asked the Minister of Health what estimate he has made for the purposes of the National Health Service of the number of patients which a doctor may reasonably be expected to see in a day or an hour.

The number of patients whom a doctor can attend varies according to the circumstances of his practice and no precise estimate is possible.

The Minister told me last week that certain doctors have 4,000 patients on their panels, and that caused them to have more than they are able properly to attend to. What provision is he making to remedy that particular situation?

I think the hon. Gentleman will find that that is the maximum which the British Medical Association agreed for any doctor to have upon his list, but there are doctors with 4,000 people on their panels who have less patients to attend than some doctors with lists of only 3,000. It is not possible to make such a sweeping generalisation in this field.

Does not the Minister realise that certain doctors today are having a great number of patients whom they have to try to look after in an hour, and that the point of my Question was how many the Minister himself expected a doctor to look after in the space of one hour?

Obviously, the hon. Member ought to realise that the number of patients whom a doctor can attend to in an hour depends upon the physical condition of the patients whom he is seeing. Some patients require more time than others, and in some parts of the country, where the age of the population is higher, a higher percentage of people will need to see the doctor, so that it really is not possible to make a generalisation of the kind which the hon. Member desires.

asked the Minister of Health if, in view of the fact that some opticians to whom he owes considerable sums under the National Health Service are being charged interest on overdue Income Tax, he will expedite payments of the sums owed.

I am unaware of any general difficulties, but if the hon. and gallant Member will give me the particulars of any cases he has in mind I will gladly look into the matter.

When I send him the case, will the Minister also inquire whether the tax which is being claimed is not in part due on the money which he has failed to pay?

As the hon. and gallant Member has not yet brought the incident to my notice, it is not good enough to say that I have failed to pay in a case which he has not proved.

asked the Minister of Health if, in view of the fact that the issue of deaf aid equipment under the National Health Service is taking longer than originally expected, he will now reconsider his previous decision and provide free batteries for existing holders of deaf aid equipment.

No, Sir.

Why?

Because we do not think it desirable to extend the deaf aid service which we are giving at the moment.

asked the Minister of Health what progress has been made in the production of streptomycin; and what increase there has been since July, 1948, in the number of hospitals where streptomycin treatment is normally available.

Production is now sufficient to cover all medical needs for which the use of the drug is reliably indicated and to provide small but increasing quantities for export. Further expansion is planned. Since July, 1948, the number of hospitals in England and Wales where streptomycin treatment is available has been increased from 30 to 220.

asked the Minister of Health at what date he asked the Medical Research Council to solve, as quickly as possible, the problem of finding a safe and effective analgesic agent for midwifery, and to devise for its administration, apparatus that is light, simple and requires a minimum of maintenance.

There was no need for me to make that request because the Medical Research Council, as I was aware, took into consideration the recommendation made in this matter by the working party on midwives, and they have decided to set up a committee in accordance with that recommendation.

Can the Minister tell the House what stage the researches have now reached, and can he also give an assurance that he will press forward with the provision of transport and the present forms of analgesia in all districts, and not wait until new forms are known?

The hon. Lady knows that there is a very considerable change taking place in this field. A lot of alterations are being made in the apparatus, and I am hoping that before very long very much cheaper and more easily transportable apparatus will be produced. However, that will not be allowed to interfere with the provision of transport for midwives, which is proceeding at a much accelerated rate.

Is the right hon. Gentleman aware that some local authorities are using as an excuse for not providing any additional apparatus, or any apparatus at all, the possibility that at some unknown date new apparatus will become available, and will he make it perfectly plain that they must not delay providing apparatus on that account?

I think it is true that some local authorities might be tempted to postpone the use of this apparatus in the hope that a lighter one will be available. I have impressed upon them that they must not allow that consideration to influence them, and we are making very considerable progress in the provision of the apparatus.

asked the Minister of Health how many domiciliary midwives are employed by the West Riding County Council; and how many of them have now been trained to administer analgesia in childbirth.

Two hundred and sixty-nine whole-time and 117 part-time domiciliary midwives are employed by the West Riding County Council. Two hundred and thirty-three are trained to administer gas and air analgesia.

Could my right hon. Friend venture an opinion as to when all the domiciliary midwives serving in the West Riding will have completed their training in this important relief of suffering?

I cannot give an estimate, but I should have thought very soon indeed. Very remarkable progress is being made over practically the whole country, and I should think that we ought lo have all the midwives trained in two years at the outside.

asked the Minister of Health which are the 11 local health authorities in which no analgesia is being used in the domiciliary midwifery service.

The number of county and county borough councils in question

Could not the right hon. Gentleman read out the names of the eight counties who have done absolutely nothing about this at all?

As there has been a reduction in one week of three, and as very considerable progress is being made—very much more than has been made in the course of the last 10 years, and very much more in six months than was made in three years before the war by the Opposition when in office—I hardly think the hon. Gentleman ought to hold up local authorities to contumely in this matter.

I am not holding up local authorities to contumely, but if the right hon. Gentleman claims that he has power to impose this duty on local authorities, what has he been doing?

The answer is—more in three months than was done in five years by the party opposite.

Is the Minister aware that, as this fight for the provision of analgesia for every mother in the country has been a fight against the prejudice of the entire community, it is quite unnecessary to make party political points?

I am indeed happy to hear that there is no desire to make party prejudice and capital out of this matter, but the fact is that if there is any prejudice against analgesia, it is on the side of the party opposite and not on this side.

asked the Minister of Health how many midwives are practising in Monmouthshire; how many of them are provided with motor cars; and whether motor car allowances are paid to them.

There are 85 domiciliary midwives employed by the County Council; 24 have their own cars and are paid a mileage allowance.

If the right hon. Gentleman has power to give these instructions to local authorities, why does he not do something about the recommendation of the working party which said that every midwife ought to be provided with a motor car and the means to run it?

In fact, steps are being taken at the present time to organise the provision of motor cars and the Monmouth County Council is organising a special scheme for this purpose. The number of cases in which mothers have received analgesia at home was lifted in Monmouth last year from the 1947 figure of 14.3 per cent. to 21.6 per cent., and the figures are increasing at as high a rate as that at which it is possible to train midwives.

While the right hon. Gentleman's answer does not seem to have much to do with the Question, would he not agree that even his answer means that three out of every four mothers get no relief whatever?

Yes, but it also means that we are providing for the mothers of Monmouthshire the possibilities of analgesia which were withheld from them by the party opposite.

asked the Minister of Health how many midwives are operating in Watford; how many of them possess a motor car; and what means are employed to transport the gas and air apparatus and the midwife to the mother.

There are five domiciliary midwives. They have one motor car and the County Council are obtaining a second one for them. Transport is by car, cycle or ambulance vehicle. In 1948 there were 321 domiciliary confinements in Watford. Gas and air analgesia was given in 219 of them.

I cannot see from the right hon. Gentleman's answer quite what is meant about transport by one motor car or by bicycle. Surely some better arrangements could be made in the case of this local authority to enable this apparatus to be provided for the mothers?

Indeed, it is quite correct that there is a very large increase in the number of cases of analgesia in the Watford area. For instance, I am sure hon. Members would like to know that in 1939, after three years, there were 53 cases of analgesia, while in 1948, after six months of the Health Service, it was at the rate of 1,126 in a year.

As the right hon. Gentleman appears to have a certain licence in his answers, so far as their relevance is concerned, may I ask him to look very seriously at the report of his own working party? I ask these questions because the midwives ask me to put them. They are working under intolerable conditions which would not be accepted in the ordinary way. Can they be provided with some mechanical transport so that they can do their job?

I have explained that the scheme for the transport of analgesic apparatus is being continued and on the 21st of this month—I think that is the date—a circular was sent out to the local health authorities informing them how they can obtain priority for motor cars for this purpose. I hope that before very long ambulances or motor cars will be available all over the country for this purpose and when we have provided them I hope we shall not be accused by the Opposition of wanton extravagance.

asked the Minister of Health whether a reserve pool of midwives can be made available in certain areas during periods when regular midwives are overworked.

This is a question of organisation of the local service which must be decided by the responsible local authority having regard to local circumstances and the supply of midwives.

Is my right hon. Friend aware that cases of bad timing may occur when a midwife may have as many as seven confinements on her hands at a given time; and would it not be desir- able to recruit an emergency pool among married midwives who may be willing to volunteer their services?

I think that it is very difficult for me, and I am sure for the House, to know what the hon. Member means by "recruit"—whether all over the country or in particular places. It is for those who are responsible for the administration of the service to make what arrangements they can in their area; and to talk of a general pool in this matter is entirely beside the point.

Will my right hon. Friend at least seek to encourage the formation of a pool in certain areas where these difficulties have arisen?

If the hon. Member will show me where the difficulties have arisen, we can then apply ourselves to the facts.

asked the Minister of Health what is the lowest cost of apparatus for the administration of trilene analgesia in obstetrics; whether he is satisfied that it is sufficiently portable; and whether any areas will now be designated as trial areas for intensive scientific investigation into the suitability of this apparatus for use by midwives in domiciliary cases.

There are several types of apparatus, all of which are portable. I understand that the lowest price of the types on the market is about £7. The suitability of existing apparatus for use by midwives in domiciliary cases will, no doubt, be among the matters investigated by the expert committee appointed by the Medical Research Council.

In view of the very low cost of this particular apparatus and the fact that it is easily portable, would it not be advisable to equip every midwife with this trilene apparatus and encourage her to use it wherever possible?

I understand from the information at my disposal that it is not yet certain that it is safe for midwives to use the trilene apparatus without assistance, and I certainly would not advise this course.

Is my right hon. Friend aware that trilene is usually conceded to be the most popular, the most simple and the most easily transportable analgetic and that its use by midwives has been prohibited by the Royal College of Gynaecologists and Obstetricians; and in those circumstances does he feel it advisable that he should counter a decision which has obviously been taken in the interest of the mothers themselves?

I have already pointed out that I think it is undesirable for this analgesia to be given without assistance. I mean by that without specialised technical assistance, and I certainly would not override the technical advice given by the Royal College of Gynaecologists.

asked the Minister of Health in view of the fact that it takes about four months to make up spectacles to a prescription, what steps he is taking to reduce this time.

Production of spectacles has increased by 52 per cent. since July, 1948. Further expansions of lens and prescription manufacturing capacity will be effective this year.

Is the Minister aware that in some cases it takes as long as six months, and as the suggestion is made in a later Question on the Order Paper today that more priority should be given to children, that time may be lengthened to seven or eight months? It is a very serious matter, because people's sight may change in the meantime.

I have asked the opticians to try to deal with cases of special urgency as quickly as possible, and these, of course, would include children who need spectacles badly. There is an inevitable delay in this matter because no one could have estimated such a huge demand for spectacles as we have received.

Does the Minister mean that enterprising aliens who come to this country in order to get free spectacles and free teeth have to wait as long as four months for them?

I should have thought it would hardly have paid an alien to spend four months in Great Britain in order to get a pair of spectacles.

asked the Minister of Health whether he will give special priority to all children in respect of applications for spectacles in view of the injury which their eyesight may suffer through early neglect.

Opticians are doing what is possible to give priority to specially urgent cases and such arrangements would certainly extend to urgent cases among children.

While appreciating the splendid work that ophthalmic opticians are doing in supplying spectacles, would my right hon. Friend ask them, as infants really need preference, to give priority to infants wherever possible?

If the hon. Member has any instance of children who are unable to obtain priority, I will certainly attend to it.

What facilities have opticians through the right hon. Gentleman's Department for repairing spectacles broken by children? Do they have to go through the whole scheme again and have their eyes tested, or can simple repairs be made?

They can have simple repairs made.

asked the Minister of Health if he will make available under the Health Service, out-patient spa treatment to patients of other hospitals than the spa hospitals when such treatment has been advised by the specialist.

No, Sir. I am advised that spa treatment should only be given under the supervision of the appropriate specialist at the spa hospital.

Is the Minister aware that there is a large number of people waiting for spa treatment; that spa hospitals are full, and that this treatment has been recommended by specialists who are capable of prescribing it, and could not he do something to make this treatment available to the people requiring it without their having to go to the spa hospitals?

I understand that the Question on the Paper is about special treatment and special hospitals. If the hon. and gallant Member has treatment for rheumatism in mind at other hospitals, that is now provided under specialist care.

asked the Minister of Health what facilities there are in Wales for spa treatment under the National Health Service; and whether he will make a statement.

I understand that the regional hospital board have made arrangements for hospitals at or near Llandrindod Wells to use the spa facilities there.

asked the Minister of Health whether he is aware that in some hospitals husbands visiting their wives and newly born babies are informed that they can see the new child on one occasion only; and what arrangements can be made for fathers to see their new offspring more often.

While I hope that all reasonable facilities will always be given, the arrangements at individual hospitals must be left to each hospital management committee and board of governors.

Is my right hon. Friend aware that in one hospital there was a refusal to allow a father to see his child, and that the reason given for that was that the nurse in the hospital knew much more about the progress of the child than did the father?

If my hon. Friend will give me particulars of the case, I will have it inquired into, but I think hon. Members must rest upon the assumption that the hospital committees are at least as much concerned about this matter as we are ourselves.

Would not my right hon. Friend agree that it is rather a shock to an infant to look upon its father, and does not he think that, in this modern age when the interest of the child is paramount, the child should be considered first?

I am not certain that the infant is always able to establish the identity of its father.

asked the Minister of Health whether he will make a statement on the reasons for the proposed transfer of the South-Western Hospital to St. Thomas's Hospital.

I have not yet received the final views of the regional hospital board about this proposal and I cannot for the present make any statement.

Is my right hon. Friend aware that the Lambeth group hospital management committee is strongly opposed to the whole project and that the delay in arriving at a decision, which has now extended over a period of at least six months, is denying very much-needed hospital beds to acute cases and chronic sick in the neighbourhood?

It is not correct to say there has been a delay of six months. It was only on 5th July last year that the regional hospital board was statutorily set up to re-organise the hospitals in the area and it is quite unreasonable to imagine that this complicated re-organisation could be done almost overnight.

asked the Minister of Health if he is aware that hospital patients in former Public Assistance institutions, are no longer receiving a weekly allowance of sweets or tobacco; and if he will make arrangements to restore these comforts to them.

I can see no justification for differentiating in favour of patients in this type of hospital; but all hospital management committees can, of course, provide comforts from their own funds, which are intended for purposes of this kind.

Is my right hon. Friend aware that the local management committee whom I consulted about this matter said they were acting in accordance with the Ministry of Health circular; that many of the people concerned are chronic sick who are sleeping in the same beds and building as they occupied some months ago and that in the same building able-bodied people, by arrangement with the Ministry of National Insurance, are receiving these comforts; and will he look at the matter again to see if, by arrangement with his right hon. Friend, some similar arrangements can be made for chronic sick people?

I am sure that the Question and answer will come to the attention of the committees concerned and that they will see that they are in error.

asked the Minister of Health whether he will arrange for at least one bed for the admission of emergency cases to be reserved nightly in all hospitals of over 200 beds.

No, Sir. Hospitals normally reserve the number of beds shown by experience to be needed, and in emergency put up extra beds.

Is my right hon. Friend aware that there is a great deficiency of beds for acute emergency cases and many lives have been endangered through lack of these facilities?

It is certainly true that there is more demand for beds today than there was before, and that there are many more beds to meet the demand. What is now happening is that we are hearing of these cases where formerly we did not.

Is it not the case that before this Act came into force no hospital in London, or anywhere else, refused emergency sick cases? Now that it is the Minister's responsibility, is he aware that, in London particularly, medical men are harassed and have to be on the telephone for over an hour every day trying to get sick people into hospital, and will he go into the whole matter again?

The hon. Gentleman is inaccurate in his statement. It was often very difficult to get emergency cases into hospital. What is now happening is that there is fixed responsibility for this whereas formerly responsibility was diffused and no one knew about the complaints.

Is my right hon. Friend aware that certain emergencies can arise where an hour or two's delay may mean a matter of life or death? Beds ought to be made available for this particular type of emergency.

They are made available. The hon. Member is unaware of the situation. All vacant beds in London are filled up by the end of the day. Where there are emergency cases, emergency beds are established in order to deal with them. There will inevitably be one or two instances of delay, and we will try to cut down that delay to the lowest possible margin.