Page 63, line 13, at end insert—
'22A. At the end of section 38(3) of that Act (which relates to charges for pharmaceutical services) there shall be inserted the words "; and it is hereby declared that regulations under this subsection may include provision in respect of charges for the supply of such substances and appliances as are mentioned in section 4 of the National Health Service Reorganisation Act 1973"'.
Page 69, line 37, at end insert—
'(2) In section 1 (2)(c) of that Act (which provides that no charge is to be made under that section for the supply of an appliance for a young person), after the word "appliance", there shall be inserted the words, otherwise than in pursuance of section 4 of the National Health Service Reorganisation Act 1973."'
§ The Commons disagreed to the Lords Amendment to the Commons Amendment in page 4, line 7 and insisted on the above two Amendments, to which the Lords had disagreed, for the following Reason:—
§ Because the said Lords Amendment and the said disagreements by the Lords to Commons Amendments involve charges on public funds, and the Commons do not offer any further Reason, trusting that this Reason may be deemed sufficient.
§ LORD ABERDARE
My Lords, I beg to move that this House do not insist on their Amendment to the Commons Amendment in page 4, line 7. I think it would be perhaps of advantage at the beginning of this debate if I were to trace the history, the somewhat involved history, of this Clause 4 of the National Health Service Reorganisation Bill. It was on December 12 last year that I informed this House of the outcome of the Government's review of its policy on family planning, and at that time outlined plans for a considerable expansion in the service leading to an eventual expenditure of some £17 million per annum. Our proposals included the provision of free advice to all who requested it, but free supplies to certain categories only, the financially needy, the socially needy, women who have had a baby or 389 an abortion in the previous year; others would have had to pay the economic cost of their supplies. This was as far as the Government felt that they should go at that stage, and indeed I do not think that anyone would question that this was, at that time, a major step forward compared to the total expenditure on family planning when we took office of £1 million per annum.
However, a week later we were considering the Bill in Committee in this House and your Lordships passed an Amendment to Clause 4 which would have completely removed the Government's powers to make any charges at all for family planning advice, treatment or supplies. This Amendment had a profound effect on our thinking, and was one of the factors which led to us making a change in policy, which was announced in another place on March 26. We then proposed that the only charge for family planning supplies, whether provided through hospitals, clinics, or general practitioners (if they agreed to participate in the service), would be the normal prescription charge and would be subject to the usual exemptions. The Amendments to make this possible were accepted in another place at the Committee stage by twelve votes to eleven and sustained at the Report stage by 243 votes to 127.
This was the position when your Lordships' House last debated the Bill on June 25, when, by a vote of 107 to 58 you reaffirmed your wish to see totally free family planning supplies. During that debate, both my noble friend Lord Vernon, who moved the relevant Amendment, and the noble Baroness, Lady Llewelyn-Davies of Hastoe, who had moved the original Amendment at Committee stage, expressed the view that the other place should be given a further opportunity to consider your Lordships' views. This has now been done and the other place has reaffirmed its decision that family planning supplies should normally be available on payment of the prescription charge, and the vote on that occasion was 247 to 220. Now, as is normal practice when it is a matter of Commons privilege, they give as their Reason that charges on public funds are involved, and trust that this Reason may be deemed sufficient by your Lordships. I very much hope that, in these circum 390 stances, your Lordships will accept their decision and agree to their Amendment.
I fully recognise the strength of the, feelings that are held in this House in favour of free family planning, and I would not wish to contest or argue with that; I should only like briefly to assure the House that we are in earnest in wanting to make a success of our family planning policy. Once family planning becomes a part of the National Health Service on April 1, 1974, we intend to institute a national policy with speed and energy. Present estimates indicate an eventual total cost of £30 million per annum compared to the £1 million per annum that was the total public expenditure in 1970 when we took office.
We intend to work through hospitals, through clinics, and, if they agree to participate, through general practitioners. We shall develop the domiciliary services, we shall train more staff, we shall sponsor more publicity. There will be no charge for advice or treatment, only the prescription charge for supplies, and, as the prescription will usually cover several months' supply, we do not believe that it will prove a deterrent. But should it do so in certain rare cases, we intend, by administrative arrangements, to enable health service professional workers to authorise free supplies—just as happens at present in respect of domiciliary cases. We are quite as determined as all your Lordships are to make a vigorous attack on the problem of abortion and unwanted pregnancy. We have ambitious plans, as I have tried to describe, and your Lordships have already made a powerful contribution to those plans. I hope now that you will accept the Commons Amendment.
But, my Lords, the noble Baroness, Lady Scrota, and three others of your Lordships, have tabled another Amendment in lieu of our previous Amendment, the intention of which is that family planning supplies would continue to be available after April 1, 1974, in those Area Health Authorities, or those parts of them, where they are free at present. I would hope that your Lordships will agree to accept the Commons Amendment, and will probably wish to devote most of this debate to a discussion of the noble Baroness's Amendment. But I must say that there would be very grave difficulties in accepting it. I have tried 391 to explain that we intend to pursue a vigorous national policy of family planning. It would surely be very damaging to any national policy to have different arrangements in different parts of the country on a haphazard basis, depending entirely on local decisions made by previous local authorities. As things are at present, I would concede that it is reasonable in a very new service in the exercise of the rights of local government, but in a greatly expanded national service, which we are aiming at, as a part of the whole National Health Service, I suggest to your Lordships that it would be quite anomalous to have certain areas where the prescription charge was payable and certain areas where it was not.
The practical arrangements would indeed be formidable. Would it apply only to certain clinics in certain areas, and would they be confined to free supplies for those who lived in that particular area? As it stands, the Amendment does not apply to charges in the Part IV services—the general practitioner services. But assuming that the necessary consequential Amendments were made, what would be the position of general practitioners if they were to co-operate? How would they distinguish between a person eligible for free supplies and one who had to pay a prescription charge? Or, if the decision is to be left to the chemist, how would he distinguish? What about people who move house from one area to another? Suppose they come from an area where their supplies have been free to an area where they have to pay the prescription charge, or suppose they prefer to attend a clinic near their work rather than their home, and the two areas are treated differently? There are a host of difficulties. Moreover, many local authority areas will in fact alter their boundaries on April 1, 1974, and I am sure that the noble Baroness would not wish us to preserve the original areas for family planning purposes only.
These are the very serious difficulties that I would envisage if we were to accept the Amendment. But I would point out that my right honourable friend, as he made clear in the other place, already has flexible powers under the Bill sufficient for him to take prescription charges off family planning supplies altogether at 392 some future date should it seem desirable, or to institute some form of controlled experiment in a particular locality or localities. Moreover, I personally believe that it would not be in the best interests of our relations with another place were we to send back yet another Amendment to them.
As I hope that this will be my last word on the Bill, may I say how very much I appreciate the constructive opposition which the noble Baroness and her colleagues have offered to it? I believe it has been much improved as a result of their efforts, but I cannot agree with this Amendment and I advise your Lordships not to accept it. My Lords, I beg to move.
§ Moved, That this House do not insist on their Amendment to the Commons Amendment in page 4, line 7.—(Lord Aberdare.)
§ 3.40 p.m.
BARONESS SEROTA moved, as an Amendment to the Motion, That this House do not insist on their Amendment to the Commons Amendment in page 4, line 7, at line 5, at end to insert:
save that the Secretary of State shall ensure that no such charges are made in any Area Health Authority or part thereof where a local health authority was at the time of the passing of this Act already providing a family planning service free of charge for all advice, treatment and supplies.
The noble Baroness said: My Lords this Amendment appears in the names of the noble Lords, Lord Redcliffe-Maud, Lord Platt and Lord Tanlaw. I must begin by thanking the noble Lord, Lord Aberdare, for his careful historical account of our discussions. I only wish that the House had always been so full as it is to-day when we were debating all stages of the National Heath Service Reorganisation Bill.
§ My Lords, it would be inappropriate for Members of this House to comment on the Commons Reason for disagreeing with the Lords Amendment to their Amendment to Clause 4, at page 4, line 7 of this Bill, and for insisting on their own Amendments with which we disagreed when the House last discussed this matter on June 25, since questions of privilege are involved, even though the main debate has turned on the merits of the case. Before answering some of the arguments which the noble Lord, 393 Lord Aberdare, put against the detailed application of the Amendment which I have just moved, I feel bound to express the profound disappointment of the clear majority of noble Lords on all sides of this House, who have now on two separate occasions, as the noble Lord reminded us, recorded their firm conviction and belief that a universal, free and comprehensive family planning service should be provided as an integral part of the reorganised National Health Service which this Bill will create in April 1974.
§ It is perhaps significant that we do so on the exact date of the 25th anniversary of the inception of the National Health Service on July 5, 1948, for there could not, in my view, be a more fitting occasion to re-affirm our belief in one of its major objectives; namely, the development of a universal preventive, as well as a curative, Health Service. In moving this Amendment, the House will be glad to hear that it is not my intention to rehearse again all the medical, social and economic arguments that have been so fully and cogently deployed throughout our lengthy debate at different stages of the Bill on this important issue. The decisions of the House have undoubtedly reflected the great changes in public opinion that have taken place in the last four or five years, and most particularly, perhaps, since the appalling and tragically high, and apparently ever-rising, figures of abortions have become obvious to all. All our debates have been concerned to achieve, from all sides of the House, is the further development of a society in which, after the pioneering and mainly voluntary efforts of the last 50 years, every child should be a truly wanted child—at conception, at birth and in the crucial formative years. That is exactly what all our debates have been about—the well-being and happiness of future generations of children and their life chances of all kinds, rather than questions of expediency, or Party loyalties or even of possible clashes with another place.
§ I had the feeling on occasions that there were some who regarded the time we have spent on considering Clause 4 as a somewhat irritating and delaying cross-current which was irrelevant to the main organisational purposes of the Bill. But the House took the view—and, I think, rightly—that the far wider and deeper issues affecting individuals and 394 families, and indeed the nation as a whole, fully justified the time and attention we have given to these matters, especially in view of the demonstrable, and what the noble Lord, Lord Aberdare, has just called the "profound" effect that it has had on Government policy, emerging eventually, as he reminded us, in their decision announced during the Committee stage in another place to normalise the family planning service within the National Health Service; so much more satisfactory a policy than the one which was before us when we were debating Clause 4 in Committee stage on the basis of the Statement of December 12.
§ We all, on all sides, give the Secretary of State and his colleagues full credit for the advances that they have made, and for the movement that that Parliamentary process has achieved as this Bill has passed through its various stages in both Houses. All that lies between us now is whether supplies for this preventive service should be provided free in all cases or on the basis of prescription charges, subject to the existing somewhat anomalous exemption system; and, most particularly, after April, 1974, in those parts of the country where some 34 local health authorities are already providing completely free and comprehensive contraceptive advice, treatment and supplies. The House is very familiar with the figures, and with the size of population served, and I do not intend to repeat them again.
§ The main purpose of this Amendment is to focus attention on the reduction of service that must inevitably take place in these areas if we accept the Commons Amendment to our Amendment. Also, I wish to ask the Government to enlarge on and to clarify certain aspects of the intentions that lie behind the Statement to which the noble Lord, Lord Aberdare, referred, which was made, to my knowledge, for the very first time only last Monday by the Secretary of State in another place; namely, that the provisions of Clause 55(4) give only him power to make charges by regulation. As we now understand it, it is not a requirement to make charges. He also indicated that if experience showed that the present proposals were in need of review and modification, there was already power by regulation in the Bill 395 to abolish charges for contraceptive supplies, if this Government or, presumably, any other Government became convinced that this was the right social priority, and if the evidence showed that the judgment of the Government was wrong.
§ I know that all those who have played an active part in these debates, and the supporters of a free family planning service, would wish me to express their appreciation of the explanation of the Secretary of State in another place of the flexibility of the provisions in this Bill. My only regret—and I feel bound to put this on the Record—is that it did not come sooner. It could have saved a good deal of time and, moreover, it would have given us an opportunity to examine properly how the Government intend to measure the comparative effectiveness in terms of public use, of their proposed prescription-based scheme as against the completely free ones, such as those at present being provided by the local authorities, which will disappear overnight on April 1, 1974. All I am now asking the House to do by this Amendment is to preserve and continue these existing services, especially when we already know that the number of people using them have dramatically increased.
§ The crux of the case for this Amendment is that the continuation of the present free services could provide an already existing, operational control base for research and development purposes which could be carefully monitored over time, either to prove or to disprove the opposing arguments about free or prescription-based services which have been put forward with such fervour and sincerity throughout all our debates on this clause. The case is based on two major principles which I hope will commend themselves to the House. First, Parliament should not deliberately, by conscious decision, reduce the availability or level of any health or social service in the processes of a purely administrative re-organisation, such as this Bill provides for. All that this Amendment does is to maintain services that already exist. Support for it does not involve the introduction of any extension or expansion or even, more significantly, any new expenditure whatsoever. Moreover, we simply do not and cannot at this stage 396 know how the additional responsibilities of giving advice, treatment, and prescribing supplies will affect our already heavily burdened general practitioners for whom this will be an additional duty and who I understand are at present in negotiation with the Government for special payments for the extended services they will need to undertake.
§ Secondly, and just as important, may I remind the House of the very telling argument of the noble Lord, Lord Redcliffe-Maud, on the last occasion when we discussed these matters, that we should not deliberately erode or discourage the democratic local initiative which has brought these developments into existence. In this Bill, just as in the Water Bill which is currently before the House. we are removing long-standing traditional services from the control of democratic local government and transferring them to the control of unrepresentative, appointed bodies. At the very least we should not destroy their innovatory achievements in the process.
§ I would therefore sue Test to the House and the Government that through this Amendment we could preserve the existing free service without incurring any new expenditure and at the same time provide an excellent practical base from which future developments in this crucial field of health and social policy could be accurately compared and effectively assessed. The only argument the noble Lord really advanced against that was one of administrative difficulty. He used such words as "serious difficulty", "grave difficulty" and "profound difficulty", and even "formidable" was included in the range of adjectives. My Lords, I do not accept that the difficulties are so great that they cannot be overcome. I am fully aware that in the post-1974 situation local government boundaries as at present drawn will disappear, and I am also aware that certain health districts within the new Area Health Authority areas may overlap either the existing or the new local government boundaries.
§ All we asking is that where the free services exist in any Area or part thereof, those who are resident there will be entitled to free supplies. The noble Lord mentioned the chemists' difficulties and 397 the general practitioners' difficulties. Here I can only quote the London Borough of Camden in which I live and which was one of the first local authorities to pioneer these services. In that borough, there are no difficulties whatsoever; the local authority purchases the necessary supplies or requisites in bulk as would be the case in future with the Area Health Authorities. Free supplies are available at local authority clinics which would presumably become part of the Health Service after April 1974. In the case of the general practitioner services, there were already, in 1972, 2,800 supply orders issued by general practitioners to patients who then obtained their free supplies from the clinics. So great was the demand and the take-up of the free services that in the first 23 weeks of 1973 there were already 2,257 such supply orders issued by general practitioners. So I really do not believe that the administrative difficulties which the noble Lord has stressed could not be overcome if the Government were, at the very least, and even at this late hour, to give some kind of undertaking that these well-established free services will be allowed to continue, for the reasons I have just indicated as research areas. I beg to move.
§ THE LORD CHANCELLOR
My Lords, the original Question was, That this House do not insist on their Amendment to the Commons Amendment in page 4, line 7, since when an Amendment has been proposed to add at the end: but propose the following amendment in lieu: Line 5 of the Commons Amendment, at end insert the words on the Order Paper.
The Question therefore is That the Amendment to the original Motion be agreed to.
§ 3.56 p.m.
§ LORD REDCLIFFE-MAUD
My Lords, may I make a very brief intervention in support of the noble Baroness who has just moved the Amendment to the Amendment to the Amendment? I do not for a moment wish to repeat the arguments that have been so ably deployed at various stages in your Lordships' House, but I should like to complement what the noble Baroness said about her experience in Camden, a London Borough, London of course being a part of Britain which has already 398 been reformed in terms of local government and which therefore is to some extent exceptional. The noble Lord, Lord Aberdare. I thought was perfectly right in explaining that outside London there would be a difficulty if this Amendment to the Amendment to the Amendment were carried—namely, that existing, pre-April 1, 1974, local authority areas would be exempt from a system which from April 1, 1974, forward would be based on new and different local authority areas.
The question I want to ask is: can the Government, when they reply to this debate, find it in their hearts to say that at least they will go almost the whole way with those of us who are dissatisfied with what the other place has said and try to see that the flexibility that is already in the Bill is used in the way that the noble Lord, Lord Aberdare, explained? Can they not use those flexible powers forthwith and so get over these administrative difficulties which, quite frankly, I do not think are insuperable? Can they not take first of all the areas in London where there is no problem, where the existing local government boundaries will not be changed after April 1, 1974, and where the relationships to the new health authority areas can be seen already? And can they not go further and look outside Greater London at those places where the local authority is at the moment providing a free service, and see how the boundaries of the new local authorities that will be operationally in existence from April 1, 1974, may include the actual population—which I think now amounts to 20 per cent. of the whole population of this country—who are getting free supplies and who, unless something is done, will in future have to pay 20p per prescription, so that free supplies in those areas outside London, as inside London, will continue to be free of the prescription charge?
If the Government can be persuaded that this is something consistent with their view, I cannot believe that the Bill is not flexible enough to deal with special cases. If ever there was a special case, I should have thought it was those people who are at present enjoying a free service—thanks to the decisions taken, as the noble Baroness, Lady Summerskill, explained in a previous debate, in all cases after 399 long debate and in the light of full consultations with voluntary organisations and other people concerned. If ever there was a special case for the flexible powers to be used to see that the people in those areas continued to get that free service, I should have thought this was it. If the noble Lord who is to reply could give us an assurance of that kind, I should myself be much happier in not pressing the Amendment and in feeling that noble Lords have not worked in vain in registering the votes which they have registered in the past.
Whatever happens, my Lords, I hope that we shall not rest on an administrative difficulty if we think that the end in view is a serious one—and the Government have made it quite plain that they share the general feeling in all parts of the House that this is a serious issue. In that case, let us make up our minds. We are a most ingenious country and we are in fact in the middle of a successful (I am sure) undertaking to recast the whole local government, National Health and water systems of our country. To say that we cannot adapt in those places where the local authority already has a free service, so that the new Area Health Authorities may ensure that the free service continued, is defeatism of the most un-British kind, and I am sure the Government would not be guilty of that.
All I would say further is to repeat very briefly that if we do not secure this assurance, if in fact the Government are not able to use their powers and if the 20 per cent. who get this service free at the moment all have to pay 20p until some future date when the Government have changed their mind, when an error has been discovered and admitted, then we shall indeed, for the first time in our history, have gone back on successful experiments in local government and, in the national takeover of local prototypes, be proved to be retrograde instead of progressive. In maternity and child welfare, in school meals and school milk, wherever local government has pioneered and the State has eventually nationalised (as it were) the welfare service, we have moved forward, and this would be the first case where we had moved back.
My Lords, I wonder whether the noble Lord would 400 explain one detail. Does he think that, outside London, the new authorities should not have the power, if they so desire, to discontinue the present free service and to make a charge? Because the Amendment says:… where a local health authority was at the time of the passing of this Act already providing a family planning service …Surely a new authority ought to have the right to make their own decisions.
§ 4.3 p.m.
§ BARONESS GAITSKELL
My Lords, the most important fact which emerged from the speech of the Secretary of State, Sir Keith Joseph, on July 2, was that there would be Government power by regulation to abolish charges for contraceptive supplies if this turned out to be the right social priority and if evidence showed that the Government judgment was wrong. Now this has very much encouraged, if it did not absolutely satisfy, many of us who have for so many years campaigned for a really effective family planning service. It is true that the experience of the 35 local authorities who provide a free family planning service shows increasing health benefits and economies. The borough of Camden informs us that, for every £1 spent on family planning, £4 is saved among the other services that they deal with. Perhaps the Aberdeen experience, where free family planning has existed for over five years, if not absolutely conclusive is highly significant in the overall health and social benefits it has achieved. We think these are signposts to the social needs and the priorities of to-day, and we regret that the Government have held back and have not given the free service a try.
The argument about the cost of such a free service put forward by the Government does not bear scrutiny, let alone analysis. Of course, my Lords, £3 million is not chickenfeed, it is not peanuts. There are many organisations, such as Help the Aged, which would jump at such a contribution. The Secretary of State, Sir Keith Joseph, says he will sharply increase the domiciliary services. This will cost much more, I believe, than the £3 million which it has been stated will be the cost of a free family planning service. This the Government have themselves said. There is little doubt 401 that some of those who insist on prescription charges feel that they have struck a blow against the permissive society. In fact, they have once more failed to help those women in greatest need of information, guidance and help; those shy and sensitive women, lacking in confidence and sophistication about form-filling—women who are loth to publicise their poverty in a place like the post office when they ask for a form. I believe there are three forms for which they have to ask. These are the women to whom Sir Keith Joseph refers, rather enigmatically, I believe, as "the casual and overwhelmed", and who are to be dealt with by "sustained persuasion".
My Lords, we feel that this could be more effectively and quickly achieved by free family planning. But, having said this, I cannot disguise the fact that the Government have come a long way. When we campaign for a free family planning service we are neither "casual" nor "overwhelmed"; we shall continue to submit the Secretary of State, Sir Keith Joseph, to "sustained persuasion"; and we shall watch the effect of his prescription charges, until perhaps he comes to accept a free family planning service such as the 35 local authorities have provided.
§ 4.8 p.m.
§ LORD PLATT
My Lords, having greatly enjoyed the speech made by the noble Baroness, I nevertheless have to remind her, in view of some of the things that she has said, that the Amendment we propose to-day starts with the words:That this House do not insist on their Amendment to the Commons Amendment in page 4, line 7, but propose the following Amendment in lieu.…In other words, we are not really reversing a decision of another place: we are proposing some kind of compromise which some of us think to be an extremely important one and which is not likely I think, to raise any financial problems.
I go along with other speakers in acknowledging the great advances made by this Government in bringing a family planning service into the National Health Service, and I give them full credit for what they have done. The arguments in favour of this particular Amendment have been so well put forward by the noble Baroness, Lady Serota, and by the 402 noble Lord, Lord Redcliffe-Maud, that I shall not attempt to go over the ground again in any way. I should merely like to speak for a moment as a medical scientist who has been on a medical research council for two periods amounting to about seven years in all, and to say how much we all regret the lost opportunities for the controlled experiment. Perhaps your Lordships will forgive me if I digress for a moment to one of these opportunities which was in fact not lost. When I was in North Africa during the war, almost the whole of the troops were down with dysentery. We had limited supplies of sulphaguandine, a newly discovered drug which was said to be effective in the treatment of bacillary dysentery. The fact that we had limited supplies gave us the amazing luck of being able to plan controlled experiments which would not have been ethical had we had enough to give this treatment to every person.
Medical science has been bedevilled in recent years by the many lost opportunities. When a new drug is put on the market which is said to be, if not a wonderful cure, an improvement on anything which has been done before, it is used with such enthusiasm by many doctors who do not keep their records properly. No control trial is done and even years afterwards nobody who has an objective mind really knows whether the new drug (which probably cost six times as much as the old one) is any better than what we had before.
Here is a wonderful opportunity of continuing free contraceptive advice and appliances without prescription in those areas where it already exists and comparing the results in a few years' time with those in areas in which the people are obliged to pay a prescription charge. One of the arguments of the Government is that a small prescription charge will not deter those who want family planning advice and materials. Our argument—and I am speaking of our argument in this House where, I take it, I am preaching to the converted since this House have shown their views in no uncertain way on two occasions—is that perhaps the prescription charge does deter and we think that is evidenced by the experiments already in progress in the London boroughs and elsewhere. When the comparison comes to be made, 403 we shall then know which argument is right and which is wrong, if we now introduce a prescription charge for everybody all over the country, we shall probably never know. For that reason alone, I think this Amendment is very worthy of your Lordships' attention.
§ 4.14 p.m.
§ BARONESS SUMMERSKILL
My Lords, I have spoken twice on this subject but I was surprised when the noble Lord said to-day that he could not visualise certain areas (there are, I believe, 33 or 35 of them) operating a free service in a country where there are many other areas which were charging. I found that difficult to understand. The service is already being operated successfully in these areas. These prototype areas are invaluable. We shall in a few years' time be able to examine the infantile mortality rate and the maternal mortality rate and gather all these and the other statistics that we want by comparing the areas where the service is operated freely with the others where it is not.
The other point is that this is not new; there are plenty of precedents for this. Those who have lived for some years and who have cut their political teeth on a local authority will recall very well that when the 1918 Maternity and Child Welfare Act was introduced it was not compulsory but permissive. Throughout the country we had what people like me called the "progressive areas" where they established maternity and child welfare clinics. In other words, for many years we had the two kinds of service: we had the boroughs who were prepared to spend their rates on these clinics and the others who were not. What happened was inevitable. If one borough was doing it then the adjacent one who had failed to do so was soon "prodded" into following suit by its mothers who said, "Look at what so and so are doing!" My Lords, we have lived through this. The social services of the past were often voluntary. In some cases we were supported by members of the Party of noble Lords opposite those local authority areas where men and women knew that it was the right thing to do, to get things going.
What we are asking for is simply that the 33 areas who are in the van of reform, 404 who have established this service, who are showing it can be done and who will be able soon to give us these important statistics, should continue the good work.
§ LORD SOMERS
My Lords, my own convictions in this matter are the exact opposite of all those who have spoken so far. But I shall not weary the House with my personal convictions. I should like to draw your Lordships' attention to one or two aspects of this matter. This House, as one of the two Houses of Parliament, has been once or twice during the past few years in a rather precarious position. It is rather more secure now than it was a few years ago; but I think that it would be very unwise indeed for us deliberately to try to go against the other place in their decision. I think that a very likely outcome of that would be that we should no longer be given no powers of major legislation. Therefore, I think that it is purely worldly wisdom to abstain from this Amendment that we have been discussing.
There is one other point which perhaps the noble Lord, Lord Aberdare, can clear it up. This prescription charge is constanly being referred to as a percentage. I wonder whether the noble Lord could give the House some idea of what the charge would actually be in terms of money—because considering what the young spend on transistors and discotheques and various other forms of amusement, I do not think it would hit them very hard.
§ LORD ABERDARE
My Lords, the reason for the noble Lord's confusion is that several noble Lords have unfortunately referred to "20p" instead of to "20 pence"; and the noble Lord, Lord Somers, thought they were talking about "20 per cent." The prescription charge is 20 pence. A prescription would normally last for several months and therefore the charge would be fairly minimal.
§ LORD GARDINER
My Lords, may I say to the noble Lord, Lord Somers, that I do not think it is the young people that we are worried about. We are worried by the fact that where there are free contraceptives, experience has shown that the service is used by a not inconsiderable group of men and women who have been married for years and who already have three, four or more children. They have 405 never used contraceptives and have now come to the conclusion that they have as large a family as they want and, if the husband is a low wage earner, as large a family as they can afford. It is because they have three or four children that they have to think of the pennies—particularly owing to rising prices. The Government answer is that there are certain exceptions to the prescription charge and that this is one of the very groups for which there will be an exception, the low wage earner.
Of course, the difficulty arises when someone asks, "Shall I have to pay or not?" And you say, "Well, it depends on whether your net income is not more than 50 pence higher than the supplementary benefit level." The person says, "What is the supplementary benefit level?", and if one knows, one tells him. Then it depends, if I follow it rightly, on what is their net income. The net income is, if I am right, the gross income with a large number of deductions of expenditures which people of this type simply do not know about. They may know some of them, but they do not know the others. It all has to be put down on a form. You have to go to the Post Office where it is not the obligation of the Post Office officials to tell you what form you want. You must know that the form is PC.11. Experience has shown that, certainly in some areas, about 25 per cent. of the Post Offices have not copies of the form in stock, and in some Post Offices they have never heard of them at all. But it is this sort of person who is the concern of many of us, and not young people.
I must join with the noble Lord, Lord Platt, in deploring the fact that now we shall not have a controlled group. I appreciate that the Government say that whether or not contraceptives are free of prescription charges will not deter people. Family planning people think that it will. If the existing local areas where it is already free could be left at least for the time being, then in due time we should know, instead of having to guess. I think it requires some justification for a Government to introduce a Bill, the sole declared purpose of which is to reorganise the National Health Service, and then use it to deprive some millions of people living in these areas of their existing rights.
§ LORD ABERDARE
My Lords, I should like to put the noble and learned Lord, Lord Gardiner, right on one thing about the forms that he mentioned. The fact is that the Domiciliary Service, which is provided at the moment in many areas, is free, and if the person who has the authority to visit a family finds that the family is really in need of help he can without any question of going into detailed financial arrangements, authorise them to go to a clinic and get free supplies. That is what is to continue. People on supplementary benefit and family income supplement automatically get free supplies. The other people whom the noble and learned Lord was talking about who have to get forms, get them for the normal prescription charges. This is to help those people who are just above the supplementary benefit level.
§ LORD HILL OF LUTON
My Lords, may I comment on one aspect of the narrow proposition which is, in effect, before the House. The noble Lord, Lord Redcliffe-Maud, spoke as if there was no problem in London, although there might be a problem outside London. But, surely, that is not the case. There will be parts of London where contraceptives will be provided free and parts where people will have to pay for them. If you look outside London, under the provisions for the reorganisation of local gvernment three or four authorities may be assimilated into one authority and there may well be one part of that new authority's area which at present is administered by a local authority which provides a free service. And so under the one local authority you will have one part of the area where the contraceptive service is free and in the rest of the area people will have to pay.
I am in broad sympathy with this movement for a free contraceptive service. But I believe that the proposition in this Amendment, in the last paragraph, is unfair to people; in that some will get a free service and some will not, and it will create a problem. I am not impressed by the argument that you need a controlled area for the purposes of research. To my mind this Amendment would be grossly unfair, in that some people, for historic reasons, will be able to get contraceptive appliances free, and others in the same authority area will get 407 them only on payment through a prescription.
§ BARONESS LLEWELYN-DAVIES OF HASTOE
My Lords, may I interject to point out to the noble Lord, Lord Hill of Luton, that this situation exists in London now. It is possible to get contraceptives free in some boroughs but not in others, and there will be no difference.
§ 4.25 p.m.
§ LORD VERNON
My Lords, I am one of those on this side of the House—I do not think that anyone from this side has spoken, apart from the Minister—who believes very strongly in the advantages of free contraception. I gave my reasons fully last week and I will not weary your Lordships by repeating them this afternoon. Because that is my belief, I think that what this Amendment seeks to do is correct. I think it is a retrograde step to take away from local authorities benefits which the people in those local authority areas are enjoying now. I would prefer that such benefits were enjoyed by everybody, but another place has decided otherwise.
Having said that, my Lords, may I say that the other place has considered this topic on two separate occasions. It is true that the Amendment has not been considered on two occasions, but on only one occasion. But there seem to me to be disadvantages in tossing this particular ball backwards and forwards between the two Houses beyond a certain time. I feel that it could be counter-productive if we pursue this matter too far, and I hope that the noble Baroness, with whom I agree so wholeheartedly, will take that into account when deciding whether to press the Amendment. This Amendment is more restrictive than the last Amendment in what it tries to achieve, but the issues which the other place will have to reconsider if the matter goes back to them are basically the same.
The only other thing I wanted to mention is the remarks made by my right honourable friend the Secretary of State in his important speech last Monday night. This has been referred to by the noble Baroness, Lady Serota. I should like to support what she said and what was said by the noble Lord, Lord 408 Redcliffe-Maud. The actual words of the Secretary of State were:Indeed, there would be power by regulation to abolish charges for contraceptive supplies if this turned out to be the right social priority and if evidence showed that our judgment was wrong."—[OFFICIAL REPORT, Commons, 2/7/73; col. 178.]If there are to be prescription charges everywhere, and if the local authorities who practise free contraception now are no longer to be able to do so, there will be no yardstick by which the Secretary of State can judge this matter. That point has been made before in this debate, but I do not think it can be made too often. I hope that the Minister will be able to answer it. He says that there are administrative difficulties, but we have also been told by people with great experience that these difficulties could be overcome.
I think that the gulf which separates the Government and those who think as I do is really very small. That is what is rather sad about the whole issue. We are all trying to achieve the same objective, or nearly all of us, which is to reduce the number of unwanted pregnancies. I believe that to be the Government's objective just as it is my objective, but in my view the way the Government are seeking to achieve it is not correct. I hope that the noble Lord, Lord Aberdare, will consider, even if they cannot accept the whole of this Amendment, whether certain selected local authorities should not continue the free service on an experimental basis. It need not be a permanent basis, but for a matter of two or three years. We should then be able to judge whether the Secretary of State is correct when he says that prescription charges will not act as a deterrent, or whether we and the Family Planning Association are right in saying that it will.
§ 4.30 p.m.
My Lords, I intervene for just a moment to ask my noble friend when he replies to help us about a point which I have been waiting to hear argued this afternoon, but which so far has not been argued. If we look at the back of this paper on which the Amendment is printed, we see that the other place rejected the Lords Amendment to the Commons Amendment for one reason and one reason only:Because the said Lords Amendment and the said disagreements by the Lords to Commons Amendments involved charges on public funds.…409 This is a constitutional point—and I am no constitutional lawyer—of financial privilege, and I have not heard it argued this afternoon. Surely if the Amendment in the name of the noble Baroness, Lady Serota, is passed we shall involve charges on public funds. If the Bill as it now stands is passed, your Lordships accepting the Commons rejection of our Amendment, there will be authorities who will charge who did not charge before; but if the Amendment is passed, those authorities who did not charge before will continue not to charge. Does not that involve charges on public funds? Should we not be confining our arguments this afternoon, not so much to the merits or otherwise of free contraception, which have been argued back and forth on previous occasions, but to this financial privilege point?
§ LADY RUTHVEN OF FREELAND
My Lords, I should like to say a few words in support of what my noble friend Lord Vernon has said. I went to the other place on Monday night. I listened to the Secretary of State and I was delighted by what he said. I felt that if we had only known before what he then said we might never have had our last debate or moved the Amendment. I was particularly struck by what he said about increasing domiciliary visits, and the fact that there were Regulations which he could change and have free contraception for everyone. That is what we wanted when we moved the Amendment, and that is what he said. As I say, if we had only known that before, I do not believe we should have had such a long debate on the subject. I wish to support what my noble friend Lord Vernon said. I do not see how one could expect any report from Area Health Authorities on this question. There must, in my view, be some control. I entirely agree with the noble Lord, Lord Platt, that in all medical matters—and I know a little about horticulture and agriculture—there must be a control. I do not go as far as the Amendment which is before us. I should like to see the Secretary of State choose a town, or more than one town, to be used as an experiment.
§ BARONESS ELLIOT OF HARWOOD
My Lords, I shall be quite brief. I am one who has voted consistently for the free contraception service, and I still wish 410 that the Government were prepared to accept it. I am glad to hear from my noble friend Lord Aberdare that the views of the Government are flexible, because it seems to me that they could easily agree to having one, two or three areas where the results of free contraceptives could be assessed in a proper manner. I hope that when my noble friend replies he will confirm that. I do not feel that I can vote on this matter, because I feel so strongly about free contraception, but I agree with those who have talked in terms of the Parliament Act. The Parliament Act 1911 was put through by Mr. Asquith (my brother-in-law, it may surprise your Lordships to know), who was the Prime Minister of the day. I cannot help feeling that at this moment his ghost must be circling round this Chamber, because the Parliament Act was passed to curb the reactionary views of your Lordships' House. To-day the Parliament Act is being invoked because (as some of us think) there are reactionary views in another place. I am sorry about that, but I feel that on this occasion, if there is a vote, I shall have to abstain.
§ LORD KINNAIRD
My Lords, there is one point which I think I am right in saying the Minister mentioned but which seems to have escaped your Lordships' notice; namely, that this Bill is to take effect as from April 1. Whether that is a wise date to choose I do not know. I have listened with interest to the many opinions on whether or not contraceptives should be free, and while sympathising deeply with many points that have been put forward I think there are other factors to be taken into account. I am in favour of free contraceptive advice, but I am not so sure at this stage about free contraceptives. It does not seem right to me that so much money should be given away at other people's expense. It is not that I grudge the money, but to-day there seems to be almost an obsession to give things away as of right. Some years ago the Evening Standard ran a column called Today in Court, and one evening it reported that a respectable looking man stood in the dock accused of stealing money from church boxes. "I cannot understand", the magistrate said, "how a seemingly well-to-do man like you can bother over such petty amounts". The man said: "Oh, but you 411 do not understand, sir; 2s. 6d. here and 5s. there soon mounts up". No, my Lords, it is not the money, but the principle involved, that matters. I shall not vote against the Government.
Before resuming my seat, I should like to say one more thing. It may be that there is a hope that contraceptives, whether freely or not freely given, will do something to reduce the birth rate in this small and beautiful land of ours, once described by Shakespeare as aprecious jewel set in a silver sea",in which case, bearing in mind the vast number of people who have been allowed to enter this country, for better or worse, I should like humbly to suggest to the Government that, before it is too late, instead of handing out ever-increasing benefits, often open to abuse, they should consider imposing a tax on all married or unmarried people with more than four children.
§ 4.40 p.m.
§ BARONESS BIRK
My Lords, there is one point I should like briefly to make arising out of what the Secretary of State said in another place, as reported in column 176 of Hansard on July 2. He said:Secondly, we shall encourage the Health Education Council and the new area health board authorities to give much increased publicity to the services which will be available under the National Health Service. Much of the increased take-up in the free zones stems from increased publicity.He then went on to discuss the question whether the 20p is a deterrent or not. What puzzles me, having worked closely with the right honourable Member in the other place when I was Chairman of the Health Education Council, is the tremendous emphasis he always, in my view quite rightly, put on the need for evaluation and monitoring. And to make that statement, that much of the increased take-up stems from the increased publicity, is something that in these days of research just cannot be done.
I am very surprised, because in the past the Secretary of State has alway been careful to insist on monitoring and evaluation. All the evidence we have at the moment points to the fact that publicity on its own, and not backed by something 412 as substantial as the free contraceptives which have been given out in the 33 areas, really has very little effect. In fact, the evidence up to now—and this is why we need a much more scientific basis for it—appears to be lending support for the free services. Brent spent a minimal amount of money on publicity; nevertheless, in the first six months of the free service, the take-up increased by 68 per cent.
For that reason—and I certainly will not go over all the other points, which I support, made by so many of your Lordships who have spoken—I believe we ought to have a much firmer and more specific answer to what is meant by the question of control, and how far the regulations will allow the various areas to be used as experimental control areas. May I also remind the noble Lord, Lord Hill, that this has always been the case, not only, as at the moment, as regards free contraceptives, but in all sorts of other services. We ought not to go backwards and charge everybody; we ought to go forwards and see whether in fact the right thing is not to charge anybody.
§ VISCOUNT MASSEREENE AND FERRARD
My Lords, may I refer, very briefly, to a point made by my noble friend Lord Kinnaird? He was worried about the financial aspect of providing a free contraceptive service, but I think that by doing so we shall in fact be saving money, because to start with we shall not need so many civil servants looking after the forms and the numbers of exemptions. Also, in a previous debate on this subject we discussed the great saving that could result from the fact that there would not be so many abortions and children in care as a result of unwanted pregnancies. Many of us consider that we might probably gain more than the £3 million that it would cost, so it is said, to have a free service.
§ 4.44 p.m.
§ THE EARL OF PERTH
My Lords, I have listened with great interest to all that has passed to-day. It seems to me that the point made by the noble Earl, Lord Waldegrave, is one of great importance. As I understand it, the present Bill lays down that there shall be charges for these prescriptions. If the Amendment now proposed went through, it 413 would mean that those charges would be varied, so that once again we should be going back and challenging the other place. My mathematics on this are somewhat as follows. I understand that the figure of charges to-day would be approximately £3 million. I have also heard that on this basis some 20 per cent. of the service would be free, if accepted. That is to say, there would be a charge of some £600,000. I do not see how we can get away from that; so let us be quite clear about what we are doing. If we are going to press this Amendment we are going back to challenge the other place once again—and I, for one, do not feel able to do it.
The only other point I should like to put to all those who have been so successful in what they have achieved already—and they have been extremely successful, though I am not going into the merits or demerits of what has been done—concerns the Statement by the Secretary of State, which shows what liberty of action he will have. Given that, together with the constitutional point on which I have already touched, following what the noble Earl, Lord Waldegrave, has said, I think it would be wrong to press the Amendment and that either we should not press the Amendment or, if it is pressed, should vote against it.
§ 4.47 p.m.
§ LORD SHACKLETON
My Lords, this is the first time that I have spoken on this Bill and I am intervening partly because of the constitutional issues which will be raised and which I propose to deal with. First, however, I should like to say that I believe your Lordships have a great deal to be proud of in respect of this Bill. The noble Lord, Lord Vernon, and certainly a number of noble Baronesses and others, have enabled us to maintain the reputation of your Lordships' House in social matters of being a reformist and modem House—an image very different from what it has had in the past.
In our debate to-day we have, on the whole, concentrated pretty narrowly on an Amendment to which I shall refer briefly. I am also bound to refer to the speech of the noble Lord, Lord Kinnaird, who took us from Shakespeare to the marriage service. He quoted the words 414 of John of Gaunt, which made me think of what would have happened if there had been a family planning service in his days—because John of Gaunt was one of my ancestors, though, I am afraid, on the wrong side of the blanket. Nonetheless, the debate has largely focused on a narrow field: whether or not it would be right to preserve what is already here; namely, existing free family planning services in a number of boroughs, about 19 of which, as the noble Lord, Lord Redcliffe-Maud, pointed out, with great vigour and to some extent in refutation of the noble Lord, Lord Aberdare, are in the London area so that their boundaries will not be affected.
As I have said, I believe that your Lordships have achieved a great deal and I also think the Government Chief Whip has achieved a gread deal—he has a very full House to-day. Yesterday, a number of noble Lords were absent, as we thought, being instructed in family planning; and here they are applying their knowledge to-day. It is obvious that a number of his noble friends have been put under great pressure not to vote for an Amendment. I hope that noble Lords who, when it comes to the end, find that there is after all, no Division (and I shall perhaps have something to say as to how I would recommend my noble friends to act in this matter) will not feel that their journey has been wasted. I feel that, though this is not a subject of necessarily great public interest (indeed, it has been suggested to me that perhaps we ought not to waste time talking about this but, instead, should use it more profitably on debating the Industrial Relations Act or something like that), this is classically the area in which your Lordships have played a role; and a very successful one.
The noble Lord, Lord Aberdare, in what was, if I may say so, a very gracious opening speech, said that we have achieved a great deal in this Bill. It is unfortunate, as I think some of your Lordships have said, that we have had some rather late revelations about the powers that are actually in the Bill. It may be that we ought to have studied the Bill, but by and large we do look to the Government to help us in these matters; but it was not until earlier this week that the other place were told by the Secretary of State that there would be powers in the Bill, by regulation, to 415 abolish charges for contraceptive supplies if this turned out to be the right social priority and if evidence showed that our judgment was wrong. What we are proposing to do in this Amendment is to provide a means to establish whose judgment was right, by carrying out a controlled experiment of a kind which the noble Lord, Lord Platt, justified very effectively. It is inevitable that in carrying cut experiments—and I am sure that the noble Lord, Lord Hill, as a doctor, would agree that not all patients are treated with absolutely the same medicine, or indeed with the same justice—that in fact it is necessary to progress to carry out such experiments.
It is a great pity that those local authorities who have pioneered, very largely at the expense of the ratepayers, in a direction which clearly your Lordships—and indeed a majority in another place—would have wished to go, are to be prevented from so doing. If we were just voting freely again to-day on whether there should be a free contraception service I have no doubt that the majority of your Lordships would support this. We have in Sir Keith Joseph an able Minister who is wedded to a principle. I am not trying to make a purely Party point because all Ministers are liable to adopt a doctrinal approach similar to the one that we saw with the museum charges, and I regret that. But I am not going to advise my noble friends to take this Amendment to a Division.
I should like to give my reasons for saying that. I should also like to deal with the constitutional aspect raised by the noble Earls, Lord Waldegrave and Lord Perth. What we are doing, and what we would do if we were to send this Amendment back to the Commons, would be entirely correct constitutionally. I am talking about constitutional right, and I will seek to explain. The only difference between the number of Amendments that we send to another place, which are sometimes rejected where there is a question of financial privilege, and other Amendments is that the Commons actually give the reason of financial privilege. It is up to the Commons to decide whether or not they wish to assert that privilege. As Erskine May makes clear, it is usually sufficient for them to hint or make mention of financial 416 privilege for your Lordships to accept it. We are accepting it.
What we proposed in this Amendment was to invite the Commons to consider a variation on it. We have accepted regretfully that they have rejected the main Amendment. It would constitutionally—and I am speaking in constitutional terms rather than in terms of practice—be perfectly proper for us to do that. The question is whether we should do so; and that is another matter. Here I am bound to say that the reason that would influence me least of all in this matter is the one that the noble Lord, Lord Somers, put forward; namely, that the Lords would be punished and not be allowed nice Bills in the future. I remember that on a number of occasions when we were in dispute with the Conservative Party, when they were in Opposition, the noble Lord, Lord Carrington, who did such a good job in Opposition, when confronted by a particularly difficult argument used to get up and urge his Party that the whole business was so unworthy that they should ignore it and not even vote against it. The one thing that stung him was if he thought there was a threat to do something to the Lords. At that moment there would be a growl of anger from the Tory Benches. I am not going to growl with anger, but I deeply regret the suggestions that have been put round that the House of Lords are not likely to recieve another major Bill in future.
I congratulate the Government, and the noble Lord, Lord Windlesham, and his predecessor, together with the Government Chief Whip, upon the very much better time-tabling which is going to enable us to get up before the end of July. We have done a good job on this Bill. I hope that it will be made clear to Ministers (it does not matter whether they are Conservatives or Labour) who not unnaturally get slightly irritated when anybody opposes their ideas and throws their timetable out of gear, that this is not a reason that we can take into account in deciding whether we should support the Amendment. There is some force in the argument that we ought not to send this Bill back again to the Commons on grounds not of constitutional law, but of practice between the two Houses. Furthermore, it would be unlikely to succeed and therefore it is 417 undesirable to establish a precedent which, on the whole, I should regret. We have to show some restraint here; we have a great deal of freedom. The Government Chief Whip and the Leader of the House do not cause deep anxiety to noble Lords on their side who do not always toe the Party line; and we treasure our freedom. Because we have this degree of freedom we have to show a certain amount of restraint.
It is a pity if an experiment is not carried out. But once again we have had another revelation from the Government: I am grateful to the noble Lord, Lord Aberdare, for saying something that I believe has not been said before —that is, that the Government have power to have controlled experiments. This is not just a matter of Party politics, it is a matter on which many of us, like the noble Viscount, Lord Massereene and Ferrard, and others, feel very strongly; this is in the social interest. Further steps in this direction will reduce the number of unwanted births and the number of abortions. This is not just a matter of curative medicine but a matter of applying desirable social institutions. We have achieved most of what we wanted. I do not believe the proposals on the domiciliary side are a substitute, but we shall see. We shall look forward with interest to what the noble Lord, Lord Windlesham, says. I hope that he will be able to tell us that at least consideration will be given to arguments which have been put forward. I would advise my noble friend, if the House so agree (and we wait to see what the noble Lord, Lord Windlesham, says), to ask leave to withdraw the Amendment. This would be the final stage in a Bill in which, by good co-operation of a kind that we manage to establish in your Lordships' House, we have achieved a great deal and have something of which to be proud.
§ 4.58 p.m.
§ THE LORD PRIVY SEAL (LORD W1NDLESHAM)
My Lords, like the noble Lord, Lord Shackleton, this is the first time that I have spoken on this Bill. But that is not for lack of opportunity, because the Bill has been before Parliament for eight months. It was introduced in this House on November 15, and the Second Reading was on December 4. Since then there have been four 418 changes to the original proposal in Clause 4 relating to family planning. I do not propose to go through all of them in detail, though I have equipped myself to do so. The final stage took place in the House of Commons on Monday of this week, on July 2, when the Commons insisted on their own Amendment of April 17. As has been said on a number of occasions this afternoon, the only reason given was:Because the said Lords Amendment and the said disagreements by the Lords to the Commons Amendments involve charges on public funds, and the Commons do not offer any further Reason, trusting that this Reason may be deemed sufficient.This part of the Bill has been changed on no less than four occasions: twice by your Lordships, twice by another place.
I agree with my noble friend Lord Vernon, whose speech we listened to with such close attention, that it would be counter-productive to toss this particular ball back to the Commons again. On Monday of this week the Commons specifically claimed financial privilege; often they waive it but they did not do so on this occasion. Nor is there any possibility that financial privilege would be waived if the Amendment before your Lordships to-day was sent back.
In reply to the questions put by my noble friends Lord Waldegrave and Lord Perth, I would point out that the Amendment before the House this afternoon would involve a charge on public funds because it would involve a net increase in the amount of expenditure. In the areas referred to in the Amendment, the Secretary of State would be prevented from making off-setting charges. I am well aware—
§ LORD SHACKLETON
My Lords, if the noble Lord is leaving the financial point, may I say that this is rather important in constitutional terms. Of course, a very high proportion of what we do here involves financial charges, and indeed the Commons would be perfectly free, if we did send an Amendment back, to accept it if it chose to do so. It is important that we should get this point right. If the Commons in fact rejected it, it would again plead financial privilege. For other reasons, I think it is right we should not do so, but I would 419 not wish the House to be misled, as I see it, on this point.
§ LORD WINDLESHAM
My Lords, there is nothing between us on that point. I agree entirely with the noble Lord. It would be open to us. I just think it would be a grave mistake to do so.
I was saying that I am well aware of the strong feelings in your Lordships' House on this issue. Those who feel deeply have pressed their case effectively and achieved a very great deal. I would pick out and underline three achievements over this considerable period of eight months since the Bill was first introduced in this House. First, the concern which your Lordships have shown for the expansion of family planning has had a considerable effect on Government thinking and on public policy. As a result of views expressed, not only by noble Lords but also by other responsible bodies, the Government are now talking in terms of a family planning service whose cost, when fully developed, would be roughly twice as much as the cost of the proposals originally announced by my right honourable friend the Secretary of State for Social Services on December 12 last year. There can seldom have been such a marked expansion of expenditure on a single item as there has been in this case since we came to office in 1970. As my noble friend Lord Aberdare mentioned in opening the debate, expenditure on family planning then, in 1970, was running at a level of approximately £1 million a year; now the estimated cost of the Government's present plans will amount to something of the order of £30 million per annum.
Secondly, at the same time there has been a noticeable change of attitude which your Lordships have helped to bring about. The debates in this House and in another place over the past months have generated widespread publicity about the rapid and determined expansion of family planning services under the National Health Service. This, together with the general concern and urgency that has been expressed, has helped to create a climate of opinion in which more people should be encouraged to come forward for help under the new services. The Government acknowledge, even if somewhat ruefully, your 420 Lordships' contribution to the wide publicity that this issue has received. The Department of Health and Social Security is already encouraging the widest possible publicity. The only difference between their efforts and those of your Lordships is that in this case the publicity has been free.
The third achievement is this. In his speech in another place on Monday, my right honourable friend the Secretary of State for Social Services gave an explicit assurance that the power to make charges is a flexible one. In her opening speech in moving the Amendment, the noble Baroness, Lady Serota, asked whether this statement could be elaborated upon. If further experience shows that the present proposals should be looked at again, there is a power in the Bill enabling the Secretary of State to do so. I am sure it is right that the expansion of the family planning services should be monitored very carefully, and consideration is being given as to what information will be needed in order to do this effectively. If there are signs that the services are not being used as much as they should be, either in general or by particular groups, further information will be sought to elicit the reasons for this. The Government also intend to consider whether experiments planned on a scientific basis would help in the monitoring process. My right honourable friend would also certainly want to give consideration to any external evidence that people were being deterred from using the family planning service because of the fact that prescription charges applied.
My Lords, I come now to the constitutional considerations, which have also been referred to by the noble Lord the Leader of the Opposition. I do not think we should make too much heavy weather of this. Your Lordships' previous Amendment has been rejected by another place specifically on the grounds of privilege. I was pleased to sense from the debate that your Lordships are now willing to accept this position and do not wish to continue to press the argument in favour of a universally free family planning service throughout England and Wales. If I have interpreted the sense of the House correctly, I am sure that that is a wise conclusion. But we are now asked in the noble 421 Baroness's Amendment to consider sending the matter back to the Commons once again. It would be the fifth change if your Lordships decided on that course of action. It would have the effect that in those areas, or parts of areas, where local health authorities already provide free supplies the National Health Service should continue to do so free of charge.
I do not suppose that the whole Parliamentary edifice would be threatened if the House of Commons was asked to reconsider this matter. But what would it achieve? A similar Amendment was considered in another place on Report and was rejected by a vote of 240 against; 138 for. In his statement on Monday, my right honourable friend the Secretary of State for Social Services referred to this similar Amendment of Dr. Stuttaford and said it would be open to equal or greater objection. He went on:It is surely wrong in a national service that a person's ability to obtain free supplies should depend on the past decisions of a local authority which has ceased to carry responsibility for the service."—[OFFICIAL REPORT, Commons; 2/7/73, col. 177.]Leaving the pros and cons of the issue on one side, and accepting the strength of feeling expressed by those noble Lords who have spoken to-day and who have spoken on many previous occasions when this matter has been before your Lordships, if I am asked for my advice as to what we should do in the interests of the House I would reply, without hesitation, that we should be wise to call it a day.
My Lords, let me end on the narrow point which has been pressed by the noble Lord the Leader of the Opposition and by others who have spoken in this debate. It can be expressed, I think, in the form of a question: Will the Secretary of State allow one or more areas to maintain a free family planning service for the purposes of research? My answer would be to say, first of all, that the Secretary of State has shown throughout this prolonged debate that he has an open mind, and this has been accepted by a number of speakers in our debate to-day. At present he is not convinced that a link has been established between a reduction in the number of unwanted pregnancies and supplies of free contraceptives. The important thing to stress, in his view, is the widest possible availability of these 422 services—domiciliary as well as in clinics —to try to reach those who are particularly vulnerable. Flexibility is contained in the Bill. If the Secretary of State is later convinced that it would be the right social policy to lift prescription charges from these items, then he would be ready to do so; but at the moment he is not persuaded that it would be either practical or desirable to retain a completely free service under the N.H.S. in any of the existing local authority areas where free family planning exists at present, whether for purposes of research or anything else. The matter is, however, under close consideration and will remain so. My right honourable friend will study all the evidence, and will consider whether any sort of small, controlled research projects would help in keeping this matter under review.
I hope that what I have said on this aspect will be helpful to any noble Lords who may still be doubtful. We have heard the advice of the noble Lord the Leader of the Opposition, and I hope that that advice will be heeded. But I do not want there to be any misunderstanding about the firmness of the Government's position in this matter. Equally, I hope that I have been able to convince noble Lords that we have no intention whatever of being dogmatic, nor will we refuse to look at the issue again if it proves necessary to do so in the future. It is now for the House to decide. We have heard all the arguments and it is with some confidence that I ask for your Lordships' support in opposing the Amendment.
§ 5.11 p.m.
§ BARONESS SEROTA
My Lords, I hope the House feels that the debate we have had this afternoon on this Amendment has been worth while. Certainly from among those whose faces I recognise in the Chamber I feel that I have a great deal of support, albeit it perhaps rather more silent to-day than it has been in former debates. Naturally I should like to answer some of the points that the noble Lord the Leader of the House has just made in his winding-up speech, but I also sense that the House would like to come to some conclusion on this matter. I will therefore try to restrain myself, although I confess that I am not 423 persuaded that the Secretary of State has an entirely open mind on this issue.
On behalf of my noble friends in all parts of the House I must express our very great regret that the Government have not been able to move to the point of taking this immediate opportunity to maintain the existing free services as a controlled experiment. We take a little comfort from the words of the noble Lord, Lord Windlesham, that the power exists in the Bill for research and experiment, and we deeply hope that the words he has used to-day will be followed by the Government. I hope that all concerned will continue to press the Government on the introduction of a general family planning service within the National Health Service, with a view to seeing that proper controls and monitoring are included in the scheme. But, for the reasons given by my noble friend the Leader of the Opposition, and I hope with the consent of the noble Lords, Lord Radcliffe-Maud, Lord Platt and Lord Tanlaw, who also put their names to this Amendment, I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ THE LORD CHANCELLOR (LORD HAILSHAM OF SAINT MARYLEBONE)
My Lords, the Question is, That the House do not insist on their Amendment to the Commons Amendment at page 4, line 7.
§ On Question, Motion agreed to.
§ LORD ABERDARE
My Lords, I beg beg to move that this House do not insist on their disagreement to the Commons Amendments in page 63, line 13, and page 69, line 37, which are consequential Amendments on the main Amendment.
§ Moved accordingly, and, on Question, Motion agreed to.