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National Health Service Money

Volume 487: debated on Tuesday 24 April 1951

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Considered in Committee of the whole House under Standing Order No. 84 (Money Committees).—[ King's Recommendation signified.]

[Major MILNER in the Chair]

Motion made, and Question proposed,

That, for the purpose of any Act of the present session to authorise the making and recovery of charges in respect of certain dental and optical appliances under the National Health Service Act, 1946, and the National Health Service (Scotland) Act, 1947; to make provision for the accommodation and treatment outside Great Britain of persons suffering from respiratory tuberculosis; to remit stamp duty on receipts given in respect of such charges as aforesaid; and to amend the National Assistance Act, 1948, in relation to requirements for services under the said Acts of 1946 and 1947, it is expedient to authorise—
  • (a) the payment out of moneys provided by Parliament of any increase in the sums payable out of moneys so provided under the National Health Service Acts, 1946 and 1949, the National Health Service (Scot land) Acts, 1947 and 1949, or the National Assistance Act, 1948, which is attributable to provisions of the said Act of the present Session—
  • (i) enabling the Minister of Health and the Secretary of State respectively to make arrangements for providing accommodation and treatment outside Great Britain for persons suffering from respiratory tuberculosis;
  • (ii) amending the National Assistance Act, 1948, in relation to requirements for services under the National Health Service Acts, 1946 and 1949, and the National Health Service (Scotland) Acts, 1948 and 1949;
  • (b) the payment into the Exchequer of any sums received by the Minister of Health or the Secretary of State under the said Act of the present Session in respect of charges authorised by that Act to be made and recovered in respect of the supply of dental or optical appliances.—[Mr. Pearson.]
  • 10.1 p.m.

    I will not detain the Committee long, but it is important to realise that we are to embark upon a payment out of a limited sum of money—£200,000—for the treatment of respiratory tuberculosis in Switzerland, and that, on the other hand, the Exchequer is to receive certain sums, taken in by the Minister of Health, which will be payments received by him for dentures and spectacles.

    On the question of pulmonary tuberculosis and the £200,000, we have heard, during the Second Reading debate expressions of opinion on all sides of the House that this sum might well be increased as soon as possible, and that there is very great sympathy about this matter. The arguments in favour are natural. They are that if we send cases abroad to be treated we are saving the labour, that we have not the beds available at home, that the cost is very little more—in fact, it may be even less—and that the country as a whole gains by the procedure, quite apart from the moral issue involved.

    It must be remembered that pulmonary tuberculosis in particular can be treated successfully everywhere on one condition, and that without that condition it cannot be successfully treated anywhere. It is that the patient who so suffers, quite irrespective of the money which must be expended, must be given an incentive to get better and to return fully into life, and must, throughout the time of treatment, whether in Switzerland or elsewhere, know that when he is partially recovered or deemed no longer to be infected, he can come back into the community to be normally treated, and know that there will be a job for him. This involves an obligation on us that we do not merely send people to Switzerland where they will get all the best possible type of treatment which, we all agree, they must have, but that we must give them a guarantee that when they come home they will never be forgotten, as they used to be in the days gone by when I was in practice as a young man. That is all I want to say on that particular point, and I hope that we shall bear it in mind.

    On the question of the receipt by the Exchequer of sums received by the Minister of Health, I think that it is fair to say that we are in doubt as to whether all the money mentioned here is likely to be brought in at all in the first year or the subsequent years, for we recognise that in the Bill itself there is a provision by means of which both spectacles and dentures can be freely given to everyone, irrespective of whether he is in full work or not, if the National Assistance Board think that he has a right to them. Therefore, we must not be disappointed if we find that these sums of money which we are expecting to be returned to the Exchequer are not, in fact, realised.

    Having said that, and finding myself grateful for still remaining in order, I will conclude by saying that all of us were glad to find that the Second Reading of the Bill had such a good passage and hope that the Financial Resolution will be equally well received.

    10.5 p.m.

    I think that we might have some explanation of this Financial Resolution. Although I listened to the debate on the Bill with great care, no one explained how this is to work out financially and economically. The argument has been used that this is in some way going to help the defence programme. I have not heard any explanation of how the charges for dentures and spectacles are to help the rearmament programme.

    I am afraid that that question cannot possibly arise on this Financial Resolution.

    I want to turn to some other aspects of the matter. The hon. Member for Hendon, South (Sir H. Lucas-Tooth) referred to the "bandits below the Gangway." I presume that if there are bandits below the Gangway we ought to be concerned about this Financial Resolution. Bandits must be in order on a Financial Resolution. But I maintain that the bandits are not here but opposite, and that the main objection to this Financial Resolution is that Members of the Front Bench have handed them the key to the citadel. Far from the critics of the Bill below the Gangway in any way weakening the financial state of the country, we are preventing a very——

    I must point out that this Financial Resolution is a limited one. It merely provides for the provision of money for the tuberculosis provisions of Clause 3 and for the requirements of Clause 4 (2).

    Let me turn to the provisions for tuberculosis. We have had very moving pictures from all sides of the House of the benefit that is likely to accrue to the victims of tuberculosis as a result of the financial provisions which will enable patients to be sent to Switzerland.

    As an old member of a local authority, and as one who has been a member of a committee that regularly visited sanatoria, I welcome this financial provision in so far as it will help to relieve the financial provisions of the local authorities in Scotland. But I suggest that we shall not have solved this problem by sending the patients to Switzerland. We may send them to the sanatoria so vividly described by my hon. Friend the Member for Sparkbrook (Mr. Shurmer), but when they come back, they will have to go to the same overcrowded slums, and if that is the position, it will militate against the benefits of this proposal.

    I believe that the money to be received from the charges for dentures and spectacles has been over-estimated. In view of the fact that the figures——

    I am afraid that question does not arise. There is no limit to the provision of money for the purpose of the Financial Resolution. As to the charges, it is merely provided that those charges be paid into the Exchequer. That is the only point on which any argument can arise today; not on the question of the amount of any charges.

    With due respect to you, Major Milner, I shall not pursue that line of argument tonight, but I hope that we shall be able to return to this when we come to discuss the Clause dealing with these iniquitous charges, when my hon. Friend the Member for Shettleston (Mr. McGovern) and I will move its rejection.

    10.11 p.m.

    I only want to try to safeguard our position when we reach the Committee stage. Shall we be limited by this Money Resolution? We found ourselves in difficulties in the past through Money Resolutions of this character, and seeing that many of my hon. Friends desire to move Amendments on the Committee stage, I think it will be the best policy to try to safeguard that right or to get an understanding of the position. If I remember correctly, the Money Resolution provides for payments into the Exchequer. I understand that the Exchequer are insisting on a ceiling in this Bill in regard to expenditure.

    May I say that there is no ceiling in this Money Resolution, by which I mean there is no limit imposed by it.

    That is quite clear as far as it goes. Would the Committee be good enough to look at paragraph (b) where it says:

    "the payment into the Exchequer of any sum received by the Minister of Health."
    Then it goes on later to state:
    "in respect of charges authorised by that Act to be made and recovered in respect of the supply of dental or optical appliances."
    Suppose my hon. Friends decided to move an Amendment which had for its object the fixing of £1 instead of £2 or £2 instead of £4, will they have the right to proceed with an Amendment of that kind if we accept this Money Resolution? That is the first question. The second is this. We find the charge for each pair of spectacles fixed at from 23s. to 35s. I shall not read that portion of the Bill, in order to save time, but will it be in order for any of my hon. Friends to move a reduction of these amounts?

    I am trying to help the hon. Gentleman but, of course, that matter is one to be decided when we come to the Committee stage. I assure the hon. Gentleman that according to my reading of the Bill there is no limit imposed by the Financial Resolution.

    Thank you, Major Milner. In Clause 4 of this Bill the National Assistance Board is empowered to grant assistance if necessary for the purpose of meeting certain charges made to persons engaged in full employment. I never remember any responsibility of this character being put upon the shoulders of the Assistance Board before, and it is bound to lead into difficulties of administration and lack of uniformity in administration. If my hon. Friends want to use their experience to get the fullest possible advantage for the people they represent when matters are referred to the National Assistance Board, will a limit be placed on anything they desire to move under Clause 4?

    Yes, Major Milner. Hon. Members have raised certain points about the scope of the Financial Resolution and I was hoping, and I am sure that other hon. Members were hoping, that we should have some information from the Minister as to whether Amendments which it may be desired to move would be in order under the terms of the Financial Resolution. It is clear that when we come to the Committee stage of the Bill certain Amendments will be moved and I feel that we are entitled to an assurance that under the terms of the Financial Resolution as it stands, it will be open to hon. Members who wish to do so to propose Amendments either for the purpose——

    I understood that the hon. Gentleman was making a request to the Government for some reply. In my position as Chairman for the time being, while the Financial Resolution is before the Committee, I can only say what is in order today and I can only indicate, as I have indicated, that according to my view of the position today the Financial Resolution places no limit on the amounts to be expended—within the terms of the Bill, of course.

    I hope that my hon. Friend did not think that I was in any way being discourteous. I may be wrong, and I say so quite frankly, but it did not occur to my right hon. Friend and myself that we could give our hon. Friends any guidance as to what would be in order and what Amendments would be called.

    The right hon. Gentleman can, of course, give an indication of the intentions of the Government in drawing up the Financial Resolution.

    All I was trying to get clear was this. I understood, Major Milner, that you were giving certain Rulings as to what it was in order for hon. Members to discuss in the debate on the Financial Resolution. I was raising a different point. I understood that some of my hon. Friends were putting questions, as they were perfectly entitled to do, to the Minister in charge of the Financial Resolution asking for guidance as to the intentions of the Financial Resolution, and whether it would be in order, under the terms of the Financial Resolution, when the Bill came to the Committee stage, for them to put down certain Amendments of the kind they have indicated.

    Clearly it is not competent either for the Chair, at this stage, or for the Government to give any indication of what will or will not be in order on the Committee stage of the Bill. That is quite clear. But I have indicated the position on the Financial Resolution for the purpose of the discussion today.

    10.19 p.m.

    I am rather taken aback at your Ruling, Major Milner. I am not challenging it, but I consulted Mr. Speaker previously, when it became evident that some of us would be unable to get into the debate on the Bill, and Mr. Speaker said that the Financial Resolution was so widely drawn that we should be able to speak on almost anything that obtained under the Bill. If that is wrong, we have been misled, and we regret that there has not been sufficient time to enable many of us to express an opinion on the Measure about which there has been so much heart-burning in the Labour Party.

    If you intend to adhere to that Ruling, I shall not question it. I merely want to say, at this stage, that some of us did not challenge the Second Reading and we do not challenge the Financial Resolution because they are both concerned with treating cases of tuberculosis abroad and we have no wish to stand in the way of that matter. We have no wish to stand in the way of dealing with these cases but, at the same time, it must not be taken that every hon. Member on this side of the Committee agrees with this Measure and will consent to the charges that will be made under the Bill.

    I am old enough, both in politics and in this House, to realise that we are embarking now on a line which will be discussed for years to come between both sides of this House, on platforms and in the country. I, for one, will not cast a vote for these charges, and we want to safeguard ourselves. We wanted an assurance here that our rights were not being prejudiced, because these temporary charges always have a habit of remaining permanent.

    I am anxious to give the hon. Gentleman and the Committee every possible latitude, but I can only deal with the Financial Resolution that is before the Committee. If I understood rightly what the hon. Gentleman has said, then, with every respect to Mr. Speaker, I must point out that he has no authority over the proceedings of this Committee or over the proceedings in Committee of the whole House on the Bill, when it will be competent, no doubt, for hon. Gentlemen to move Amendments, it may be—I do not commit myself—on the lines of the matter which the hon. Gentleman has just discussed. That must, of course, await the appropriate opportunity.

    I do not seek to challenge in any way your Ruling, Major Milner, and I will only say in conclusion that in so far as the Measure is concerned, we are assuming that our rights are protected—because the Committee stage is not for the Tories only, it is for this side also—and that, if any hon. Member here with constituency rights desires to protect the working class, he will have the right to go to a vote of this House and I, for one, shall maintain that right.

    We have been trying to see if we can help our hon. Friends. Perhaps I should say on behalf of my right hon. Friend and myself that the Government did not draw the Financial Resolution with any anticipation of cutting out Amendments to the charges. I am not sure that I can give any further undertaking than that. However, our view, taken here, supports our intention: that is, that we did not draw the Financial Resolution to exclude possible Amendments, and we do not think it could rule out any of those possible Amendments.

    I want to make a brief inquiry concerning the money that will be paid out by the National Assistance Board for these dentures and spectacles. Do I understand, Major Milner, that you are ruling that there is no ceiling so far as the Ministry is concerned on the expenditure on dentures and spectacles, and that there is no ceiling whatsoever on what the National Assistance Board may spend on these items?

    I was a little doubtful about the effect of the last observation of the Secretary of State for Scoland. The right hon. Gentleman said that the Government had not drafted the Money Resolution with the intention of excluding Amendments on the Committee stage. Yet it might so happen that, by a strange coincidence, it would have that effect. I wonder if the right hon. Gentleman would be prepared to be a little more specific and to give an undertaking that the Government will do everything in their power to facilitate the discussion on the Committee stage.

    I do not want my silence to be interpreted as meaning that we have any intentions, much less any powers, as I see it; but subject to your guidance, Major Milner, having said what I did say, it would not seem to be of any relevance at all for me to say that we would facilitate it. It would then be for the Chair to call the Amendment. I shall be glad to be guided. Major Milner, on this point.

    Question put, and agreed to.

    Resolution to be reported Tomorrow.