HL Deb 25 June 1973 vol 343 cc1723-60

[No. 7] Clause 4. page 4. line 7, leave out from "and" to second "for" in line 8 and insert "it is hereby declared that the power conferred by section 1(1) of the National Health Service Act 1952 to provide for the making and recovery of charges includes power to provide for the making and recovery of charges".

3.45 p.m.


My Lords, I beg to move that this House doth agree with the Commons Amendment No. 7. It might be convenient to your Lordships, including those who have Amendments on the Paper to this Amendment, if we spoke at the same time to Amendments Nos. 112, 114 and 129. It is almost six months to the day since your Lordships expressed your firm belief in expanded family planning services and rejected the Government's proposals for the making of charges to the majority of patients. The proposals we announced on December 12 last year seemed to us then to strike the right balance between the need for free supplies for certain cases and the economic cost of free supplies for all. But Parliamentary and public opinion has moved very noticeably towards the provision of supplies on a more generous basis than we had proposed, and, as a result of the views expressed in this House and representations made by various professional and other responsible bodies, we have looked again very carefully at the issues involved. This reconsideration led to the announcement made in another place on March 26, that the Government intended to make family planning supplies available at the prescription charge rate, with the usual exemptions, and that the service would be provided on the same basis as other parts of the National Health Service.

With your Lordships' permission, I would quote a short passage from the speech made by my right honourable friend the Secretary of State for Social Services during the Committee stage of the Bill in another place. He said: The Government changed their mind partly because of public opinion, partly because of the evidence of opinion of our own colleagues, and because there was a change of opinion inside the Government Party. There was a change of opinion in the country and the Lords represented such a passionate concern to reduce the rate of abortion and unwanted pregnancies that the Government looked again at what they had in mind. That is quoted from Hansard, Standing Committee G, April 17, cols 296 and 297.

Since then there has been a great deal of discussion in another place about whether even a small charge such as the prescription charge for supplies will act as a deterrent to the take-up of services. I think that most of your Lordships will accept that there is a very great difference between a prescription charge of 20p, which will for the most part cover supplies for several months, and the arrangement that we were considering previously on December 19, which was for an economic charge for supplies for most people, which would have been round about £4 a year. Much evidence has been quoted both in this House and in another place from areas which have provided an entirely free service and which have seen large increases in the numbers of women receiving contraceptive help from clinics. Apart from the general argument that a change in service provision of this type is nearly always accompanied by much publicity and by an increase in clinic sessions and premises, I think we must bear in mind that the comparison is only with the existing system of family planning in which invariably a considerable charge is made for supplies, and not with the new system which we are now proposing.

We have three very good reasons why we have not gone quite so far as your Lordships did on December 19. The first reason that I would put before your Lordships is that the family planning services, from April 1 next year, will be seen as an integral part of everyday health care provided by the National Health Service. All differences will be abolished and this should help to persuade those who now find it embarrassing to seek help that this is just one of a number of services to which they are entitled.

The second reason is that the cost of providing entirely free supplies would add another £3 million to the already considerable increase which is entailed under the present proposals; and £3 million is no inconsiderable sum when there are so many pressing needs in the health and welfare field. The effect of reducing the maximum cost of supplies to the prescription charge is to increase the estimated eventual cost of family planning services to £30 million in Great Britain.

The third reason is perhaps the most important one. We believe that the majority of people would consider it wrong if the Government were to make family planning supplies entirely free while those who are sick have to pay a prescription charge for their drugs—in some cases the drugs which they require for their very lives.

These debates on family planning have taken up a great deal of time in the course of the passage of this Bill through both Houses of Parliament. There are those on the one side who feel that we are going too far and there are those on the other who feel that we are not going far enough. After giving full consideration to the arguments for and against the prescription charge, Members in another place voted decisively during the Report stage of the Bill in favour of the provision of supplies on the same basis as for other drugs under the National Health Service. I hope therefore that your Lordships will accept that the views which you expressed on the Committee stage have had very great impact on the future provision of family planning services and that the Government have gone as far as they sensibly could to meet your wishes. I hope your Lordships will agree to accept these Amendments made by the other place. I beg to move.

Moved, That this House doth agree with the Commons in the said Amendment.—(Lord A berdare.)

3.54 p.m.

LORD VERNON moved as an Amendment to the Commons Amendment No. 7: Line 4, leave out ("includes") and insert ("does not include")

The noble Lord said: This Amendment seeks to make contraceptives and contraceptive appliances freely available instead of subject to the prescription charge as provided in the Bill. If I am successful with this Amendment I shall wish to move a series of consequential Amendments.

Before I come to the arguments, I should like to make two points. The first is that the sole purpose of this Amendment is to give the House of Commons an opportunity for second thoughts on a matter of widespread public concern which has considerable social implications for the future. I think this concern was admitted just now by the Minister when he said that public opinion had moved so strongly on this issue. I feel that in giving them such an opportunity we should be fulfilling one of the principal functions of this House, for which there are good precedents. The final decision rests, as it has for many years and it always must, with the other place.

The second point is that I should be less than generous if I did not recognise straight away that my right honourable friend the Secretary of State has moved a long way towards meeting the wishes of this House when we voted by a nearly two to one majority in favour of a completely free service; that is, that supplies should be free as well as the advice. From an estimated expenditure of £12 million to £17 million when the Bill was first introduced my right honourable friend is now going to spend £30 million. That is a big advance, for which we should all be grateful. But for the expenditure of only an additional £3 million it would be possible to eliminate the prescription charge. The sum of £3 million is not peanuts—we all know that a great deal can be done with £3 million within the National Health Service—but it is a relatively small sum in relation to the whole. When we speak about an expenditure of £3 million it is to some extent misleading because of maternity benefit for unmarried mothers, the cost of abortions running at about £100 a time, the cost of unwanted children in care, perhaps £1,800 a year—and anything that prevents these things happening represents a substantial overall saving both to the Exchequer and to local authorities.

The object of making contraception available free of charge is to reduce further the number of unwanted children in this country, at present estimated at 250,000 a year. There are a number of reasons for this: first and foremost, perhaps, is the need to reduce the 108,000 resident abortions, not counting people who come from overseas. Abortion is a long-stop, and I am sure we should agree on all sides of the House that it is infinitely preferable to prevent a child from being conceived than to abort it when it is conceived. Most of us would also wish to reduce the misery and family tensions that so often go with unwanted and illegitimate children being born.

Finally, and very relevant to some of us—perhaps not to all, but certainly to some—is the effect of unwanted pregnancies on the pressures which are steadily building up in our small over- crowded island as the population continues to increase by nearly a quarter of a million every year. This is not the moment to debate the Report of the Population Panel. Its conclusions are so important, and in some ways so alarming, that I hope a special occasion will be available later for a debate, when the Government have decided on their attitude to it. It is perfectly true that the Panel do not come out in favour of a free service as against prescription charges. Indeed, in the costing of their recommendation that family planning should be integrated with the National Health Service, they assume that prescription charges would be paid, because prescription charges are at present part and parcel of the National Health service. So it was fairly natural that they should do that. But the Panel did not consider the merits or otherwise of prescription charges. Had they done so, they might well have come to the conclusion that a free service was desirable. But that is speculation.

What is relevant about the Panel's Report is their conclusions, and I should like to read two paragraphs to your Lordships. I quote from Command No. 5258, first. Paragraph 35 says: Looking further ahead to the middle of the next century, problems of accommodating a further 10 or 20 million people"—? that is, 10 or 20 million over and above the 10 million that have to be accommodated by the beginning of the century— are likely to be progressively more difficult. Sooner or later, Britain must face the fact that its population cannot go on increasing indefinitely. Society will have to adapt itself to the social and economic implications of an age distribution consistent with a stationary population. Any socially acceptable measures to restrict population growth will inevitably take a long time to achieve their aim, and since the effectiveness of such measures is very uncertain, the time has come when the Government should consider whether, and if so, how to act to influence the rate of population growth. Then on the specific question of family plannng services on the National Health, the Panel says in paragraph 43: Policy in regard to family planning services should take account of population implications instead of being decided, as at present, entirely in terms of its effect on health and social welfare. The first positive step towards a population policy should be the development of comprehensive family planning services as an integral part of the National Health Service, so that everyone knows of their existence and is free to use them.

In my submission, and indeed I believe it is a matter of common sense, if people have to pay a prescription charge they are not "free to use them". There is a hindrance put in their way, which in the opinion of many practising doctors acts as a deterrent. There is a great deal of evidence about that: a free service has been operating in Aberdeen since 1967 and their example has been followed since early last year by nineteen London boroughs and by a number of cities and counties throughout England and Scotland. In all, nearly 20 per cent. of the population of the United Kingdom is benefiting from free contraceptive advice and supplies, irrespective of social or medical need. The experience of all those local authorities is virtually identical: since the introduction of the free service the increase in attendance at family planning clinics has been dramatic. In Birmingham it is up by 39 per cent. in six months; and in Hammersmith it is up by 100 per cent.

The Minister mentioned the question of publicity. He said that some of these results were due to publicity. In the case of the borough of Brent there was virtually no publicity and the increase was, I think I am right in saying, 68 percent. In Camden there has been an increase of 35 per cent. in the number of new patients seen in 1972 over the previous year, and 45 per cent. of the new patients were unmarried. Aberdeen is an especially interesting case because of their longer experience. In six years, I think it is, there have been notable reductions in the birth rate—now at near stability level; in the fertility rate—especially in the reduction of fourth and subsequent children; in high risk pregnancies; and in the infant mortality rate. There have been social benefits in housing and education which are not, presumably, unconnected with these reductions. I do not wish to argue that all these benefits are directly or wholly attributable to family planning or free family planning; but it surely cannot be denied that the free service, administered so effectively by the Chief Medical Officer of Health, Dr. McQueen, has contributed to those results.

To move from Scotland back to England, I should like to quote briefly what was written by the Chief Medical Officer of the City of Lincoln in the British Medical Journal on March 3, 1973. Doctor Haigh said: The case for a free family planning service is overwhelming. The local authority family planning service in Lincoln became completely free in September, 1972, and the number of women attending in the first quarter was twice the average for the previous four quarters. This proves that although the cost of supplies may prove to be insignificant it is indeed a disincentive to many women, and particularly many of the women whose needs are greatest. Those are the views of Dr. McQueen and of Dr. Haigh, two eminent medical officers of health. There are other medical officers of health who agree with them. There are a great many general practitioners who have first hand experience of this matter in the field and they are in favour of this Amendment.

The effect of this Bill is that from April, 1974, all local authorities practising a free service will have to introduce prescription charges. It is not a question, therefore, of not putting the clock forward, but rather one of putting the clock back for nearly 20 per cent. of the population. It is a retrogressive step and it is because it is retrogressive that such deep feeling on this issue has been aroused. How much better if the remaining 80 per cent. could be given the benefits now being enjoyed by the 20 per cent. That is what this Amendment seeks to do.

Lastly, my Lords, prescription charges for contraceptives are illogical. The Minister mentioned just now that one objection to free charges in the view of the Government was that it was not fair that people who are suffering serious illness should have to pay for their drugs whereas people seeking contraceptives should get them free. My answer to that is that preventive as opposed to curative medicine—X-rays, immunisation, and so on—is already free under the National Health Service, and nothing could be more preventive than contraception. There is a further anomaly: for social reasons drugs for the treatment of venereal disease are issued without a prescription charge so that the maximum number of people should benefit. The male sheath accounts for something like 50 per cent. of the contraceptive methods used in this country. I understand that some two million couples use it. Although not foolproof, it is generally agreed that the sheath provides a very high degree of protection against venereal disease. Yet sheaths are to be subject to a prescription charge, whereas drugs used in the treatment of venereal disease are not. What could be more lunatic than that?

I have probably spoken too long to this Amendment already, and I have not even covered all the ground. I have not mentioned some of the difficulties arising from exemptions from prescription charges. But I hope I have said enough to persuade your Lordships that the Government are making a big mistake in not spending the additional £3 million necessary to eliminate the prescription charge and to provide a completely free service, and that we are, therefore, fully justified in asking the other place to reconsider their decision. I beg to move.

4.11 p.m.


My Lords, I have great pleasure in associating myself with the noble Lord, Lord Vernon, in his Amendment. The noble Lord, Lord Aberdare, based his case against the Amendment largely on the question whether many people would avail themselves of the freedom of contraceptive appliances from prescription charges, and upon the argument of expense. But those arguments were, I think, very effectively met by the actual experience quoted by the noble Lord, Lord Vernon. The main arguments about this issue have been put very often. I think the basic position is that we have to be realists. The noble Lord, Lord Aberdare, very generously recognised that public opinion is changing pretty fast, and we have also to realise that sexual behaviour is changing pretty fast and has changed very considerably over the last two or three generations, more particularly among the young. This has not been entirely because of a casual disregard of moral standards. It has also been because a number of serious and responsible people of all ages have come to the conclusion that some of the moral standards of their forebears ought not to be binding to-day, in very different conditions, and that the time is ripe for a reconsideration and restatement of certain of our moral standards in the matter of sexual behaviour.

I do not think we can burke the issue that the real choice will be between contraception and abortion, and that if this Amendment is rejected we shall have to face more abortions. I myself draw a line about abortions which I think is not respected by a great many of my noble friends. I draw a very sharp line between action which prevents the creation of a life and the destruction of a life after it has been created, even at the very earliest possible stage. I do not wait until the stage at which the embryo might be likely to survive if it were delivered. Therefore, for moral reasons, I should myself very greatly abhor anything which encouraged, as the rejection of this Amendment is bound to do, an increase in the number of abortions.

There are also medical and psychological reasons, and these are of major importance in relation to the young. We should not forget that in 1971 abortions were performed on 2,618 young people under the age of 16, and 625 of those were under the age of 15. In the case of these children the choice is not really between producing an unwanted child, which may be a serious enough thing for an adult, and having an abortion. The arguments for abortion are stronger because the burden of responsibility of the child is greater. The arguments against abortion are stronger because the traumatic effect on a young child will be disastrous in many cases. And the arguments for allowing the pregnancy to go full term are also serious on social grounds. Therefore, from every point of view, so far as the young are concerned, it is for their protection that we ought to do everything we can to equip them with contraceptive devices, and put no obstacles in their way in those cases where it is clear that they are going to engage in this kind of activity whether we like it or not. It is for their protection particularly that I would associate myself with this Amendment.


My Lords, may I strongly support the noble Lord, Lord Vernon, and the noble Baroness in the remarks they have made, and particularly underline what the noble Baroness has said on the alternative, which I think your Lordships ought to face, between having a free and comprehensive family planning service and encouraging people to go in for abortions. Whenever we have discussed abortions, whether in this House or the other place, people have always said, "Why don't you argue in favour of a free and comprehensive family planning service?" This is precisely what we are doing. We who support abortions do not do so because we like it; we abhor the very idea. But if your Lordships do not reject this Amendment from the Commons then you are in fact going to encourage people to have abortions.

Do not let us run away with the idea that we are ever going to do away with abortions entirely in this country, or in any other place where free and comprehensive family planning services are introduced, because none of them is foolproof; but we can minimise the extent of them. Certainly I do not think we ought to tolerate a level of abortions as high as the figure mentioned by the noble Lord, Lord Vernon—well over 100,000 being performed on citizens of our own country, quite apart from the large number of women coming from abroad, because this country is the abortion centre of Europe—or so it has been claimed. This is not a status that I like to claim, and I should like to see the number vastly reduced. I am sure that your Lordships could take a step in that direction by approving a totally free service.

The noble Lord, Lord Aberdare, asked whether this small charge would act as a deterrent. I do not think we can afford to take that risk, particularly bearing in mind—and I know this is an argument that will appeal to the Tory Party—that calculations have shown that for every £1 you spend on a family planning service you will save £25 on the kind of expediture which the noble Lord, Lord Vernon, mentioned—maternity benefits, child care, children getting into trouble later in life, education services and so on. If you discount those expenditures back to the time when you have encouraged expenditure on family planning services, you are getting a most fantastic return on your money—25 to 1. Those figures have been borne out by experience in many other countries, particularly in the United States, where the investigation of the benefits to be obtained from family planning have been far more comprehensive.

I do not think anyone has ever disputed those figures which have been produced in relation to this country. Certainly the noble Lord, Lord Aberdare, and his friends in the Department of Health and Social Security cannot get up and say in this House, or outside, that £3 million is, after all, a large sum of money to spend and we have to bear in mind the burden on the public purse which it would create, because the very reverse is true. By spending this £3 million you are saving the taxpayer an immense amount of money in later years, and reducing the human misery and hardship which is caused by even the small number of unwanted births which are going to be prevented by removing this charge from all, and not just from those who are exempt from other prescription charges.

It cannot be doubted, as the noble Lord, Lord Vernon, says, that there is a small minority who will not take precautions, either through carelessness or through laziness, and who will be deterred by even the thought of the 20p which the noble Lord dismisses as an insignificant sum compared with the £4 per annum economic charge if people had to pay for the pill or the sheath. I agree that 20p is a much smaller amount, but I dispute strongly his contention that an expenditure of 20p over several months, which is what we are talking about, is not going to put some people off from using the services. Also I would strongly dispute his contention, which he has repeated, following the Secretary of State for Health and Social Services, that the majority of people would consider it wrong to make supplies of family planning services free when life-saving drugs are charged for on prescription. I do not believe that this is the view of the majority of the general public. I do not know on what authority the noble Lord, Lord Aberdare, makes that assertion, but the public opinion polls that I have looked at show the reverse: that most people have argued in favour, as we are doing this afternoon, of a free and comprehensive family planning service, and they do not equate this kind of expenditure with the life-saving drugs.

My answer to this is that if you object so strongly to having such a differential, why not abolish prescription charges altogether? If the noble Lord, Lord Aberdare, is saying that because we do not want to create an anomaly we will abolish the prescription charge on lifesaving drugs, I will say "Hear, hear!" and go into the Lobby with him. But until we have a government that is committed to restoring free pharmaceuticals of all kinds, then I think that there are strong arguments for making a differentiation, bearing in mind that for every birth you prevent by means of the free comprehensive family planning service you are saving a vast sum of money on the maternity services in hospitals, and on the rest of the expenditure which the noble Lord, Lord Vernon, has described. What is the logic of denying the woman the free service of contraceptives when, as soon as she has an unwanted baby, you are prepared to take her into hospital where the cost is perhaps £50 a week and provide her with the best of medical care? Nobody argues with that, but they are quarrelling with the 20p which it is going to cost the country to prevent those unwanted births. I think it is out of all proportion.

There is tremendous concern, as the noble Lord, Lord Vernon, says, about the quality of life in this country which we are going to experience in the next 30 years as a result of the increasing population. Going beyond that into the middle of the next century, if one looks at the Ross Panel Report, what kind of life are we going to bequeath to our children and grandchildren? What kind of existence is it going to be when, over the whole of the British Isles, people are nose to tail in traffic jams breathing in fumes, towered over by immense office blocks, and covered with cement dust from the factories that will be necessary to support the population? Is this the kind of world we are trying to create?


My Lords, may I interrupt the noble Lord for a moment? In view of the latest figures showing a decline in the birth rate, is he going to be so dogmatic as to say that he is quite sure that there is going to be this tremendous increase? I ask him to look at the latest figures for the movement of the birth rate.


My Lords, this is what people said in the 1930's and the 1950's when the birth rate was falling. They said that we had nothing to worry about any more because, if you extrapolated the existing trends, in a few years we would be below replacement level.


My Lords, may I ask the noble Lord to answer my question? Is he certain that there will be a large increase in the population?


My Lords, I personally am not going to take the risk, if I have any say in the matter. I do not think that it is worth taking the chance that we, in this country, are going to be starved of the resources that we need to maintain our existing standards of life, let alone to increase them. The noble Earl is tempting me into much wider fields, as to whether we shall be able to import the food that we need to support the existing population of this country, when we can grow only enough food indigenously to feed 30 million people. This is a matter that worries me very much. It is not enough simply to contain the population at its existing level: I should like to make every effort to reduce it.

The noble Earl has led me rather wider than the Amendment. I am saying that if the Government will come out in favour of a free and comprehensive family planning service, then we can forget about the £3 million, we can even forget about the few unwanted births, tragic though they are; what we will then be saying is that at last we have a Government committed to a population policy and prepared to take every step, within the confines of human liberty, to bring that about.

4.25 p.m.


My Lords, I should very much like to support the Amendment proposed by my noble friend Lord Vernon. The only point of difference betwen the Government's new proposals for family planning and my own convictions is whether they will make more women use family planning. The Government have rightly pointed out that there is no proof available, and of course we are now talking of the new proposals. I accept that there is no proof in this matter, but I would suggest that plain common sense tells us that a message in the Press or posters in the street or in the buses, saying "family planning is free", is far more likely to attract the attention of those who need it than "family planning is 20p". Also there is evidence that a completely free service increases the use of family planning by those who need it. For example Aberdeen, whose report was rather scorned by the Secretary of State, did begin, as the noble Lord, Lord Vernon, said, as long ago as 1967. They have had a great increase, particularly in social class 5, from 6 per cent. in 1965 to 14 per cent. since 1969. I think that that is very important.

My objection to prescription charges for contraceptive devices is that we may, by this charge, discourage the very people we are most anxious to help. I know that in theory they can get an exemption from charges, or a refund, but in practice they have to go to the post office to get a leaflet and exemption claim forms. Surveys have shown that these forms are not displayed, and sometimes not even stocked, by post offices. A recent survey in Colchester showed that only one post office in nine displayed these exemption forms. I myself have tried to get them from two local post offices, and they did not know what I was talking about.

Regardless of the outcome of this debate, I would ask the Government what assurance they can give us about the availability of N.H.S. exemption forms. If you claim exemption under category 5 (persons receiving supplementary benefit or family income supplement, one of the six categories entitled to claim) you have to apply to the Social Security Supplementary Benefit Offices, or pay the charge and claim a refund. To me it is extraordinary that you can give birth to a child in hospital, which may cost the State a good deal, you can have a free abortion (and that, I know, costs anything from £80 to £100), you can have a vasectomy free, which may also cost the State a large amount of money, but you are now not to be allowed to use, without payment, a contraceptive device which costs 20p.

I should like to add one further illustration of the urgent need for poorer people to have access to family planning advice and supplies free of charge. Miss Ann Cartwright's excellent study (which I am sure most people have read, Parents and Family Planning Services, published in (1970) shows that in the North of England—and I know something about the North of England, having lived there for many years—29 per cent. of working class married women using any form of birth control were using the method of withdrawal by the husband. Withdrawal is perhaps better than no method at all, but surely we should be doing everything possible to attract these women to professional advice on better and safer methods. I believe that only the message that family planning is free will do that.

A very large proportion of unwanted children are the result, I am afraid, of Friday night at the pub or Saturday night at the pub. So many women accept sexual relations as a part of life. They do not particularly enjoy it, but they accept it. They would certainly be much happier if they knew they could have contraceptive advice which would protect them from another unwanted pregnancy.

There are many points that I should like to touch on but I shall not. I shall be very brief. Family planning is best seen as preventive medicine, as has been said by the noble Lord, Lord Vernon, the noble Lord, Lord Avebury, and the noble Baroness, Lady Wootton of Abinger, and I am quite certain that we can only regard it as preventive medicine, because otherwise it is going to cost us all a great deal. About 11 million of our population are at present covered by free family planning services run by local health authorities and family planning associations. It would be shamefully retrograde, and probably very damaging to impose prescription charges now in those areas.

Unfortunately, we cannot change the attitude of young people, and it is young people whom we also wish to protect. The pattern now, in what is called the permissive society, is that whatever we may charge them we shall not prevent them from having sexual relations before marriage, which of course the majority of us older people deplore. But surely it is better to give them contraceptive advice and help than that they should either produce illegitimate children or have abortions. I beg your Lordships to reconsider the Amendment which has come to us from another place, and to substitute the Amendment passed by your Lordships' House to Clause 4 before Christmas.


My Lords, I associate myself with the noble Lady who has just spoken, but on an absolutely different ground—the ground of the dignity of this House. A year ago, we carried this Amendment on free contraception by a very large majority. Shortly after, the Labour Party's magazine hailed it as a victory for Labour. My Lords, it was nothing of the sort. We on this side would never have carried that Amendment had it not been supported by a large number of Conservatives and, I think, by all of the Cross-Benchers.

Shortly after that it was said (I think in The Times by Mr. Crossman) that it was a victory for women Life Peers. My Lords, it was nothing of the sort, as the noble Lady who has just spoken can prove. It was a victory for the House of Lords, speaking and voting independently on a matter of public and general interest and principle. This House was doing exactly what it did in 1906, when it voted on Lord Buckmaster's Amendment against the Conservative Government of the day in favour of the first very tentative public provision of contraceptive advice. On those two occasions this House has been worthy of its existence, and I beg that we may get away with it this time, too.


My Lords may I back up the noble Baroness who has just spoken? When this Bill came before this House I spoke in favour of free birth control prescriptions and, though I appreciate fully how far the Government have come towards the decision of the House of Lords, I am afraid that I cannot vote against this Amendment to the Commons Amendment. I shall vote for it on humanitarian and social grounds. I completely agreed with the noble Baroness, Lady Wootton, when she drew a sharp distinction between abortion and stopping a child before it is conceived. The whole idea of abortion is utterly repulsive and I shall certainly always support anything that can be done to prevent it. I appreciate the fact that the Government have pointed out that there are a great many cases where there are exemptions, but it is very difficult for the less-educated poorer sections of the community to have to fill in these forms. Furthermore, in many cases it will be the woman's responsibility and she may have to pay out of her own pocket, which also applies to unmarried girls. It will be a drawback if we do not have free prescriptions for birth control.

My noble friend Lord Aberdare asked why people should have free prescriptions for birth control if other people have to pay for prescriptions for drugs. There are two answers to that question. First, we do not live in a strictly fair world, and I do not suppose we ever shall. Secondly, we have this social problem of unwanted pregnancies, and I think my noble friend Lord Vernon said that there are 250,000 children in care. I do not want to delve into the financial aspect, because that is rather sordid. There may well be some link between juvenile crime and unwanted children—I do not know whether it has ever been proved, and I do not suppose that it really can be proved—which is another reason why free contraceptive prescriptions are essential.

The noble Lord, Lord Avebury, mentioned the problem of over-population in this country, and I agreed with what he said. Before the noble Earl, Lord Longford, goes out—perhaps he is not going out—may I say that, although the figures for deaths and births have been equalising over the last two years, some of that equalisation is due to abortions; and free contraceptive prescriptions are bound to do away with many of those abortions. So although the noble Earl was correct in what he said about population figures, I do not think the logic of his argument was quite so correct. I will not detain the House any longer. I detest voting against the Government, but I feel that I have no option. This is a humanitarian and a social problem, and we must have free contraceptive prescriptions.

4.36 p.m.


My Lords, I have never before had an opportunity of following the noble Viscount and identifying myself with what he has said. Usually, I have risen up full of sound and fury and have denounced him wholeheartedly, but I agree with everything he has said to-day. I want to make only two points, because I spoke at some length last year and I think the time has come when we should get on to the Division. I have discussed this matter with very many people, including people in the other place, who have given great thought to it and who have felt that perhaps this Bill is being rushed through the House and that insufficient attention has been paid to it. I am sure there are others who, in their hearts, think that what we want to do might pander to the permissive society and suggest to young men and women that their intercourse is favoured by those in authority; otherwise they would not be prepared to distribute free birth control. These things should be said out loud, so that if there are people here to-day who feel in their hearts that, socially, this is the wrong approach, they can consider it further.

The noble Lord, Lord Vernon, went into some detail about the local authorities, but there are 33 local authorities in this country—large and small cities, large and small boroughs—represented by responsible people, who have introduced a free contraceptive service. I want the House to recognise that before they did so there were exhaustive debates in the council chambers, as there had to he. We can sit in this place feeling rather divorced from the feelings of people who may read in the newspaper reports of what we say. But the councillors in those local authorities are living with their people. The local papers report the debates exhaustively, and if constituents feel aggrieved they can attack their councillor in the street, as has happened in many places. But despite that, these responsible local authorities have decided that it is in the interests of the people that a free contraceptive service should be introduced and, furthermore, they have been prepared to spend the rates on it.

I have the great good luck to live in Camden, which I believe is the finest local authority in the country. A month ago, I went to open a Citizens' Advice Bureau in Waltham Forest, which is a very important local authority in the East End, and—although another social service was being discussed—I was impressed by the number of councillors, senior citizens and important people of the borough who turned up to discuss it. These people have already discussed a free contraceptive service and have decided that they should have it. I hope that nobody here will feel that this Bill is being rushed through both Houses by some group which is composed of certain fanatics. That is not so. We are discussing a social service which has already been discussed in detail by huge authorities all over the country. Aberdeen, of course, is a wonderful example, I feel, because Aberdeen was led by a great doctor who defied convention and persuaded the people that it was right to introduce a free contraceptive service.

The only other point I want to make is this. I was utterly surprised at the new point made by the noble Lord, Lord Aberdare, to-day when he said that people who have to pay for their drugs will be a little jealous of those who have a free contraceptive service provided for them. My Lords, what a ridiculous thing to say! How can we compare the woman or the man who needs a tranquilliser because they have had a row with their spouse, and who has to pay for that tranquilliser, with the need of a poor woman who has had a number of children and who wants to limit her family, and whose husband perhaps has too much to drink on a Saturday night? Can we compare these two things? Does the noble Lord know that to-day there are such things known as iatrogenic diseases which are appalling the medical profession and which stem from consuming drugs which have not yet been adequately tested? In the case of almost every hospital now patients are being admitted with obscure symptoms, and after a time the consultants say that they are due to a certain drug. In the United States they take a firmer line about it, and I hope that we here shall change. But these people certainly consume these drugs, which cost money.

Here we are talking about something which I believe is a necessity in a poor family. We are talking about something which will not be put in the medical cupboard with the thousands of tablets, powders and medicines which have been prescribed at public expense but which have never been consumed. These devices to control birth are things which will he used, not stored up unnecessarily. So I hope that the noble Lord, Lord Aberdare, will not give another thought to this extraordinary excuse which he has produced to the House to-day, that people who pay for a tranquilliser will be jealous of those who get a contraceptive for nothing. I think the time has come when this House should show the country that it is composed of responsible people who are prepared to face up to their responsibilities to-day.


My Lords, the noble Lord, Lord Aberdare, has put the case for his Amendment so well and so carefully that it might be imprudent for someone like myself to speak at all, because I shall be rapidly associated by some of the champions of the other side with some repressive views and many of them will probably assume that I have had a direct instruction from the Vatican this morning.


No—from God.


Noble Lords are nodding their heads. Therefore, I think it is now necessary to explain that neither the noble Lord, Lord Windlesham, nor I get our instructions quite so directly or receive them quite so obsequiously as that.


They seem to arrive.


But those champions of the other side do not like anybody to reply to the arguments.


The point is that you have never had a baby, Frank. You left it to Elizabeth—eight times.


Order, order!


My Lords, I do not know whether it is thought that this is a valuable point, but it is very odd that if someone even begins to imply that they might speak on the other side they get all sorts of hysterical speeches from my noble friend here.


The truth is hard to bear.


May I proceed, with the leave of the House and of the noble Baroness?




My Lords, as I was hoping to say, the noble Lord has put the main practical arguments so well that there is no need to dwell on them, but I did venture to ask the noble Lord, Lord Avebury, who has temporarily left us—I would have put it to the noble Lord, Lord Vernon, but I did not wish to because he was deploying his argument very well, if I may say so—that he was just assuming that we know what the population of this country will be by the end of this century. If anybody has lived as long as I have—and one or two here have, but perhaps not many now—they will remember that in 1941 a Royal Commission was set up because the population was vanishing. By the time it had finished reporting, the population was going ahead too fast; and so on—and it has gone up and down ever since then. I accept the point made by the noble Lord, Lord Avebury, if he likes to put it that way, that it is as well to be prepared, but it is ludicrous at the present time to talk confidently, if I may say so with respect, about the state of the population at the end of this century, let alone in the middle of the next one.

My Lords, may I make just one point to the noble Baroness, Lady Wootton?—and I know that she, at least will not become violent. She may wither me with a glance, but she will not denounce me or assault me. So I put it to her as the most gentle champion of the other side: she assumes that we have had these developments and that there has been a great increase in sexual life outside marriage, and I am bound to call a lot of it (not all of it, but a lot of it) sexual promiscuity. She says, as other have said, that we have got with it a lot of illeeitimacy, venereal disease and abortion. It is also noticeable that during this same period we have had a great increase in contraception; contraception has become much more available. May I just submit to the noble Baroness and others—and I hope they will contain themselves while I lay one point before them which they have not contended with—that it is possible that there is some connection between the two, and that it is not cause and effect in quite the way they think. If anyone asks what has been responsible for this change of attitude—which, if you like, we can deplore or congratulate ourselves on—and why there is much more sex outside marriage, one reason which most people would be inclined to give is that it is much safer, there is much more contraception about. That is common sense, and that point, at least, I would put on the other side. But I am not expecting people to support me personally—they might associate me with all sorts of very odd points of view—so let us just place ourselves firmly behind the well argued case which has been presented by the Government, bearing in mind that this must surely be a non-Party question. I cannot believe that Keir Hardie ever said anything useful on contraception.


My Lords, I think it is only right that somebody should speak from these Benches to support the Government and the noble Earl who has just sat down. I should like to oppose the Amendment proposed by the noble Lord, Lord Vernon. With the exception of the noble Earl, all those who have spoken before me seem to think that this prescription charge will result in an enormous increase in the number of unwanted babies. Let me say right away that I entirely agree with what was said by the noble Baroness, Lady Wootton; that abortion is a far worse answer to the problem than are contraceptives. But I am hoping to approve that there is no real need for either—or there need be no need, shall I say. I think there will he a need for some time to come, because the young have been educated so much by the mass media in that direction that it will take them a long time to get out of it.

My Lords, let us be quite honest about this subject. Unwanted pregnancies among the young come from one source and one source only, and that is what I might call playing with sex. They have been taught to do that, of course. The young of to-day are not very willing to listen to advice from their parents, and that is why I am hoping that, if they have to get these contraceptives by prescription from their doctor, they will listen to their doctor even if they do not listen to their parents. I am not so foolish as to think for a moment that the imposition of a prescription charge is going to Mop the whole thing at once. The important thing is that they will be on prescription and they will have to have advice from their doctor. Anything that we can do to stop this playing with sex is surely desirable.


My Lords, what on earth put the idea into the noble Lord's head that the only people who suffer from unwanted pregnancies are the very young? Has he not heard of the problem of the woman with four or five children who does not want any more, or the woman about whom the noble Baroness opposite was speaking? Is that not much more serious?


My Lords, is the noble Lord suggesting that people will go to get free contraceptives from automatic machines without seeing their doctor? I did not think that that was what we were talking about at all.


My Lords, to answer the noble Lord, Lord Avebury, of course it is an important problem; but when you have arrived at that age and you are married then, presumably, first of all, you are able to pay the prescription charge—which is, after all, only about two shillings or something like that. It also seems to me that by that time you have arrived at a sense of responsibility, which you use to prevent your having unwanted children. The young have not got that sense of responsibility and they need guidance. They will not take that guidance from their parents nowadays. Let us hope that they might take it from their doctors.


My Lords, before the noble Lord sits down may I ask whether he is really suggesting that it is part of a doctor's function to stop, as he puts it, people playing with sex?


My Lords, I most certainly think that it is a doctor's function to advise anybody who goes to him for advice as to what is the best thing to do.

I should like to end on another note. It is to ask a simple question. Is it really true that we are no longer a Christian nation?


My Lords, may I intervene again? I do not think the noble Lord understood me. Is the doctor's advice going to be different, because there is a prescription charge, from the advice that he would give if there were not a prescription charge? The noble Lord has misunderstood the whole problem.

4.53 p.m.


My Lords, I wish to speak on another aspect of this problem; it arises from the mode of implementation proposed for the administration of the family planning service. I did not appreciate when the original Amendment to Clause 4 was accepted with such emphasis by your Lordships that it would involve doctors having to prescribe appliances. This emerged clearly only when the Secretary of State proposed in another place that a service should be provided through prescription by doctors and that the usual prescription charge would be made.

The mechanism of implementing Clause 4, therefore, involves two things: the prescription by doctors and a charge being made when that prescription is filled. No doubt this is a convenient method by which to implement Clause 4, but I submit that there are some grave objections to involving doctors in this way. I agree that a doctor should prescribe "the pill" for women and should be directly involved in the ordering of certain devices that rest on his medical opinion. Again, if a pill becomes available for men, this also should be prescribed by a doctor. There are a number of situations in which a doctor's advice and direction are properly needed. But when we come to the supply of appliances for use by men, that is, essentially, the supply by presription of condoms, a totally different situation arises.

There are two objections to including these as articles to be obtained under a doctor's prescription for which a charge is to be made. First, there is the making use of the doctor's services not for medical or clinical services but as a method of convenience to implement sociological policy. It has been truly said: It is a perilous line we cross when we invite the medical profession in the National Health Service to issue prescriptions not upon their clinical judgment of medical need but in pursuance of a social policy. I have spoken several times in your Lordships' House on the unacceptability of this tendency, seen to-day more and more often, to persuade the doctor to use his medical skill and knowledge for non-medical, that is, for sociological, purposes. I fear that so far I have not been very successful in this. In fact, on a recent occasion I was told, correctly, but silent if I feel strongly that I am not with a certain amount of glee, that I was in a minority of one. While this may be true, it is no reason why I should remain wrong. Many doctors are having second thoughts on this tendency—and not only doctors; others are also beginning to realise that all is not well here.

However much your Lordships may disagree with my first reservation in this matter of obtaining a doctor's prescription for non-medical reasons, I hope that at any rate I shall gain your approval of my second reservation: that it is equally objectionable, undesirable and undignified, for doctors to be used as a means of ordering, prescribing and paying for contraceptive appliances for the use of men. I cannot see how anyone can support that. The whole suggestion is so objectionable that I do not propose to elaborate upon it. I only call attention to the situation in which a busy doctor's waiting room is further crowded by great strapping men, perhaps not even married, queuing up for their requirements. I do not know what plans the Department of Health and Social Security has in this regard, but there are many forms and variants of sheath from de-luxe to utility standard and with various amendments in structure and form. Is just one standard type to be provided, or will a doctor have to inquire about his client's wishes and write his prescription accordingly?

An utterly indefensible situation is created and no doctor, man or woman—and I emphasise that women doctors are involved here—should be put in such a position just because it may be a convenient method to apply. The Department of Health and Social Security can surely issue a standard article, and suitable variants should be obtained through the usual commercial channels and not through a busy doctor's surgery. I sincerely hope that it is not the intention of the Secretary of State to use doctors—I might even say "abuse doctors"—to write prescriptions for this purpose. Perhaps he already is well seized of the objections and has intentions to make some collateral arrangements. Let us have some sense of proportion in this matter, and let us not inflict on the family doctor a procedure that can be demeaning, inappropriate and undignified.

I should have liked to have moved an Amendment in regard to the supply of contraceptive substances and appliances to add at page 4, line 6, except in the case of appliances used by men", but I am advised that it is too late to do this and that it would not be in order to do so. It is therefore with great regret that I am unable to do so; but I feel that the whole situation should be drawn to the attention of your Lordships.

5.0 p.m.


My Lords, I want to make one or two brief points. Unfortunately I was ill when this matter first came before the House. It was apparent to me some time ago that so long as contraception was integrated into the National Health Service, it was immaterial whether it was on prescription charge or not. I was more concerned with the abolition of prescription charges generally. But having until recently served for four years as Chairman of the Health Education Council, I found that it became more and more apparent from evidence that we received in the way of letters in response to our advertisements, and from calls from people, that it was absolutely imperative, if health education was to play a really vital part, that it must go hand in hand with a free contraceptive service.

It seems to me quite illogical for the Government to be spending money (and at the moment the Health Education Council is asking for something like £400,000 for education about contraception) when at the same time £3 million is being saved. I can assure your Lordships that this will inhibit exactly those people who need not only advice about contraception but also the facilities. It is all very well for the noble Lord, Lord Somers, to say that once people are married they can afford contraception. But he should read the sort of letters that I have read from women who are not at work but bringing up large families; women who do not know what their husbands earn; who find it almost impossible to make ends meet, with the cost of living rising all the time; whose husbands do not use contraceptives. Such women are in the position where literally they cannot afford contraceptives, and they are among the people we are talking about.

If your Lordships could see some of the letters which I have read you would appreciate that there are such tragic, case histories and you would agree that the decision made earlier by this House was right. For goodness sake let us go the whole way. The principle has been accepted. It is now a question of two things; one is the amount of money. Although I am aware that you cannot transfer money from one area to another, I think it pertinent, particularly so far as health education is concerned, that the two primary objectives are to try to stop people smoking and to try to stop them conceiving unwanted babies. In 1972–73 there was an increase of £51 million over the previous year in tax revenue for the sale of tobacco. I am sure that it would not be beyond the wit of the Chancellor of the Exchequer to see that at least a small amount of that money was used to provide for something that in the long run would be far more economically viable—by a reduction in the number of unplanned and unwanted babies. In the gentlest fashion I should like to join issue with the noble Earl, Lord Longford. Although the population angle is extremely important, I think that to-day we are concerned basically with the current situation and with the human side of it. lf, by preventing the conception of unwanted and unplanned babies, we are—as we should be—helping to solve the population problem, that is right and proper.

To-day we should be concerned with the fact that contraception is being integrated into the National Health Service, but without taking the final step. As the noble Lord, Lord Vernon, rightly mentioned, immunisation, the cervical smear and chest X-rays are all free. These are things which we are promoting in health education. To except contraception does not make sense. It may make logic on the lines mentioned by the Minister. But what may be logical in administrative terms can be insane in human terms and short-sighted economically. This does not call for a price on contraception but for the further education of people so that they may understand the difference between these things. If you are not well and can afford to pay for a prescription there is a tremendous incentive to do so because you want to get better. But it is an entirely different social and educational project to get people to come forward for contraception. It raises a further barrier. The noble Lord, Lord Brock, spoke eloquently about the dignity of the doctor, but I think we must also talk about the dignity of human beings and the needs of the patient. When I was a member of the Health Education Council, one of the things we did was to try to bring home to men their sexual responsibilities. That was why we produced that rather controversial poster "The pregnant man". The sexual responsibility of the male is still not appreciated as much in this country as we would desire. That is not an anti-male or feminist remark on my part; it happens to be a fact.

If we succeed in getting this Amendment accepted—as I hope—the majority of men who can afford to do so will continue the habit which they have formed of going to chemists' shops and barbers' shops to buy condoms. This story about queueing up at the doctors' surgeries is really rather a horror tale. I am not attempting to make a Party political point. I started out some months ago not feeling so strongly on the subject, but now I am absolutely convinced that unless this Amendment is accepted we shall spoil what is really a very important social "ship" for a ha'porth of tar.


My Lords, this has been a fascinating—


My Lords, there are one or two other noble Lords who wish to speak, including the noble Viscount, Lord Ingleby.


My Lords, I shall be very brief. I feel that all the arguments that I should have used have already been very well deployed. But as one of the signatories to this Amendment to the Commons Amendment, and a medical one at that, I thought I should make clear to the House how very strongly I support it. I hope that your Lordships' House will show its independence, as it did on December 19, and vote in favour of the Amendment to the Amendment.

5.7 p.m.


My Lords, from the Cross-Benches I should like to say that I strongly support the Amendment before us, and to give two reasons why. The first is that here we have an opportunity to salute local government for having pioneered a service. That is something that local government has often done in the past and never, I believe, has Parliament gone back on a successful piece of pioneering by local government. I will not bore your Lordships by reminding you of the various services which were pioneered by local government in the early years of the century and then gradually taken over by national Government and made generally available. Having got as far as local government has in this respect, and as central Government is taking a large part of local government into the comprehensive National Health Service, I think that it would be a tragedy for national Government to take a backward step by not accepting this Amendment, or something like it.

I must pay tribute to the noble Earl. Lord Longford, for having made one of his characteristically honest and courageous speeches. He drew attention to something which was very much in my mind when trying to come to a decision on the general subject. I think that we should be honest enough to admit that the noble Earl is perfectly right when he says that during our lifetime—his lifetime and mine—the increased knowledge of how to avoid pregnancy is one of the reasons for the change in the attitude of the young, and the not so young, towards sexual intercourse. I am delighted to think that, for the first time, it gives us an opportunity to be really moral in this respect, and not dominated by fear in deciding what should be the right relationship with the other sex. Be that as it may, I think that by accepting this Amendment to the Amendment we shall probably increase the number of people who will have sex outside marriage, but what is absolutely certain, as I think, is that we shall decrease the number of abortions and unwanted pregnancies: and, incidentally, we shall decrease the amount of suffering and money that has been spent on children coming in unhappy circumstances. For those reasons, I hope that from the Cross-Benches there will be on this occasion, as in the past, support for the Amendment.


My Lords, also speaking from the Cross-Benches, I must take a slightly different view. Aberdeen has been mentioned a good many times in the course of this debate. I feel that in order to get an absolutely fair picture there are certain other facts about Aberdeen which have not been mentioned and which ought to be brought to your Lordships' notice. The figures of cases are as follows: termination of illegitimate pregnancies in 1965, 32; in 1970, 194. V.D. rate, all ages, in 1965, 751; in 1972, 1991. V.D. rate in the 15 to 24 age group, in 1965, 98; in 1972, 457. These are all under free family planning services.


My Lords, I have rarely felt so exercised in my mind as I have over this Amendment, because there is no getting away from the fact that here we have a moral problem. In order to try to help myself to make up my mind, I consulted a number of my friends, most of them doctors, and I found a considerable division of opinion. Therefore what was one to do? I think that here, from the moral point of view, it is a matter of which is the lesser of two evils. I entirely agree that if Lord Vernon's Amendment is approved it will probably increase the number of people who outside marriage have sexual relations; but, looking at the matter from this moral point of view, I am bound to say that I have been appalled lately by the figures that have been emerging about the abortion rate in this country.

One tries to balance the one against the other. I am going to vote for the Amendment to the Amendment, but in so doing I wish to say that I still maintain most strongly that sexual relations are meant to be within the married state, and I believe that that sexual union is meant to be part of a whole, beautiful, spiritual union. That is the position in which I stand. I still think it is the duty of the Church to go on maintaining that attitude, but when we come to this very difficult problem, one tries to balance the one course against the other, and, on balance, as I say, I support Lord Vernon's Amendment to the Amendment.

5.12 p.m.


My Lords, I should like first to explain that I was not attempting to pre-empt any noble Lord's speech; it was just that I thought it was perhaps time, as this is a Back-Bench Amendment to the Amendment, for me to explain what is the attitude of the Front Bench on this side towards it. This has been a most distinguished debate—all four proposers of the Amendment to the Amendment are distinguished in themselves—and I think the quality of the speeches has been quite remarkable: they have also, rather to my delight, been somewhat one-sided.

I should like to explain the attitude that we on this Front Bench have to the issue. As your Lordships know, the Press, the public and, indeed, another place generally treat the Upper House with a sort of benign neglect; but on this occasion, rather uniquely, when we amended Clause 4 at the Committee stage, to have a completely free and comprehensive service, all the serious leading newspapers of the country applauded the decision. As the noble Lord, Lord Aberdare, himself said, and as the Secretary of State said in another place, the Government realise that public opinion has changed, and because of Parliamentary opinion—in other words, our action here—the Government were impelled to take a new look at it and to change their opinion. We give the Government great credit for changing their minds in the way they have, but we very much regret that they decided to add a prescription charge.

My Lords, there have been many arguments made against that decision this afternoon, and I do not propose to repeat them. It is the experience of all the clinics, and most of the practising doctors who have anything to do with this matter, that the charge would be a deterrent, with all the results that one can expect to flow from it. It seems to me extraordinary that, having committed themselves to £30 million on family planning, the Government should cavil at the last £3 million. It is rather like saving £5 million on school milk and then having to give the farmers a £30 million subsidy, or, as my own Government did, trying to save £3 million on overseas' students fees, but having to spend nearly all of it on administration, exemptions and special grants for the needy. It is the same kind of argument. I do not even believe that it is a Treasury argument, because it is simply the cost of what you know about, put against savings which you have not identified and cannot identify. It is the most elementary mistake in accounting that you can possibly make.

I was particularly glad that the right reverend Prelate spoke as he did, because we were all especially impressed at Report stage by the wise and compassionate speech of the right reverend Prelate the Bishop of Bath and Wells. He made a special point that the Board of Social Responsibility of the Church opposed any financial or other restrictions that would inhibit people from using family planning, and he specially stressed the need for counselling in the clinics. This is, I think, the answer to the noble Lord, Lord Somers, and partly to the noble Viscount, Lord Ingleby: because if you destroy this, if you create the deterrent, if you drive people from the clinics, then you drive them to the slot machines, the garages and the barbers' shop, where there is no counselling, and nobody is going to warn the young about venereal disease and irresponsible sexual behaviour. So I particularly welcome the stand made by the right reverend Prelate.

The Government obviously recognise the importance of family planning, and we give them full credit for their change of mind. They would not have changed their mind if they had not thought that Parliamentary and public opinion made it necessary, and they would not have done so if their medical advisers and their own moral and political sense had not brought them to do it. What we are doing now is giving the Government and the other place another chance to look at this again. We arc asking them not to spoil such a splendid ship for a ha'porth of tar. We arc giving them a chance to make our family planning service a free, comprehensive and a counselling service of which the country can be proud.


My Lords, we have had a most thorough debate, and I imagine that most of your Lordships have now made up your minds which way to vote and that any words of mine are likely to be wasted. Therefore I shall not keep your Lordships long. My opening remarks on this Amendment put the case as clearly as I could, and I am grateful to the noble Earl, Lord Longford, for saying so. I am also grateful for what he said in support of the acceptance of this Amendment. I would put it to your Lordships that it really is unjustifiable to claim that one is asking the other place to think again, as both the noble Lord, Lord Vernon, and the noble Baroness, Lady Llewelyn-Davies, did, because in fact an Amendment to prevent any charging for family planning was heavily defeated on the Report stage in another place by a majority of 102. In these circumstances I do not think there can he any justification for saying that the other place has to think again. Nor do I really think that in a matter such as this, which is so clearly linked with financial provisions, your Lordships ought perhaps to be too hasty in sending the Amendment back to another place.


My Lords, with regard to the first point made by the noble Lord, it was a vote which was taken very late at night only on Report stage and, as he knows, in the all-Party Committee the vote was 12 to 11, which I think is very significant. In answer to his second point, each House is responsible for its own privilege. We can look after our privilege and the other House can, and does, look after its privilege very adequately.


My Lords, the fact is that despite the late hour there were quite a number of people voting—242 to 140. We are as anxious as anybody in this House is provide a full family planning service and to cut down the number of abortions, which we deplore as much as anybody else; but we are setting about it in a very thorough way and we are making the family planning service a full part of the National Health Service. The noble Lord, Lord Vernon, compared it with the preventive services, but the fact is that nowadays a person going to his doctor and getting a prescription then goes to the chemist and has to pay his prescription charge. This will be on exactly the same basis—something like one-fifth or one-sixth of the population from clinics, but in practice there is a considerable gap between entitlement and actual ability to obtain a service. We are preparing to expand these services as quickly as possible to meet demand and we are proposing to make extra money available for increased publicity to encourage take-up.

The noble Baroness, Lady Birk, has not had a chance to intervene before, but she knows a great deal about these matters and I must say to her that the people she mentioned (those with very low motivation) would not be expected to pay for their family planning supplies and the domiciliary services which have done so much to help these people in the past—


My Lords—


Would the noble Baroness forgive me if I continue? We do not have much time. So far as the noble Lord, Lord Brock, is concerned, there is no intention of making doctors prescribe sheaths if they do not wish to. I should like to remind him that the Conference of representatives of local medical committees in 1972 came to the view that family planning should be provided free of charge to National Health Service patients, irrespective of medical or social grounds; so I think that his profession do accept the need to cooperate. We are having conversations now with general practitioners, and of course there will be no question of being compelled or urged to prescribe the sheath.

May I make one last point. My noble friend Lord Ingleby mentioned Aberdeen. So often Aberdeen is held up as a tremendous success in the family planning field, but when one looks very carefully it is very difficult to see a clear-cut case for saying that free supplies in Aberdeen have been all that effective. We did some comparisons with three other cities over the last ten years, and these show that the legitimate birth rate in Aberdeen in 1971 was very slightly lower than in Dundee and Edinburgh, and significantly lower than in Glasgow. But because Aberdeen had a much lower birth rate in 1962, the drop in Aberdeen over the 10-year period was actually less than in the other three cities. So it is not a clear-cut case and there are many sides to it. If we were com- pletely convinced of the absolute effectiveness of free family planning no doubt we should be prepared to move in that direction, but we are not so convinced, my Lords. We are proposing that the sheath should be available on a prescription charge, with certain exceptions, and I hope that your Lordships will think carefully and that you will agree with this Commons Amendment.


My Lords, before the noble Lord sits down, since he mentioned a point that I had made on this question of motivation, I must with respect point out that the domiciliary services are not the complete answer. They also cost a great deal of money, and you will not, without a free conception service, motivate the people who are in the greatest need. I am afraid those are the facts.


My Lords, if you cannot motivate them through a domiciliary service, how can you motivate them?


By making it free.


My Lords, the Question is that Amendment No. 1 to the Commons Amendment No. 7 be agreed to. As many as are of that opinion will say "Content", to the contrary "Not-Content". I think the "Contents" have it.




Clear the Bar.


My Lords, the noble Lord, Lord Vernon, had the right to reply and wished to exercise it.


My Lords—


My Lords, the Question has been put and I think that the House would wish to apologise to the noble Lord, Lord Vernon, if he has lost his chance to speak. However, the Question has been put, and I think a decision ought to be reached.


My Lords, I will repeat the Question. The Question is that Amendment No. 1 to the Commons Amendment No. 7 be agreed to.

5.26 p.m.

On Question, Whether the said Amendment (No. 1) to the Commons Amendment No. 7 shall be agreed to?

Resolved in the Affirmative, and Amendment agreed to accordingly.


My Lords, the Question is, That Commons Amendment No.7, as

Their Lordships divided: Contents, 107; Not-Contents, 58.

Airedale, L. Gaitskell, B. Rathcreedan, L.
Alexander of Tunis, E. Gardiner, L. Redcliffe-Maud, L.
Amherst, E. Garnsworthy, L. Redesdale, L.
Amory, V. George-Brown, L. Roberthall, L.
Amulree, L. Greenway, L. Royle, L.
Annan, L. Greenwood of Rossendale, L. Rusholme, L.
Archibald, L. Hale, L. Ruthven of Freeland, L[...]
Arwyn, L. Henderson, L. Sainsbury, L.
Auckland, L. Hoy, L. St.David[...], V.
Avebury, L. Hughes, L. Samuel, V.
Bernstein, L. Janner, L. Segal, L.
Beswick, L. Killearn, L. Sempill, Ly.
Birk, B. Kilmany, L. Serota, B.
Blackett, L. Leatherland, L. Shackleton, L.
Blyton, L. Lee of Asheridge, B. Shepherd, L.
Boothby, L. Lichfield, L.Bp Shinwell, L.
Bowden, L. Llewelyn-Davies, L. Simon, V.
Brock, L. Llewelyn-Davies of Hastoe, B. [Teller.] Slate[...], L.
Brockway, L. Southwark, Bp.
Brooke of Ystradfellte, B. Lloyd of Hampstead, L. Stocks, B.
Buckinghamshire, E. MceLeavy, L. Stow Hill, L.
Burton of Coventry, B. Macleod of Borve, B. Strabolgi, L.
Byers, L. Maelor, L. Strange, L.
Champion, L. Massereene and Ferrard, V. Strathcarron, L.
Chorley, L. Meston, L. Stratheden and Campbell, L.
Cottesloe, L. Milverton, L. Sudeley, L.
Crook, L. Monck, V. Summerskill, B.
Davies of Leek, L. Monson, L. Taylor of Mansfield, L.
de Clifford, L. Morris of Grasmere, L. Vernon, L.[Teller.]
Diamond, L. Northchurch, B. Vivian, L.
Donaldson of Kingsbridge, L. Ogmore, L. Walston, L.
Douglas of Barloch, L. Phillips, B. White, B.
Douglass of Cleveland, L. Platt, L. Wigg, L.
Elliot of Harwood, B. Popplewell, L. Wise, L.
Evans of Hungershall, L. Porritt, L. Wootton of Abinger, B.
Faringdon, L. Raglan, L. Wynne-Jones, L.
Aberdare, L. Ferrers, E. Merrivale, L.
Ailwyn, L. Fraser of Lonsdale, L. Mowbray and Stourton, L. [Teller.]
Alport, L. Furness, V.
Balfour, E. Gainford, L. Nugent of Guildford, L.
Barnby, L. Gowrie, E. Oakshott. L.
Belstead, L. Grenfell, L. Onslow, E.
Berkeley, B. Girimston of Westbury, L. Rankeillour, L.
Carrington, L. Hailsham of Saint Marylebone, L. (L. Chancellor.) St.Aldwyn, E.
Colville of Culross, V. Saint Oswald, L.
Conesford, L. Hanworth, V. Sandford, L.
Courtown, E. Hawke, L. Shannon, E.
Craigavon, V. Ingleby, V. Somers, L.
Daventry, V. Lauderdale, E. Stamp, L.
Denham, L.[Teller.]. Limerick, E. Strathclyde, L.
Denwent, L. Longford, E. Tenby, V.
Drumalbyn, L. Lothian, M. Thomas. L.
Dundee, E. Loudoun, C. Tweedsmuir of Belhelvie, B.
Eccles, V. Lucas of Chilworth, L. Windlesham, L.(L.Privy Seal.)
Emmet of Amberley, B. Macpherson of Drumochter, L. Wrottesley, L.
Exeter, M. Mancroft, L. Young, B.

amended, be agreed to.As many as are of that opinion will} say, "Content" on the contrary, "Not-Content". The "Contents" have it.

On Question, Motion agreed to.