§ 3.50 p.m.
§ Report stage resumed on Amendment No. 2.
§ LORD FISKE
My Lords, after the exposition of the noble Earl, Lord Mansfield, and after my noble friend Lord Garnsworthy's speech on this Amendment, there is very little I need to say, but there are two points I should like to underline and to stress. I am puzzled by the speech of the noble Lord, Lord Aberdare, because I feel that he dealt 1263 in a very slender way indeed with the arrangements that will be made for London. Here I think we must look a little into the organisation. One of the things that the Bill does is to remove the remaining vestiges of the Health Service from democratic control to Ministerial control, and we know that it is the intention of the Secretary of State to set up a series of nominated bodies, which I, as a good democrat, can only see as creature bodies, to run various aspects of the Health Service. A nominated body is a creature of the Minister: it is nominated by him; its various members are appointed and dismissed by him at will, without reason given, because there is no need to do so. So that in the use of nominated bodies which are remote from democratic control, remote from the people, un-get-at-able, one has to be more particularly careful than usual.
But in the case of the London Ambulance Service one could argue, and one could accept the argument of the noble Lord, Lord Aberdare, that the Ambulance Service should in every case be transferred to the hospital board, or whatever it is to be called, for the region it serves. That would be logical and reasonable, and at least tidy. But in London it is not proposed to do that, as I understand; it this control for the whole of London is to be given to only one Regional Board, who will have to have powers delegated to it by the other three nominated Boards for the capital. If I have got that wrong, I hope that the noble Lord will put me right. But as I see it, it is not tidy, it is certainly not democratic, and I should have thought it was terribly clumsy. If an exception is made by the Secretary of State, by admitting that he cannot in London hand over the Ambulance Service to the hospital boards for the area, then of course he is departing from his own scheme in the case of London. I should like an answer to that question, if there is one.
The second question is one that I raised very briefly on Second Reading. All the time that the old London County Council and the Greater London Council were responsible for the Ambulance Service in London they carried out, through their mechanical services department, a great deal of research. They were, if 1264 my memory serves me right, responsible for the low-loading ambulance which was introduced in the world of the Health Service, and they were also responsible for the development of glass fibre for the bodywork of ambulances, which made the development of the vehicles much more flexible than they were before. I am sure that developments of this kind continue. This can be done only because the Greater London Council has a huge and magnificent mechanical engineering department, under the control of some of the most skilled professional men in the country. They look after not only the ambulances, but the fire engines, the school buses, a fleet of motor cars, tugs and sludge vessels on the river and a whole host of vehicles of all descriptions, which gives them a knowledge and insight and an organisation which can be so much more useful, so much more far-seeing, than will the small residue that is left to the ambulances by themselves. In this, as I see it, there must be some deterioration in the progress that the Ambulance Service will make over the years immediately ahead. If those two facts are taken into account, then I should have thought, since the Secretary of State is departing from his tidy organisation for hospital boards taking over ambulance services, we might make a further step and do as the noble Earl, Lord Mansfield, suggests in the Amendment.
§ LORD BALFOUR OF INCHRYE
My Lords, I listened at the Committee stage, and I have listened to-day, to the arguments on this particular point. If I may say so without any offence, I found the reply of the noble Lord, Lord Aberdare, unconvincing and inadequate. The purpose of the Bill is not to have a centralised medical service with centralised control; the purpose is to give patients and prospective patients the best possible service which can be given to them. Here we have an Ambulance Service which is efficient, which is functioning well, which is under the control of the G.L.C., and serving the citizens of the G.L.C. Why does the noble Lord say that he must change it? On another Amendment in the Committee stage, the noble Lord said that he was glad that I had advanced the view that the particular activity we were discussing on that Amendment should not be centralised but decentralised. To-day 1265 he comes forward with proposals for intense centralisation without any convincing arguments to support it.
The noble Lord, Lord Aberdare, told us nothing about the expense of the greater administration which will be entailed in the proposals put forward in the Bill. He told us nothing of the engineering problems brought forward by the noble Lord who has just spoken, and which are so vitally important. The noble Lord, Lord Aberdare, did not try to counter the fact that the present Service is efficient and good. He advanced the view that if anybody says that it should be left as it is—"Let well alone" was his phrase—why have a Bill at all. That was not a very convincing argument on his part. Of course we need the Bill because it is designed to remedy in many directions weaknesses which we know exist in the National Health Service. But it is not necessary in respect of the efficient London Ambulance Service. Unless the Government can bring forward a greater measure of argument and convey conviction to your Lordships in a way that I feel they have not done so far, I sincerely hope that the noble Earl, Lord Mansfield, will take this to a Division and obtain an expression of view from your Lordships.
§ 3.59 p.m.
§ BARONESS SEROTA
My Lords, the noble Lord, Lord Aberdare, knows that I approach the general issues raised by the noble Earl's Amendment as one who is in full agreement with the general principle that the ambulance services should become an integral part of the unified Health Service created by this Bill. But I must confess that I feel that a very strong case has been made, both to-day and in Committee, for an exception in the case of London. I do not say this on the ground that what is proposed means moving the ambulance service out of local democratic control; because, as the Minister quite rightly pointed out, this is happening throughout the country as a result of the reorganisation. We on this side—and I know that this view is shared by noble Lords in all parts of the House—have no love for the appointed bodies that my noble friend Lord Fiske has just mentioned, and we shall do our best at a later stage on Report to persuade the House to include some kind of local authority and Area Health Authority membership in the bodies that are to take 1266 over the management of the Health Service from the local authorities.
My real cause of concern stems, as did that of my noble friend Lord Garnsworthy, and I think of the noble Lord, Lord Balfour of Inchrye, from the arrangements which the Government are proposing to make for the operation of the service if it is transferred from the Greater London Council. My noble friend Lord Garnsworthy has made this point, as has my noble friend Lord Fiske, and I must confess that I was very concerned to hear on Committee stage that the operational management of the ambulance service is to become the responsibility of a joint committee of the four proposed Metropolitan Regional Health Authorities, with one Regional Health Authority responsible for the day-to-day management of the service. If I have misunderstood this, I hope that the noble Lord, Lord Aberdare, will correct me.
I see this proposal as a most striking demonstration of the weakness of the Government's basic thinking in the organisation of health services in the Greater London area. If they had proposed one metropolitan region, or possibly two, as we suggested in Committee, then it might have been possible to retain the unified ambulance service which Londoners need in a city like this within the Health Service, and organise it on a comprehensive and unified basis without once again breaking up a service which was unified only in 1964 on the reorganisation of London government. At that time, noble Lords will recall, nine ambulance services were brought together to serve the unified Metropolitan area. Moreover, in spite of what the noble Lord, Lord Aberdare, told the House, looking through the make-up of the other Health Service regions, I can discover no other region where the metropolitan heart of the region is to be divided into four segments and administered through four separate Regional Authorities. This will not happen in Greater Manchester, in the West Midlands area, in the Birmingham area, or in the North-East.
So here we have the Government, in my view rightly, standing on the principle of integration of the ambulance service in the Health Service, yet proposing, because they have failed to take due account of the realities of Greater London, to 1267 divide the service between four Regional Authorities. In my view, that is not good management. As the noble Lord, Lord Balfour of Inchrye, reminded the House, it will cost us more to provide, and it will not necessarily result in a better service. Indeed, in my view there will be difficulty in maintaining the existing excellent standards of service that the G.L.C. provide. Unless the noble Lord, Lord Aberdare, can convince me—and here I speak for myself—that the Government have really thought through the day-to-day operational issues involved of administering the service through four metropolitan authorities that cross the heart of the centre of the Metropolis, then I, for one, would support the noble Earl if he were to press this Amendment.
§ 4.5 p.m.
§ LORD ABERDARE
My Lords, this is Report stage and I must remind myself, as Deputy Leader of the House, that, strictly, I have no right to speak again. However, if I may have the leave of the House, I should like to explain just a few things on the pure practicalities which I am afraid I did not explain sufficiently clearly, because my noble friend Lord Mansfield either did not touch on them or touched on them only briefly, and I had tried to explain them at the Committee stage. The fact of the matter is that we are as anxious as anybody that the London Ambulance Service should remain intact. I am not going to argue now with the noble Baroness about the number of Regional Health Authorities in London. We had a go at this matter on the Committee stage. There are very strong reasons for having four authorities in London which do not apply in any other of the large cities. Therefore, we propose to set up an organisation that will treat the London Ambulance Service as a whole and retain it as a whole. In order that the service works satisfactorily, we shall nominate one Regional Health Authority to look after the London Ambulance Service, but the policy will be governed by a committee on which will be represented all four Regional Health Authorities who have an interest in London. On one point raised by the noble Lord, Lord Fiske, I would say that it may well prove to be necessary in other parts of the country, in other conurbations, that, rather than have Area 1268 Health Authorities running the ambulance service, it may be a regional responsibility or a joint responsibility of the areas. Therefore, London is not a unique case.
So far as the mechanical engineering department is concerned, we would hope that for the time being an agency arrangement would remain for the G.L.C. to continue to run the vehicle service. Noble Lords who are supporting this Amendment are suggesting an agency service the other way round. I would suggest that it is far better that matters of policy should be transferred to the National Health Service, leaving the mechanical engineering side to be run on an agency basis by the G.L.C. My Lords, I am sorry that I have spoken again at such length, but I thought those points ought to be made clear to your Lordships.
§ THE EARL OF MANSFIELD
My Lords, there is no doubt that the debate to-day in your Lordships' House has shown how great is the sense of unease felt in all parts of your Lordships' House over this particular matter. I do not intend to answer my noble friend's argument point by point. If I suggest that in some cases he was scraping the barrel in his arguments, I do not wish to be offensive. The noble Lord said that one of the blessings—if such they would be—from this reorganisation would be that ambulance men would be invited to visit hospitals, but I wonder how many ambulance men do not visit hospitals in the course of their duties as things are.
There are two matters which I would bring to your Lordships' attention. If this Amendment, and those consequential upon it, are passed now, it will above all give the Government time to reflect on these issues; time to see, and decide, where this ambulance service is going, and how it should go. The time for reflection will be a little more pointed, and perhaps a little more poignant, than it was between the Committee stage in your Lordships' House and the Report stage. Secondly, in this particular Bill, which has come to your Lordships' House before being considered in another place, in our deliberations we have no "Banquo's ghost" stalking about representing the "will of the people" expressed in another place. We can express the 1269 "will of the people", and it will be the will of the people, because some years ago, when Londoners were asked to vote for that part of all the services provided by the Greater London Council which they most liked, the London Ambulance Service easily topped the poll. I will leave the matter there, except to thank
§ Resolved in the affirmative, and Amendment agreed to accordingly.
§ 4.16 p.m.
§ THE EARL OF MANSFIELD moved Amendment No. 3:
Page 2, line 22, at end insert—
("(2A) It shall be the duty of the Greater London Council to make provision for securing
§ all those who have taken part in this debate this afternoon.
§ 4.9 p.m.
§ On Question, Whether the said Amendment (No. 2) shall be agreed to?
§ Their Lordships divided: Contents, 77; Not-Contents, 60.1269
|Airedale, L.||Garnsworthy, L. [Teller.]||Redesdale, L.|
|Alport, L.||Geddes of Epsom, L.||Ritchie-Calder, L.|
|Amherst, E.||George-Brown, L.||Royle, L.|
|Amulree, L.||Grantchester, L.||St. Davids, V.|
|Arwyn, L.||Gray, L.||Segal, L.|
|Atholl, D.||Greenway, L.||Sempill, Ly.|
|Auckland, L.||Hale, L.||Serota, B.|
|Avebury, L.||Hatherton, L.||Shackleton, L.|
|Bacon, B.||Hayter, L.||Shinwell, L.|
|Balfour of Inchrye, L.||Henderson, L.||Slater, L.|
|Beswick, L.||Hylton, L.||Snow, L.|
|Brockway, L.||Hylton-Foster, B.||Stamp, L.|
|Buckinghamshire, E.||Kilmany, L.||Stocks, B.|
|Champion, L.||Leatherland, L.||Stow Hill, L.|
|Chorley, L.||Llewelyn-Davies of Hastoe, B.||Strange, L.|
|Clwyd, L.||McLeavy, L.||Summerskill, B.|
|Croft, L.||Mansfield, E. [Teller.]||Taylor of Mansfield, L.|
|de Clifford, L.||Masham of Ilton, B.||Vivian, L.|
|Douglass of Cleveland, L.||Milverton, L.||Wade, L.|
|Elles, B.||Nunburnholme, L.||Walston, L.|
|Faringdon, L.||Ogmore, L.||Wells-Pestell, L.|
|Fiske, L.||Penrhyn, L.||White, B.|
|Forres, L.||Phillips, B.||Williamson, L.|
|Gaitskell, B.||Platt, L.||Willis, L.|
|Gardiner, L.||Rankeillour, L.||Wynne-Jones, L.|
|Garner, L.||Rathcreedan, L.|
|Aberdare, L.||Hailsham of Saint Marylebone, L. (L. Chancellor.)||Monck, V.|
|Amory, V.||Moran, L.|
|Bath and Wells, L. Bp.||Harvey of Prestbury, L.||Mowbray and Stourton, L.|
|Belstead, L.||Hawke, L.||Napier and Ettrick, L.|
|Brooke of Cumnor, L.||Hemingford, L.||Northchurch, B.|
|Colville of Culross, V.||Howe, E.||Nugent of Guildford, L.|
|Courtown, E.||Hurcomb, L.||Oakshott, L.|
|Craigavon, V.||Inglewood, L.||Orr-Ewing, L.|
|Daventry, V.||Ironside, L.||Roberthall, L.|
|Denham, L. [Teller.]||Jellicoe, E. (L. Privy Seal.)||Rowallan, L.|
|Derwent, L.||Kinloss, Ly.||St. Aldwyn, E. [Teller.]|
|Drumalbyn, L.||Kinnaird, L.||St. Helens, L.|
|Ebbisham, L.||Lauderdale, E.||Sandford, L.|
|Eccles, V.||Lothian, M.||Seebohm, L.|
|Effingham, E.||Loudoun, C.||Selkirk, E.|
|Elliot of Harwood, B.||Lovat, L.||Strathclyde, L.|
|Emmet of Amberley, B.||Macleod of Borve, B.||Templemore, L.|
|Ferrers, E.||Mar, E.||Todd, L.|
|Gowrie, E.||Merrivale, L.||Wakefield of Kendal, L.|
|Grenfell, L.||Molson, L.||Young, B.|
|Grimston of Westbury, L.|
that ambulances and other means of transport are available, where necessary, for the conveyance of persons suffering from illness, or expectant or nursing mothers, from places in Greater London to places in or outside Greater London.
(2B) So far as concerns the duty imposed on the Greater London Council by subsection
(2A) of this section the following provisions shall apply to that Council as if they were the local health authority for the whole of Greater London, that is to say sections 2, 57, 58, 63, 65, 71, 72 and 74 of the principal Act.")
§ The noble Earl said: My Lords, I spoke to this Amendment, standing in my name and that of the noble Lord, Lord Garnsworthy, and so did my noble friend Lord Aberdare. It is, if I am not using un-Parliamentary language, the guts of the matter. It contains two subsections which lay on the Greater London Council the duty to make provision for securing ambulances and other means of transport in certain circumstances. My Lords, I beg to move.
§ On Question, Amendment agreed to.
§ THE EARL OF MANSFIELD
My Lords, I beg to move Amendment No. 4, to which I have already spoken. It is consequential upon Amendment No. 3.
Page 2, line 25, leave out ("27") and insert ("26").—(The Earl of Mansfield.)
§ On Question, Amendment agreed to.
§ THE EARL OF MANSFIELD
My Lords, I beg to move Amendment No. 5, which is similar to those which have gone before.
Page 2, line 26, after ("1968") insert ("and by local health authorities by virtue of section 27 of the principal Act").—(The Earl of Mansfield.)
§ On Question, Amendment agreed to.
Page 2, line 26, after ("which") insert ("sections").—(The Earl of Mansfield.)
§ On Question, Amendment agreed to.
§ Amendment moved—
§ On Question, Amendment agreed to.1272
§ Clause 3 [Medical and dental service for pupils]:
§ 4.20 p.m.
LORD GARNSWORTHY moved Amendment No. 8:
Page 2, line 38, leave out ("may") and insert ("shall").
§ The noble Lord said: My Lords, it may be to the convenience of the House if, in speaking to this Amendment, I at the same time address myself to Amendments Nos. 9, 10, 11, 12, 13, 14 and 15, since they are all part of the one purpose; that is, to make certain that the School Health Service shall enjoy a degree of priority which ensures no falling off in standards as compared with those which obtain to-day. This applies in regard to all pupils and students, as instanced in the clause and in the Amendments. If anything, there may well be areas where the service could be improved. Hitherto, the School Health Service has been within the control of the local authorities and has involved both the health departments and the education departments of those authorities. Under this Bill, local authorities will no longer be responsible for providing the doctors and other professionals—the dentists, the nurses and so on—essential to the provision of an effective School Health Service. They are losing this responsibility and are thereby losing the power to provide those specialists. As worded at present, the clause transfers to the Secretary of State for Health and Social Services those powers and responsibility to provide the service. Clearly, those powers and that responsibility will be extended to the National Health Service, and the Area Health Authorities will be the appropriate bodies to discharge them.
§ I can appreciate the anxieties which prompted the note of dissent to the Report of the Working Party on Collaboration, and I think the House would do well to take note of those who registered that note of dissent: Sir William Alexander, the Secretary of the Association of Education Committees; Mr. D. Andrew Davies, the Secretary of the Welsh Joint Education Committee, and Mr. G. Turner, Chief Dental Officer and Principal School Dental Officer for the County Borough of York. I believe that the Amendments to which I am now speaking would go 1273 a very long way to meet the understandable anxieties to which I have already referred and to ensure observation of the priority that this service must surely be given, and to extend these facilities to those in the slightly higher age range covered by the use of the word "students". They would place on the Secretary of State the duty to make arrangements with the local education authorities for a School Health Service which covers the complete range of young persons in these educational establishments, and would ensure the observation of a proper priority and the provision of specialist staffs.
It may be helpful if I read the appropriate parts of the clause as it would be amended, and if I take a few minutes to do it then I trust that it will be justified by making clear the effect of these Amendments. The clause would read:
(1) It shall be the duty of the Secretary of State to make provision for the medical and dental inspection at appropriate intervals of pupils in attendance at schools maintained by local education authorities and for the medical and dental treatment of such pupils.
(2) Without prejudice to the powers of the Secretary of State apart from this subsection, he shall—
(a) make arrangements with each local education authority for the provision by that authority in the area of the authority of medical and dental inspection and treatment of and medical counselling with psychiatric psychotherapeutic and nursing support of—
(i) senior pupils and students in attendance at any educational establishment, other than a school, which is maintained by the authority and at which full-time further education is provided, …
My Lords, that represents the effect of these Amendments.
§ I have said little about an effective service for students. We discussed these matters fairly fully in Committee. I shall now content myself with saying that the importance of this age group can be exaggerated only with difficulty. They need the provision of facilities which are easily available. They meet problems which are perhaps often peculiar to their age and their environment. They often have strains and stresses which are a reflection of a life that can be so markedly different from that experienced by the majority who have taken up employment and are self-supporting. Without the provision of staff such as may be necessary 1274 to cope with the need, local education authorities are placed in a position of the greatest difficulty. I think we have reached a point where we all appreciate that if full advantage is to be taken of the educational opportunities offered these young people, regard must be paid to the physical and mental wellbeing of the scholar, pupil or student. Further, this means not only an adequate child guidance service but also a service for the older student, whose problems can jeopardise educational progress.
This series of Amendments would secure that the local education authorities are fully involved as partners as of right, and that Area Heath Authorities would be placed under the same obligation as that under which local authorities are placed by Clause 12(2) on page 14 of the Bill. If I may read subsection (2) of Clause 12, it reads as follows:
Every local authority shall make available to Health Authorities acting in the area of the local authority the services of persons employed by the local authority for the purposes of the authority's functions under the Local Authorities Social Services Act 1970",
and so on. That is turned round the other way, and this series of Amendments places on Area Health Authorities the duty to provide the staffs in just the same way as local authorities are called upon to provide staffs for the Hospital Service. What is good for the goose is, in this respect, it seems to me, good for the gander as well. I beg to move Amendment No. 8.
§ THE PARLIAMENTARY UNDER-SECRETARY OF STATE, DEPARTMENT OF EDUCATION AND SCIENCE (LORD BELSTEAD)
My Lords, Clause 3 of the Bill, to which the noble Lord's Amendment refers, transfers the existing duties and powers of local education authorities for medical inspection and treatment to the Secretary of State for Social Services, and certainly it is not the intention of this Bill to subtract any ability to provide a medical service. Yet Amendment No. 9—and the noble Lord has been so good as to make it clear that he is taking Amendments Nos. 8 to 15 together—will lay a new duty on the Secretary of State to ensure that local education authorities make arrangements to provide specified services for a proportion of those who are in schools and colleges. The noble Lord rightly reminded the House about the note of 1275 dissent to the Report of the Joint Working Party on Collaboration; but I must remind the House that the Joint Working Party decided, albeit with a note of dissent, against the terms of the noble Lord's set of Amendments. I am bound to say that I cannot believe it would be sensible, on the one hand, to allocate responsibility —for that is the effect of these Amendments—for maintained schools to the Area Health Authorities; and, on the other hand, to have further education authority pupils receiving education under Section 56 out of school and, by arrangement, independent direct grant pupils to have a continuing Schools Health Service.
At present, local education authorities have merely a power, and not a duty, to provide services for senior pupils in colleges of further education. In some cases, arrangements are made for the existing School Health Service to extend beyond the schools; but I should be misleading the House if I gave the impression that authorities generally provide medical services in further education. I do not think it reasonable to expect the National Health Service to assume a duty after April 1, 1974, to provide services which in many cases do not exist at all.
This argument applies more forcibly to Amendment No. 14 and its associated Amendments. Not only is there no power at present for local education authorities to provide student health services, but the wording of Section 48 of the Education Act 1944 specifically precludes this from happening. The Government would not support legislation specially for students without a much closer examination of their special health needs. I would remind the House that the whole purpose of this Bill is to provide an integrated service for the population as a whole. I think that it would be difficult to argue that a special section of the population within an age group (and that is what the student population is) should be provided for as a special case, as a duty, by law.
My Lords, having said that, may I assure the House that this does not mean that the sort of arrangements which often exist, for instance, for universities, cannot be developed by local education authorities and Area Health Authorities under this Bill. At Committee stage, I submitted a number of suggestions. It would be possible, for instance, for there to be 1276 co-ordination of advice and counselling services which can be provided by local education authorities, through the general practitioner services, with the organisation of the medical services for the particular circumstances of students. This would be possible. What is needed now is for the Education and Health Service interests to come together to consider how existing services should be carried forward and, if necessary, improved. I think your Lordships will agree that the Bill, through the joint consultative committees provided for in Clause 10, provides that this can be done.
The noble Lord referred also to special strains on young people who are in further or higher education. I think he was referring specifically to his Amendment No. 13 which deals mainly with further education. I have sought to explain to the House why I do not believe that further education should be specially singled out for legislation. I would assure the noble Lord and the House that, in any case, the words of this Amendment are contained within the meaning of the terms "medical treatment" and "treatment" which are to be found in this clause. The final Amendment, No. 15, is consequential on those preceding it. For the reasons that I have given, I must ask your Lordships to resist this Amendment also.
§ LORD GARNSWORTHY
My Lords, I am grateful for the statement that the noble Lord has made and I thank him for the assurances. I believe that it has been of value to pursue the purpose of these Amendments. My anxiety is to see to it that at no point is the necessity for giving priority to the School Health Service overlooked. I believe that what was said in Committee and again this afternoon will help towards that end. I have no intention of pressing these Amendments to a Division. I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ 4.36 p.m.
§ LORD GARNSWORTHY moved Amendment No. 16:
Page 3, line 17, at end insert—
("(3A) The Inner London Education Authority may make such provision (so far as it is not made by the Secretary of State) for medical and dental inspection and for free medical and dental treatment, as they may consider desirable or expedient—
(3B) The Inner London Education Authority shall have power to make such arrangements for securing the provision of free medical treatment for persons, for whom full-time and part-time education is provided by the Authority in pursuance of paragraph (a) of section 41 of the Education Act 1944, as are necessary for securing that comprehensive facilities for free medical treatment are available to them either under this Act or otherwise.")
§ The noble Lord said: I shall have to take rather more time over this Amendment than I did with the last series of Amendments because it is a very substantial one. I shall speak to the Amendment in two parts, dealing in the first part with subsection (3A) and in the second part with subsection (3B). At Committee stage I moved an Amendment to confer on local education authorities reserve powers to provide free medical and dental treatment for their pupils to the extent that it was not already being provided for by the new Health Authorities. The Amendment was rejected on behalf of the Government. It has been re-drafted and simplified and, in particular, to meet the criticism voiced by the noble Lord, Lord Belstead, that it was originally too widely drawn, its effect is limited to the Inner London Education Authority. In Committee, we discussed at some length the need for the Amendment.
§ To summarise, the Inner London Education Authority is possibly in a unique position and the School Health Service it now provides as a single service in Inner London will largely be transferred to, and divided between, four new Regional Health Authorities. It will be administered by no fewer than seven Area Health Authorities, three of them concerned only with the Inner London boroughs, and four with both the Inner and Outer London boroughs. Understandably, the Inner London Education Authority regrets the loss from democratic control of an efficiently-run service; but it appreciates that it cannot provide a wholly independent School 1278 Health Service in isolation from an otherwise unified Health Service.
§ I have no wish to criticise in advance the efficiency of the seven proposed Inner London Area Health Authorities, nor am I concerned that the existence of a reserve power would remove the incentive for Area Authorities to take a positive attitude towards school health. The noble Lord, Lord Belstead, touched on this in Committee and I refer to what he had to say in column 907. On the other hand, it is possible to foresee a situation in which the priorities of the new Area Authorities might differ, resulting in an uneven level of service over their area but where the provision made by some of the new Authorities in respect of a particular aspect of school health did not meet the standard previously achieved by the Authority. In circumstances such as these a reserve power is essential to enable the Authority to make some complementary independent provision of services which it considers important and which the Area Authority might be unable to do as a matter of policy. It might also be unwilling to supply, again as a matter of policy.
There is no doubt that the Joint Consultative Committees, to be set up under Clause 10 of the Bill, could be of some use in achieving a high and uniform standard of school health provisions. However, without a reserve executive power used as a last resort I suggest that in the face of differences of approach by Area Authorities the Bill's collaborative arrangements could not alone guarantee the high and uniform school health provisions they would hope to see maintained in Inner London. At the Committee stage mention was made of the availability of Section 111 of the Local Government Act 1972. This section is available to the Authority but it enables the Authority to do only
any thing … which is calculated to facilitate, or is conducive or incidental to, the discharge of their functions".
I am grateful to the noble Lord, Lord Belstead, for writing to me about the effect of the section.
§ As the Bill stands, most of the school health functions of the Authorities are to be transferred. Thus Section 111, I am advised, will be of no assistance to them if they hope to continue to exercise certain of these functions even on a reserve 1279 power basis. As the noble Lord, Lord Belstead, is reported in column 908 of the OFFICIAL REPORT Of December 18 as indicating, if the authorities are able to provide services under their retained education powers then Section 111 could be of some assistance.
§ My Lords, I turn to subsection (3B) of the Amendment. Again I moved Amendments in Committee concerned, in whole or in part, with the provisions of the Health Service for students. We have already had some discussion about the health needs of students, but your Lordships will appreciate that these Amendments are concerned with the position in that part of London covered by the ILEA. In reply to the first Amendment that I moved, the noble Lord, Lord Belstead, pointed out, correctly, that generally speaking the powers of the new Area Authorities to provide a student health service will be wider than the powers at present enjoyed in this respect by local education authorities. This does not of course apply to the Inner London Education Authority, who have private powers under Section 56 of the Greater London Council General Powers Act 1968 enabling them to provide free medical treatment for persons over the age of 19 for whom full-time or part-time education is provided by the Authority.
§ These Private Act powers depend for their effect on Section 48(3) of the Education Act 1944, which is scheduled for repeal in the Bill. It is extremely doubtful whether the Authority would have power in future to provide a student health service. The second of the Amendments to which I have referred sought to confer on local education authorities a general reserve power to provide school health services and included a specific reference to the provision of a student health service. Both Amendments were rejected by the Government. What I am now proposing would secure for ILEA a specific power, as opposed to merely a reserve power, to continue to provide a health service for students in their further education establishments. The student health service is geared to the needs of students attending courses of higher education. It comprises a general practitioner service and medical counsel in psychiatric and psychotherapeutic, social work and nursing support.1280
§ My Lords, there is a very great deal more that I could say about the work of ILEA in this part of the School Health Service. There is tremendous need for this continuous aid at a no less efficient level. I think, and I would ask your Lordships to say to the Government, that in regard to ILEA and the student health service, as indeed with the other part of the Amendment, they are much in the same position as the Greater London Council over the ambulance service. They are doing an excellent job and there is no fault to find with them. To transfer the service to the National Health Service in the way suggested could place in jeopardy some of the good work being done. Certainly the Authority would like to feel, and indeed ought to be able to feel, that it possessed the power to do the job if there was a breakdown or a weakness, or if some other fault developed.
§ I think that in Committee the noble Lord, Lord Belstead, suggested that if the Bill did not work out in the way he indicated it was hoped it would do, there would be another request for a General Powers Act. Now is the time to deal with the situation. If we have to allow a situation to develop where the greater London Council, on behalf of the ILEA, has to come forward for new general powers, there will be a considerable waste of time and I submit that in the interval there would be damage to the service.
§ My Lords, I apologise for taking so long in speaking to this Amendment, but it will be appreciated that it is a matter of considerable concern to the Inner London Education Authority. They have a unique case and one which I trust will commend itself to your Lordships. I hope that what I have said will alert the Government to the fact that what they had to say in Committee has not been as reassuring as perhaps the noble Lord, Lord Belstead, intended it should be.
§ 4.48 p.m.
§ LORD BELSTEAD
My Lords, since we debated during the previous stage of the Bill the position to which this Amendment refers I have again looked carefully at the position, as I promised to do. I am bound to say to your Lordships that the objective which noble Lords opposite have again put forward in this Amendment is still subject to very strong objections on the principle of the matter.
1281 The noble Lord, Lord Garnsworthy, has very fairly made clear that the effect of the Amendment is to complement, or to extend, the National Health Service and not to replace it. Nevertheless, I put to your Lordships that it is surely wrong in principle that one public body should be enabled to act of its own volition to provide services in default of another public body. I should have thought it as wrong that a local education authority should have concurrent powers to judge and provide services provided by an Area Health Authority as it would be for an Area Health Authority to have similar powers in relation to education services. I think it certainly questionable to assume that a concurrent power would benefit the recipients of the service. I would venture to suggest that the reverse might be more likely: it would create a risk of falling between two stools, with each of the authorities leaving it to the other to provide the services. I suggest to your Lordships that it borders on the absurd for Parliament to place a duty on the Secretary of State and then to make alternative provision on the assumption that he will not carry it out. Finally, I would remind the House again that the Working Party on Collaboration did not make this recommendation, although, as the noble Lord, Lord Garnsworthy, has fairly reminded us, there was the Note of Dissent.
For these reasons, my Lords, I do not believe that the reiteration of the existing General Powers Act, to which the noble Lord has referred, is appropriate when taken in relation to this Bill. I do not make these points as the last words on this subject. What I am trying to do is to restate the principle underlying this Bill, which we believe to be right; namely, that an integrated service must have advantages and it would not be sensible to leave a part of the School Health Service outside, even though the reasons have been clearly put forward by the noble Lord, and are understandable. I will return to that point later.
In Committee, the noble Baroness, Lady Serota, asked that the position of Inner London, dealing with seven Area Health Authorities, should be looked at again, and I promised the noble Baroness that I would do this. But I have also had to re-study the opportunity which 1282 the ILEA will still have to see that the health needs of Inner London pupils are catered for. First, all the staff and premises of the School Health Service will be transferred; and I would emphasise that it is the intention of the Secretary of State to continue to develop health resources after the transfer of responsibility. Secondly, it will be the function of the joint consultative committees to examine needs, and on each J.C.C. relevant to this Amendment the ILEA will have representation. It will also be the function of each J.C.C. to examine Area Health Authority plans. Finally, collaborative arrangements are to be considered shortly by the London sub-committee of the Working Party on Collaboration. I admit that it is most necessary that this should be done, and I am sorry it has not been possible to get the first of the meetings started sooner. This, my Lords, is an absolute undertaking. It is something which certainly Inner London has every right to expect, and it is now a definite commitment. In addition—and this is most relevant, I agree, to the needs of any large city—there are educational grounds to be taken into account.
Just in capsule form, may I remind your Lordships that at the previous stage of the Bill I submitted to your Lordships that, for instance, sight testing, the testing of hearing, examinations of some kind or another, any sort of screening of an educational kind, child guidance arrangements and also Sections 33 and 34 of the Education Act 1944 will all be things which will remain in operation and can be utilised by education authorities, not least the ILEA.
I turn now to the second limb of the noble Lord's Amendment. At the previous stage of the Bill the noble Lord represented the importance of continuing a service for the student population of Inner London. I should like to give this assurance. The Secretary of State will undertake to continue to provide for the health care of students in ILEA F.E. establishments. This does not mean that we can necessarily undertake to continue indefinitely a service precisely as provided or envisaged by the ILEA or that the ILEA themselves will not be asked to provide the student counselling and welfare elements which may need to be coordinated with the health services for students. But I assure your Lordships that 1283 there need be no fear that the service will not be continued: and because of the point which has been put by the noble Baroness, Lady Serota, and also of course in general by the noble Lord, Lord Garnsworthy, about the number of health authorities with which Inner London will be having to deal, it is proposed that special consideration should be given to the future arrangements for student services within the London sub-committee of the Working Party on Collaboration.
§ LORD GARNSWORTHY
My Lords, may I on behalf of my noble friend Lady Serota and myself thank the noble Lord for what he has just said. He has replied at some length and has very kindly taken up most of the detailed points that have been posed. I have a feeling that the noble Lord will agree with me that in what he has now said he has indicated an advance on what was said in Committee. In particular, we should like to thank the noble Lord for what he has said about getting the London subcommittee of the Working Party on Collaboration off the ground. We were very pleased to hear this. I should like to thank him for what he has had to say about the care that will be taken in regard to the student health service. I do not wish to take up any more of your Lordships' time on this. I do not intend to press the Amendment to a vote. It seems to me that it has been well worth while, in the light of the assurance and the undertaking given by the noble Lord, Lord Belstead, to have had this discussion. With your Lordships' agreement, I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ 4.58 p.m.
LORD GARNSWORTHY moved Amendment No. 17:
Page 3, line 18, leave out from second ("the") to ("to") in line 19 and insert ("local education authorities by which schools (other than voluntary schools) are maintained and of the managers or governors of voluntary schools").
§ The noble Lord said: My Lords, I have an idea that I may be on a slightly different wicket here. I tabled an Amendment in Committee which said substantially what this Amendment says. When we were discussing the earlier Amendment in Committee the noble Lord, Lord Belstead, undertook to consult 1284 with the local authority associations, and he gave a pretty clear indication that if the purpose at which my Amendment was aimed commended itself to them, the Government would at this stage of the Bill be prepared to see amendment. I should like to thank the noble Lord for having communicated with me during the period since we discussed this subject in Committee. I am hopeful that, as now drafted, the Amendment will commend itself to the Government, and I should like to thank the noble Lord for the help that has been given in redrafting the Amendment. I beg to move.
§ LORD BELSTEAD
My Lords, as at present drafted, the Bill lays this duty on the managers or governors of all maintained schools, county as well as voluntary. As the local education authority would always have the ultimate responsibility if there were any major difficulty over Health Service staff being allowed access to schools, it seems reasonable to recognise this fact in the Bill. That is what Lord Garnsworthy's Amendment is doing. May I add to what the noble Lord has just said that the actual wording of the clause will not prevent authorities from making arrangements for the managers or governors of county schools to consider the day-to-day problems that might arise over making the accommodation which the authorities have provided available. I hope that will set the matter a little further in its true light. The Amendment has been well explained by the noble Lord. The Government are grateful to the noble Lord, Lord Garnsworthy, and we should very much like to accept the Amendment.
§ LORD GARNSWORTHY
My Lords, I thank the noble Lord for something that was not wholly unexpected, but nobody could have made the concession in a more delightful way than he has. I should like to thank him for the explanation he gave, because I think that what he said really helped to fit the Amendment in the context of the Bill.
§ On Question, Amendment agreed to.
§ 5.0 p.m.
BARONESS ELLES moved Amendment No. 19:
After Clause 3 insert the following new clause:
§ Sex education for children
§ ". It shall be the duty of the Secretary of State in conjunction with the Secretary of 1285 State for Education and Science to approve the content of any programme of sex education for children in schools which shall be given only by teachers or by such organisations as they may approve."
§ The noble Baroness said: My Lords, I beg to move the Amendment standing in my name, together with the names of the noble Baroness, Lady Macleod of Borve, and the noble Viscount, Lord Ingleby. I realise that this might seem a matter of detail which need not be included in a major Bill concerned with the complete reorganisation of the National Health Service. Nevertheless, the sponsors of this Amendment feel that sex education for children is a matter of such vital importance, affecting the whole of a generation, that it ought to be considered in the context of such a reorganisation, and especially in connection with the family planning advisory service which is being set up under Clause 4 of the Bill.
At the Committee stage I raised certain issues in connection with Clause 4 and my noble friend Lady Young was kind enough to say that she would give me written answers to my many questions. I am extremely grateful to her for the trouble she took in giving me very full and comprehensive answers. I should like to make them available to your Lordships' House, particularly those concerning the policy on which the family planning advisory service was to be based and the responsibility for publications and the kind of information to be put out under the ægis, of course, of the Department of Health and Social Security. My noble friend Lady Young has been kind enough to allow me to read out part of the reply she has given me. In this connection I should like to quote the following passage:
The schools have the responsibility for the place of sex education in the curriculum and it is up to them to decide whether to use material produced by the Family Planning Association or other bodies. At the national level is the Health Education Council, which was set up five years ago to take on the health education responsibilities of the Department and of an existing voluntary body".
This body I understand to be the Family Planning Association. My noble friend's reply continues:
The Council is financed mainly by the Department and the Secretary of State is currently making provision to bring the Council's total expenditure to close to a million pounds
a year. The Council are required to obtain his approval to the broad division of their budget and in the current financial year their approved programme attaches particular priority to contraception, V.D., smoking and health. Subject to this approval, the Council have a measure of independence for the way in which they carry out their activities.
So, my Lords, it is in this connection that we are putting forward our Amendment and asking the Minister to give this matter his usual kind and generous consideration.
§ The Health Education Council, as many of your Lordships will know, was very ably chaired by the noble Baroness, Lady Birk, and she has done sterling and very valuable work for this Council throughout the years that she has been chairman. Realising the importance of this subject the noble Baroness was also chairman of a sub-committee which dealt entirely with sex education. I understand that she is no longer chairman, and that there is now a new chairman, and that the Health Education Council is undergoing a process of reorganisation. At this stage it is difficult to find out precisely what its policy is going to be, and it is not for me to make any comment on the policy of that Council, either at the moment or in the immediate future. We have no information about it, and it is precisely because of this kind of uneasiness about the policies coming within this Bill, expressed so ably by my noble friend Lord Mansfield concerning the London ambulance services, that I think it is right to raise this matter, since it is of considerable importance.
Without going into details of the Health Education Council, I may say that the Family Planning Association, which is the other body concerned with teaching and informing children on sex education, has in fact given its views on this subject quite clearly in an article which appeared in the Daily Mail on February 6. On being asked, "What duty does the F.P.A. think it has towards society's view of traditional morality?"—it answers quite straightforwardly:
Our job is simply to help people to avoid unwanted pregnancies. We cannot stop anything. We do not know what society's view of morality is. Do you? Everyone has their own view of morality, and what we do is seek to realise the aims and objects of our Association which includes this, to educate the public in the field of procreation, contraception and health, with particular reference to personal responsibility in sexual relations.
I think that is a very fair statement of the Association's aims and objects.
The effects of the last five years' sex education I raised during the Committee stage, and I pointed out the enormous increase in cases of V.D., together with the enormous increases in the number of abortions and in the numbers of illegitimate children being born to girls under 20. I cannot of course prove—nor do I think anyone else can—that there is any close connection with the kind of sex education that has been given, but it must be open to anybody to have certain doubts on the matter. A report which was produced by a working party of the Royal College of Obstetricians and Gynæcologists, under the chairmanship of Sir John Peel (who is of course a very eminent gynæcologist and who certainly cannot be accused of being emotional), states on page 82, among other findings on the subject of sex education:
Practically nothing is known about the effects of sex education programmes, either in regard to the future health and happiness of the individual children or in relation to unplanned pregnancy. It was suggested that wrongly orientated sex education could be having a result which was the exact opposite of what it was desired to achieve, in that it was arousing curiosity and the desire to experiment. The rapidly rising incidence of unplanned pregnancies in the young age group gives some support to this idea.
§ So I put it to your Lordships that perhaps there should be a reassessment of the kind of sex education that is being made available to children, and that in the reorganisation of the National Health Service both the Department of Health and Social Security and the Department of Education and Science should co-operate to see that a responsible programme is presented through teaching and through organisations such as the B.B.C. What worries us particularly is the fact that there is this measure of independence which my noble friend Lady Young clearly mentions in her letter—the Council have a measure of independence for the way in which they carry out their activities. We would ask that in giving this kind of sex education the consequences should be clearly spelt out to children regarding the risks involved in unintended pregnancies, and also the risks that accompany the use of the kinds of contraceptives that are now being made available—risks of infertility, cancer and so on. These risks are not always mentioned 1288 when sex education talks are given to children.
The other point I should like to make concerns the Christian ethic. I realise, of course, that it would be impertinent, impracticable and impossible to demand that only the Christian ethic should be taught when teaching sex education. Nevertheless, we would hope to see that it is taught, showing that there is also a moral responsibility attached to these kinds of relationships, because it is just as much a value judgment to say that it is responsible to have sexual relationships outside marriage as it is to say that they should be confined within marriage. Indeed, it is not only the Christian ethic that supports this theory: there are many other religions which also believe in the same moral standards. We have been greatly encouraged by a letter from the Chief Rabbi, who has consented to our reading it out. His letter reads:
The Chief Rabbi is in general agreement with these proposals."—
he is referring to the proposals in our Amendment—
In particular he strongly favours the proposal that sex education for children should be given by approved medical or educational authorities only. He further strongly supports the recommendation that training courses for under 16s be first approved by the Department of Education and Science.
§ I would therefore ask my noble friend to consider whether he can be helpful in this matter. We are aware that when certain films were going to be shown in schools Ministers were very worried about the way in which they could prevent them from being shown. They had to ask local education authorities whether they would be kind enough to stop the showing of them. This, frankly, is not good enough, my Lords. If a Department is taking on the responsibility to be in charge of sex education, it should exercise its responsibility in a responsible way. I therefore ask the Minister to view our proposed Amendment with the kindness and generosity with which he viewed the last two Amendments.
§ 5.11 p.m.
§ BARONESS MACLEOD OF BORVE
My Lords, it is with regret that I support the Amendment moved by my noble friend—a regret that it should be necessary to ask the Secretary of State for the Department of Health and Social Security 1289 and the Secretary of State for Education and Science to assume the proper role of the parent in the teaching of sex education to children. Many parents, as we all know, fulfil their obligations; but many more are unwilling or unable to teach their children, thereby, in my view, abrogating their responsibilities.
The child of to-day has an inquiring mind. Children ask questions and they want to know the correct answers. Those of us who say that the young know it all are, I suggest, passing the proverbial "buck" because they do not want to face the facts. The subject of sex education is a particularly delicate matter and in my view it is as important for a child to have the right teacher as it is to have the right knowledge. It is no use giving the biological details if at the same time the principles of moral values and behaviour are not taught. There are many excellent teachers in our schools; in particular, I am told that the staff who visit the schools which are run by the Inner London Education Authority are excellent. But there are not enough trained teachers. There are also many organisations, particularly connected with the Churches, who try to visit schools in their areas but they can only go into the schools at the invitation of the heads of those schools.
An inquiring child can pick up bits of knowledge outside school—from the Little Red Book I have in my hand, for instance. Perhaps some of your Lordships will have seen it; I am sure you have all heard of it. Or perhaps the child picks up knowledge from friends in the playground. I suggest it is our responsibility as adults to see that the education is comprehensive. A programme and syllabus on this subject are bound to take some time to prepare. I wonder whether my noble friend the Minister, in conjunction with the Minister for the Department of Education and Science, would consider authorising and giving approval to the making of films for use in schools. Whatever method of communication is used, the parents of the children of this country will feel reassured if the content of any programme on sex education for their children in schools is approved by the Department of Education and Science and the Department of Health and Social Security.
§ 5.15 p.m.
§ VISCOUNT INGLEBY
My Lords, it seems to me that providing a contraceptive service for teenagers is rather like providing a fire service for people who may be liable, either by accident or design, to burn their own houses down. The fire engine comes along and puts the fire out, but, unfortunately, the damage has been done. The house is damaged and, in this case, there is the possibility that the house may be set on fire again. The damage is not only physical but is also spiritual and mental. It arises largely from the kind of sex education that says, "Do what you like so long as you take the proper precautions". Perhaps I may give one or two examples. The observation:There is only one way to make sure you do not get pregnant, unless you have decided you want a baby—use a reliable method of birth control",is quoted from Straight Facts About Sex and Birth Control, a leaflet for boys and girls issued by the Family Planning Association in 1971. My Lords, there are in fact other ways.
The advice columnist of Petticoat, a magazine which is read by over 200,000 adolescents, when interviewed on the B.B.C. television programme "Sob Sisters" on May 9, 1972, stated that she could never advise anyone not to make love. One wonders whether she was married, whether she had children of her own, and whether she would have given this advice to them. A feature article in the magazine Nineteen produced by the same publishers, assured readers that venereal disease was an inevitable byproduct of our more liberated sexual attitudes.
It is this kind of advice that is partly responsible for the increase in births to girls under 16, which was 3,068 in 1971, and is also partly responsible for the increase in venereal disease. It is this kind of advice that is destroying family life. If you have free love before you are married, although all things are possible under the grace of God, what are the chances of your forming a happy and stable marriage afterwards? In this connection, President Manley of Jamaica recently banned a number of American films in his country because he said they were destroying the nation. The main strength of our society lies in its family 1291 life. If you destroy family life you destroy the country. Surely it is up to this House, above all, to do all that we can to defend family life. With all humility, and acknowledging that we are far from perfect, ought we not to set before young people the ideals of chastity before marriage and faithfulness afterwards? There is no other way if family life is to be maintained at its best. I should like to pass on to the Government a suggestion from a family doctor to invite representatives of parent groups, informed doctors, teachers, social workers and marriage guidance counsellors to work out a comprehensive plan for sex education in the schools, recognising that it is on the right kind of sex education that the family life of this country depends.
§ 5.19 p.m.
§ BARONESS GAITSKELL
My Lords, I hope that the Government will not accept this Amendment. Those of us who place great emphasis on sex education—and we are many—think that interference by central Government is neither good nor necessary. This would only inhibit local initiatives and diminish participation by parents, teachers, school managers, the Church, probation officers and others—all those who should have a voice in these matters.
No arbitrary ruling from the Department of Health and Social Security or the Department of Education and Science in arranging a few lectures can replace organisations made up of people in all walks of life who have been gathered together, as when they were gathered together by the Health Education Council in a conference. No one should be afraid to give children sex education. That really is the point. It is the only way in which we shall get a generation of parents who will be able to educate their own children about sex. Nowadays, parents are not able to educate their own children about sex.
I am going to give a few statistics about this to show that my reactions to this Amendment are not purely emotional. In 1971, among girls under 16, there were 1,350 births; 2,646 notified therapeutic abortions, and nearly 4,000 known pregnancies. Added together these figures make about 8,000 1292 unwanted pregnancies. Also, in 1970, 9,210 teenagers were treated for gonorrhoea, and 475 of them were under 16. My Lords, are these girls to be abandoned, with exhortations to be good if they cannot be careful? Are they not to be helped and instructed in birth control and sex education? Is it more responsible not to teach them birth control? That is the question we have to ask ourselves, when we know that half of all local authorities provide birth control for the unmarrieds as well as the marrieds.
§ 5.22 p.m.
§ LORD BEAUMONT OF WHITLEY
My Lords, this Amendment is, if the movers will forgive me for saying so, very well-intentioned. The noble Baroness, Lady Gaitskell, is possibly a little over-unkind to it, because it is not against sex education as such but merely against some kind of regulation of sex education by the Secretaray of State. But I think it is totally impracticable and totally at odds with all the best practice in sex education in schools at the moment. Because more and more we are getting away from the concept of sex education as such—not because we are going back to the old system of not teaching anything about it at all, but because as we come more to terms with it, as we progress in techniques in teaching sex education, so it becomes more a part of the whole of education of the whole of the school, not something to be singled out, any more than sexuality can be singled out from the rest of a child's development.
Sex education now is usually not something which happens in special classes, with all the giggles and embarrassment that that brings about—"Now we will talk about sex". It is very often not only quite obviously part of biology classes, but part of hygiene classes, part of moral education classes. And it is in the moral education classes, it seems to me (whatever they may be called, they exist in a large number of schools now), that this subject is really tackled on the level that the movers of this Amendment would want it tackled. Modern teaching of moral education is a process whereby children are educated, not indoctrinated, into being able to make moral judgments for themselves in a more informed and a more intelligent way than they have in the past. Moral 1293 education classes cover all kinds of social issues: everything to do with the relationship of Man to society, of which, of course, sex and sexuality in the course of a child's growing up are a very important part.
I suggest to the movers of this Amendment that it cannot be said to schools which are doing this particularly good form of education about sex, "All the rest of what you are teaching in this particular course is all right; one can be allowed to make one's own decisions about it. But when you reach the particular occasions when you are actually going to mention sex, that becomes a different matter. Everything you are going to teach must be vetted by the Secretary of State and all the teachers must have been approved by the Secretary of State" That is a very unrealistic suggestion. If we still had a situation—and it still exists, I quite agree, in some schools—where sex education was regarded as something very special, very separate, something to be talked about only in inverted commas and with bated breath, what is suggested might stand up. But, in view of what I think many noble Lords in this House know to be the extremely good educational practice nowadays in so many schools, I think this Amendment does not stand up on any grounds of practicality whatsoever.
§ 5.25 p.m.
§ BARONESS SUMMERSKILL
My Lords, it seems to me that different people are interpreting this Amendment in different ways. I approach it simply from the viewpoint of common sense and it seems to me that it says that sex education should be given in the best possible way. To that I say, "Hear, hear!" and I should have thought that all of us would agree with that. I suppose that most people in this House in their childhood were taught their sex education from the birds and the bees and then later on they went to school and some girl or boy, regarded as more unpleasant than the rest, would whisper something into their ear, and their sex education was begun and finished. But now we have to approach it in a different way. I realise that this whole question can provoke controversy, as we have seen to-day to my surprise—I am absolutely astonished at the contributions that have already 1294 been given. I did not believe that there could be controversy over this question.
Now, of course, the old argument that what was good enough for us should be good enough for the children can no longer be sustained. Furthermore, to argue that is is superfluous and not in the real interests of the children is to ignore the impact of the powerful influences to which children are exposed to-day. The pictures of violence and erotic incidents brought right into the living-room of a captive family, day after day, must disturb and influence the child to-day. These are influences to which we were never exposed. I find it difficult that a Government, any Government, should allow this material to be shown, ignore the influence on the child, and tackle the end product: when the child becomes an adolescent or a rather nasty young man or woman, violent perhaps, then of course we are concerned with pouring money into all kinds of organisations which will reform the teenager. Let us begin in the family living-room, and there is generally only one because usually only one room is well warmed in the winter. So everybody sits there, and if the grown-ups want to see a sex picture on television then the sex picture is switched on. To think that the children are always in bed is nonsense, because in the poorest families the overcrowded conditions are such that the child goes to bed at the same time as its parents. If sex instruction is given by people other than the parents, at least it should be given by those who are well equipped to give it.
The permissive society has thrown up a rather unpleasant kind of creature who calls itself (I will not give it a sex) "a sexologist", who does all kinds of curious things; and then, when you begin to turn over the stone, you find the only interest of the sexologist, generally, is in just how much he or she will get for a certain lecture or a certain appearance. These so-called experts who pose in this field have motives which are suspect; therefore I believe it behoves the education authority to protect children at all cost.
Furthermore, the Government have a duty to reassure the parents. I believe somebody here said that the parents should give this instruction; but parents 1295 run away from it. Parents long for some well-equipped individual in the school to do something which embarrasses the great majority of parents. Therefore the time has come when we should choose the best person available to do this work. On television last night I watched a class of girls, with two or three boys, receive sex instruction. Some looked a little shy, and indeed in one of the papers this morning there was a comment on this, and I was astonished to observe that the individual giving the sex instruction was a bearded man. This, if I may say so—
§ BARONESS SUMMERSKILL
My Lords, noble Lords may laugh, but this was an example of the wrong choice of teacher, for few young girls would ask a man questions in front of the rest of the class on such an intimate subject. The proof that I am right in this belief is that the grown women that we want to teach birth control throughout the country are reluctant to go to their National Health Service doctors for birth control advice if the doctors are men. In fact this is a subject which a woman, even in this permissive age, is too shy to raise with a man, with the result that many of them fail to get birth control advice at all. Everybody knows this, and in consequence nearly all family planning clinics are staffed by women. As to the noble Lord who laughed, and who knows so much about this, has he been to a family planning clinic where there was a black-bearded man?
§ BARONESS SUMMERSKILL
Well, my Lords, here is my case. I approach this on the grounds of common sense. What we are asking is that the most suitable individual should be invited to give sex instruction and I say that a large, black-bearded man is not really the most suitable person to put either in a family planning clinic where the women in the neighbourhood are expected to come, or to teach 12-year-old girls the most intimate things in their lives. So I am using common sense and saying that all this Amendment is asking for is that the most suitable people should be invited to give this 1296 instruction. I believe that it should be given by somebody whom the child has learned to respect and so provide an antidote to the exploitation of sex on television.
This is something which concerns children who are completely powerless in this matter; who are regimented in their classrooms, who will sit and listen to whatever teacher on any subject is brought before them, and what the Amendment is asking for is nothing but that the most suitable person should be invited to teach children that which is of such an intimate character.
§ LORD BROWN
My Lords, may I remind the noble Baroness that surely this Amendment calls for not only the most suitable people to teach but also that the content of the teaching should be approved. She has made no mention of the latter point at all.
§ BARONESS SUMMERSKILL
My Lords, may I ask whether the noble Lord went to see the film in another place on the subject of sex? I have known the noble Lord for years and I do not think he has ever known much about sex.
§ LORD BROWN
My Lords, may I point out to the noble Baroness that she has completely ignored part of the Amendment? She has spoken about almost everything under the sun except the real content of this Amendment.
§ LORD AVEBURY
My Lords, I could not help laughing at the noble Baroness when she was speaking about this "large, black-bearded man" I did not think she was truly serious about the part that he played, because what does it matter whether a man has a beard or not? Is that a qualification? Is the noble Baroness seriously suggesting to the House that cleanshavenness is a qualification for giving good instruction on sex?
§ 5.34 p.m.
§ LORD AVEBURY
My Lords, I have not been to a family planning clinic 1297 and asked advice from a large, black bearded man, and I doubt whether many of your Lordships have had such an experience. But I did see the television programme to which the noble Baroness has referred, and I thought the teacher came across extremely well. It was a mixed class, as the noble Baroness will recall, and so far as I could see the pupils were not in any way inhibited from putting questions to the teacher by reason of the fact that he was not cleanshaven. I think upon reflection the noble Baroness will agree that the proposition which she has made is so absurd as not to bear very much examination. I will now leave it at that, and will turn to the arguments which were put by the noble Baroness, Lady Elles.
§ BARONESS SUMMERSKILL
No, my Lords; the noble Lord asked me a question. He said that he has been in many family planning clinics and has seen black-bearded men. If he will give me a list of the family planning clinics where big, black-bearded men teach women I shall be very glad to have it.
§ LORD AVEBURY
Really, we are not supposed to be discussing family planning clinics. I do not know whether the noble Baroness has read the Amendment, but she has ranged very wide on this, if I may say so. As I understand it, the noble Baroness, Lady Elles, is not suggesting that the Secretary of State should have any influence on the content or the personnel who are involved in television programmes, and in particular television programmes which deal with the matter of sex education. As I read it, her Amendment is entirely confined to the schools, and while I might well agree with some of the criticisms made by the noble Baroness in regard to television programmes which are put on at hours when children do in fact watch, whether the I.B.A. and the B.B.C. think so or not —as the noble Baroness is aware, they have what is called a "family viewing time" and it is assumed that all children under a certain age go to bed after that although, as the noble Baroness said, they do not—what we are speaking about at this moment is the instruction that they get in schools and the people who give that instruction. There may be another occasion on which the noble Baroness could make some remarks on 1298 the content of television programmes, when it would be more appropriate.
If I may continue to speak to what the noble Baroness, Lady Elles, said in moving this Amendment, it seemed to me that she was rather critical of the Family Planning Association and of the material which it provides to the schools to assist in the education of the pupils. If I understood her correctly, she was suggesting that in this material there should be a content of the traditional morality which has been taught in the schools from time immemorial. I think that on reflection the noble Baroness might agree that the function of moral education is an extremely important one—and here I agree with my noble friend Lord Beaumont of Whitley—and is not one that the Family Planning Association should be expected to undertake. One of the principal objects for which the Family Planning Association was founded, was to educate the public in the field of procreation, contraception and health, with particular reference to personal responsibility in sexual relationships. It is somebody else's job—and particularly, I think, the job of the Churches and the religious denominations of all kinds—to provide the source material which the schools need for courses in moral education. One would not expect the Family Planning Association, or indeed the Health Education Council, which she also mentioned, to fulfil this task.
The noble Baroness said that the Health Education Council was being financed by the Department to the tune of £I million a year. I do not know whether it was suggested that there should be some reduction in this sum, or whether there is a hidden meaning in the Amendment before us that some of the grants made by the Government to bodies such as the Health Education Council and the Family Planning Association should be reduced consequent upon the Secretary of State obtaining these additional powers which she has suggested that he or she ought to possess. That might be worth explaining to the House before we make up our minds about the Amendment.
There is, however, a more fundamental point to which I wish to refer. Why should the noble Baroness and her friends single out sex education as the one aspect 1299 of the curriculum which should be subjected to this sort of control by the Secretary of State? Why does she not think that history is a subject of great importance on which the Secretary of State might like a say? If our children are being given all sorts of wrong ideas in history, chemistry or physics, why not allow the Secretary of State to intervene and not only say what the curriculum should be for any of those subjects but also say who are the proper people to teach them? Is it right, for example, that, say, Marxists should teach history in our schools or—
§ THE EARL OF LAUDERDALE
My Lords, I am obliged to the noble Lord for giving way. Does he not recognise that the question whether a Marxist may be teaching history in our schools might not be strictly relevant to this National Health Service Reorganisation Bill, whereas the Amendment is designedly drafted to be relevant to the subject matter of the Bill?
§ LORD AVEBURY
Perhaps I have not made myself clear, my Lords. I will try to do so. I was giving an analogy. I am asking whether it is not a matter for consideration, at least if some aspect of the school curriculum is taken out of the hands of the Schools Council and those other bodies which have given reputable advice, that other subjects might also be put within the control of the Secretary of State. In other words, where does one draw the line? Should what the Amendment proposes be extended to other subjects which are part of the school curriculum, subjects which we may consider to be of equal importance?
I have previously had some criticism to make of what is taught to my children in school. I recall that on one occasion I wrote to the head teacher of the school attended by one of my children and objected strongly to a textbook that was being used for teaching geography because I felt that certain statements made about the Republic of South Africa were inaccurate and misleading. I pointed that out to the head and I wrote to the Schools Council asking for the terms of the textbook in question to be considered. I did not say that, because it was in my view inaccurate and misleading, that fact was justification for taking the subject of geography out of the hands 1300 of the Schools Council and putting it under the control of the Secretary of State. I hope that the noble Earl, Lord Lauderdale, will see that there is an analogy between the teaching of sex education and the teaching of any other subject, and that what goes for the first may be extended over the whole curriculum.
The noble Baroness, Lady Elles, and the noble Viscount, Lord Ingleby, suggested that some of the results of sex education in recent years were an increase in promiscuity, a rise in the incidence of veneral disease and an increase in the number of births to girls under 16. The noble Baroness was honest enough to admit that she had no evidence whatever to support that contention. Indeed, I think that such evidence as exists contradicts any conclusion of that kind. I will not go into the details but will refer only briefly to an article in The Doctor of January 4, 1973, entitled "The puzzles and paradoxes of V.D." in which the whole question of a possible association between permissiveness and V.D. was discussed. The author asked why, if permissiveness and promiscuity were to blame, there was an increase in only one of the two main venereal diseases. He wrote:In Britain the number of new cases of syphilis each year has remained virtually unchanged over the past two decades. The number fell dramatically after 1946 to fewer than 2,000 a year and has never exceeded this figure.On reflection, therefore, the connection which people try to demonstrate between what they call the permissive society and V.D., births to young girls and so on, has yet to be demonstrated.
I do not know whether the noble Baroness watched the interesting television programme in which Robin Day chaired a discussion between Bishop Huddleston and Dr. White, on the one hand, and John Mortimer and Jill Tweedie, on the other. The programme concluded with a summary in which it was clearly demonstrated, at least to my satisfaction, that one cannot put the blame for these matters on what is called the permissive society, though no one has yet really defined what the term means—what the protagonists really mean when they argue about the effects of what they call the "permissive society". I think that much of the disagreement 1301 between the two sides in this television programme boiled down to a question of semantics, with the Bishop and Dr, White talking mainly about sexual permissiveness and John Mortimer and Jill Tweedie extending the discussion to a much wider field in terms of the impact of violence and so on, and not purely in sexual terms.
§ THE EARL OF LONGFORD
My Lords, it is not for me to intervene in the noble Lord's speech, and I do so only to put a question to him. He must have been aware that there was a total difference of view between Bishop Huddleston and Mr. Mortimer in regard to the whole sexual issue. He must also have been aware, if he listened to the whole programme, that the general public, when asked for their opinion, were overwhelmingly in favour of Bishop Huddleston and against Mr. Mortimer. I trust that the noble Lord was aware of those facts.
§ LORD AVEBURY
I was, my Lords; and of the letters that were written in response to the invitation by the B.B.C., about 60 per cent. of the population seemed to support the Bishop and Dr. White and were against Mr. Mortimer and Jill Tweedie.
§ BARONESS ELLES
My Lords, may I remind the noble Lord, Lord Avebury, that we are discussing education for children and not those who watch Trevor Huddleston on television on a Sunday night?
§ LORD AVEBURY
My Lords, I apologise for being slightly led astray, particularly by the remarks of the noble Baroness and especially on the question of television. I return immediately to the question which has been dealt with in the debate so far only partially—namely, whether we should have the Secretary of State specifying the content of sex education and whether he should be entitled to select those people who are entitled to teach sex generally in our schools.
I think the noble Baroness and her friends are trying to set a dangerous precedent here, though they probably did not realise what they were doing when they drafted the Amendment or how the idea they have in mind could be extended into other fields, so that ultimately the 1302 Secretary of State would assume total control over what is taught in our schools. I am sure your Lordships would not wish such a situation to arise. The present Secretary of State may be, and I am sure is, completely admirable and anxious to act in conformity with the views of Parliament. However, at some time in the future we may have in office a totally different type of Secretary of State and he would, as a result of this Amendment, possess enormous powers, powers which I feel we should regret giving to the holder of the office.
§ 5.50 p.m.
§ BARONESS ELLIOT OF HARWOOD
My Lords, I intervene not to discuss what the B.B.C. does or what programmes it puts out, but simply to relate an experience in regard to the teaching of sex education in schools. That is what this Amendment is about. I entirely agree with those who are anxious to preserve the standards of family life, and so on, which most people want to see preserved. But what is important is the method by which it is done. The reason I disagree with this Amendment is simply that I believe it is the duty of the local education authority, and the schools in the areas for which local education authorities are responsible, to work out the best method of doing it. May I give an example? I was for six or eight years chairman of the education authority of my county council, and one of the very first things I was asked to do when I took over the chairmanship was to get together with a group of education people, with the doctor, and with one or two parents, to work out a scheme by which sex education in the schools in Roxburghshire (which is my area) would be able to deal with this subject.
We had a meeting, and we had two headmasters of big schools, a headmistress, a doctor (a woman, the noble Baroness, Lady Summerskill, will be pleased to hear), the director of education and myself. In a perfectly simple way we worked out the method by which sex education should be given. It worked exceedingly sensibly. At first, it was taught only in the senior schools, but yesterday before coming down I rang the director of education (because the events I have referred to occurred some years ago) to find out how this matter had worked out and whether it had been a 1303 successful experiment. He told me that not only was it very successful but that they had had no difficulties, no trouble, no complaints from religious groups, and that the subject was now taught in the schools, including in a slightly different way, the junior schools. I asked him whether he thought it would be a good idea that this should be controlled, either in Scotland or in England, by the Secretary of State or whether it was better left to the local education authorities and the communities in which these young people are being educated. He said very strongly that he thought it would be a great mistake if this subject were taken away from the responsibility of the people who are planning the curricula of local education authority schools and placed in the hands of the Secretary of State for Education, or, as it would be in Scotland, of the Secretary of State for Scotland.
That is the reason I am against this Amendment. I do not believe that this is a subject which should be treated separately and left in the hands of the central organisation. I believe that it should be done in the schools, with the teachers and with the local community. There are many places where it is being done highly successfully, and it would be very much wiser to do that than to treat this as a separate subject and something which ought to be, as it were, adjudicated on by a central body. Our local education authorities are the people responsible for what is being taught in the schools. Very often the parents are on committees at the schools which their children attend and they can, if they wish, make complaints direct to the schoolmaster. The whole matter is on a simple plane, and children, parents and teachers all work together. I am sure that that is the better way. I have every sympathy with the words of the noble Viscount, Lord Ingleby, the noble Baroness, Lady Gaitskell, and the noble Lord, Lord Beaumont of Whitley, on the standards we want. Of course we want the best possible standards, but we shall be able to make them better by making the responsibility a local one and by getting the local people —parents, children, doctors, and so on—interested in the schools. I am not in favour of this Amendment, which says that it will be for,…the Secretary of State for Education and Science to approve the content of any pro- 1304 gramme of sex education for children in schools…I do not think that that is the way to do it.
§ BARONESS BACON
My Lords, I shall be very brief. I could not possibly vote for this Amendment because it breaches an important principle of the British education system; that is, that in our country the Minister does not dictate to the schools what is taught nor how it is taught. Strictly speaking, I do not think that it is even the local education authorities who are given the responsibility for this, but in fact the teachers in this country are left free to teach what they like and how they like and are then responsible to the managers or governors, or the local authority. That is something we must preserve.
I well remember being in Russia many years ago and meeting the Russian Minister of Education. In a discussion on education, he said to me: "Who makes your plan in Britain?". I asked the interpreter to ask what he meant by "the plan", and I gathered that he meant a national syllabus drawn up by the Ministry of Education in Russia and that that was followed by every school in Russia having the same curriculum and being taught in exactly the same way. I do not want to see that happening in our country. I want to preserve the freedom of the teachers in this country to have the right to teach what they believe, in the way in which they determine it shall be taught.
I do not think that this Amendment is really about sex education, although it mentions sex education. What I object to is that it brings in this important principle, which will be something quite new, in that the Secretary of State should approve the content "of any programme of sex education…". I agree with the noble Lord, Lord Avebury, that this might be followed in other ways and we should be taking away the freedom of the teachers which is so enjoyed by them in this country. Therefore, I could not possibly vote for this Amendment.
§ THE EARL OF LAUDERDALE
My Lords, the freedom of the teacher is a cry that is readily raised—freedom of conscience, freedom of speech, freedom of the Press. These issues are readily raised and readily used sometimes to extenuate an argument that may not be very sound 1305 against a matter of real principle. I am quite certain that no noble Lady, with teaching experience or otherwise, would argue that if teachers are known or thought to be teaching something that is wrong, that that freedom should not be curbed. I only say "if".
Coming to the substance of this Amendment, I can assure the noble Lord, Lord Avebury—who according to my reading glasses (I cannot see very well) is not now in his place—that it contains no hidden meanings. The purpose is plain: it is to establish a principle that in a very delicate area, the source of much disquiet and breakdown of family life in our society, there should now be a new look by the Government, and a simple principle has been put forward to bring it about. I wish it were the case that the whole of Britain were like the Borders of Scotland from which my noble friend Lady Elliot of Harwood comes, and indeed from which I come, but it is alas! not the case. There are many industrial areas where the whole attitude is different, and there have been examples in the recent recollection of Members of this House of exceedingly dubious education—if that is the word that can he used—and very dubious propaganda is being showered on young people in an unbalanced fashion. It will be common ground to all of us—and let us seek what is common ground between us—that we want to arrest and curtail the spread both of unwanted pregnancies, particularly among the under 16s, and the spread of V.D. The question must be faced, "What are we to do about it?" One answer, and the answer given readily by those who oppose this Amendment, is that there should be more and more contraception. But, surely, the more troops you commit to a battle the more casualties there are likely to be.
§ BARONESS ELLIOT OF HARWOOD
My Lords, the noble Lord is quite wrong in saying that the reason we want this teaching in schools is more and more contraception. What we have said is that we want this teaching in schools so that children will understand the ordinary physiological and biological things of life. The noble Lord is quite wrong if he thinks that more and more contraception is what we are looking for. What we are asking in this Amendment is who is to do 1306 this? My view is that it should be done by the schools and be the responsibility of the local education authorities.
§ 6.0 p.m.
§ THE EARL OF LAUDERDALE
My Lords, I am much obliged to my noble friend for clearing up what was perhaps an inadvertent misrepresentation on my part. I did not mean to suggest that she was using this argument. I know that the noble Baroness would never use such an unworthy argument. But it is used, and it is used, among others, by the Family Planning Association, and if there is any doubt I can give quotations from their pamphlets, which I have here.
§ LORD PLATT
My Lords, may I intervene for a moment? If quotations are to be made, I hope that they are not made out of context, because the Family Planning Association has for many years taken a most responsible attitude to sex education in general.
§ THE EARL OF LAUDERDALE
My Lords, I am sure the noble Lord will allow me to develop the argument, because I am coming back to the context. One argument is that the simple way to stop the rot is to allow and encourage plenty of contraception. Another approach, which is that, I think, of my noble friend Lady Elliot and many others, is that there must be real sex education, and also—and this is the critical point—that it should be real and balanced, and indeed the best sex education and not simply instruction in contraceptives.
If sex education is worthy of the name, it will be balanced instruction. If it is worthy of the name, it will give both sides of the picture. If it is to be a creditable feature of our liberal open society, it will not brainwash children into the belief that they can do these things without injury to themselves, even if they escape the apparent physical consequences by taking what are known as "precautions". If this education conforms to the best standards of our national life, it will address itself to responsibility and also to choice, the choice between indulgence and restraint, to take the first choice, and a critical one, and one that is critical to citizenship. It will draw attention to the fact that this is not simply something to be indulged in for fun and pleasure but is a matter to be considered and learned 1307 about in the context of love and of marriage. And some Family Planning Association material—and I have two pamphlets here which come from that organisation and which I will show to any Member of the House who is interested—simply treats sex as a pleasant means of what are known as personal relationships, without any reference to marriage whatever.
My Lords, what is fundamental to our Amendment and indeed to our purpose in moving the Amendment, and if necessary perhaps pressing it, is to learn, and if needs be to test, the Government's attitude to a matter that is of great concern, irrespective of how one arranges the matter with the local education authorities; and of course we appreciate that there are difficulties of that sort. One of the excuses that has been used to evade doing anything about it was, I regret to say, used by Sir Keith Joseph in a letter to the Order of Christian Unity, of which a small number of noble Lords of all denominations are members, including myself. In his letter he said:Of course, the Government would not wish to pass moral judgment on matters of personal behaviour, individual behaviour.That is one of the standard let-outs for people who want to dodge the issue.
What about the Government's judgment that individual behaviour is or may be either harmful or beneficial to society? Such judgments are made all the time. Selfless public service is publicly rewarded. Is that a Government judgment about personal behaviour or not? Of course it is. Volunteering to help others in social service is encouraged by the Government and society. These are judgments on private behaviour. Volunteering for the national Defence services is positively encouraged. Courage in itself as a virtue is encouraged. To say that the State or the Government are not interested in individual behaviour and questions of morals is simply not true on the facts. By the same token, the State treats drunken disorder or drunken driving or theft or murder as crimes. These are judgments on individual behaviour. Since the State does in fact exercise such judgments, Sir Keith Joseph's reply is disappointing and in my view unworthy.
1308 Then there is the attitude which is implicit in some of the Family Planning Association literature, or there is the attitude that was evident at the much advertised 1971 Conference of the Health Education Council, which also enjoys a Government subsidy: the attitude that sex outside marriage is wholly legitimate and in no way to be discouraged, provided care is taken to make sure that there is no V.D. or unwanted pregnancy as a result. When, at the 1971 Conference of the Health Education Council, subsidised by Her Majesty's Government, the National Marriage Guidance Council delegate spoke, she was simply ridiculed because she urged that sex education should be related to sex in marriage. These attitudes really contradict the State's official protection of the marriage state and indeed of the institution of marriage. The very fact that we have an established and large body of law relating to marriage is evidence that the State, on behalf of society, does have an interest in its stability and permanence. I believe that even this Government are beginning slowly to recognise that there are matters that still require attention in this field; otherwise why make gestures to counter offence which is given to family life by public indecency?
But, my Lords, morals apart, it is surely the implicit menace to stable family life through irresponsible attitudes to sex that is ultimately at issue in this question. Surely it is common ground that disturbed children are often, and perhaps usually, the product of a broken or disturbed home. Surely it will be common ground that they often grow up to be disturbed parents at best and criminals at worst. And surely it would be common ground that they beget children still more disturbed and still more prone to criminality. So, my Lords, moral judgments apart, inadequate preparation for marriage, and the treatment of ad hoc "stable relationships"—like David Frost's glorious two years—as being equivalent to marriage, simply tend to undermine the growth of responsible citizenship. It is an uncaring and a destructive society, one cursed with its own death wish, that treats these matters lightly.
Nor should we too readily accept at face value the rather raucous propaganda of Humanists and others, or the misplaced playing to the gallery of some 1309 churchmen, one or two of whom are personal friends of mine, that contraception by itself and contraceptive instruction and free availability of both in all forms for use outside marriage is the only cure for the rising V.D. and abortion rates. Just before I came into this Chamber my attention was drawn to a letter in the Guardian of February 8 from the consultant venereologist of Newcastle General Hospital. The signature was A. S. Wigfield, and the comment was:The V.D., abortion and illegitimate birth rates are not the outcome of non-availability of contraceptives, but of totally inadequate sex education in its truest sense.What do the Jewish minority say? We have heard the view of the Chief Rabbi quoted. What does the Church of England say? My old and personal friend the right reverend Prelate sitting on the Bishops' Bench is silent; perhaps we shall hear from him. We know that the Church of Scotland and the Methodist Church are very anxious about this matter. Sex education should be related to the context of love and marriage. I hope that the Government are beginning to see light and to realise that the only foundation for a stable society is family life, starting with the children.
§ LORD GARDINER
My Lords, would the noble Earl allow me to interrupt, as I am getting more and more confused. Is not the question we are discussing whether sex education should be determined by teachers and parents—and no doubt local ministers and clergy—discussing things together, or by Sir Keith Joseph, of whose views I gather the noble Earl does not think very well?
§ THE EARL OF LAUDERDALE
My Lords, I am much obliged to the noble and learned Lord, Lord Gardiner, for his intervention. His interventions are always telling, and always valuable. I do not approve of Sir Keith Joseph's attitude, but I have learned to observe in this, and other Governments, that no Minister lasts very long. In any case, what we are looking for is the situation in which the Secretaries of State for Health and Education and Science together would recognise a responsibility in this field.
If the Government feel that they must hide behind various excuses on this matter, they may well be open to the 1310 charge of a casual, lighthearted, and indifferent attitude, and, if so, that will certainly not be forgotten. Governments are not often amenable to reason, but they are very often amenable to the ballot box, and they should be aware that there could be a backlash in this matter. I hope that we shall have a forthcoming and oncoming reply from the Front Bench. I believe that we should be very grateful to the noble Baroness, Lady Elles, for the way that she moved this very telling and important Amendment.
§ 6.13 p.m.
§ LORD GARNSWORTHY
My Lords, I have been a member of boards of managers and governors since 1937, and in those years I have learned, in the discharge of my duties and from my assessment of how schools should be organised and run, to live by this handbook, which is based on the Education Act 1944. I have listened with not just passing interest to what has been said in this debate by a number of speakers. I have been amazed that so many noble Lords should have been concerned more with talking about sex than about sex education. If we are to serve the interests of the children —with which we are all concerned—it would be as well if we lowered the temperature a little. If we were to get half as worked up about the commercial exploitation of teenagers by commercial interests in the advertising they undertake, we might be getting to grips with some of the problems that have been mentioned this afternoon.
I have no doubt that everyone who has spoken is actuated by the highest motives. Of course we are worried when young people make mistakes. We were worried, and we still are worried, when we think of our introduction to sex and how we learned about it. We have to be very careful lest we think that we are well equipped to lay down rules whereby children should be taught in school. I doubt very much that any Secretary of State, whether for Education or for Health, could draw up a programme of sex education that would be completely satisfying throughout the length and breadth of the country. I doubt whether we have any right to say that teachers can reasonably be expected to undertake sex instruction. In regard to other organisations—and non-profit-making bodies may be concerned—I think that the House 1311 would do well to pay attention to what my noble friend Lady Bacon said about the Education Act 1944. She reminded your Lordships that if this were written into this Bill, we should be doing something for education in regard to this subject that we were not doing in regard to other subjects. I think that it would be very wrong to do it. It is one thing to say that the Secretary of State should be able, and perhaps ought, to give advice, but it is an entirely different matter to say that he shall approve the content of any programme of sex education.
What is wrong with allowing boards of governors and managers to discharge their function in the matter of having an oversight of the school curriculum? That is a responsibility that certainly is laid on them in the county where I reside. I should have thought that any body of managers and governors of any school would make it their business, if this subject is to be undertaken in school, to do what they should do in regard to any other subject; that is to say, approve the curriculum. There is no reason at all why they cannot consult with parent/teacher associations; there is no reason at all why they cannot consult with the medical fraternity as to the best way in which health education can be undertaken, having regard to what the headmaster and the staff have to say. It seems to me that this machinery is sensitive machinery—or it ought to be. It ought to be a sensitive sounding board, with contact with the parents, and an understanding of the problem that the teachers are up against in doing their job as they are supposed to do it. In each locality there would be a body of people, advised by the headmaster—who himself would be working in co-operation with his staff—that would approve the content of the curriculum in regard to this subject, or any other, if it thought, and was persuaded, that this is a subject that ought to be taught in the school.
I doubt that we have done very much good by the discussion that we have had this afternoon. I say that regretfully, because there is not one of us who is not worried when we see young people going wrong. But this afternoon we are not discussing contraceptives, or a great many other things that have been mentioned here. If the Government resist this 1312 Amendment, I hope that my noble friends will be inclined to give the Government their support.
§ LORD CAMOYS
My Lords, I must first apologise for not getting here earlier, owing to the fact that I had a bad parachute accident yesterday. I therefore, unfortunately, did not hear the first part of the debate. What I want to stress is that sex education should be undertaken by the parents. I have five children and eight grandchildren. I have not discussed it with my grandchildren because they are not old enough, but I have spoken openly to my five children and pointed out the dangers and so on. I believe that we must stress that it is the duty of the parents to teach the facts of life to their children, and not that of the schoolmasters.
§ 6.20 p.m.
§ LORD BELSTEAD
My Lords, the noble Baroness, Lady Elles, suggested in her opening speech that the House might consider that this Amendment was a detail in the consideration of the Bill. But I would agree with my noble friend that this Amendment is no detail and that, in her usual way, the noble Baroness lucidly showed the House what is her concern in this matter. I should like to say at the outset that I will certainly draw to the attention of my noble friend the two specific suggestions made by the noble Viscount. Lord Ingleby, and my noble friend Lady Macleod of Borve—although I am afraid that, for reasons which I shall give in a moment, I cannot accept them—and to assure them that what they said will be looked at very carefully.
This Amendment is no detail because, of course, it affects all our children. It is no detail because, as my noble friend Lady Elliot, the noble Baroness, Lady Bacon, and other noble Lords have reminded the House, it is a cardinal principle of our whole approach to education in this country that there should be no central control of the school curriculum. When I say that, I am not forgetting parents. I am saying that because those are the terms in which the Amendment is drawn. I do not want to suggest that I could, or should, submit to your Lordships any of the historical or philosophical bases for this principle. Sufficient to say that, when we come to think about 1313 it, there are probably few of us in the House who would not accept that it is an essential part of the traditional freedoms of this country. That is why, as the noble Lord, Lord Garnsworthy, has reminded us, the Education Act specifically places a responsibility for the school curriculum on local education authorities, and on school governors and managers. That is why, in practice, great freedom in this matter is given to school heads and their staffs.
That is not to say that advice may not be given from the centre about possible lines of approach to a subject, and guidance is of course given by members of Her Majesty's Inspectorate when they visit schools, and in the courses and conferences which they arrange for serving teachers and for those who train the teaching profession. That advice is summarised in my right honourable friend's Department's Handbook of Health Education, which has long taken the line that sex education is not, as the noble Lord, Lord Beaumont of Whitley, reminded us, just education about sexual matters. Of course it includes that aspect; but surely it is education about human values, about family relationships, about parenthood and about emotions as expressed in literature or in art. Its whole purpose is to help young people, as they grow up and become increasingly aware of their own emotions, to think clearly about values and about their future responsibilities.
The Amendment which has been put forward by the noble Baroness and her noble friend Lord Ingleby proposes that programmes of sex education should be given only by teachers and by organisations to be approved by two Secretaries of State. As I have already said, it is the fact—and I know that this is a matter of concern to many of your Lordships—that freedom in this matter is conferred on those responsible for the running of the schools and upon the teaching profession. I think that the noble Baroness, her noble friend and I would not greatly differ on this, but where I feel unable to go along with this Amendment is in regard to the central part of it; namely, that a duty should be placed centrally on two Secretaries of State to approve the content of any programme of sex education.
1314 The point is that in this country we do not have centrally approved syllabuses or timetables, and there are no arrangements for the submission of school work programmes for departmental approval. It is perfectly true that religious education depends upon what are called "agreed syllabuses", but, as their name implies, these are agreed by those concerned with education in the area of each local education authority. This new clause—and, like so many of your Lordships, I well understand the reasons behind it—would introduce central control without any local agreement in respect of one aspect of education, and I am bound to say that, although I fully understand the reasons for it, the Government feel unable to support this proposal.
There is a serious point here. I suggest that this debate makes it perfectly clear that if all of your Lordships who have spoken this afternoon went in two by two and filled successively the position of the two Secretaries of State, the policy would alter every time a new couple took the floor, if I may put it in that way. This is one of the dangers of central control and it is surely one of the arguments for local discretion. It is usual for local education authorities and schools, when they are developing programmes for this sort of education, to take account of parental views, and my right honourable friend the Secretary of State for Education has made it clear in public that she very much hopes this will always be so. From the point of view of my right honourable friend's Department, the impression is that, while it is impossible to satisfy all sections of opinion, local education authorities have shown great responsibility in their approach to what is inevitably a contentious subject.
A number of education authorities have produced, through working parties, reports or schemes of work, or are still carrying out studies with the intention of producing reports, while others arrange study days and discussions for teachers and others who may be involved in providing this sort of education. An example of the type of report produced by local education authority working parties (and I think this was mentioned a few weeks ago in the debate initiated by the noble Earl) is the Gloucestershire scheme for education in personal relationships in, family life. Schools are not required to 1315 use such schemes and are free to adapt them, but they cover many aspects of the problems of providing education in this field and are undoubtedly a good basis for consideration by schools and by parents. As the noble Baroness, Lady Elliot, reminded us, initiatives of this sort are not new, but that does not mean that they are any the less valuable.
During the last 10 years, there has been an increasing amount of information in schools in the biology field, in science courses, particularly for the 5 to 13 year olds, and for what was, in the 1960s, the new C.S.E. examination. There are also a number of curriculum development projects, founded by the Schools Council, which provide an opportunity for personal relationships to be considered in the context of individual integrity with other people and the needs of society. These projects are designed to be capable of being used in classes containing pupils with a wide variety of different beliefs, which is something that many schools have to deal with to-day. Another project, on religious education in secondary schools, is developing material relevant to the continuation of a specific programme of religious education acceptable to people of different religious convictions.
As has already been metioned, sex education is not just a matter of imparting information. Your Lordships may also like to know that many colleges of education are developing student-counselling services, and my right honourable friend's Department and the Association of Teachers in Colleges and Departments of Education are jointly organising a conference next September on this topic, which is also the subject of a number of courses of in-service training—
§ THE EARL OF LAUDERDALE
My Lords, before the noble Lord leaves that point, can he say whether these courses and this counselling relate to sex in marriage and in the context of marriage?
§ LORD BELSTEAD
My Lords, I shall not leave that point to one side, but may I answer my noble friend in a moment? The sources of guidance for teachers are many, and include many local education authorities which have their own working parties and arrange conferences and discussions through 1316 teachers' centres. Help is also available through school medical officers and nurses. There is information about material suitable for use in schools from the Health Education Council, and courses are also organised by the Health Education Council, often in conjunction with Her Majesty's Inspectorate. There are also courses and help offered by voluntary bodies.
My Lords, I am sorry for that rather long catalogue, but I have quite deliberately laid before your Lordships some of those details because I realise that many of the speakers this afternoon—my noble friend Lady Elks, on the one side; the noble Baroness, Lady Summerskill, on the other; and the noble Viscount, Lord Ingleby, from the CrossBenches—arc worried about what materials are being made available and what is being done, and I thought that your Lordships ought to have a little of the detail that at least I have at my disposal, and ought to know that we in the Government have this concern, too. That is why I was anxious that your Lordships should know that the instruction which is being given is sound, is well thought out and has a very real concern for young people behind it.
The noble Baroness, Lady Summerskill, most understandably, brought up the concern which she has about people who have perhaps not got concern for young people behind them and who may be operating purely for financial gain. The noble Baroness drew the conclusion that the Amendment should therefore be supported. May I say to the noble Baroness, Lady Summerskill, that I can remember an occasion some time ago when my right honourable friend the Secretary of State for Education and Science said in another place that local education authorities and schools should think very carefully indeed before deciding to show a particular film; and this, as I say, was said in the House of Commons. But, my Lords, my right honourable friend did not lay it down as being her view that this particular piece of material should not be used. She gave it as her view that local education authorities should consider very carefully, and she gave that view after knowing that the Health Education Council had found that that particular piece of material had no educational content in it whatsoever. My Lords, I suggest that this is the right 1317 way to go about it, and that we do not have to accept this Amendment to be able to achieve that particular result.
In addition, there are some practical considerations—and the noble Lord, Lord Beaumont, touched on them. If one envisages the number of secondary schools in the areas of over 160 local education authorities in England and Wales, one realises that the task of vetting in the way that the new clause would require would be pretty formidable. The final part of the noble Baroness's Amendment provides that only teachers and such organisations as the two Secretaries of State may approve should be involved in these courses of instruction. I must say that where I find it difficult to agree with the proposers of this Amendment is that I do not believe it would be right to attempt to single out a part of the curriculum in this way. Nor can I agree with the proposers of the Amendment that approval should be given centrally by the two Secretaries of State. Where I certainly agree is that great care should be taken in approving the way instruction is given, and by whom; but this is for the local education authorities and the governors and managers, and the good sense of the teaching profession, to decide.
In answer to my noble friend Lord Lauderdale, may I just say that I believe that the Department's handbook on health education provides a sound basis for teachers. The noble Earl drew the attention of the House to the strength of family life and to his concern that it might be jeopardised, and he mentioned my right honourable friend the Secretary of State for Social Services. I know that my right honourable friend the Secretary of State for Social Services is on record as saying that he would be concerned indeed if any policy of his jeopardised accepted standards of morality; and perhaps my noble friend Lord Lauderdale might like to know that the very opening lines of the handbook on health education issued by the Department of Education and Science contains these words:The great majority of children will later marry, set up a home and bring up children of their own. In doing so, they will satisfy their own deepest human needs and at the same time play an important part in the building up of society. To play this part harmoniously and effectively through early marriage, the first experiences of housekeeping, childbirth and the rearing of children 1318 from infancy until they stand on their own feet calls for a wide range of practical skills and of human understanding.I believe that guided by words of that sort is the way that we should try to go; not taking central control, but keeping open every opportunity for good advice based on knowledge and the values recommended by your Lordships this afternoon.
§ 6.35 p.m.
§ BARONESS ELLES
My Lords, I thank my noble friend very much for that reply, and I am extremely grateful to all those who have taken part in discussing the Amendment which we have proposed—both those who spoke on the same side as myself and, indeed, those who spoke against the Amendment. I feel that, in fairness, perhaps, I should answer one or two of the comments which were made against it, since they were put more or less in the form of questions, in particular from the noble Lord, Lord Avebury. I certainly had no intention that there should be any hidden meaning behind the fact that £1 million was to be given to the Health Education Council. I was merely quoting what was in a letter from my noble friend Lady Young. It shows that the amount of money that is available to this body, and the amount of money that will be spent on all kinds of information on health, is given by the Department of Health and Social Security, and to some extent, therefore, one would expect them to be responsible for the way in which that money is spent. But there was no intention of mine or of my noble friends, certainly, that this money should be cut off or curtailed in any way whatsoever.
Then I was asked if I was being critical of the Family Planning Association. I have leaned over backwards not to be critical of anybody but merely to state facts as I am aware of them and as I see them. If I may say so, my Lords, I was extremely interested in what may have been a poignant slip of the noble Lord, Lord Avebury, in his parellel between sex and history. When he talks about the teaching of history, and the teaching of Marxism in history, then according to one's own view it may lead to a disease of the mind; but at some stage in life that might happily be reversed by some other form of teaching. 1319 The fact that we have perhaps forgotten in this debate—and I think nobody has raised the matter strongly—is that the teaching of sex education badly can lead to irreversible effects on the human body of so many girls. Indeed, the noble Baroness, Lady Gaitskell, was herself the one to quote the most recent figures, which, as she is aware, have been rising. I am not saying that this was the context in which she meant to make her statement; nevertheless, these figures are going up each year, as the noble Baroness is well aware and as your Lordships are also well aware. It is therefore our duty to see that the Department of Health and Social Security fulfils its function of being in charge of the health of the nation. This is what I sometimes regret our noble friends on the Front Bench fail to appreciate: that if you are having sex education in schools which can result in ill-health and irreversible effects on children, it is the duty of the Department of Health and Social Security to provide suitable and adequate education in that field.
The principle which was enunciated by the noble Baroness, Lady Bacon, referred to 1944, when the Education Act was introduced. But in 1944 we did not have the social problems that we have to-day; and sometimes you have to query whether the principles are indeed the right ones when you see that damage is being done. You do not go on firing a gun just because you say, "I have always fired it": you see what you are aiming at and see what happens as a result of that action. I think, therefore, we are entitled to inquire whether the principle of not interfering in sex education is the right principle. I raise it only as a query; and, of course, it is not for me to impose any condition but merely to ask that that matter should be reconsidered.
I do not know whether I understood the noble Lord, Lord Garnsworthy, correctly, but as I understood him—I may have got his point wrong—he said that he did not think that the Secretary of State for the Department of Education and Science or the Secretary of State for the Department of Health and Social Security would be capable of approving a programme on sex education. As they would have available all the advice of Ministers, doctors, specialists and so on at their disposal, to advise them on an 1320 approved programme, how can it be said that boards of governors in local schools or local education authorities are more capable of doing so? I will not take up any more of your Lordships' time on this subject. I am grateful for all that has been said. I hope that I have answered some of the points that have been put on our proposed Amendment, and I am grateful to my noble friend Lord Belstead for the remarks he made. I hope that he will take what we have said to both the Ministers concerned and that we shall have a more satisfactory reply than we have had so far. I beg leave to withdraw the Amendment.
§ BARONESS GAITSKELL
My Lords, before the noble Baroness sits down, I should like to apologise about the statistics I gave. It was a mistake on my part. They were meant for the next Amendment. I apologise to both the noble Baroness, and to the House.
§ Amendment, by leave, withdrawn.
§ 6.42 p.m.
LORD GARNSWORTHY moved Amendment No. 20:
After Clause 3 insert the following new clause:
§ Provision of Recuperative Holidays for Schoolchildren
§ ". —(1) For the avoidance of doubt and without prejudice to the provisions of section 111 of the Local Government Act 1972, it is hereby declared that the Inner London Education Authority (hereinafter called "the Authority") shall have power to make arrangements for the provision of recuperative holidays for pupils in attendance at any school maintained by them or at any educational establishment, other than a school, which is so maintained.
§ (2) For the purpose of carrying out their functions under subsection (1) above the Authority may either themselves or jointly with another local education authority or authorities provide and maintain such residential and other establishments or arrange for the provision of such establishments, as may be required."
§ The noble Lord said: My Lords, I hope that my noble friend Lady Gaitskell was not intending her remarks to apply to this Amendment. I am hoping for a very much cooler atmosphere for the consideration of Amendment No. 20. If I may, I should like to speak at the same time to Amendments Nos. 21 and 22, thereby saving your Lordships' time. All these Amendments are an indication of the anxiety felt by the Inner London 1321 Education Authority with regard to the preservation of the school health service as they have built it up. Amendment No. 20 aims at securing a specific power by ILEA to provide recuperative holidays. Recuperative holidays are generally provided under Section 48(3) of the Education Act 1944. Essentially, they are provided for children who, because of their physical condition, are in need of a short period of recuperation where they will receive rest, good food, fresh air and regular hours.
§ I might mention briefly the manner in which ILEA achieves this. First it supports voluntary organisations such as the British Diabetic Association and the British Epilepsy Association. It has been supporting latterly the Shaftesbury Society. It has been supporting organisations catering for deaf and partially-hearing children by way of making financial contributions to the cost of holidays as organised by those bodies. Secondly, it has been placing children in private recuperative holiday homes. Then, it has itself two recuperative holiday homes: Cambridge House at Bognor Regis and Rowland House at Little-hampton.
§ There has been a doubt as to which of the relevant powers ILEA is said to possess should be relied upon in any particular instance. Where, as is usually the case, the holiday has been shown to be a legitimate extension of medical treatment, by the provision of some form of continuing medical supervision at the holiday home, the holidays are clearly provided under Section 48(3) of the 1944 Act, within the term "arrangements for securing the provision of free medical treatment." The proposed repeal of Section 48(3) of the 1944 Act in Schedule 5 to this Bill will remove a power under which the authority has in the main been able to provide recuperative holidays. The proposed new clause would not only restore the former situation but would put the whole matter beyond doubt. The responsibility for recommending children would rest with the medical staff of the Area Health Authorities in Inner London. ILEA feel that this small but important aspect of the school health service is seen as being more appropriately provided by that Authority which is able economically to arrange recuperative holidays for pupils throughout its area than by individual 1322 and perhaps hard-pressed Area Health Authorities who might find it difficult to justify a similar level of provision in respect of their own much smaller area.
§ My Lords, there is the matter of child guidance clinics. Although there is little reason to doubt the Government's intention in respect of child guidance, it remains a matter of doubt whether child guidance is a health function that is provided under the Authority's school health powers or an educational function. To the extent that it is a health function, and in view of the proposed repeal of the Authority's main school health powers, there is a danger that this power to provide child guidance service no longer will be available to the Authority. There is a precedent for spelling out a local education authority's powers as to child guidance. It is Section 1 of the Education (Scotland) Act 1969, which amended the 1962 Act, from which the present suggested new clause is derived. It is felt that the matter ought to be put beyond doubt so far as ILEA is concerned, particularly in the light of the Government's stated intention that this important aspect of local education authority work, which is closely interwoven with the work of the schools, should not be transferred to the Health Authorities.
§ Touching on the speech therapy service, as with child guidance and recuperative holidays, this small but important aspect of school health is seen as being most effectively and economically provided by the body which has shown that it can provide a well-run service for the whole of its area. If the service is split between the seven new authorities a loss of effi-efficiency and co-ordination is seen as inevitable. Although it can be argued that certain elements of speech therapy service are provided, and could continue to be provided, by ILEA under their purely educational powers which they are to retain, as distinct from the health powers, it is also certain that to provide a complete service ILEA need to rely on the health powers which they stand to lose under this Bill.
§ The object of the new clause is to put beyond doubt that ILEA will be able to continue to provide a full speech therapy service for their pupils. There is a strong sense that ILEA is losing powers that it has valued. In regard to these three matters, recuperative holidays for school 1323 children, the speech therapy service and the child guidance service, I would ask Her Majesty's Government to accept that ILEA ought to have, deserves, and would put to good use, the powers that these clauses would give it. I beg to move.
§ LORD HYLTON
My Lords, I should like to emphasise the importance of recuperative country holidays for children from Greater London. The reason for this is the very great housing shortage we still have, the very great overcrowding of many families and the very bad conditions which exist in multiple occupied houses. If I may I will go on to say the briefest word on speech therapy and child guidance and look back also on the question of ambulances. I believe it a cardinal principle of Conservative reform that where you have a service of acknowledged excellence you do not lightly cast it aside even if so doing might appear on paper to be a rather more tidy arrangement.
§ 6.51 p.m.
§ LORD BELSTEAD
My Lords, I would ask the noble Lord, Lord Garnsworthy, not to press these Amendments, and I will seek to explain why. If the first of the Amendments, No. 20, were right, what is proposed should be right for all authorities and not just for the Inner London Education Authority. The Government feel that they could not accept what would be a pretty substantial potential blanket alteration to the Bill. May I put some details to your Lordships? We believe that when the details of this operation for recuperative holidays are looked at it will be found that the Amendment is not required in nearly such a stark form as perhaps my noble friend Lord Hylton or the noble Lord, Lord Garnsworthy, believe. It is not that recuperative holidays are not important—I entirely accept all that has been said by both noble Lords—but that under educational legislation there will be a pretty wide discretion for these to be provided where there are educational grounds for considering that they are required. It is true that LEAs are sending children on convalescent holidays under their Section 48 powers, but I seriously suggest that there may well be some doubt whether local authorities need in every case to fall back on their Section 48 powers. When 1324 this matter is looked at I believe that authorities will find that in many cases there is an educational function. So far as Inner London is concerned, this is something which ought to be discussed in the new Joint Working Party on London Reorganisation.
My Lords, may I say a word about the speech therapy services? I was a little worried to hear my noble friend Lord Hylton, who I know has considerable experience of these matters in Inner London, say that when something is working well it should be preserved. I was concerned, not because that is not a good Conservative principle—it is—but because this case I think is an exception to that principle. The noble Lord will know that the Quirk Committee has reported, and he will be aware that the two Secretaries of State are consulting the relevant bodies, and not least the speech therapists, to get their views. I am sure that all noble Lords who are interested will be aware that one of the main recommendations of the Quirk Committee was that the speech therapy services should be unified. At the moment the Government have no view on this matter because we are genuinely consulting. But the acceptance of an Amendment which would fly straight in the face of the recommendation of the Quirk Committee is a little more than I can agree to.
I suggest that the third Amendment, No. 22, is unnecessary. It is drawn in terms of the Child Guidance Services so that the functions of those services may include four different ways in which they might be operated: for the handicapped, for advice to parents, for the provision of special education and for giving advice to Inner London boroughs. The view of my right honourable friend's Department is that education authorities have ample powers under education legislation for the specific functions (a), (b) and (c). I believe that (d) also is something which would fall within the education functions of an authority. I single it out only because it is drawn rather more widely and perhaps in terms which are a little more vague.
The noble Lord said that an undertaking had been given—as indeed it has—that the Child Guidance Service will not alter. In addition to that, educational psychologists are employed on child guidance functions, but I would make it clear 1325 that there is no question of the school psychological service, which has wider functions than child guidance, not remaining an L.E.A. service. There is every intention that it shall be strengthened and developed. I can only repeat that there will be nothing in the Bill regarding the Child Guidance Service which would prevent the same people from doing the same work in the same place after April 1, 1974, as they did before. I know that noble Lords opposite are worried that this will be done within the ambit of the Inner London Education Authority dealing with seven different Area Health Authorities. But at this point I think that I must dig in my toes and say that this is something about which I have already given an undertaking to-day, in the context of the student health service, and that it will be considered carefully as soon as the subcommittee of the Working Party on Collaboration in London meets.
§ LORD GARNSWORTHY
My Lords, I am grateful to the noble Lord, Lord Belstead, for the courtesy and clarity with which he has spoken on most of the points raised. I qualify that because some of the statements he has made leave us a little anxious, and we shall need to read carefully what he has said and to take advice. I am grateful to the noble Lord, Lord Hylton, for supporting the argument which I set out to present. I deliberately cut out a good deal of what I intended to say and I did not touch on the Quirk Report. But I think I ought to say that what the noble Lord the Minister has said requires very careful consideration. I appreciate that he has given an undertaking and assurances. I do not think the Government have grasped the point—that is clear from the discussions we have had—that the situation in Inner London is quite different from anywhere else in the country.
My Lords, I have had many years experience of working with the old L.C.C. and with the ILEA. I have formed the view that they have developed these specialist services to a point of excellence when compared with what is happening in the rest of the country. They have provided a wider range of services than most authorities—they have been able to do so because of their size—and have developed an expertise. Their anxieties, expressed by them directly to 1326 the Department and put inadequately in the debate by myself, are deserving of still further consideration. They fear very much that the standard they have built up will be threatened. They are not satisfied that they will have powers to enable them to deal with that situation and, as I said on an earlier Amendment, it would be time-wasting and not at all helpful if at some later stage they had to come back asking for another General Powers Act. I shall not press this Amendment to a Division and I shall not move the other two. As I say, we must have some reservation until we have carefully studied what has been said this evening. I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ Clause 4 [Family planning service]:
§ 7.0 p.m.
LORD STAMP moved Amendment No. 23:
Page 3, line 28, after ("requirements") insert ("of married persons or of unmarried persons over sixteen years of age").
§ The noble Lord said: My Lords, I move this Amendment in two capacities: as a bacteriologist for over forty years, and also as an educationist particularly concerned with the education and welfare of girls, being chairman of an interdenominational girls' school and also a member of the Executive Council of the Association of Governing Bodies of Girls' Public Schools. My main concern therefore is as to the effect that the Amendment your Lordships passed in Committee extending the facilities for providing birth control not only to the married, but also to the unmarried, irrespective of age, might have on the health and welfare of the teenage girl. As a bacteriologist, I am particularly aware of the seriousness of the problem of the increase in venereal diseases, a matter to which the noble Baroness, Lady Elles, referred briefly on Committee stage in her Amendment, and on which several noble Lords have touched this afternoon. I know that the subject will be coming up later, but I should like to deal with it in some detail in the broader context of this Amendment, and my comments later on will be that much more brief.
§ If your Lordships will bear with me, perhaps I should first give some facts and figures showing the overall magnitude 1327 of the problem. It is estimated that there are about 150 million cases of gonorrhoea in the world to-day, and about 50 million cases of early infectious syphilis. There are about 1,500,000 cases of gonorrhoea in the United States, nearly one-third of them in the teenager. So far as this country is concerned, an up-to-date report has just been published in Health and Personal Social Service Statistics giving the position for 1971. A total of 307,664 attended clinics for the first time in that year, compared with 116,462 in 1959. Of these, 114,711 were female, compared with 30.353 in 1959. The greatest increase was in gonorrhoea, the total rising from 31,344 to 57,571, and in females from 6,380 to 18,516. It is evident, therefore, that the proportion of cases in women is increasing and is now about one-third of the total number of cases; and the number has nearly trebled in 12 years.
My Lords, the figures of particular concern in the context of this Amendment are of course those relating to teenage girls. In the eight years from 1963 to 1971, in girls under 16 the figures have risen from 182 to 410, and for teenagers over 16 from 2,091 to 5,733. Thus the proportion of cases in teenagers is roughly one-third of the total for women, and the number cases has nearly trebled in eight years—in fact, more than trebled in the case of the schoolgirl. If I may quote from the Report for 1971 of the Chief Medical Officer of the Department of Health, he says:
The increase in gonorrhoea in young people remains the greatest cause for concern.
The figures for this country are, of course, from all points of view far less than those reported for the United States, where there is a veritable epidemic of gonorrhoea in high school and on campus. There is some evidence, though, that the upward curve has been steepening here in the last few years, which is only to be expected as the reservoir of infection in the population becomes greater, and the venereologists can only wonder how high their graphs will climb. Certainly we cannot afford to assume that the experience of the United States will not be repeated here. It cannot be over-emphasised, also, that these overall figures give a far from accurate indication as to the true incidence of the disease.
Many, through ignorance, embarrassment or fear, never go near a doctor. Also, a high proportion of cases of female gonorrheoa are symptomless over a long period. I personally can recall many cases of V.D. infection that were discovered only when patients underwent routine investigation following their admission to hospital for some completely different condition, especially on the gynæcological side, or even more often, when attending ante-natal clinics.
§ This shocking state of affairs is of course due to the increased frequency with which premarital and extra-marital intercourse is being practised, and is accentuated by the increased difficulty in curing the disease owing to the development of strains of the organism concerned—the gonococcus—that are resistant to antibiotics normally used. It is reported that a particularly virulent, multiply resistant strain is being isolated from American Forces in Vietnam—a further indication of the seriousness of this aspect of the problem. The position with regard to syphilis—a disease that was once a major scourge—has of course been radically altered owing to its continued favourable resistance to penicillin, one factor which may well have been overlooked by the noble Lord. Lord Avebury, when he made his remarks.
§ LORD PLATT
The noble Lord said, "resistance to penicillin". I think he means exactly the opposite.
§ LORD STAMP
Yes; the continued favourable response to penicillin. That may have been one factor which was overlooked by the noble Lord. Lord Avebury, when he made his remarks. Even with this disease, though, there is a hard core of some 3,000 cases per annum, which must always be a menace in view of the particular seriousness of the disease. There are other forms of sexually transmitted diseases referred to as "non-specific genital infection", the cause of which is largely unknown and treatment therefore largely ineffective. These have shown a dramatic increase in the male comparable with that of gonorrhoea. The cases of gonorrhoea that are not cured may develop a wide variety of medical complications. I do not propose to go into these, much as I feel inclined to do so. But what a prospect for increasing numbers of the young in our country to look forward to!
1329 In any debate such as that which took place on Amendment No. 37 in the Committee stage on the proposal to extend facilities for birth control, not only to the married but also to the unmarried, I should have expected that the V.D. problem would have been fully discussed. I was not able to be present on that occasion as I was in hospital, but I was surprised to find, on reading Hansard, that it was not even mentioned. In fact, the whole proposal seemed to be accepted with surprisingly little comment as to its implications. The only comment I would make is that, while in the case of the married it is very properly designed to aid in family planning, in the case of the unmarried it might more aptly be referred to as fornication planning.
Leaving aside the moral issues for the moment, what effect is the proposed legislation likely to have on the V.D. rate, in particular in the context of this Amendment in the case of the schoolgirl? It has been said that the great majority of those would take advantage of the service are "going steady" and therefore would not contract V.D. In answer to this, I would ask: how many of the teenagers suffering from gonorrhoea started off by "going steady", and how many in fact who start off that way, continue to do so, particularly if they start early? It needs only one encounter of one of them with a third promiscuous person for them both to become infected. In any case, what is meant by going steady "?—a stable sex relationship for a fortnight, three months or a year? To depend on extra-marital faithfulness is a very risky proposition, and those who argue along these lines are, I feel, undertaking a great responsibility in relation to the V.D. problem. More pre-marital sex, which surely must follow on increased facilities for contraception, is only too likely to result in greater promiscuity—, which certainly will result in more V.D. And this is the opinion of venereologists I have consulted who are, after all, in the best position to know.
The second question is: will the recommendation even have the desired effect of reducing the abortion rate? I know that the noble Baroness, Lady Gaitskell, gave some figures and perhaps I might amplify them. For the year 1970–71 (the last year referred to in the 1330 publication I mentioned earlier) for all teenagers the rate rose from 16,626 to 25,511; and for those under 16 from 1,791 to 2,646—and a provisional report just issued by the Registrar General for the year 1972 has just shown a further rise to 3,099. It has been generally assumed that more freely available contraception would effect a reduction. It is said that teenage girls who want to will have sex relationships anyway, so that everything must be done to protect them from pregnancy. This may seem the obvious solution, but is it the right one? On balance, the provision of free contraception might, far from reducing the abortion rate, have the opposite effect, bearing in mind that on the one hand protection is far from 100 per cent., owing to imperfections in the mechanical methods and the improper use of the Pill (which is particularly likely in the case of the teenager) and, on the other hand, the lack of restraint on teenage sex relationships that such provisions would encourage. Professor McLaren, Professor of Obstetrics and Gynæcology at Birmingham University and a recognised expert in the field, maintains that the supply of free contraceptives would make no impact whatever on the increasing abortion epidemic. If there are some who disagree with him, one thing is certain: it would have a most unpleasant impact on the venereal disease epidemic.
The health of the teenager, though, is not solely a question of medical aspects: there is the moral and sociological side. About this there is the deepest anxiety among very many concerned in education, whether as governors or staff of schools—be they public, grant-aided or State, boarding or day—as to the implications of extending the facilities for contraception to the schoolgirl in the way envisaged or permitted in your Lordships' Amendment to the Bill. If the State accepts schoolboy and schoolgirl sex relationships, which can so easily be construed as condoning or even encouraging them—an idea which I should have thought would have been utterly repugnant to most parents—where do you draw the line? Even the age of 16 means little when one considers how eager younger girls are to copy their elders. Knowledge of contraceptive methods would soon get about among the early teenagers, without even the benefit of the counsel that older 1331 girls, in the most favourable circumstances, might receive. I know I am speaking for very many in the educational field when I emphasise that they are fighting an up-hill battle against deteriorating moral standards among teenagers; and their position will be infinitely more difficult if schoolboy and schoolgirl sex relationships are in effect condoned by the State provided that no pregnancy follows. That may not be the intention of this legislation but it will be its effect—and one which no amount of advice by counsellors on sex matters can fully counteract.
The question of sex education for school children has already been discussed to-day and I do not propose to go into it further, except to say that, as a bacteriologist, I sometimes feel that a visit to a V.D. clinic would do more good than anything else. This, however, is hardly possible in view of the tremendous pressure on these clinics to cope with the ever-increasing number of cases. But it would at least bring home to schoolboys and schoolgirls, as nothing else would do, what V.D. is—a rotten disease in more than the sense in which they use the term. Perhaps colour films on the subject might be the answer.
My Lords, I do not propose to go into the broader issues of the long-term results that this looser and more casual attitude to sex in the formative years of life may have on fidelity after marriage, on divorce and on family life, important as these are in the social context. To me, they are all interconnected, as has been emphasised already, and particularly by the noble Viscount, Lord Ingleby. I fully agree with the noble Lord, Lord Aberdare, when he said of Amendment No. 37 on Committee stage that it went far beyond the intentions of those who introduced the Bill for the reorganisation of the Health Service. But it has provided an opportunity to discuss what I consider to be most important health and sociological problems facing the country. When one thinks of the number of Questions that have been tabled recently in your Lordships' House concerning the eradication of brucellosis in cattle, and the relatively little consideration that has been given to the prevention and eradication of venereal diseases in the coming generation, 1332 one cannot help wondering whether we have not been getting our priorities wrong.
According to my researches into the Index of Hansard, apart from the speech of the noble Baroness, Lady Flies, to which I have referred, there have been only two very brief references to venereal disease in your Lordships' House in the past ten years—both of them in Questions, and one for Written Answer—not forgetting the remarks which the noble Baroness, Lady Summerskill, made in 1962 during the debate in response to the gracious Speech. So perhaps this discussion to-day is overdue.
This Amendment is clearly in the nature of a compromise to meet all the complex issues resulting from teenage extra-marital relationships, affecting as it does only those under 16 years of age. But it does involve young persons for whom we still have responsibility, whether as parents, teachers, educationists or legislators; and by avoiding giving any impression that the State approves of pre-marital schoolboy or schoolgirl sex relationships we shall at least do something to show that we accept these responsibilities. I hope your Lordships will agree that this subject should be fully ventilated in your Lordships' House, however much we may differ as to the emphasis that should be put on the issues involved. Even though it comes up only as an Amendment on Report stage it is, to me, comparable in importance to some of the great debates we have had in recent years on social legislation, affecting as it does the health—and I use that word in every sense—of generations to come. Whatever decision your Lordships may come to, at least I hope everyone will be aware of what is involved. I beg to move.
§ 7.19 p.m.
§ LORD HYLTON
My Lords, before making my contribution to this debate. I think it would be useful to explain the basis from which I speak. I am, first of all, a layman in medical matters; I am a parent of young children, and I am a Catholic. Before anyone leaps to erroneous conclusions, I should perhaps explain that I voted, after some heart-searching, for the Amendment to make the family planning service an entirely free one. It will also be known to your Lordships that within Catholic circles 1333 there has in recent years been rather a greater variety of opinion on the question of contraception within marriage.
At the Committee stage I spoke of the concept of responsible parenthood, and I was delighted when this seemed to be taken up in a rather favourable sense by my noble friend Lady Young. I am very glad now to support these Amendments because I feel that they are very necessary. They go right to the root of the purpose of providing a family planning service, and to my mind they rightly question the terms of reference of this service. Is the service one designed simply to prevent abortions and unwanted births, or is it a service to provide a comprehensive gynecological facility, serving the wellbeing of the whole family, as was mentioned by the noble Baroness, Lady Llewelyn-Davies of Hastoe, when describing the Aberdeen experiment? Or, in the same general line of country, is it to be a comprehensive service of advice, as at one point described by my noble friend Lady Young? In brief, either we can have a full family planning service, or we can limit it to simply a birth control and contraceptive service. This Bill, as drafted, appears to repeat almost exactly, word for word, the wording of the 1967 Act. Perhaps the Act of 1967 was not as clear as it might have been. It may be that some degree of muddled thinking crept in somewhere, and, in particular, that there may be a confusion between ends and means, and rather too great an emphasis on means.
Next, if I may turn to the question of advice to be given within the context of the service, is it to be purely technical advice? Is it to be moral advice, or is it to be social advice thought to be for the good of the community at large? In Clause 4, in lines 28 and 29 the Bill refers to "the giving of advice on contraception". Is this the only advice that can be given? Are other varieties of advice permitted? I hope that when questions of abortion arise, as they are sure to do in the context of the service, the possibilities for mothers to have their children adopted will be made clear and fully explained to them, because it is a fact that there is now a long waiting list of approved couples whose great wish is to adopt children. The position has become so difficult, because there are so few children offered for adoption, that 1334 many adoption societies have been obliged to close their lists of potential adopters. There is another point on which I would question the wording of the clause. As drawn now, in lines 29 and 30, medical examinations would appear to be limited only to persons seeking advice on contraception. This, it seems to me, is a narrower wording even than that adopted in 1967.
I turn now from these considerations, which go a little wider than the Amendment, to the question of persons under 16. I believe that there are two very clear principles which should guide us. The first is that nothing should be done to undermine or influence the parents, or encourage them to avoid their responsibilities. Secondly, nothing should be done to undermine the mature and responsible personal relationships among single persons. At the Committee stage the right reverend Prelate the Bishop of Bristol asked whether the counselling context could be preserved in the circumstances of a free contraceptive service. I am sorry that the right reverend Prelate is not here to-day. He did not receive an entirely satisfactory answer, with the possible exception that it was explained to him that counselling would continue to be given in clinics. But do the under-16s go to the clinics that now exist? If I may quote my noble friend Lady Young, at the Committee stage, she said (column 1008 of the OFFICIAL REPORT for December 18):we do not know the best way of attempting to solve the problem of unwanted pregnancy.and she went on:… we shall consider how to provide contraceptive services for those young people who are going to have sexual intercourse anyway.I suggest to the House that it would be far better not to take the powers by legislation until after that consideration has taken place. I know it may be objected that excluding the under-16s is to exclude the most vulnerable people. My reply to that would be that the right thing to do is to attempt by all possible means to strengthen the influence of the parents, There is already in existence at least one method of doing this. That lies in the adult education services to local authorities, and with such bodies as the Workers' Educational Association. If they were to put on courses entitled, for instance. "How to understand your 1335 teenage children—how to cope with sex, drugs and violence", I am sure that they would be very widely attended. If they were put on in the most deprived wards of the biggest cities, where perhaps the greatest problem exists, I believe they would be well attended and widely listened to. My Lords, it may well be that in time we shall have to provide a family planning service of some appropriate kind for the under-16s. I suggest to the House that it would be far better now to get the service for the over-16s, and those who are married, properly organised and straightened out before attempting this further task.
§ 7.29 p.m.
§ BARONESS SUMMERSKILL
My Lords, I believe what noble Lords, including myself, are trying to ask the House is: Is it wise to supply contraceptives to school children? We have legally increased the school leaving age to 16. I was very impressed with the speech of the noble Lord, Lord Stamp, and I feel honoured to think that in 1962 I mentioned the same subject. I will continue, in the next Amendment on this matter, if the House will bear with me, to expand on what the noble Lord, Lord Stamp, has said about the health hazards of pre-marital intercourse, particularly among children.
We are talking about children; undoubtedly to-day adolescent girls—and I am particularly concerned with girls—are bigger, heavier and appear more mature than their mothers did before them at the same age. But there is no indication of their superior wisdom, experience, or knowledge of the problems involved in pre-marital sexual intercourse—none at all. The size of the girl, the fact that she may look almost like a woman, is no indication at all of her knowledge of the problems about which we are speaking.
I agree with noble Lords opposite who spoke about the parents. The amount of information these girls have is precisely what the parents are willing to impart. Noble Lords have rather dismissed the whole question; I think the noble Lord who last spoke said that this should be a parents' matter. Yes; but if the parents wash their hands of it—if they are shy, timid, or lazy—then the child is left without any information whatsoever. So 1336 we cannot dismiss the whole problem by saying, "This is for the parents and the home and nobody outside should interfere." To turn to the big girls I am speaking about—these mature young women with children's minds—we have raised the school-leaving age of these girls to 16. Is it logical or wise in the interests of schoolchildren to provide them with contraceptives? We have heard this afternoon about the need to provide medical and dental care; psychotherapy; recuperative holidays, all kinds of things for our school children. Can we reconcile the provision of all these important services for the growing child with providing her with a contraceptive?
Noble Lords may think I am forgetting the boys. We have not much time, and I do not want to go into an exposition of this subject, but the sexual urge of a boy is entirely different from that of a girl. I was told by a doctor yesterday that the sexual urge of a boy may be such that you may as well provide him with a contraceptive. Very well. In that case, my Lords, I am quite prepared to sacrifice my principles of sex equality in favour of the male.
§ A NOBLE LORD: Shame!
§ BARONESS SUMMERSKILL
Do not start again. It may be of course, my Lords, that the boy is more capable of looking after himself in this matter than the girl because, after all, it is the girl who is most vulnerable. I am very impressed with what the brilliant obstetrician Sir John Peel said, that if you give these contraceptives to some girls they will experience a desire to experiment. I believe that that is so. After all, if a girl sees that contraceptives are available she might almost have a "dare" with another girl that she will go and get some from the clinic. The next thing of course is that she may try to experiment. I would remind your Lordships of the hazards. As I say, if the House will bear with me, on the next Amendment I am going to detail these health hazards to which a girl is subject.
On the subject of illegitimacy, we are told that times have changed and little stigma is attached to having an illegitimate child. Since our last big debate on this subject at the Committee stage, there has been the case of Cathy, who I think last week was found in a bed-sittingroom. 1337 Cathy had left her comfortable home and was found having delivered herself of a child, and then dying of hemorrhage and shock. Who can dare say that times have changed? Cathy left her little home in Aberystwyth—a Nonconformist background, I am sure—desperately ashamed and afraid, and hid herself in London, How have times changed? It may be that a film star can declare to the world that she has had a child outside marriage; but for the schoolgirl—and we are speaking about schoolgirls now—the prospects for an unmarried mother are fraught with tragedy. She thinks of the business of having an abortion, all the time full of shame; generally deserted by the boy friend who, after he has impregnated her, is no longer interested. If she has parents who are very kind she is fortunate, but most parents in these crowded roads are still ashamed of what the neighbours will think of their daughter who has become pregnant. Times have not changed to that extent.
I say to the House that we have a responsibility in this matter. If the Government representative stands at that Dispatch Box and asks for these services for children in order that they shall have a fuller, better life, in order that their welfare shall be safeguarded, then, my Lords, we cannot possibly on the same day reconcile that approach with the provision of contraceptives to 15-year-old girls.
§ 7.36 p.m.
§ LORD AVEBURY
My Lords, may I pursue the theme that the noble Baroness has introduced in saying that the prospects for an unmarried mother are fraught with tragedy. The noble Baroness quoted the dreadful case, which we all read about in the newspapers, of a girl who was not under age in fact, but could well have been. What the noble Baroness is saying to the House, as I understand her, is that one should continue to deny contraceptive advice to a girl who might be placed in this position simply because she has not reached the age of consent. So we are going to get many more of these tragedies if the noble Baroness's advice is accepted, and those concerned will not be mainly in the age group from which the girl in question came. They will be the under-16s, and the incidence of illegitimacy, and indeed of abortions, in teenagers will drastically increase, to the great 1338 detriment of the girls themselves and their families and of the social structure of the country.
It is a dreadful thing, my Lords, when one considers the rise in illegitimacy, to which the noble Baroness, Lady Gaitskell, was referring earlier on. It is ghastly that there are so many abortions. But is there not an element of schizophrenia in the thinking of some people who with one breath say that they will deny contraceptive facilities to the young, and who with the next breath are complaining about the alarming increase in the number of abortions about which we have been reading recently? They cannot have it both ways. If you have an efficient and comprehensive family planning service, then the abortion figures will begin to decline and the tragedies, such as the noble Baroness, Lady Summerskill, has referred to, will no longer take place. This poor girl from Aberystwyth would have been able to go to her own G.P. or to the family planning clinic in her home town and obtain the kind of advice and treatment which could have prevented that tragedy from occurring. The noble Earl wanted to intervene.
§ THE EARL OF LAUDERDALE
My Lords, I am much obliged to the noble Lord for giving way. Would he not agree that it is equally schizophrenic to deplore abortions, and for that matter V.D., and at the same time applaud the free-est possible distribution of knowledge to those who are not yet capable of absorbing it responsibly?
§ LORD AVEBURY
My Lords, I do not quite know what the noble Earl is getting at. Of course one deplores abortions; they are a matter of last resort when contraceptive facilities have failed. The increasing figures of abortion are evidence of the failure of the contraceptive services in this country. That is what I am saying. If you have a free and comprehensive family planning service and you do not attempt, as this Amendment suggests, to deny it to girls below the age of 16, then you will begin to gel somwhere.
The noble Baroness said that we would encourage experiments among young people if these services were made available to them. I do not know how much attention she has given to the research 1339 which has been done on this subject or whether she states this simply as a matter of conviction. But if she would look, for example, at the study which has been made at the youth advisory clinic in a hostel by the Brook Advisory Centre, which was reported in the British Medical Journal for June, 1971, she would see that this showed that only 15 out of 587 patients examined had not had sexual intercourse before attending the clinic, and these 15 patients had a stable relationship which they know would lead to sexual intercourse, and wished to prevent the risk of an unwanted pregnancy by means of an efficient method of contraception. If that is so, and if these figures are representative—and we have no reason to doubt that they are—the provision of the facilities by the Family Planning Association and the hospitals is not encouraging sexual intercourse; it is encouraging experiments as the noble Baroness suggests. I think if there had been such evidence she would certainly have been able to produce it. The noble Baroness is certainly well able to make her own arguments and to provide such back-up evidence as to convince your Lordships, and she has not done so. Therefore I suggest that the evidence does not exist.
§ BARONESS ELLES
With your permission, my Lords, it may be remembered that on a former Amendment, quoting the report of the Working Committee which was chaired by Sir John Peel, I mentioned that it suggested that it was arousing curiosity and a desire to experiment. Perhaps the noble Lord, Lord Avebury, may think that the noble Baroness, Lady Summerskill, was referring to that report, which was quoted from this document.
§ LORD AVEBURY
My Lords, I think the noble Baroness mentioned Sir John Peel as a distinguished authority on this subject, but she quoted an opinion and she did not back this up with any statement, figures or research on which he had based his opinion. Obviously one must pay close attention to anything which is said by so distinguished a person as Sir John Peel, but just because one has names to conjure with that does not 1340 absolve one from the responsibility of producing figures and facts to support assertions that are made.
My Lords, I am grateful to the noble Lord for giving way and I do not want to interrupt the flow of his argument, but just to put the record straight I think the noble Lord accused the noble Baroness of not having any proof. She said that she had not proof but she had evidence, and as evidence—and I think it is arguable that it is evidence—she produced a quotation from that reputable report.
§ LORD AVEBURY
My Lords, obviously I do not want to become involved in an argument with my noble friend on semantics, but I have quoted from a survey which was conducted in a hospital of 587 patients who were attending that hospital. If other noble Lords wish to produce a survey of 587 patients which shows that of these patients all except 15 had not had sexual intercourse before they visited the particular centre and they were encouraged to do so by having some method of contraception made available to them, then obviously that would be evidence to which one would have to pay careful attention. And if Sir John Peel, or anyone else, had produced such evidence, then why was it not given in your Lordships' House? I suggest that it is because it does not exist.
The noble Baroness had to depart from her principles because she said that there is a difference in the sexual urge of boys and girls at this age. I was very surprised to hear her say that. As a well-known and respected advocate of equal rights, I should have thought she would be the last person to stand up in this House and suggest that something should be made available to boys which should not be equally conferred on girls. But of course there are practical difficulties, and perhaps she has recognised this. What will happen if a young boy of 15 goes into a chemist's shop and asks for sheaths? Is the chemist to ask for his birth certificate or to inquire of him whether he has reached the age of 16? What responsibilities are going to be laid on chemists if this Amendment is passed? Because of course it does not make any distinction between boys and girls. It was only in the speech made by the noble Baroness that that distinction was made. I suggest that 1341 this is a practical difficulty which must he taken into account by the Government when deciding what their attitude is to this Amendment.
I should like to say in conclusion that probably the under-16 age group is more in need of professional advice than any other category of people in this country The girls in this age group who see doctors in the birth control clinics in hospitals have access to skilled professional help which obviously they desperately need and they are much better looked after than those risking unprotected intercourse, pregnancy and infection. I know it is difficult for many of your Lordships to accept that young people under the age of consent are having regular sexual intercourse, but if you make access to contraception more difficult it will not solve the problem: on the contrary young people need to be made aware that skilled and sympathetic advice is regularly available.
§ 7.46 p.m.
§ THE LORD BISHOP OF BATH AND WELLS
My Lords, I do not want to say very much. I find that the basic position of the Church, which is fairly well known, is more and more widely rejected by the majority of the community. Therefore one feels slightly that one is disqualified from taking part in this debate. But I hope that the Church is in fact helping, from her position, to preserve some of the positive values in human relationships for the community as a whole. Whatever I say now does not represent a falling away from the basic Christian affirmation. Let us be quite certain about this. There is no weakening on the part of the Church; she has not weakened, and she will not weaken, in her belief that sexual intercourse should take place only within the stable and lasting relationship of marriage. We well realise that this is for many an unacceptable standard, and in face of this situation we try to emphasise the need to develop, and assist in developing, a greater sense of responsibility in people. We teach this in the schools to children in regard to the natural consequences of their actions, and in regard to sex this means encouraging people to avoid the possibility of conception occurring.
Secondly, we feel that we should do everything possible to encourage people of all ages to seek advice in sexual 1342 matters; and this particularly concerns the young. Although many people approach family planning clinics and advisory services with the overt request for contraceptive supplies or for abortion, the meeting which takes place provides an opportunity for the person who may be in some doubt to discuss the prior question as to whether he or she wishes to have intercourse in what may be an unstable and temporary relationship. The evidence is that such advisory services do much to assist the young, in particular, in sorting out their ideas on sexual matters. The article by Ann Hills in The Times this morning, which many of your Lordships will have read, on the wise counsel of Mrs. Crabbe, was I thought quite first-class and ample evidence that in a free service there need be, and must be, no diminishing of the full counselling available for the deepening of mature and responsible human relationships.
I think the Board of Social Responsibility of the Church of England would wish to encourage the provision of full, free family planning services, and would oppose any financial or other restriction that would inhibit people from using them. This includes restrictive regulations as to the minimum age of people who may benefit from the services of such clinics. We are against using financial or other restrictions in order to regulate sexual behaviour. To restrict the provision of the family planning service to those unmarrieds who are over 16 years of age would in my view simply be to ensure that a proportion of those young people who are at risk of pregnancy would not be reached by the counselling services. Figures supplied by the National Council for the Unmarried Mother and Her Child indicate that the number of illegitimate children born to teenage mothers in 1970—the last date for which figures are available—represented 23 per cent. of all illegitimate births.
I conclude by quoting Lafitte in the work, Abortion in Britain Today, published last month:Among the young and unmarried the attitude has been noted that pre-marital sexual intercourse is permissible as long as it is a spontaneous act of love with a loved one, but implicitly contraception is not permissible because it denies spontaneity.1343 It seems to me that that is the kind of prevailing attitude with which we are faced more and more and which must be taken fully into account. I wonder whether this Amendment of my noble friend Lord Hylton does in fact take this into account. I think it fails to do so and would prevent us from getting in among the young people to talk with them instead of talking at them.
§ LADY RUTHVEN OF FREELAND
My Lords, I wish to begin by saying how much I support everything the right reverend Prelate said, as well as the remarks of the noble Lord, Lord Avebury. I wish to be practical about this and to start by asking how anyone is to know whether a girl or boy is 16 or under. Those who live in the part of London from where I come will know that one sees a great many young people whose age it is impossible to tell. They not only look exactly alike, but wear the same clothes. It is almost impossible to tell boy from girl, even by looking at their feet. I do not see how it would be possible to prevent an unmarried girl under 16 from putting on a wedding ring, if that is to be the test, or even producing a birth certificate. While I entirely support the Amendment simply because in my view it is wrong for a person younger than 16 to produce a child, I should not like on this occasion to go into the question whether such youngsters should have sexual relations; that is not for us to judge now and people must judge for themselves. I suggest that it would be extremely difficult for all the authorities, be they in hospitals, health centres or elsewhere, to say whether many 16 year olds were married or unmarried. Indeed, I do not know how they would go about discovering the truth about the person's age.
§ 7.54 p.m.
My Lords, the right reverend Prelate said that he was to some extent disqualified from speaking in this debate—his statement was of course quite untrue in that respect—because he represented the Church. As a member of that Church I have always welcomed his support and I shall take a slightly different line to-night which I hope will not indicate a split in the Church of England. I, too, am rather disqualified by the fact that I am speaking 1344 from the Liberal Benches, which again I hope will not indicate a split in the Liberal Party.
I feel that there is a danger in this debate that as we speak we shall be giving the impression of being for or against what is called the permissive society. In fact, I have never liked the expression "permissive society" because to a certain extent every society has been permissive. The Victorians were far more permissive of drugs and travelling on the Continent without passports, although they were very fussy about any statesman who got involved in a slightly illegitimate connection with anybody. That sort of thing had to be hushed up. We have gone to the other extreme, though on certain questions, such as smoking, we may not be thought to be permissive enough. Rather than "permissive society" I should prefer the term "promissive society" because what we have at the moment—and this is why I strongly support the Amendment of the noble Lord, Lord Stamp—is a situation in which we make a great many more promises than we are able to keep in the matters which we are discussing to-night.
Noble Lords will have heard the very reasoned case, on expert grounds, made by the noble Lord, Lord Stamp, and some admirable remarks from the noble Baroness, Lady Summerskill, who in a way I am glad is not in her place. Her absence encourages me slightly, lest she might say that I am disqualified from speaking in that I address your Lordships not as a bearded man but as a half-bearded one. In fact, owing to a slight medical difficulty I was unable to shave one part of one cheek. I suppose that one could say that I should be disqualified also on the ground that I do not have great medical knowledge of this subject.
Because I am anxious to be brief I will raise only two points. First, the message which will go out from this House, as the noble Lord, Lord Stamp, said, is one which may be of very great importance to the whole country and possibly even to another place. If I were accused with those who support the Amendment of "shutting the gates of mercy on mankind"—perhaps I should say "womankind" or "girlhood"—I would take the line that we could be doing the opposite. Were we to promise 1345 things which we could not really perform Or guarantee, such as the idea that copulation without population as a certainty is quite easy, we could be doing more harm than good. In other words, we could be suggesting that everyone has a right to do this. That may or may not be an arguable point.
There has been strong evidence to show that there is no method of contraception which is 100 per cent. safe or even very much less reliable. I am sure that figures will be quoted later in the debate. If one is encouraging people on the understanding that it is their privilege and right to indulge in what I would call miscellaneous experimental copulation, then in my view the result is bound to be an increase in the number of unwanted pregnancies.
I do not like bringing up again the question of abortion, but it has already been mentioned. Noble Lords may remember that, with the best intentions, we in this House passed legislation which was intended to prevent illegal abortions from taking place. We wished to bring all abortions within the National Health Service. The last episode in that debate took place when I did not press an Amendment, though I feared that there might be a racket in the performing of abortions. My fear was dismissed in one sentence by the noble Lord, Lord Molson, who, though expressing great kindness towards the intention of my Amendment, pointed out that I was so fanatically obsessed with the subject that I was quite unable to see straight and that there could be no objection to the performance of abortions by private people for any sum they liked. I notice that in another place two days ago two honourable Members who supported that abortion legislation expressed great worry because the figures for abortions had gone up sharply in the last year. Of 150,000 abortions, about 100,000 had taken place in the private sector. That seems to show that we have not prevented a great many abortions from taking place in the private sector. Indeed, our legislation has enormously increased the number of abortions.
I believe that to promise free contraceptives to teenagers—by their using them we should know that they would technically be committing a crime—would nave precisely the effect of their saying, 1346 "We can do it now, and we might as well do it, and it is up to the Government to ensure that we come out of it all right". Could we get this subject off the religious and moral plane on to an ordinary commonsense one, and apply that reasoning to other things we all approve of? I have never gone in for mountaineering or for deep sea sailing. They are excellent pursuits. They are dangerous, but pursuits that children should be allowed to do and to be taught. But if it took the form of some of the climbers I heard referred to in a broadcast the other morning, who go about in plimsolls and shoes doing very dangerous mountain climbs which only experts would do, on the understanding that the whole of the Swiss Red Cross would be available to help them afterwards; or that those who had never sailed but had been simply given a copy of the Admiralty Instructions had a perfect right to launch out into the Atlantic whenever they liked and expect the British Navy to bail them out, it might be encouraging adventure but certainly the result would be a great many more deaths among teenage mountaineers and would-be sailors. I believe that by this Amendment we should be doing the same kind of thing. It is simply giving a promise, which we are incapable of keeping, that it will not lead to unwanted pregnancies if people are given free contraception to any extent that they want.
There will be other Amendments later on, and all I can usefully say on this Amendment is that it will be disastrous not to learn from what I believe is the moral of the abortion debate, that admirable though the intention may be in giving these free contraceptives—they may be as honourable as the Order of the Bath or as honourable as the honourable Member for the Scilly Islands or earthly paradise or any other constituency that does not exist—in practical terms it would be quite disastrous and if they were pressed I should be very pleased to have voted with the noble Lord, Lord Stamp, and the noble Baroness, Lady Summerskill—about whom I have made remarks in her absence—
I will make them in her presence because she 1347 reminds me of Portia in Shakespeare's The Merchant of Venice, who not only has the maddening habit of beating a man at his own game by first of all making an emotional speech about mercy, but that lady went even further than that when there was the episode with the ring and she was pressed to receive a present. She received it, insisting that the present would be one which she knew her husband could not give, and when he tried to wriggle out of that she said:I see, Sir, you are liberal in offers: You taught me first to beg; and now me thinks;You teach me how a beggar should be answer'd.It is because I am a Liberal that I think that Liberals are less liberal about the promises of their Party than others. This introduction in the Bill of free contraceptives, which the Amendment is out to cure, is a case of making promises which are very cheap and liberal to make but which are not really liberal, and not sound.
§ BARONESS STOCKS
My Lords, my noble friend Lady Summerskill provoked me to speak, which I had not otherwise intended to do, by suggesting that Clause 4 encourages experiments. I ask noble Lords to consider whence comes the encouragement to experiment. Read the popular Press—the Sun, the Daily Mirror, the News of the World, and the Sunday People; keep your eyes open as you walk through the Strand or Tottenham Court Road; look at the paperbacks in your local stationer; whence comes the encouragement to experiment? It is there all the time. Our National Health Service Bill at least makes provision for averting its worst consequences. The National Health Service cannot do everything, but let it do what it can to avert the worst social consequences. I am an old square. I do not believe in sexual promiscuity and when I was young I did not believe in pre-marital intercourse and a lot of the things that people do now. I do not always sympathise with my grandchilden's generation. But that is not the business of the National Health Service: it is the business of the Church.
§ 8.5 p.m.
§ LORD MOLSON
My Lords, the noble Baroness who has just spoken has very much fortified the unanswerable and 1348 moving arguments that were put forward by the right reverend Prelate. I was most impressed by the intervention of the right reverend Prelate. Without in any way abandoning the moral and religious principles for which the Church stands, he brought a humane and reasonable view to bear and indicated that it was not his wish that legislation or financial considerations should be used in order to enforce the morality which he preaches. I am quite sure that he is entirely right in what he has said. The noble Baroness, speaking from another Bench, has expressed very much the same point of view. I agree with her that when one considers all the propaganda in the newspapers, on the radio and so on, that the argument that the provision of free contraceptives will have any perceptible effect in encouraging the younger generation to experiment seems to me to be remote from reality.
I was surprised when the noble Viscount, Lord Barrington, suggested in his speech that he was going to leave the moral and social arguments which had previously been put forward, and try to apply common sense. It seems to me that common sense arguments point in exactly the same direction as the moral principles that were advanced by the right reverend Prelate. It seems to me to be wrong that those who are most in need of contraceptive advice and help in that way should be deprived of it.
My Lords, one may deplore a sin and yet not wish to make it a crime. Even if it were a crime, one would not necessarily, in all circumstances, wish to impose a penalty. But, above all, one should surely desire to avert a state of affairs when the sin would result in the suffering of an innocent person. It is in order to prevent unwanted pregnancies that this House should reject the Amendment that has been put forward. I believe that from every point of view—moral, humane and practical—this Amendment ought to be rejected.
§ LORD PLATT
My Lords, there remains very little for me to say because I have not yet heard a single speech in favour of the Amendment. We have heard many speeches about the very alarming state of affairs among teenagers—the pregnancy rate, the abortion rate 1349 and the venereal disease rate—and I do not think that there is a single person in this House who is not very concerned about the situation. But have we heard a single argument in favour of a cut-off point at the age of 16? I do not think that we have heard a single argument that supports that point of view. It seems to me that given this boy and girl (because occasionally one has to remind the House that a boy is concerned in this) and given that they are determined on a certain course, what they need is counselling and advice. Many of these people will not go to their parents for advice; many of them will not go to their family doctor for it. Where will they go? If they are worried they may think, "Well, perhaps contraception is the way out", and they will go to a clinic specially set up under this Bill which deals with family planning from every aspect.
I should like to remind your Lordships that the first words in Clause 4 are "for the giving of advice on contraception", I admit—and I think the noble Lord, Lord Hylton, was right to draw attention to this—that those words are perhaps too restrictive, and that the Government might think of perhaps a slight alteration in wording which emphasises the whole point of these clinics being primarily for advice and counselling, and only secondarily for the prescription of contraceptives when that seems to be the right answer to the particular problem, whether the girl is 15¾ or 16¼. I hope that the younger girl will not be deprived of the advice and counsel that she may very much need.
§ BARONESS GAITSKELL
My Lords, I do not support this Amendment because I favour encouragement of sexual intercourse among under-16s—on this I am with my noble friend Lady Stocks. It is true that young people are to-day much more mature than they were in the past, and I totally disagree with my noble friend Lady Summerskill that they have mature bodies and baby minds. This is absolutely untrue and she has shown no evidence whatever for this.
§ BARONESS SUMMERSKILL
My Lords, may I ask my noble friend a question? I am twice the size of my noble friend. Does she think I have twice the knowledge of sex?
§ BARONESS GAITSKELL
My Lords, may I go into two minutes of personal biography? I was married for the first time before I was 19, and married again later, after I had divorced my first husband; so I think I must know something about sex. Because of the fact that young people are mature, it seems to me that they need knowledge of sex—sex education and birth control education—much more than they ever did before. I have given the statistics, and so has the noble Lord, Lord Stamp—I gave them in the wrong place, but never mind.
The noble Lord, Lord Stamp, spoke a great deal about gonorrhoea, and this is a very grave problem. But may I say that this is an international problem. It is a problem full of anomalies, and obviously it needs a great deal more research than it has had up to now. The noble Baroness, Lady Elles, has suggested that the 8,000 unwanted pregnancies in the under-16 group—the statistics from the Brook Advisory Centres which I quoted—were due to what she calls bad sex education. But I believe that these were probably due to their having had no sex education and no birth control education at all, no contraceptive education. Again I ask; is it more responsible to deny knowledge of birth control to the young and to the unmarried than to give them contraceptive advice? This Amendment detaches the Government from their responsibility to the 16-year olds and the under-16-year olds, to stop them from having more unwanted pregnancies and more abortions.
§ 8.15 p.m.
§ BARONESS ELLES
My Lords, I think we all seem to be agreed as to the end we want to achieve, which is better health for the young, protection for the under-16s against those things we have kept on repeating—illegitimate children, venereal disease and abortions. But I think we are perhaps in two minds as to how to achieve this. We can all quote figures, but all we can see is that there has been in the last five years a very rapid increase in pre-marital intercourse, and it 1351 is this that is worrying the people who say we should not have free contraception readily available for people of all ages, including those under 16. I think that is the basis of our argument. We say that to allow contraceptives to be freely available to people under 16 will encourage them to have more intercourse, and will therefore encourage them to have the kind of consequences which, as we all know, can be the result of sexual intercourse. When we talk about venereal disease, we can see the figures for ourselves. In 1970, there were a quarter of a million cases which came before the clinics, and last year there were 300,000. We all know that venereal disease conies from intercourse; it is not contracted just by sitting on a bus. So we cannot say it is not because people are promiscuous that there is an increase in venereal disease. I do not have to be a doctor to know perfectly well that people do not get venereal disease unless they have sexual intercourse. If we have 50,000 more cases in a year, we cannot say that people are not being more promiscuous; otherwise there would not be that increase in the figures.
§ BARONESS GAITSKELL
My Lords, will the noble Baroness give way for one moment? Venereal disease does not come from sexual intercourse at all. It is transmitted when it is there. This is the distinction that ought to be made.
§ BARONESS ELLES
My Lords, I absolutely appreciate the point, and I thank the noble Baroness for having made it. Nevertheless it cannot be transmitted except through having sexual intercourse. Perhaps I should have spelled it out more clearly.
With very great respect to the right reverend Prelate, whose religion I am proud to follow, in perhaps a more humble capacity, I was slightly amazed to hear that he supported the article by Anne Hills in to-day's Times on the no doubt excellent work done by Mrs. Crabbe, but it ended up, curiously enough, by referring to, "an elderly unmarried midwife", as she was called—because you have always got to be elderly and unmarried in this context to be somewhat a figure of fun. But when she said, "I think young people should be prevented from having sex before 1352 marriage", the comment was, "I call that discrimination against young people". I was very surprised, in view of the tenets of the Christian faith, as I have always understood them, that the most reverend Prelate went along with that argument. I do not intend to pursue this, but as I say, I was slightly surprised. Apart from these comments, having said what I have said previously and in the Committee stage, I will certainly support the noble Lord, Lord Stamp, in his Amendment.
§ LORD BEAUMONT OF WHITLEY
My Lords, I think the noble Baroness, Lady Elles, has brought us back to the real point. She is quite right. We all want the same thing. What we are arguing about is whether withholding contraceptives from under-16s will in fact do anything to stem the misery and the casualties. The figures we have had, which the noble Lord, Lord Avebury has quoted, have shown that the overwhelming majority of people who go to at least one clinic, have had sexual intercourse previously. We have other figures, which have not been quoted (I am afraid that I have not got them with me, but I think they are well enough known and will not be challenged in this House) but which show that there are still an enormous number of people who have sexual intercourse when unmarried, when under age, without using any contraceptives. That is the evidence on one side.
There is also the fact, as mentioned by one or two noble Lords, that the pressures in our society to experiment with sex, the urge to have sex with someone else at a young age, are regrettably enormous. Even if one accepted the case that the movers of this Amendment are putting forward, and were to say that it might possibly be one of the factors, it must still be a very minor factor compared with the newspapers, the films, the whole image which the mass media project. What we are being asked to do by the proponents of this Amendment is to reject that possibly small addition—and I do not grant it, but possibly small addition—to the factors which lead people to have sexual intercourse, but at a cost of how much misery to how many children. This is what we have to weigh.
Let us get one thing quite clear; it is not our job to be sending out messages to 1353 the world. We are here debating the Report stage of a Bill; we are here to pass legislation, or to amend it; and it seems to me that, however much some of us may wish—and possibly a majority may wish—that we could get up here in the House of Lords and repeal the permissive society, we cannot do so; and anyway this is not the way to do it. What is more, this is not even the way to start. There are places to start if we wish to do it, but we must not begin by abolishing the provision of help to the people who most need it, and who will be the first casualties if we start on this course.
§ 8.22 p.m.
§ LORD ABERDARE
My Lords, we have had a most interesting debate on this subject. I feel that the noble Lord, Lord Stamp, is probably satisfied with the controversy that he has aroused. I must say that I feel, as I did on the Committee stage, that we are embarking on a number of difficult subjects to do with family planning policy within the context of a Bill which is concerned with more matter of fact affairs of reorganising the National Health Service. My noble friend Lord Hylton and the noble Lord, Lord Platt, complain about the wording of Clause 4, but what the clause seeks to do is only to transfer to the Secretary of State the powers which hitherto have been exercised by local health authorities and which include the family planning service.
On the Committee stage, as your Lordships are well aware, my advice was not heeded and an Amendment was carried removing the power to charge, which again was intended only as repetition of the present power to charge that is held by local health authorities. Now we come to a number of Amendments, of which this is the first, of a more detailed nature on family planning. I must say at the start that I do not think they are appropriate to this Bill. I appreciate only too well the strong feelings that have been expressed by those who have spoken in favour of this Amendment. Many of your Lordships throughout the House share those feelings, although not the remedy that is suggested in this particular Amendment.
I must say, frankly, that I start with a considerable prejudice against all these Amendments, although we certainly will 1354 discuss each one in turn on its merits, and I shall convey to your Lordships what the Government opinion is. Perhaps I might say in passing, with regard to the Amendment made to this clause at the Committee stage, that we felt it right, in view of the fact that a considerable number of your Lordships voted for the Amendment (it was passed by a considerable majority), not to bring it back to this House. The Government are still giving it careful consideration, but we did not think that it would be right to seek to interfere with that decision at the Report stage.
The effect of the two Amendments we are now discussing would be to prevent the National Health Service from providing contraceptive advice, treatment and supplies to unmarried persons under the age of 17. Some of your Lordships seemed to think that the figure was 16, but in fact the effect of them is on unmarried persons under the age of 17. At least that would be the position in England and Wales, because so far as Scotland is concerned we have already enacted legislation for the reorganisation of the Health Service without any similar restriction on the provision of contraceptive services.
I must ask your Lordships not to accept these two Amendments, and principally for two reasons. The first has already been put by the noble Lord, Lord Avebury, and by my noble friend Lady Ruthven; and that is its impracticability. It would be very difficult, if not impossible, and would introduce fearful complications to distinguish between those who were entitled to services under the National Health Services and those for whom there would be no power to provide contraception. If the restriction which we are asked to accept were to be propert[...] implemented, doctors and others working in the Health Service would have to require evidence of age, or the marital state, from a number of people before they could agree to provide them with contraceptive help. To have to produce a birth certificate or a marriage certificate would for some people be the last straw, particularly if, having plucked up courage —as some people no doubt have to—to attend a clinic or general practitioner's surgery for the purpose, they then found that they had to make a further visit in order to produce the document which established their right to seek treatment. 1355 I admit that this is a pure point of practicability, but it is a very important point.
My second objection is much more one of substance, and was admirably and very shortly expressed much more efficiently by my noble friend Lord Molson. I understand the misgivings of those who fear that making contraceptive services available for the unmarried could encourage pre-marital sexual relations. We considered the moral aspects of the family planning services very carefully before we made our announcement on December 12 last. The fact is that the great majority of local authorities are already providing contraceptive services for married and unmarried people alike. We believe that it would be quite wrong at this point to change this policy and to discriminate against the single person. The reason lies, as has been put by many of your Lordships, in the regrettably large numbers of illegitimate births and abortions that occur every year among the unmarried. In 1971, in England and Wales there were over 4,000 illegitimate births among girls under the age of seventeen. I agree that not all of these may have been unintended, and certainly not all of them will have led to unwanted children; but surely in this age group it is not unreasonable to assume that the great majority of these births were the result of pregnancies that were regretted.
On top of these there were a very large number of abortions. The statistics do not show the number that occurred exactly in the age group referred to in the Amendment, but we know that in 1972 there were in England and Wales 3,150 abortions on girls under the age of sixteen, and 28,256 abortions on single girls aged sixteen to nineteen inclusive. If one adds to these figures the marriages that took place mainly in order to legitimise the pregnancy—marriages which inevitably face a higher than average risk of breakdown—one gets a picture of the great amount of misery, social misfortune and possible harm to children born in unpromising circumstances resulting from the sexual behaviour of young people. Of course it can be argued that young people should not engage in premarital sexual intercourse, but we know that they do, and various of your Lordships have pointed to the amount of publicity that tempts them to do so. I think 1356 it would be unrealistic to suppose that the problems of teenage pregnancy could be substantially affected otherwise than by making contraceptive services available to those who are having sexual intercourse anyway.
What I think is important is that those engaged in providing contraceptive services consistently say that the unmarried girl who seeks contraceptive help is nearly always already sexually experienced and has a steady relationship with one boy friend. When one considers how the rise in illegitimate pregnancies started a long time before the pill was generally available, one can see that the present standards of sexual behaviour are part of a general code of conduct and have been affected little, if at all, by the making available of contraceptive services to unmarried people. What we believe is most important is that contraceptive services for the young should be provided in the context of personal counselling, and this is something to which we shall be giving very careful thought when producing guidance for health authorities on the development of contraceptive services in the future. I very much welcomed, as others of your Lordships did, the intervention of the right reverend Prelate, the Bishop of Bath and Wells, on the subject of counselling.
We are not talking about handing out contraceptives on a plate to all young unmarried girls. If we want to help solve the problem of unwanted births to young unmarried girls under 17, surely what we need to do is make advice and counselling readily available in conjunction with treatment and supplies. We want to ensure that the first always goes with the second; that advice is always given in conjunction with treatment and supplies. This seems to us to be far preferable to a policy of no advice and no treatment for young unmarried girls under 17. Incidentally, if I may say so to the noble Lord, Lord Stamp, this seems to us the more effective way of tackling the problem of V.D. The noble Lord showed that the rise in the incidence of V.D. has taken place over a number of years, but the availability of professional advice on contraception for the unmarried is of more recent origin. Thus the rise in V.D., as with the rise in illegitimate conceptions, can be seen as two parts of the same problem. The provision of advice to the 1357 under 16s, in the context of professional guidance, is designed to tackle one part. To remove the services from the young would be to run the risk of increasing the illegitimacy and abortion rates, without any compensating fall in V.D. I hope that your Lordships will not accept these Amendments. I think we have had a useful debate. We all seem to share the same anxieties, but I hope your Lordships will feel that it is through advice coupled with treatment that we are likely to be able to affect this problem with greater success.
§ BARONESS LLEWELYN-DAVIES OF HASTOE
My Lords, after that extremely powerful speech there is really no need for me to make a speech at all, although I should have liked to reply to one of the points made by the noble Lord, Lord Stamp. But I think I must make just one point which has gone rather by default. The noble Lord, Lord Stamp, appeared to scold your Lordships because we were the only people who were asking for free contraceptives and a comprehensive family planning service. I should like to remind your Lordships that the British Medical Association has also recommended an absolutely free and comprehensive service and that family planning advice should be available to all women of childbearing age. The Royal College of Obstetricians and Gynæcologists also strongly recommended a comprehensive contraceptive service within the National Health Service, and all the leading serious newspapers applauded the decision taken by your Lordships, although the Amendment was, I think, debated out of order when we were discussing the under-16s. I wanted to get that point clear. All of us are concerned about the protection of minors, especially in the context of the protection of young girls. We are nearly all of us parents. I have three daughters, two of whom are still teenagers. We are all concerned for them, and I am quite certain that the only possible way of dealing with a problem which worries us all is the way proposed by the noble Lord, Lord Aberdare, and, above all, described in the deeply compassionate and wise words of the right reverend Prelate.
§ LORD STAMP
My Lords, I should like to thank the Minister for his reply, and all noble Lords who have supported this Amendment or who have taken part 1358 in this debate. Even though many differing views have been expressed, there is one point that we all have in common; that is, we all have the welfare of our society at heart. In the debate in Committee, the emphasis was on the need for an extension of contraceptive facilities in relation to family planning, to enable families to restrict themselves to numbers which they could afford to keep, to take care of and alleviate overcrowding and to meet the threatened population explosion, on which many of your Lordships laid particular emphasis. In this debate, the emphasis has been on the health and welfare of the young.
In this connection, the overriding question is: How do we meet the rising tide of abortions or unwanted pregnancies, and also of venereal disease? Is there anything we can do which may be effective in alleviating the one problem, without adversely affecting the other? In my view, in the end, there is only one solution; that is, to encourage, by every possible means and through every possible channel, self-restraint in the young—in other words, morality—if only as a matter of absolute practical necessity. One does not have to be a practising Christian to believe that. I believe, though, for reasons that I have gone into, that this Bill in its present form will have the reverse effect. On the other hand, I sense that most noble Lords hold a different view and I therefore beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ 8.37 p.m.
§ THE EARL OF LAUDERDALE moved Amendment No. 25:
Page 3, line 34, at end insert—
("( ) The manufacturer of any contraceptive substances or appliance (hereinafter called 'contraceptive') supplied whether in accordance with the provisions of the preceding subsection or otherwise, shall display on the packaging of any such contraceptive a conspicuous health warning notice.")
§ The noble Earl said: My Lords, may I begin by saying that I, and I am sure other noble Lords, very much welcome the spirit in which my noble friend Lord Aberdare and, before him, my noble friend Lord Belstead have replied to Amendments on this general subject. It has been most encouraging to all of us to realise from their speeches that the 1359 Government are really seriously concerned with the problem, even though in practical terms, they may not see the merit of some of the Amendments that have been put down. It might be for the convenience of the House if this Amendment were taken with Nos. 26, 27, 28 and 29, because they all bear on the same principle, which is that of giving warning.
§ My noble friend Lord Aberdare said just now that, having advised the House against the Amendment on free contraceptives which was successful in Committee, he felt it would be improper for the Government to seek to reverse that decision in this House, and that consequently he and his friends would give very careful consideration to the other Amendments that are down and which, to some extent, arise from it. With this Amendment, in regard to which others will no doubt be making points relative to the subsequent Amendments, we are now looking at quite a narrow question, which is whether it is good or bad to try to reinforce the protective purpose which is common to all sides of the House by making sure that contraceptives are made available only with due warnings as to their possible effects or failures. Because merely to make these things more readily available without corresponding warnings of their limitations and of the difficulties that attend their use is surely encroaching upon, and indeed defying, that principle of responsibility which has been urged from every quarter of the House hitherto.
§ Now it may be argued—and it has been argued by Sir Keith Joseph in a letter addressed to the Order of Christian Unity—that, for example, it would be quite wrong to label certain contraceptives with a warning that they would not give protection against V.D. if the purpose of the contraceptive is indeed not to provide such protection. I do not find that a very satisfactory argument. For example, various substances are by law labelled "Poison", not because they are sold in order to be poisonous—they may be sold as cleaning substances in the house—but in order to warn people of the dangers of handling them or, in particular, of letting them get anywhere near food. Therefore, the question whether a particular contraceptive is in 1360 fact designed to, let us say, ward off V.D. is not really a reason for refusing to have on it a warning that it is no protection against V.D. We admit that the young are ignorant; we admit that they have the minds of children; we admit that they need instruction. That is common ground. Therefore, my Lords, as to the question of whether or not one should require in some way that there be a warning issued with each contraceptive concerning, let us say, its inefficacy with regard to V.D. or the possibility of its failure rate, or whatever else, to say that it is wrong to make such a requirement goes quite counter to the trend of the debate so far.
It has been argued, again by Sir Keith Joseph, that the analogy of the health warning on cigarettes does not apply. His argument is that it has been used in the case of cigarettes only because there is what he calls—and I quote—
a well established direct relationship between smoking and ill health".
How "well established" must something be to be seriously considered? What is "well established"? Would Sir Keith accept the evidence that has been provided from responsible sources about the failure rate in married women over 25 using contraceptives regularly? For example, the London Rubber Company, in its evidence to the Select Committee on Science and Technology in 1970, admitted that it might well be that their product was ineffective once in the lifetime of every woman. Is that, or is that not, a serious admission? And once is enough!
§ What about, for example, the testimony of Sir Richard Doll and Dr. Martin Vessey over the period of 1968 to 1972, presented to the Medical Research Council and the Family Planning Association? The accidental pregnancy rate, both method and patient failure, is given as: in the case of the pill, 0.2 per 100 women in a year; in the case of the diaphragm or cap, 2.8; in the case of the coil, 2.0; in the case of the sheath or condom, 3.5; and in the case of chemicals alone, 15.6. These are surely serious figures, because once is enough. The noble Lord, Lord Avebury, who has been enjoying himself this evening, is, I know, eager to be on his feet and he would be the first to say, "Let us have exact evidence".1361
§ LORD AVEBURY
No, my Lords, I was not going to query the figures that the noble Earl has been giving the House. What I was going to ask him was whether he would complete this picture by telling us what the risk of pregnancy is if no contraception at all is used. That is the one figure that he has left out.
§ Tim EARL OF LAUDERDALE
My Lords, I am grateful to the noble Lord because he sometimes plunges straight into the trap which has been kindly arranged for him by good friends on this side of the House. The whole point is that we are trying to argue that if these instruments, these appliances, these substances, are to be made available, they should be made available with a proper warning; that is all. There are, of course, various other kinds of risk that I have not referred to: I have spoken now merely of the failure rate. There is the health risk of the pill, on which I have reason to suppose we shall be hearing presently from the noble Baroness, Lady Summerskill; and there is the suitability of a warning of the crime of intercourse below the age of consent. Is it wrong to give warning of a crime? Is it stupid? Is it inhumane? Is it unkind? Is it unthoughtful? Is it neglecting the young to warn them? Of course not! Is there any real reason, therefore, why the question of warning should not be very seriously considered?
There is another aspect which might appeal, perhaps, to the instinct of self-preservation of this Government, if to no other instinct of theirs. Much attention has been drawn of late to the thalidomide case. As the Bill stands, the Government are in the position of approving the issue of various substances, including things that might well be classed as drugs. Do the Government really want to put themselves in the position that ten years hence somebody will lay an action charging the Government with irresponsibility in not giving warning of the consequences? Surely the Government's own instinct of self-preservation (and there are times when we think it has worn pretty thin) would argue that the case for ensuring that these things are covered in every case by a proper, visible warning speaks for itself. This applies whether these things are being provided free, as is the case under the Bill at the moment, 1362 or whether they are being provided for payment. The thalidomide drugs were not supplied free, but that did not spare those responsible. If there is any measure of Government responsibility in this matter, which by the Bill there is, whether these things are free, as the right reverend Prelate is happy to see they will be, or whether they are for a charge, surely it is in the Government's interests to make sure that some system of warning is provided.
My Lords, it may well be that these Amendments, as tabled, are not adequate for their task. It may well be that the provision requiring these warnings somewhat extends the scope of the Bill. But once the Government have accepted the responsibility which they have in this Bill of making these things available, either for a charge, as was the case, or free, as will be the case now, that responsibility surely cannot be altogether ignored. Since my noble friend Lord Aberdare has said that these Amendments will be considered on their merits, I hope the phrase "on their merits will work out a little better this time than it did on a previous occasion which will be well within the recollection of my noble friend the Leader of the House, now sitting on the Front Bench. I hope these Amendments will be seriously considered. It may be that the Government will be happy to come back with a consolidated Amendment on Third Reading that covers these points. The issue that there should be a warning surely speaks for itself. I beg to move.
§ 8.50 p.m.
VISCOUNT INGLEBY moved Amendment No. 26 as an Amendment to Amendment No. 25:
At end insert ("which shall include in the case of the oral contraceptive a warning of the side effects which may arise from the use thereof, and in particular the risk of infertility, thrombosis, cancer, and depression.")
The noble Viscount said: My Lords, I speak with some diffidence on this question. This is to ensure that a warning of the side effects of the pill should be printed on the package. This recommendation is supported by a number of well-known general practitioners and gynaecologists, including Dr. Ursula Dick, Professor Ian Donald, Dr. A. W. Frankland, Professor Hugh McLaren,
Professor J. S. Scott, Dr. Walter Somerville, Dr. David Sturdy, Dr. Mary Belton and Dr. Winifred Rushforth. From talking to a doctor I understand that the side effects of the pill are well known. If this is so, it seems to me that nothing but good can come from having a warning printed on the package, particularly in view of the fact that these pills are stolen from time to time. I read in the Sun of January 29
One firm which sells 60 per cent. of the birth pills used in Britain has had two big thefts. Enough pills were stolen to supply nearly a thousand girls for a month. 'There could he no black market for the Pill other than to under-age girls,' said a spokesman.
I beg to move.
§ BARONESS SUMMERSKILL
My Lords, I should like to speak to this Amendment and to all the Amendments on the Order Paper, because so many are related to each other. I mentioned previously a little girl, Cathy, about whom we all read. I listened to the right reverend Prelate and to others just now counselling perfection; that is, encouraging the girl or boy to come to them. Then they will talk to them, give them some good advice and persuade them what to do. Then, if they do not agree, they will give them a contraceptive. This is completely unrealistic. The children we are talking about do not seek advice. They are not prepared to go and be counselled. I want the House to realise that the little "Cathies" of life, the potential Cathies, do not ask anybody's advice. Cathy ran away from her mother and father and tried to conduct her life in the way she had tried to conduct it for nine months before. That goes for so many of the boys and girls that we are talking about to-day. We should like everybody to be nice and to go to counselling and to come away feeling that it is all settled. I must say to the right reverend Prelate—and I am sorry he is not in his seat—that the churches are empty. How many young people are in the churches to-day? They are all full of middle-aged women or older women who use them as a social club. The churches are empty and the children are not going to get much counselling from priests or prelates because they are not attracted to go to the churches.
If that is so, how can we warn these boys and girls, these young men and 1364 women, as they deserve to be warned, that what they propose to do may be dangerous to their health, that the disease they contract may even be lethal or that the girl may become pregnant? I am going to suggest that our only contact with the Cathies of this world may be through a warning put on the packet of contraceptives. Of course, she may have had a contraceptive and it failed. Anyway, here is a certain way of contacting these young men and women. If that is the only chance, then the Government should grasp the opportunity. The Government should not dismiss it as being impractical—it is not. I am going to suggest that a leaflet be put in every packet of contraceptives.
On the Committee stage, I quoted from the first article of the British Medical Journal of October 14 under the heading, "Infertility after the Pill". I quoted from the eminent gynaecologist, R. P. Shear-man, who found that in a group of 230 women with secondary amenorrhoea, 42 per cent. had it after withdrawal of oral contraceptives. The quotations from the British Medical Journal are some of the most recent. I have not gone back a long way. I have taken the most recent in order that noble Lords who hear about them can go to the Library and read them for themselves. The British Medical Journal has given frequent warnings as to the danger of the pill. I want to put this on record so that noble Lords may digest it perhaps to-morrow morning. On December 3, 1972, Dr. Varvel writes:Your recent articles on the association between the pill, carcinogenicity, chromboem bolism and infertility prompt me to write to you regarding the frequency with which side effects are seen in general practice. Hardly a day goes by without a young woman attending the surgery suffering from side effects of the combined preparation … amenorrhoea is a side effect seen probably weekly.I am trying to be fair and to put the other side. On February 3, Dr. M. J. V. Bull of Oxford in a letter sought to minimise the side effects of the pill—he wants the girls to have them. What does he write? He stated that in his 415 patients there were 137 who had no side effects. He then gave the others. They are: 27 suffered from over-anxiety; 21 from general malaise; 41 from depression; 37 from headaches; 42 from loss of libido; 6 breast symptoms; 17 from nausea; 50 from weight gain; 42 from vaginitis; 28 1365 from oligomenorrhoea; 48 from amenorrhoea; 16 from spotting; 39 from breakthrough bleeding; and 29 from other symptoms. That is the case for the pill. I am trying to prove that the doctors who read the "B.M.J." know what these girls suffered from. Why are these men and women writing to B.M.J. saying that the pill should not be given because it is unsafe and dangerous?
Then we come to the risk of cancer. On October 28, 1972, the British Medical Journal had an article on the tests on the pill for carcinogenicity. It said:This week the committee on the safety of medicines published its long awaited report on the tests of various oral contraceptives for carcinogenicity in rats and mice. Taken at their face value, the conclusions drawn by the Committee are reassuring …It goes on to say:The studies now reported neither incriminate oral contraceptives as carcinogens nor exonerate them. We shall simply have to wait and see what the epidemiologists learn from prospective studies.Why are the Government ignoring this excellent advice to wait and see? They are simply saying that it has not been proved that these pills are not carcinogens. Let us wait and see. What is the hurry? The only hurry is that the pharmaceutical industry should have more profits! The pressure all the time is coming from them. There are eight to ten different pills on the market. Always there are promises of more coming along. When the report came from the Committee on the Safety of Medicine, the pharmaceutical industry said" Good! Now we can have some more". But the fact is that it has not been proved that this may not produce cancer.
On November 11, 1972, under the heading, "Tests for Pill on Carcinogenicity", Dr. Barnes writes:It would seem only prudent to wait until older women who have taken the Pill have been followed up for 20 years before distributing this active material wholesale to teenagers with the assurance of an official medical committee that such use involves no carcinogenic hazard. I wish I could share the relief of the Secretary of State at the Committee's recommendation.Successive Ministers of Health have always been concerned with the incidence of venereal disease because it is a transmissible disease; and, as the noble Lord, 1366 Lord Stamp, reminded us in his excellent speech, in his Annual Report for 1971 the Chief Medical Officer said that the main epidemiological concern was still the increase in gonorrhoea in young people. This is the main concern in this country. I have all the figures here, but they have already been given by the noble Lord, Lord Stamp, and I believe that the noble Lord, Lord Aberdare, gave some, Surely, my Lords, a warning of the dangers of this transmissible disease should be given, particularly as the Pill does not even provide the limited protection that the condom provides. One reason why the condom now is very popular (I think it is used by 40 per cent. of the people who practise birth control) is that at least it provides some limited protection against gonorrhoea.
Then we come to the oldest risk of all—pregnancy. The permissive society which, it is alleged, does so much for young people—making them free and easy, removing their inhibitions and so on —cannot, unfortunately, relieve a girl of the burden of a pregnancy and the subsequent misery regarding abortion of which we have heard to-day; or the decision, which is equally heartrendering, whether to seek adoption or to keep the child, with all the difficulties involved in its support. My Lords, what arrant nonsense it is to talk of unisex, as though the burdens of pre-marital intercourse were equally borne! While Cathy left her comfortable home and died alone in appalling circumstances, the man, equally responsible, went off scot-free; and so I make no apology for putting the case for the girl much more strongly than I put the case for the man.
I do not want to weary your Lordships any more, because all this may be read in the British Medical Journal. I ask that a leaflet should be prepared giving some of these facts in order that it could serve as a warning and help these unfortunate girls. Nobody except the Government can do this. The Government may ask the pharmaceutical industry to do it, but I have not observed that the pharmaceutical industry is in a great hurry to react to any gentle approach. I would have said that this could have well been embodied in legislation in order that the pharmaceutical industry should be compelled to issue a warning about what, as I read to your Lordships just 1367 now, a well-known doctor said is the dissemination of dangerous material.
§ 9.5 p.m.
§ BARONESS GAITSKELL
My Lords, the trouble about statistics is that there is always an anti-statistic to take the place of one given, or to counter the last one, and before I come to refute some of the statistics put forward by my noble friend Lady Summerskill I will make one or two comments. We live in dangerous times. Every day we get a new warning about health, food, drugs, vitamins—endless warnings, right down to orange squash. During the 8 a.m. news this morning we were warned about the dangers of vitamins A and D. How far are we going to carry these warnings if we are not to become a nation of raving hypochondriacs? Will every woman who is going to have a baby get statistics about the maternal mortality rate to pin above her bed? Why is it that the Pill is put in such a special category merely because it is a pretty efficient contraceptive?
What I find so disconcerting is the way the emotional attitude to the Pill can bend the facts concerning it and the way some people are always trying to put the fear of God into women about it. I do not advocate the use of an oral contraceptive alone, or represent it as the best one in use to-day. It depends on the woman, the country, the circumstances; and every woman should be able to choose. The prejudice engendered against the contraceptive Pill is all the more unreasonable because in this country only a qualified medical practitioner can prescribe it. If more safeguards for the Pill are wanted, let us train more doctors in contraception. No method of family planning is 100 per cent. safe or sure, but failure rates will not stop people from having sex. The list of warnings seems to have grown longer: infertility, thrombosis, cancer, depression—all so far not really proven. Let us glance at some of the statistics and take first the statistics for infertility, the ones that my noble friend Lady Summerskill talked about.
I have scratched around, my Lords; I got the article in the British Medical Journal and read what the gynaecologist in Sydney. Dr. Shearman, noted. From 1966 until 1972 he noted 96 cases of amenorrhoea in women, post-Pill. The 1368 cases responded to treatment and were self-limiting. Prolonged infertility is present in less than 1 per cent. of women—I take that statistic from the medical bulletin of the International Planned Parenthood Federation.
Perhaps the most interesting fact about oral contraceptives is outlined in one of their medical bulletins. An investigation was done by the same three doctors who first established the relationship between the pill and the risk from thrombosis. They found there was no risk of breast cancer: and this was encouraging because, as we all know, one in 20 women in this country who contract cancer of the breast in fact die from it. In fact, there was some evidence that the Pill gave protection against benign breast disease. So we should note carefully that even a slight reduction in breast cancer would more than offset mortality from thrombosis. The number of Pill users has now returned to the level at which it stood before the adverse publicity which it received in 1969, and there is slight evidence that the mortality related to the Pill, which we do not wish to underestimate, has depreciated. The International Planned Parenthood Federation Medical Bulletin also states that the mortality rate of pregnancy is 10 to 15 times greater than the risk in one year's use of the Pill.
My Lords, I have never believed that young people to-day are more promiscuous than their parents. Various studies have been made that contradict this idea. In fact, I believe that contraceptives help to maintain a stable relationship. Come to think of it, all this reading in bed—not exactly an aphrodysiac—is really an assault on our common sense. What this Amendment is asking for is less sex, and for young people, no sex—a return to the state of innocence in our society. But to-day we have a more honest and less atavistic attitude to sex, and therefore this Amendment is really rather ridiculous.
§ LORD AVEBURY
My Lords, I have been waiting to ask the noble Earl, Lora Lauderdale, what exactly was the trap that he mentioned when I put a question to him in the course of his speech. He gave us many figures concerning the rate of pregnancies which resulted from the use of various methods of contraception, 1369 and I then asked him to complete the series by telling us what the rate of pregnancy was if there was no use of contraception. The noble Earl said: "Ah! the noble Lord has fallen into a trap, and I shall spring it presently". But he has failed to do so. I think it is rather important that your Lordships should not be deprived of the information which is obviously in the possession of the noble Earl. If one is going to look at the matters of contraception from their relative failure rates, then one also wants to know, presumably, as a user, what is the likelihood of becoming pregnant if one does not use any method of contraception at all. I am hoping that the noble Earl will give us some information on that.
The noble Earl talked about the responsibility of the Government. I think we have certain responsibilities as Members of this House not to excite unnecessary alarm, as the noble Earl has done, and as the noble Baroness, Lady Summerskill, has done, in reference to thalidomide. I think the noble Earl is being highly irresponsible (I have chosen that word carefully), and he should make it clear that there is no question whatever of the use of any method of contraception having the sort of tragic effects on the patients which thalidomide had in the case of those unfortunate mothers who took it during their pregnancy. Is it not an outrageous use of the privilege of this House to put the fear of God, as the noble Baroness, Lady Gaitskell, put it, possibly into the minds of some of the users of certain methods of contraception by making insinuations of this kind across the Floor of the House?
I think the noble Baroness, Lady Summerskill, was hardly any better when she uttered vague threats of the amount of infertility and other disastrous side effects that may be caused by the use of the Pill. She quoted some articles from the British Medical Journal, but not, I may say, in tow, because if your Lordships look at the one on carcinogenicity, I think you will see that the reason why they could not come to any conclusion is fairly clear; namely, that the tests on rats and mice mean nothing in the context of human patients. This is not an indictment of the Pill; it is merely saying that the experiment was badly chosen, because 1370 these particular animals are subject to a greater frequency of carcinoma, as I understand it, whether they have been given the ingredients of the Pill or not.
I would refer the noble Baroness to another set of figures which I think is interesting, given by the Adelstyne, on health trends, showing the number of deaths where therapeutic drugs have been implicated in selected categories up to 1970. I will give the figures from the year 1970. In that year there were 13 deaths where contraceptives were said to have been implicated and there were 24 deaths attributed to the use of analgesics. If one follows the argument put forward by the noble Baroness, Lady Gaitskell, to its logical conclusion, we ought equally to have warnings on packets of aspirin sold by the chemist. Take, as another example, Doctor J. Collis Browne's Chlorodyne—a specific which I find is extremely effective, though I believe it has now been taken off the chemists' shelves and put on prescription because it contains a small amount of opium. As to the picture, Dr. J. Collis Browne has a moustache and not a beard, if I may say so to the noble Baroness, Lady Summerskill. There are many preparations which one can buy from the chemist on prescription which have a very small degree of risk attached to them; so why is the noble Baroness trying to single out contraceptives as needing to have these warnings attached to them?
I think she appreciated more than the noble Earl, Lord Lauderdale, that this was not really the right way to go about it. She went rather further than the terms of the Amendment itself, and suggested that some sort of leaflet should be inserted inside the packet. So in effect she is saying that one could not get all the information that patients might need in the sort of warning that you get on a packet of cigarettes. Surely this leads us to the conclusion that the printed warning is not the right solution to the problem which has been outlined. The packet is not the only chance, as the noble Baroness put it, to convey the information that the patient needs, because although there have been strong arguments against proper sex education in schools, and the amount of advice available to the under-16s in the Family Planning Association 1371 clinics and so on, if those things are maintained that is where the patient can get advice on the relative merits of different forms of contraceptives, their failure rates, and so on. They could have far more comprehensive information given to them across the consulting room desk or in the Family Planning Association clinic than could possibly be got on to the cover of the packet.
If it is really a question of distributing warning notices as widely as possible, including, for example, what is referred to in Amendment 28—that it is possible that by indiscriminate sexual intercourse (although the word "indiscriminate is not actually used) the transmission of venereal disease may occur—why stop at the contraceptive packet? If it is an important warning for us to get across, let us put it on a packet of cigarettes, because a lot of people who smoke may also sometimes have sexual intercourse. Why not put it on the wrappers of loaves of bread? If the noble Baroness really wants to get this message across, surely she is being far too restrictive in putting it only on contraceptive packets where it will reach only those who are sensible enough to use contraceptives and it is not going to reach the very large number of people who indulge in sexual intercourse and thereby run the risk of contracting venereal disease if they have not been to the Family Planning Association clinic or to see a doctor.
§ THE EARL OF LAUDERDALE
My Lords, I am very much obliged to the noble Lord for giving way: he is always very courteous in doing so. This business about warnings can, of course, be pushed almost to absurdity. The warning with regard to an aspirin is very different from that with regard to a contraceptive. The issue in regard to an aspirin is very different from that in regard to a contraceptive. The noble Lord earlier quoted the example of Dr. Collis Browne's famous chlorodyne. He apparently has not been taking it recently very much, otherwise he would have noticed that the label does have a warning saying it is dangerous to exceed the permitted dose.
§ LORD AVEBURY
My Lords, I did say, in passing, that it has been taken off the chemists' shelf and put on prescription. But the point I was trying to make, and the noble Earl, I think, 1372 cannot really refute it, is that there are certain things which can be bought on prescription from a chemist, and aspirin is one of them—we will leave Dr. Collis Browne out of it—
§ LORD AVEBURY
Yes, my Lords, and I said we will now leave him out of it, because there are certain other preparations, such as aspirins, which have appreciable risks attached to their use and which do not carry any warning. I hate to repeat myself, but the noble Earl opposite obviously was not paying attention: what I said was that if you once accept the principle of putting warnings on the packet, then you certainly cannot stop at contraceptives. It would have to apply to analgesics where the mortality rates are higher than those resulting from the use of contraceptives.
One word, in conclusion, about statistics on safety. Apart from the evidence which has been quoted by the noble Baroness, Lady Gaitskell, concerning infertility, there was also an article in the British Medical Journal on November 27, 1971, in which it was stated:In fact, it is worth emphasising that the return of ovulation can he expected within the first three cycles after stopping oral contraception in 98 per cent. of women.As the noble Baroness, Lady Gaitskell, also pointed out, there is a return of fertility within the following few months in all but one per cent. of women who take the pill. If I may say so to the noble Baroness, Lady Summerskill, with great respect, I do not think it helps when somebody as eminent as she is in the medical profession raises alarms of this kind in the minds of patients who may read her speech. Surely it would be far better for the kind of advice which noble Lords moving this Amendment are seeking to give to be a personal matter between doctor and patient, or between family planning clinic and the person who goes there to seek advice. That would be the best solution. Therefore I will vote against this Amendment if it goes to a Division.
§ 9.22 p.m.
§ LORD PLATT
My Lords, I am chairman of a steering committee which is keeping a general supervision on some prospective studies into the use of the 1373 contraceptive pill in hospital practice, family planning practice and also general practice. The study has been proceeding for some years, but even now it is not at a stage at which I can quote statistics from it. I am very grateful to noble Lords who have been into the question of other statistics. What I can say is that it has not shown up during these years any immediate cause for alarm of any kind. If it had done, the Medical Research Council would immediately have taken some action and warned doctors and the public of some probable effect which seemed to be coming from the Pill. No such serious effect has apparently arisen so far.
With regard to the comparatively minor effects which the noble Baroness, Lady Summerskill, has quite rightly pointed out, some women do gain weight; some do not feel so well; some become a little depressed, and some complain of headaches, and so forth. The noble Baroness blamed the pharmaceutical industry for promoting this Pill as hard as they could because of the benefit to their profits. But surely women are not so stupid that if something is giving them headaches, making them feel ill, feel slightly sick, put on weight, or having other undesirable effects, they will go on using it. A sensible woman will not do so; she will use some other method of contraception which is available. The young women that I know best, a married grandchild, two daughters and a daughter-in-law, have all been on the Pill and they have all been off the Pill again. They make their own choice as to whether or not they think it worth putting up with these minor side-effects.
Another thing I should like to say is that there is strong evidence that since the Report of the Scowen Committee, and the change in the nature of oral contraception in general use in this country, the rate of thrombosis, which is the serious and dangerous complication, has diminished very significantly. That danger is not as great as it was. With regard to labelling these patents, do noble Lords realise that (although I do not have figures) 80 or 90 per cent. of all contraceptives used are in fact used by responsible married couples who already have two or three children? Are they going to see this message—as Lady Gaitskell 1374 says, this bed-time reading: "Don't take this! You may get this. You may get that. Don't have intercourse with a girl under 16, or with a married man of 50", or some such thing? I think it is just ridiculous. As to the risk, Lady Gaitskell has also reminded us that oral contraceptives in this country are available only on a doctor's prescription. Is it not a doctor's duty to weigh up the pros and cons and give the right kind of advice, and give a warning when it is necessary?
Does the noble Baroness, Lady Summerskill, when she prescribes penicillin, have a leaflet given with it, saying, "If you take this you may become sensitive to it. You may have an injection in the future which will kill you"? Yet it is perfectly true. Fortunately, it is a rare occurrence, and it is hardly necessary to include the leaflet. Does she put a leaflet in with other antibiotics to say that in one case in thousands it may cause an extremely serious anæmia from which the patient may die? There are many other drugs one could also quote. In each case the doctor is prescribing. He knows, we hope, why he is doing it and what the risks are. To say that every doctor is not as responsible as he ought to be is of course begging the question. Those are all the points I wanted to make. I hope that we shall not repeat warning notices on all contraceptives.
§ 9.26 p.m.
§ BARONESS LLEWELYN-DAVIES OF HASTOE
My Lords, I am anxious not to prolong this debate, but I thought it might just be worth while saying from this Bench that we accept every word that the noble Lord, Lord Platt, has said. We think it a great mistake to try to deal with contraceptives as if they were a completely different kind of medicine from any other. Medicine is all of a whole. We think that contraceptive services should be part of the National Health Service. We think no difference should be made between warnings on one kind of medicine and warnings on another. Though I have some sympathy with the idea of warning about venereal disease, and about unlawful intercourse with people under 16, above all we on this side think that this is not a subject that should be dealt with by Act of Parliament. It is far too huge a hammer 1375 to crack this particular nut. We should have to have a new Act of Parliament every time there was a different new medicine. All kinds of developments are coming, not only in contraceptives, like prostaglandins, but in all sorts of other antibiotics and so on. We should have to have a new Act of Parliament every time it was wanted to put new medicine out through the doctors. I am sure this should be left to the common sense and diligence of our own doctors and clinics; and that is our general view.
§ BARONESS YOUNG
My Lords, I should like to begin by saying that we are very sorry to hear that Lord Dundee is indisposed, and hope he will soon be well again. Lord Lauderdale, in moving these Amendments, began by saying that it was very necessary to give a warning to the public about the possible dangers arising from various contraceptives. May I say that we regard this whole question as a serious matter requiring most careful thought. In this respect, we regard the education of the public about contraception and sexual matters generally as being something of great importance. It is quite clear that there are both misunderstandings and myths which surround this subject, and the Department of Health and Social Security and the Health Education Council will be considering what best guidance should be given to the new National Health Service authorities about the matter, and the Council itself will be considering its future activities in this field. Furthermore, it is necessary to consider what contribution can be made by mass education, by talks to groups and by the personal approach which health visitors and other professional workers can bring. This gives an opportunity to discuss all aspects of the matter, including possible failure rates of contraceptives as well as the other possible side effects.
Some noble Lords may have seen the factual leaflet which the Health Education Council first brought out two years ago which describes the various methods of contraception and their advantages and disadvantages, and which has also formed the subject of Press advertisements. The Council is at present mounting an experimental television campaign in one area inviting people to ask for information about contraception so that those who wish it can be told about family planning 1376 facilities and the various methods available. I will not go on to discuss other educational approaches, but I wanted to show that although, for reasons which I will shortly explain, I must ask the House not to accept these Amendments, we believe that there is a need for the public to be better informed about contraception in all its aspects.
I should now like to turn to the Amendment moved by the noble Viscount, Lord Ingleby; namely, the proposal that packets of oral contraceptives should carry a warning notice about the side effects. In this case, I think there are some quite serious practical difficulties. The fact is that the risk of untoward effects from the contraceptive pill vary greatly with the individual patient and, therefore, no one warning notice to the public could be anything but rather misleading for a large proportion of users of the pill. For most women, the risk is negligible, and in the case of thrombosis is several times less than the risk of thrombosis associated with pregnancy. To print warnings which would cause needless anxiety would be to discourage the use of effective contraception with consequences measured in terms of abortions and the mental and physical ill health which can arise from unintended conceptions.
I suggest that the proper course for the House to take would be to regard the responsibility for advising the individual patient as resting on the doctor who can consider the particular medical and other circumstances and discuss with her the form of contraception most suited to her needs. It has already been said by the noble Lord, Lord Platt, and others, that of course contraceptive pills can only be provided on a doctor's prescription, and therefore if the patient has taken a pill the doctor is able to warn her about possible side effects. If these occur, they may well be avoided in the future by switching to some other form of pill, which is an added reason for not setting out the blanket warning suggested by the Amendment.
May I now turn to the points raised by the noble Baroness, Lady Summerskill. We are of course all aware of her great concern in this matter and the number of times that she has raised it in this House, but I feel it is only right to say that the Committee on the Safety of 1377 Drugs, so far as oral contraceptives are concerned, did not feel that they would be justified in recommending their withdrawal from the market provided they were available only on prescription and that doctors and the public were aware that they involved some risk. So far as the risks are concerned, they have had this to say on cancer. Reporting in 1972, they said that the evidence did not show that long-term use of oral contraceptives as at present formulated might give rise to cancer, and the Committee concluded that although a carcinogenic effect could be produced when some of the preparations were used in high doses in certain strains of rat and mouse, this evidence could not be interpreted as constituting a carcinogenic hazard to women when these preparations were used as oral contraceptives. In the light of the Cornmittee's conclusions, which were accepted by the Secretary of State, a warning on cancer at the present time does not appear necessary or appropriate.
So far as the other side effects are concerned, the noble Baroness, Lady Summer-skill, raised a number of them, including depression, nausea and, possibly, infertility. It was largely because of such side effects that the Committee recommended that oral contraceptives should he available only on prescription, so that their use could be supervised and patients warned to look out for side effects and to report to their doctor so that, if necessary, appropriate methods could be taken to mitigate them. I hope I have said enough to answer these very serious points and to indicate that the Committee on the Safety of Drugs has reported on these matters.
I come to the next Amendment, and I am afraid that we regard this suggestion also as being unduly discouraging to the use of contraceptives. Furthermore, it would be very difficult, if not impossible, to determine what the maximum failure rate was for any particular contraceptive. Various surveys have been attempted, but these have shown considerable variations in pregnancy rates among people using contraception, and what is not clear is the extent to which pregnancy was due to the failure of the contraceptive or to its ineffective use by a particular patient.
I turn now to the suggestion that a warning about the transmission of venereal 1378 disease should be printed on packets of contraceptives. I believe that in this connection we need to consider the possibility that a warning to that effect really could be offensive to a large number of people whose sexual experience is confined to a single partner within marriage and for whom there is no risk of V.D. A warning like this could, in any event, be misleading where the sheath is concerned, because this offers effective protection against gonorrhœa and limited, though less effective, protection against syphilis. Here again we certainly share the view of the noble Viscount that the public need to be better informed about the possibilities and dangers of sexually transmitted diseases, but we do not think that this blanket approach is the right one. Rather it is necessary to consider a more selective approach to the education of different groups about these diseases and in fact the Health Education Council is undertaking an experimental campaign in two areas of London with a view to improving the educational methods used in this sphere.
Finally, I come to the suggestion that warning notices about the illegality of sexual intercourse with girls under 16 should be printed on contraceptive packets.
§ BARONESS LLEWELYN-DAVIES OF HASTOE
My Lords, may I intervene at this point? I was not aware that all the Amendments to which the noble Baroness has referred had been moved.
§ BARONESS YOUNG
They are being considered together. I understood that the noble Earl, Lord Lauderdale, when moving his Amendment asked that they be considered at the same time.
§ LORD STAMP
My Lords, I was expecting to be able to say something 1379 about my Amendment No. 28. I do not know if I shall be allowed to do so later.
§ LORD STAMP
My Lords, the noble Baroness, Lady Young, has replied, as it were, to the points that I intended to make but before I had made them. However, I wanted to enlarge on them. I trust that I shall have an opportunity to do so.
§ BARONESS YOUNG
My Lords, as I said the noble Lord, Lord Stamp, will have an opportunity to speak when I have concluded by remarks. As for the suggestion that there should be warning notices about the illegality of sexual intercourse with girls under 16, I would only say that it is considered that the sort of people likely to be tempted to have sexual relations with girls under 16 are not the sort who are likely to be educated by warning messages on packets of sheaths. In any event, the relevant provisions in the Sexual Offences Act are by no means straightforward, and there would have to be quite a lengthy explanation of the effects of the different sections, and this hardly seems justified for the small benefit that there might theoretically be from such a proposal.
For these reasons we believe it would not be right to accept these Amendments as they stand. In any case, there is already legislation on the Statute Book in the shape of the Medicines Act 1968, which deals with the placing of warning notices on medicinal products. Contraceptive substances are already subject to the labelling regulations made under Part V of the Act, and contraceptive appliances could be made subject to similar controls by an order under Section 104 When new medicinal products are considered for licensing the question of appropriate warnings is always considered by the Committee on Safety of Medicines. In the case of prescription products, however, it is normally appropriate for such warnings to be addressed to doctors rather than to users, so that they could be included not on the packaging but in literature addressed to practitioners—including data sheets which will shortly 1380 become a statutory requirement for all products promoted directly to practitioners. Known serious side-effects are always included in such warnings.
I hope that this will go a very long way towards satisfying those who are concerned and who have tabled these Amendments. We believe that there is already an adequate statutory basis for control over these matters, and I must therefore ask the House not to accept these Amendments. Before sitting down, I should like to thank the noble Baroness, Lady Llewelyn-Davies of Hastoe, for her remarks supporting the Government's view in this matter: we feel they are most helpful. We are all concerned about what is clearly a very serious matter, but we feel that there is a law which will deal with it.
THE DEPUTY SPEAKER (VISCOUNT HOOD)
Does the noble Viscount, Lord Ingleby, wish to speak? The Amendment before the House is Amendment No. 26.
THE DEPUTY SPEAKER
I will deal with that at the end. All these Amendments are Amendments to Amendment No. 25.
§ Amendment No. 26, by leave, withdrawn.
§ 9.42 p.m.
LORD STAMP had given Notice of intention to move, as an Amendment to Amendment 25, Amendment No. 28.
At end insert ("which shall include a warning that the practice of sexual intercourse with or without the use of the said contraceptive may involve the transmission of venereal disease.")
§ The noble Lord said: My Lords, I should like to make one or two points. I agree that this Amendment should be withdrawn, but for the record I should like to make one or two points which I should have done had I introduced it in place. In speaking about this Amendment, I am particularly concerned with 1381 the need to issue a warning as to the risk of V.D. in using the oral contraceptive, a point which the noble Baroness, Lady Summerskill, made. Here again, one can only canvass the views of the expert—in this case the venereologistand I should like to quote from some of the writings in this field. I have done some homework about it and believe that it ought to go in the record.
First, I should like to quote from an address entitled "Attitudes to Venereal Disease in a Permissive Society", given by Dr. Arthur Wigfield, consultant venereologist at Newcastle. This was reprinted in the British Medical Journal dated November 6, 1971, and is of the greatest interest to all who are concerned with the problem. In this address he says:
Few would deny that there has been a vast increase in pre-marital intercourse. It is difficult to substantiate this belief without figures to prove it, but there is evidence to suggest that women taking 'the pill' indulge in sexual intercourse more often and with more partners than those who are not on the pill. Too few realise that it does not afford protection against the acquisition of venereal disease such as is given by mechanical harriers.
My Lords, as to the lack of statistical proof, it is of course very difficult to obtain statistical evidence comparable with that produced over the years linking heavy smoking with cancer. The investigations are so different—that on the V.D. problem involving matters of the strictest confidence. Nevertheless, some statistical evidence has been obtained by the Swedish workers, Juhlin and Liden, and is reported in a paper entitled: "Influence of Contraceptive gestogen pills on sexual behaviour and the spread of gonorrhoea", published in the British Journal of Venereal Diseases (1969, volume 45). In the summary, they state that:
The number of sexual partners per year and the frequency of intercourse was significantly higher in the women taking pills than in the others, and were highest in the age group 20 to 25 years. In the whole study group more persons stated that the number of partners and the frequency of sexual intercourse had increased after starting to use contraceptive pills. It is considered that this increase in sexual activity probably increases the risk of gonococcal infection. Gonorrhoea was diagnosed in 67 per cent. of the women.
Similar conclusions were drawn by Dr. L. Cohen of the Royal Infirmary, Cardiff,
in a paper entitled: "The 'Pill', promiscuity and venereal isease", published in the same journal in 1970 (vol. 46). In this paper he makes the point, and I quote:
The doctor working in the venereal disease clinic is in the best position to note the changes in sexual habits and infection rates in his local population. The general practitioner does not as a rule see his own cases of venereal disease as his patients may not admit their promiscuous behaviour to him.
My Lords, I think that is a very profound statement, and it is an additional reason why we should pay particular attention to the opinion of the venereologist.
In the summary of this paper, Dr. Cohen states:
Oral contraceptives are being used increasingly by both married and unmarried women, and there is increasing extra-marital sexual activity among all women taking the oral contraceptives, regardless of marital and social status. Decreasing use of the condom is an additional factor in spreading venereal diseases. Fear of pregnancy acts as a brake on promiscuity, and removal of this brake increases sexual activity and the incidence of venereal infection. The oral contraceptives fulfil their function as an almost perfect method of preventing pregnancy, but one of the byproducts would appear to be increased promiscuity with a consequent increase in the risk of contracting venereal diseases.
My Lords, I have reprints here of these two papers if anyone would like to see them. If the evidence of the experts suggests that the use of the pill as a contraceptive method increases the risk of V.D., surely this should be publicised as widely as possible and a repeated reminder of this given, as recommended by this Amendment.
§ This Amendment—and here I come to a point on which I thoroughly agree with the noble Baroness, Lady Young—does not quite meet what I had in mind, which is simply to draw attention to the risks involved with the pill with regard to V.D. It includes other contraceptives, which at present, to all intents and purposes, would be the condom. This bothers me a lot, as this is the only form of contraception which does afford some method of protection against V.D., and it would certainly therefore be preferred by the venereologist. I am all for warning about V.D. wherever possible, but in view of what I have said I think this Amendment could be improved, and I should not wish to move it in its present form.1383
BARONESS MACLEOD OF BORVE had given notice of her intention to move Amendment No. 29 as an Amendment to Amendment No. 25:
At end insert ("which shall include a statement that it is an offence to have sexual intercourse with a girl under the age of sixteen years, subject to the exceptions set out in sections (2) and (3) of the Sexual Offences Act 1956.")
§ The noble Baroness said: My Lords, may I just clear up one point before asking leave not to move this Amendment. I have discovered that the sections of the Sexual Offences Act should be Sections 5 and 6, and not 2 and 3. I discovered that at two o'clock this morning. Having made that clear, may I beg leave not to move the Amendment.
§ 9.48 p.m.
§ THE EARL OF LAUDERDALE
My Lords, may I first of all thank all noble Lords and Baronesses who have taken part in this discussion for their sympathetic treatment of this matter. May I also endorse Lady Young's wishes to our good friend Lord Dundee for his early recovery from what began as 'flu and turned out, as I understand, to be pneumonia. He was given the advice by myself that the best cure was a bottle of whisky and a "wee sucker"—but apparently that has not been sufficient.
One or two points should be dealt with before we leave this subject. First of all, the point has been made that warnings can very well be given, and can best be given, by the doctor or the counsellor in the privacy of the surgery. No doubt that is true, but there is no doctor and no counsellor inside the slot machine. The slot machines are freely available all over the place, and they are available to children of any age. They carry no warnings whatsoever. It is said, "Grown-ups don't need to be warned of these things". That may be the case, but we have been talking largely this afternoon and evening about young people who are physically mature but who mentally are still children. It is for their protection—which is the common wish of the whole House—that these Amendments have been put forward.
Endeavours have been made, but I think that they are not worthy of an answer, to try to compare the warnings that we recommended for contraceptives with warnings that should be used with of the most surprising remarks fell from 1384 aspirin or even with bread. Perhaps one the noble Baroness, Lady Llewelyn-Davies of Hastoe, who we can never resist listening to and looking at, and in whose company it is always a pleasure to be. I was a little surprised when she said, in that deft manner that is so captivating, that medicine is all one, and of course what relates to an aspirin relates to a contraceptive or a cough cure. The point that we are trying to make, and which I think we have made with some vigour in this debate, is that a contraceptive is very different from a cough cure, an aspirin, a sleeping pill, and very different from something that you rub on your aching joints. So although all medicine is one and the whole world is one, there are distinct aspects of it.
§ BARONESS LLEWELYN-DAVIES OF HASTOE
My Lords, can I ask the noble Earl whether he put a warning on that bottle that he sent his noble friend?
§ THE EARL OF LAUDERDALE
My Lords, alas! I was unable to send it to my noble friend, but he told me that he had a supply, and I think that he is a case of an adult who knows where the limits are.
It was suggested that a new Act of Parliament is going to be needed for every warning. I really do not think that that is an argument one need pay much attention to. I have to confess that I was rather disappointed in the fair Minister's reply. It is always such a pleasure to listen to my noble friend Lady Young, and I come here to do so. Education of the public is a splendid object, but it does not answer the question of teenagers going to the slot machine. She was worried lest the printing of warnings should cause needless anxiety. For years warnings have been put up in public lavatories about the dangers of V.D. Nobody complained that this raised unwarranted anxiety. Then there was the point that a V.D. warning might give offence to married people, or to those with what is regarded as a stable relationship with a single partner. Well, I should have thought that if people in this single partner stable relationship are going to be offended by the sight of a warning, they probably need their heads examined.
Whether that is the case or not, I am disappointed that the Government are not prepared at this point of time to take the 1385 matter further. I take the points that the noble Baroness has made. There are difficulties and there are limitations, and the Committee on Dangerous Drugs is at work. In the light of all that has been said, and the courtesy and patience with which your Lordships have listened, I think that enough has now been said to, air the matter. Therefore, with the greatest respect, I also beg leave to withdraw my Amendment.
§ Amendment, by leave, withdrawn.
§ 9.55 p.m.
§ LORD GAINFORD moved Amendment No. 30:
Page 3, line 34, at end insert—
("( ) No contraceptive shall be supplied under the provisions of subsection (1) above to any person under sixteen years of age unless—
§ The noble Lord said: My Lords, I beg to move Amendment No. 30. The time is now rather late, and I do not want to repeat too much of what has already been said in the debates on these Amendments. Once again as parents we have all expressed our anxiety about children. There is a great deal of liberty these days for young people, and particularly for teenagers. It cannot be denied that children mature much earlier than in previous generations, so it is quite natural that they should wish to prove their virility. In these days of so much uncertainty and confusion they feel that, in showing how adult they are, they are achieving some, thing definite; but if that liberty encourages young people to indulge in sexual practices there is grave danger for them.
§ When the young are cautioned, by parents, by teachers or by any adult in authority against sexual practices they tend to regard the warning as coming from people whose moral or religious views restrict them, so that they are behind the times and no longer "with it"; and stressing a point on religious or moral grounds can raise a spirit of rebellion. The young have a wonderful vigour and confidence, which makes them feel 1386 that they know everything. I hope I am misinformed, but there seems to be such a great accent on sexual education or such great publicity about it, that strong temptations to experiment are likely to be produced, particularly in mixed schools where young girls and boys get together, and any encouragement to sexual freedom, whether direct or indirect, at such an early stage of life must be accompanied by stringent caution. My Lords, I beg to move.
§ THE EARL OF LAUDERDALE
My Lords, may I add one word to what my noble friend Lord Gainford has said? This Amendment, like other Amendments, arises out of the earlier Committee stage decision of this House to put the free issue of contraceptives into the Bill; and, whatever is our remedy, we surely agree that for the under-16s there is a special situation. There is something called the age of consent, and there is the Sexual Offences Act. Here, surely, is a perfectly reasonable safeguard, which might well have come in handy—I do not say in the case of Cathy, but in other cases. If a counsellor, when dealing with a child of under 16, was obliged and expected to consult with the parents, guardian, or whoever it might be, there would be support for whatever is the home or for whatever acts in place of the home. That is the point we are trying to make by this Amendment. I think it is self-explanatory, when we see that the Lane Committee has had evidence laid before it of schoolgirls of 13 coming up for their second abortions. To suggest that it is wrong for parents or guardians of the under-16s to know what is happening, is surely to say that you can do anything you like to a child. But these are our children; they are our wards; they are society's wards, and we have a great responsibility for them. We have ourselves to blame if criminality occurs. I merely plead that this matter be treated very seriously indeed, and not with the element of ridicule and lightheartedness which, unfortunately, has marred one or two little corners of our debate this afternoon.
§ 10.0 p.m.
§ LORD ABERDARE
My Lords, certainly we do not in any sense treat this as a matter of ridicule, or with lightheartedness.
§ LORD ABERDARE
I never thought my noble friend would. In fact, we look on this particular Amendment with a great deal of sympathy, and I can tell my noble friend Lord Gainford that I listened to him with great interest. I think it is universally felt to be a matter of very great regret that it should be necessary to provide contraceptive services for people under the age of 16 at all. But, unfortunately, as I said on a previous Amendment. No. 23, we cannot ignore the evidence of the need for them which lies in the rates of illegitimate births and abortions in this age group. In 1971 there were 1,513 babies born to girls under the age of 16, and in 1972 there were 3,150 abortions in this age group.
My Lords, the Amendment proposed by my noble friend is concerned with the supply of contraceptives under the National Health Service. It would not therefore affect the purchase of what might be called the non-medical methods of contraception, mainly the sheath, from the chemist, the barber and a variety of other sources. Indeed, it would obviously be extremely difficult to attempt to apply to the non-medical methods the restriction which is suggested in the Amendment. But so far as the other methods are concerned —those which can be obtained only on a doctor's prescription—the situation which it is sought to achieve under paragraph (a) of the Amendment in fact already exists; in other words, a person has to produce a medical prescription to the supplier. That would certainly be the case with, for example, the Pill. But the difficulty I have is that paragraph (b) introduces into the arrangements an element which it is more difficult to accept, first of all, for practical reasons. In the majority of cases the supplier would be the retail chemist, and we should not think it right to place upon him the onus, first of all, of determining whether the person concerned was under 16 years of age, and, secondly, of satisfying himself that the parent or other responsible person was aware of the prescription.
We believe it is better to leave these matters to the good sense and judgment of individual doctors. The Medical 1388 Defence Union have told the profession that if a girl under the age of 16 were to seek advice on contraception it would be prudent for the doctor to satisfy himself that the request was made with the knowledge and concurrence of her parents or guardian; and much the same recommendation was made to local authorities by my Department in 1967. I should expect that in the great majority of cases a doctor would not feel it right to provide contraceptive treatment for a girl under 16 without obtaining her parents' consent, or at least making sure that they were aware of the fact. But there might very occasionally be circumstances in which this would not be in the girl's best interests—and perhaps I could give your Lordships a couple of examples of the sort of situation which might occur.
Take the case of a girl who has left home and is living in circumstances which expose her to a real risk of pregnancy. Providing her with contraception might be a matter of urgency which could not wait on an attempt to contact her parents or to deal with the girl's problems in another way. Or there might be a girl whom the doctor knows to be sexually active, perhaps even promiscuous, but whose parents could not bring themselves to acknowledge the nature of their daughter's behaviour and would strongly resist the provision of contraception for her. The doctor might then be faced with the dilemma of choosing between the health needs of the girl and the claims of the parents. I believe that these cases are very rare, but it has to be acknowledged that they occur, and we believe that it is right to leave it to the good sense and professional judgment of the individual doctor. We should all like to think that the parents could be fully consulted in all cases, but this is a matter where the particular circumstances of the individual can be very important in determining the right approach. Because of this, and because I believe it to be wrong to place an obligation on the chemist to act as a further check, I hope that my noble friend, having aired this matter, will agree to withdraw the Amendment.
§ LORD GAINFORD
My Lords, I am grateful to my noble friend the Minister for his advice and his assurances about this matter, and to my noble friend Lord 1389 Lauderdale for his support in it. I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ Clause 6 [Provisions supplementary to section 5]:
LORD ABERDARE moved Amendment No. 31:
Page 5, line 17, leave out ("such") and insert ("with respect to the order such bodies as he may recognise as representing officers who in his opinion are likely to be transferred or affected by transfers in pursuance of the order and such other").
§ The noble Lord said: My Lords, this Amendment has been put down in fulfilment of a promise that I gave to the noble Lord, Lord Garnsworthy, at Committee stage that we would write into the Bill a specific requirement for consultation on matters concerning staff. I beg to move.
§ LORD GARNSWORTHY
My Lords, I think it right that I should express our warm appreciation to the noble Lord, Lord Aberdare, for the manner in which he has made good the promise he gave at Committee stage. This has given considerable 1390 satisfaction on this side and we are grateful.
§ On Question, Amendment agreed to.
LORD ABERDARE moved Amendment No. 32:
Page 5, line 25, at end insert ("; but it shall he the duty of the Secretary of State before he makes such an order to consult with respect to the order such bodies as he may recognise as representing officers who in his opinion are likely to be transferred or affected by transfers in pursuance of the order.").
§ The noble Lord said: My Lords, this Amendment has the same purpose as the previous one and follows an Amendment to subsection (2) put down by the noble Lord, Lord Garnsworthy. We have widened it further to include subsection (3) of Clause 6 because we think this would be of advantage. I beg to move.
§ LORD GARNSWORTHY
My Lords, again we are extremely grateful to the noble Lord for fulfilling the promise he made.
§ On Question, Amendment agreed to.
§ House adjourned at seven minutes past ten o'clock.