this new partnership the Family Planning Association continues to draw much of its support from voluntary sources. It is essential, I submit, that it maintains a large degree of independence and freedom while also developing further its partnership with the statutory bodies. Can the noble Lord, Lord Beswick, in his reply reassure us, please, on this point, if not to-day perhaps at a later stage?
Turning to the financial clauses I think it is a little odd that we should have a charge laid on the Exchequer by a Private Member's Bill without the amount of the charge being in any way specified. If this is so, I think that the House ought to be told, either now or at a later stage, some measure of the extent of this financial provision.
Finally, I would draw attention to those parts of Clause 1 which refer to contraceptive substances and appliances. I believe there is a feeling—it may be only a suspicion—that there is something like a near-monopoly in the supply of some of these items. I do not know whether this view is well founded, but the Minister will know, or can find out, and perhaps he will let us know later. If it is not well founded, so much the better; let us hear that. If, on the other hand, there is anything like a monopoly, I am sure that we should all want to see the matter referred to the Monopolies Commission before public funds are used in what will amount, as a by-product, to a very considerable publicity campaign in favour of the manufacturers of contraceptives. My Lords, having said that, I am glad to welcome this Bill from these Benches, and I hope that we shall not now be very much longer in finishing off what we began 41 years ago.
§ 3.0 p.m.
THE LORD BISHOP OF CHESTER
My Lords, owing to an unavoidable engagement this afternoon it may be necessary for me to leave before the end of this 161 debate. If so, I apologise to your Lordships' House. The noble Baroness in charge of the Bill has graciously indicated to me that she will not regard my absence as a discourtesy to herself.
I rise to give my support to this Bill. It touches, of course, upon a matter of deep and personal concern, and for that reason it is bound to arouse certain strong emotional reactions. Since under its terms it must be possible for advice to be given on contraception to unmarried persons, the Bill arouses certain apprehensions about the future. Will the new opportunities, it is asked, give rise to an unrestricted libertarianism? Will it encourage sexual intercourse outside marriage? Will it contribute further to a decline in moral standards? For myself, I do not believe that the ethical and moral objections to this Bill can be maintained. The information and advice which it will provide are already available, whether we like it or not. Those who want the service which the Bill will make legal will get it somehow, whether we think they should or not. And surely it is better that those who want advice on contraception should be able to get it from properly qualified persons rather than be forced to go to less reputable and less skilful sources.
The noble Lord, Lord Sandford, has asked me to give your Lordships some assurance about the attitude of the Churches in this matter. I can only draw his attention to the decisions of the last Lambeth Conference, in 1958, which gave their approval to the use of contraceptives in proper circumstances for family planning. I believe that those decisions were of great importance and have had a considerable mark upon Christian thinking on a wide scale. Indeed, in this respect it may well be that as a result of this Bill the moral issue about which many of us care deeply will be enhanced. Instead of going to commercial sources, whose only interest is to sell advice and apparatus, those who want advice will be able to go to skilled and trained persons, who have no ulterior motives and who will be able to give advice on the larger issues involved in the use of contraceptives.
In giving my support to this Bill I would, however, add a note of caution. I understand that in certain quarters this Bill is being represented as a victory 162 for freedom and as a removal of restraints, so that those who are minded to do so need feel themselves no longer restrained in their desire to indulge in sexual intercourse, be it within or without the marriage bond. I am sure that that is not in the minds of the promoters of this Bill, but it is being said. The Second Reading of the Bill should therefore be the occasion when those of us who feel strongly about the need for discipline should give expression to their convictions. The fact that information may be misused is not necessarily a reason for withholding it, but the making of information available may be the right opportunity for a word of warning about the possibility of the misuse of that information.
I am one of those who believe—and I venture to think that most of your Lordships would believe—that sexual intercourse outside the marriage bond is contrary to God's will and that, whatever may be the short-time rewards, such disobedience always in the end brings disillusionment and sorrow. Unfortunately, in recent months some of those who should have known better have not spoken as unequivocally as they should, nor given the kind of guidance that so many young people seek. Now that many of the fears which in the past surrounded sexual intercourse have been removed there is a widespread impression that restraint and self-discipline are no longer needed. It would be an unfortunate consequence for individuals, and for society, if this Bill were interpreted as adding still further justification for sexual licence or as the giving of Parliamentary approval to unrestricted sexual intercourse. By placing the responsibility for giving information and treatment into the hands of responsible people, I trust that the opposite will be the case, and for that reason I give my support to this Bill.
§ 3.6 p.m.
§ BARONESS SUMMERSKILL
My Lords, I should like to speak for a few moments on one aspect of the Bill which is in the minds of many people in this country and to which at this stage of the passage of the Bill I think it is relevant that we should give some consideration. I wholeheartedly support the principle of the Bill, provided that the method of birth control taught is known to be without risk to the health of the 163 woman. Any method about which grave doubts have already been expressed must be excluded. Therefore I want to speak on the comparatively new method of contraception which has been introduced—namely, the contraceptive pill.
It is not unusual these days to read reports of inquiries into the deaths of young women who are known to have taken contraceptive pills, and I observe that coroners are becoming increasingly outspoken on the subject. The last report of this kind was on Saturday, June 3. The report in The Times was headlined, "Wife's death 'linked with the pill'". Mr. A. Gordon Davies, the Southwark Coroner, said at the inquest,I link this death with the taking of the birth pill.Recording a verdict of misadventure, he said:If there are any hazards in the taking of the pill, I think they should be widely known.The Times report continued:Dr. James Cameron, pathologist, said Mrs. Daphne Roberts, aged 20, died from pulmonary embolism and that a doctor had diagnosed her complaint—before death—as pleurisy.The Coroner said: 'This is the second time I have dealt with a case of this type, and on both occasions the woman suffered chest pains similar to those in pleurisy. I think these pains should be a warning for a woman to stop taking the pill'.It is clear that many coroners are becoming apprehensive. I think it is significant that this case was originally diagnosed as pleurisy, because one can deduce from that that there may be cases where women die after suffering from what has been diagnosed as pleurisy.
We cannot afford to ignore the investigations of the Medical Research Council, which reported recently the preliminary results of three investigations into the relationship between the use of oral contraceptives and the development of thromboembelic diseases. The British Medical Journal, summing up the investigations in its issue of May 6, said:Many doctors will regard the prescribing of the present oral contraceptives as an interim measure until safer means are available.Further investigations have been made into cases where women who have been taking oral contraceptives have not died, but have suffered from temporary paralysis and other serious symptoms. These do not hit the headlines of the popular Press, 164 which is generally interested only in the ultimate outcome—death, which, of course, is more dramatic. But these cases are reported in the medical Press.
Investigations were undertaken by Dr. Edwin Bickerstaff, of the Midland Centre for Neurosurgery and Neurology at Birmingham, and Dr. MacDonald Holmes, of the Staffordshire General Infirmary. A report was given in the British Medical Journal of March 25, 1967. I should like to quote from the summary of that report in order that the Minister himself and those who advise him may read the whole of the investigations in some detail. The summary said:Episodes of acute cerebral arterial insufficiency occurring in otherwise healthy women below the age of 45 have been studied before and after the introduction of oral contraceptives.I should emphasise that that means before the production of oral contraceptives.In the 10 years before 1964 25 such patients were seen in whom investigation showed no evidence of vascular anomalies, cardiac or renal disease, or hypertension. In the three years 1964–66 the number of such cases referred was 25. Eighteen of these 25 patients had been taking one or other of the oral contraceptives.The summary goes on:… it is suggested that there is an apparent association between the use of oral contraceptives and the increased number of episodes of cerebral arterial insufficiency that cannot be disregarded, and certain factors are discussed which in the light of present knowledge might contraindicate their use or warrant their discontinuation in individual patients.No doubt more evidence will now be available. As this report shows, we have only that material which has come to light in the last three years on which to work; and further investigation will he made in this and other countries. Therefore I believe it would be wrong for us in our local authority clinics at this stage to advise the pill as a contraceptive device while there are other methods which are without risk to the health of the mother.
§ 3.14 p.m.
§ LORD MITCHISON
My Lords, I feel sure that the House wishes to get on to the Criminal Justice Bill, and therefore what I propose to say can be said quite shortly. I agree entirely with the objects of this Bill. I think the methods in it are the right methods and the machinery the right machinery; and perhaps I need 165 say no more than that for the moment. But I share the view expressed by the noble Lord, Lord Sandford, about the omission of Scotland. This Bill, in the form in which it was introduced in another place, could not have been there amended to include Scotland. Indeed, it would have had to be, in some respects, a rather different Bill, because there are differences in the structure of local government in Scotland and differences, sometimes of an unwritten character, in the relations between the Central Government and the Scottish local authorities. This is, after all, a Bill for extending a power which the local authorities already have in medical cases to cases where there are other considerations involved, not necessarily medical ones. It could not have been so amended under the Rules of Order in another place and, moreover, it there required a Money Resolution. If Scotland had had to be included (or could have been included) by way of Amendment there would have been a case for a second Money Resolution.
Consequently, it seems to me that it could be a grave mistake to imperil the objects of this Bill—with which, I take it, the House in general is in agreement—by trying to bring in Scotland. Moreover, as I said just now, I recognise that there are differences in the relations between the Central Government (in that case the Secretary of State) and the local authorities in Scotland, and it may be a mistake to have the power of direction contained in the English Bill—which the Minister, incidentally, has said he does not propose to use for the present—put into a Bill dealing with Scotland. But I hope these considerations will not be treated as an excuse for not dealing with the Scottish question.
Again I recognise that at this time in the Session it may be too late to deal with Scotland if it has to be dealt with under a separate Bill. But I trust that we shall hear at some stage from the Government that they sympathise with the objects of the Bill as regards Scotland, just as they do as regards England and Wales. As regards England and Wales, the Minister of Health said in another place that if this Private Member's Bill had not been introduced the Government themselves would have brought forward a similar measure. I hope that there will be sympathy as re 166 gards Scotland also. I hope, too, that local authorities in Scotland (who in matters of this kind may have possibly slightly more independent positions in practice than is the case in England) will show their willingness to uphold the principles in support of which we have already heard two or three very eloquent and, if I may respectfully say so, very sensible speeches. It seems to me that it may well be even more a local authority affair in Scotland than it is in England.
I do not want in any way to attempt to speak for the Government, but I hope that what I am saying is broadly in line with the views of the Government as regards Scotland. I have some reason to believe that it is. I say "broadly in line" because I am speaking, as your Lordships can see, "off the cuff". I therefore cannot put my words with the precision required from those who speak formally on behalf of the Government. I certainly do not expect my noble friend who is to reply to answer now; perhaps he may be able to do so at a later stage. But I trust that this Bill will not leave us altogether without some expression of opinion that in matters of this kind what is right on one side of the Border is probably right on the other side of the Border, too; and that there is no sharp differentiation in rectitude at one border of the town of Berwick and at the other border of the town of Berwick. The town of Berwick, I understand, is neither England nor Scotland. I am told that they are still at war with Russia because they were left out of the last peace treaty. Be that as it may, let us hope that we are not going to have one set of canons of conduct and the like laid down for England and Wales, and the Scots just left out.
§ 3.19 p.m.
My Lords, coming as I do from a country where, from time immemorial, women have ruled the roost, I think I ought to put in a word at this stage on the matter we are debating. I do not know what the intentions of the Government are with respect to Scotland in regard to this Bill, but I would humbly say—although I do not know what the answer will be—that before applying this Bill to Scotland it would be wise for Her Majesty's Government to ascertain the opinion of the General Assembly of the Church of Scotland about the matter. It you legislate contrary to the opinion of 167 the General Assembly of the Church of Scotland you are apt to have a whole nation in arms against you.
After listening to what has been said in this debate, one point occurs to me. A man marries a woman. The reasons, as a rule, why a man marries a woman are that he should have legitimate children, not only to inherit his property, but more often, in these days, to bring them up in the pursuits to which he has devoted his life and to becoming good citizens in the same way as the father has. If, on marrying a woman, he finds that his wife refuses to have children, it seems to me that the whole basis of the marriage is ruined and he ought to be able to get a divorce at the earliest possible moment. Otherwise, it is not worthwhile marrying. That is only a remark in passing.
There is one other point about which I should like to ask the Government, and it has been ably dealt with by the noble Baroness, Lady Summerskill. It occured to me that we have had bad experience in the past with drugs of various kinds. We had thalidomide in another branch of this business which has had a most unhappy history. I have seen these coroners' reports, and it occurs to me to ask this question. Supposing the advice given and the drugs supplied by the local authority are held to have produced serious injury or death to the person to whom they have been administered, does an action for damages lie against the local authority? I think it is pertinent that we should know this. That is all I feel inclined to say at this stage. I should like to tackle the right reverend Prelate on something that he said, but I will do that on another occasion.
§ 3.23 p.m.
§ VISCOUNT ADDISON
My Lords, I will not detain the House for more than a few moments, because, whatever controversies may exist over the matter of family planning, I gather that they are somewhat overshadowed by the differences of opinion which will emerge on the Criminal Justice Bill which is to come before your Lordships later this afternoon and to-morrow. I am sure that this Bill deserves a general welcome as making possible a comprehensive family planning service available to all who need it, or want it, under the National Health Service. I have only 168 two minor reservations. Like the noble Lord, Lord Sandford, and my noble friend Lord Mitchison, I am sorry that the Bill does not extend to Scotland, and I hope that something may be done to make sure that this deficiency is rectified. Surely the need is the same in Scotland as it is in England and Wales, and one would not like to think that they do not get the same service as we do.
The other point is that there is no specific mention in the Bill of hospital authorities. However, it is recognised that hospitals are for the sick, and their direct responsibility for family planning can properly be limited to those of their patients who require advice and treatment of this nature on medical grounds. By placing family planning fully within the ambit of the National Health Service, the Bill makes possible a much more integrated service in which the family doctor, the local health authority and the hospital management committees can all work together with the existing Family Planning Association to provide a comprehensive service to the whole community. It is good to know that the Family Planning Association, which has done such valuable work, has already initiated discussions with the County Councils Association and the Association of Municipal Corporations to see how best they can play their full part in ensuring the effective success of the Bill. I wish the Bill a smooth passage through your Lordships' House as quickly as possible and, if possible, without substantial amendment.
§ 3.26 p.m.
§ LORD SEGAL
My Lords, before we are faced with a mass migration southwards from Gretna Green, I should like to endorse the plea so eloquently made by my noble friends Lord Mitchison and Lord Addison. Owing to the somewhat attenuated representation on the Liberal Benches opposite, I wish to express a note of satisfaction at the inclusion in this Bill of gallant little Wales. I think we owe a tribute to the wisdom and foresight of the Government for not having omitted to include Wales in this Bill. Although far smaller in area than Scotland, Wales yields to no-one in her spirit of fierce patriotism Wind national pride. I am no Welshman, and have visited that country only rarely, but, rather by accident than by design, I was nurtured 169 in a cradle of Welsh culture, fortunately on English soil.
Wales may not have quite as much heather as Scotland, but the leek is a noble vegetable and far more edible. A profusion of Welsh petticoats is no less becoming than the kilt. To me, the voices of a Welsh choir are in no sense less appealing than the skirl of the bagpipes, and the cadences of the Welsh tongue fall at least as pleasantly on the ears as the accents of the Scottish Highlands. So we must be thankful that on this occasion the Government have not forgotten Wales and have wisely included her in this beneficent Bill.
§ 3.28 p.m.
§ THE PARLIAMENTARY UNDER SECRETARY OF STATE FOR COMMONWEALTH AFFAIRS (LORD BESWICK)
My Lords, we are grateful to the noble Baroness, Lady Gaitskell, for sponsoring this Bill, and I should like to join with all those in the House who have already thanked her for the way in which she has explained its provisions. Certainly she has earned the gratitude of the Government. I make clear at the outset that the Government attach importance to this Private Member's Bill and, as my right honourable friend the Minister of Health made clear in another place, if the original sponsor had not been fortunate in drawing an early place in the ballot, legislation on these lines would have been introduced by the Government.
A number of noble Lords have asked me about the position of Scotland, and perhaps I may take this opportunity of making it quite clear that the Bill refers to England and Wales. The position of Scotland, so far as the National Health Service is concerned, is different, and the provisions there follow a different National Health Service Act. I understand that the sponsor of the Bill has been in correspondence with the Secretary of State for Scotland, and I hope that my noble friend Lady Gaitskell will have some further words to say on the question of Scotland when she comes to reply to the debate.
After what my noble friend has said, I do not feel that there is any great need on my part to spend further time in 170 advocating this Bill. Whatever may be the attitude or the reservations of any individual Member of the House about family planning or, as some still prefer to call it, birth control, I think we should all agree that there has been a quite profound shift of opinion in our society in recent years. This, I think, was brought out clearly by the noble Lord, Lord Sandford, and the right reverend Prelate in what they respectively had to say. Social welfare workers, especially, know how lack of planning, often due to ignorance, leads to broken marriages, degrading poverty and even on occasions to criminal abortion. Assistance given by health and social workers may avail nothing at all if the family has yet another child. Access to family planning advice and treatment, therefore, is considered essential.
A full service of family planning in the community, co-ordinated with other personal social services, is intended to offer a twofold advantage: first, to the individual, by making his family life happier; and, secondly, to the local authority in easing the demand for services to assist the over-burdened family. At present, as my noble friend has already said, local authorities may provide family planning advice and treatment only for women for whom pregnancy would be detrimental to health.
The Minister of Health, in his circular to local authorities to which my noble friend has already referred, urged local authorities to review their present arrangements and suggested some of the ways in which they might extend them and improve them. Response to this circular indicated that, almost without exception, authorities throughout England and Wales provided a service of advice and treatment in medical cases, and local authorities continue to expand their provision for medical cases. But the Government's view, shared by the responsible local authority associations, is that there is a need for local authorities to be able to do more. Existing family planning powers of local authorities do not meet the wider need for advice and prescription of those who wisely wish to plan their families, even though there be no specific danger to health. This Bill, if enacted, will remedy deficiencies of the existing law.
My Lords, may I interrupt the noble Lord? As the Government have clearly, from what he said, studied this question carefully, would he give me an answer to my question: in the event of things going wrong, would an action lie?
§ LORD BESWICK
My Lords, I propose to reply to the debate, if the noble Lord will allow me, in my own way. I was coming a little later to the point he raised.
Under the National Health Service a general practitioner is free to decide whether or not to give family planning advice to a woman who merely wishes to plan her family sensibly and where there is no particular medical reason. If he decides not to do so, he may refer the patient to the local authority service, or the patient may decide herself to change to another doctor in the Service who is willing to advise her. Advice from the general practitioner is free in all cases, and he may prescribe and supply drugs free on medical grounds. Where no specific danger to health is involved, the practitioner may make a charge for prescribing drugs and for prescribing and fixing appliances. The present need is to provide a wider service of family planning advice and treatment under the National Health Service. Local authorities, I think we all agree, are the natural focus for health education and for preventive services. Contraceptive advice and treatment fall under this heading, and the skills required in the family planning centres are those which it is most appropriate for the community medical services to provide.
The noble Lord, Lord Sandford, and my noble friend Lord Addison, asked about the position of hospitals. In respect of family planning, hospitals are in the same position as local health authorities under the present provisions: that is, they are able to provide only women for whom pregnancy would be undesirable on medical grounds with contraceptive advice and treatment, or, by arrangement with a family planning clinic, to refer them to that clinic and pay for the advice and treatment given there. A good deal has been said in another place, and indicated by Lord Sandford, to the effect that the hospital would be a suitable place for extending this facility of advice and provision of drugs or appliances. But 172 hopitals are defined, inter alia, in the original 1946 Act as institutions for the reception and treatment of persons suffering from illness. Pregnancy of itself cannot be regarded as an illness. So far as possible, no people should go into hospital unless their presence is necessary as patients, staff or visitors.
One other very relevant point here is that the gynæcological and maternity services of hospitals are among the most heavily burdened of all. Moreover, in many instances hospital clinics are not conveniently situated geographically, whereas local authority health clinics are usually much better situated. The position, therefore, is that hospitals can already make, and will continue to make, a contribution to family planning. Among women referred to hospitals for various forms of treatment or for maternity care will be some for whom contraceptive advice or treatment is indicated in the interests of the patient's health. It will be for the consultant to reach such a decision and to take action appropriate to the particular case. For some, advice in general terms may be sufficient. In other cases, the consultant will refer the patient to her family doctor, or to the local health authority clinic. So it will be seen that the general answer to the noble Lord is that it is more natural and more convenient for patients to turn to the community services provided by local health authorities and the family doctors, rather than to the hospital service.
My noble friend Lady Summerskill asked about the dangers of one particular form of contraception; and I was again asked what would be the position if an action was brought. So far as the latter part of the question is concerned, I am afraid, I am not able to give the noble Lord, Lord Saltoun, any direct answer; and, of course, it does not arise out of this Bill. I would say to my noble friend Lady Summerskill, who voiced her anxieties again—and I have heard her so voice them before—that I respect and admire the way she persistently brings to our attention the fears which she holds and the facts as she sees them. As she knows, there have been preliminary researches into this question, and the report of the M.R.C., of May 6, 1967, said that, whereas there may well be a risk of thrombosis due to the use of oral contraceptives, that risk is only three times 173 above the normal, whereas the risk during the time of pregnancy is six times above the average. These are preliminary facts.
§ BARONESS SUMMERSKILL
My Lords, may I just put a point to my noble friend? He says that the woman is at risk during pregnancy. But she faces up to that risk willingly and is prepared to risk becoming pregnant. What we are doing now is providing a drug to a young woman who could have an alternative, and therefore it is wrong to put her at risk. There is no alternative to pregnancy.
§ LORD BESWICK
My Lords, I quite understand what my noble friend says. But what she has said, and the facts to which I have referred (which of course have to be assessed by those more qualified than I) and indeed, I should hope, all the relevant information, are taken into account by the responsible medical practitioners before they make any decision as to what form of contraceptive they should prescribe. But, beyond that, all I can say to my noble friend is that I will certainly ensure that what she has said, and said so persuasively again to-day, and the danger or possibility of other legal complications in this matter, will be studied. That is as far as I can go this afternoon, and I am sure the noble Lady appreciates my position in this matter.
My Lords, the point has already been made that, as drafted, the Bill draws no distinction between the married and the unmarried, and that it is wide enough to enable local authorities to provide a service for unmarried persons. The Minister of Health's view is that the wisest course is to leave this matter to local authorities, who are expected to have a full regard to public opinion within their area when framing the arrangements for their service.
As to the payment for the service, the present position is that in cases where no specific danger to health is involved—the cases we are mainly concerned with to-day—a general practitioner can charge for prescribing a drug and a chemist can charge for supplying it. The noble Lord, Lord Sandford, asked about the possibility of a monopoly position arising in the supply of drugs and appliances when 174 the provisions of this Bill are fully operative. All I can say is that this matter will be entirely one for the Board of Trade and the Monopolies Commission. There will be no difference between these articles and any other articles available to the public.
§ LORD SANDFORD
My Lords, may I interrupt the noble Lord, with great respect, because I think there is a considerable difference here. I was concerned that there is a suspicion of a monopoly position now, and if there is any suspicion it should be investigated and the facts determined before we spend a great deal of public funds in giving a publicity boost to an advertising campaign for the manufacturers of contraceptives. This is a position which does not apply over the whole retail field; it is rather special.
§ LORD BESWICK
My Lords, the noble Lord has said that there is a monopoly position. I am saying that I do not know whether there is or not. I think he has in mind one particular appliance which may or may not be prescribed when the service is in operation. As with drugs, I see that there is a danger so far as monopolies are concerned. This is not a matter for my right honourable friend the Minister of Health but one for the Board of Trade and the Monopolies Commission, and I shall have to leave the matter with them.
A number of authorities are now providing a limited domiciliary service in medical cases under their existing powers for persons unable to make their way to a centre for advice and treatment. The Government envisage an expansion of this arrangement for both medical and social cases if the Bill becomes law. The need for a domiciliary service for family planning is analogous to the need for a domiciliary service for people who suffer from physical, mental or social handicaps and who, because of their handicap, must be assisted in this way if they are to avail themselves of other services provided outside their own homes. The taking of smears to detect incipient cervical cancer is a case in point where, in appropriate circumstances, it may be necessary to provide some form of domiciliary service. And of course those to whom this sort of service would be applicable may well be those who are most in 175 need of the service and, at the same time, among those most reluctant to seek advice. I am advised that, as drafted, this Bill would enable a local health authority to provide a family planning service either by providing the service itself or through arrangements made with a voluntary organisation. Where the service is provided through the agency of a voluntary organisation it will be open to the authority to defray the cost of the service to the body concerned and this could be done, as at present, either by paying a grant or by making a per capita arrangement, or by providing premises and other facilities free of charge. The noble Lord, Lord Sandford, asked me about the financial provisions of the Bill. At the outset the amount involved is expected to be very small. As the service develops there will be corresponding savings. At this moment it is not feasible to make any very accurate estimate as to what the cost would be, but it is expected to be reasonable.
Local authorities are becoming increasingly aware of the need to encourage a climate of opinion in which advantage will be taken of a wider provision of facilities, and social workers are playing a growing part in informing and educating families with whom they come into contact. Any successful family planning service must be acceptable to the prevailing public opinion: local authorities, who have a direct responsibility for health education generally, are particularly well equipped to dispel ignorance on this subject. The Minister of Health has said that he is favourably impressed by the level of activity in the provision of family planning services by local authorities. Although there is a residual power of direction in this Bill to enable the Minister, where appropriate, to convert the power of a local authority to provide services into a duty to make arrangements in accordance with his direction, it is doubtful whether it will need to be applied. The evidence available to the Minister suggests that many authorities regard the extension of their powers in this field as long overdue.
My Lords, no problem is of greater importance to the well-being of mankind in the world to-day than the limitation of population growth. Those who are concerned with the quality of life have no choice but to be concerned with its quan 176 tity. The right reverend Prelate spoke of the fears which some people have of unrestricted libertarianism or, as he put it, the decline in moral standards if this Bill becomes law, but he went on to say that it would entirely depend on the use or misuse of the facilities which are provided. The knowledge which this Bill seeks to spread can enter into it, but it will not necessarily bring happiness. As with the knowledge of, say, nuclear energy, it is for human beings to decide whether the knowledge, when used, will bring happiness or unhappiness. Used responsibly there is no doubt that this knowledge of how to control conception, which will be made more widely available, can bring increased happiness and an enhanced quality of life to a society devoted to less selfish ends. For this reason, my Lords, I commend this Bill to the House.
§ LORD SANDFORD
My Lords, before the noble Lord sits down, may I ask him whether he will give us the reassurance for which I asked about the charitable status of the Family Planning Association?
§ LORD BESWICK
My Lords, that is a matter upon which I cannot give the noble Lord information to-day, but I will certainly see that it is available at a later stage.
§ 3.48 p.m.
§ BARONESS GAITSKELL
My Lords, I wish to detain your Lordships for only one moment, simply to thank all those noble Lords who have taken part and to make just one or two points. The noble Lord, Lord Sandford, asked what the cost to the Exchequer would be for the promotion of family planning facilities. I asked the same question, and I believe a figure of £1 million was given as the cost by the time the facilities were in full operation. In view of what the Minister has just said, I do not know how reliable or definite this figure is. I also agree with the noble Lord, Lord Sandford, about the monopoly position of certain contraceptive appliances, and I think that the President of the Board of Trade should take very serious note of it.
I wish to say only one more thing, and that is with regard to the point made by the noble Baroness, Lady Summerskill, about the pill. I am neither in favour of 177 nor against the pill. There are many other contraceptive devices which can be used. It may be that there is a small danger about the pill, but there are millions of women in America and Britain who are using it, and, for all that coroners say, the numbers of deaths (and they are not even sure about those) are in the region of—is it 18 or 25, or what is the number?, And we have no comparative figures for the deaths from thrombosis complications in ordinary maternity cases. So we have to keep a sense of proportion about this thing, the pill. All the time it is being improved. It has many advantages, and, despite what my noble friend Lady Summerskill says, the young people, when they go to their doctor for contraceptive advice, are free to choose. They know what they are choosing: they read their newspapers; they see the dangers; they read about the dangers, and I think they are fully aware of them.
I only wish to thank the right reverend Prelate the Bishop of Chester for his support and to say how much I agree with him that these facilities may need a new morality, but they certainly do not need no morality in our social life.
§ On Question, Bill read 2a, and committed to a Committee of the Whole House.