National Health Service Bill
Order read for consideration, as amended.
Bill re-committed to a Committee of the whole House in respect of the Amendment to Clause 1, page 1, line 15, standing on the Notice Paper in the name of Mr. Marquand.—[ Mr. Marquand.]
Bill immediately considered in Committee.
[Colonel Sir CHARLES MACANDREW in the Chair]
Clause 1—(Charges In Respect Of Certain Dental And Optical Appliances)
4.9 p.m.
I beg to move, in page 1, line 15, to leave out from "patient," to end of line 16, and to insert:
On the Committee stage there was a great deal of discussion on the provisions of Clause 1 (2) of this Bill which sought to exempt hospital in-patients from these charges. Two main issues were raised in the discussion. One was whether greater clarity could be obtained in the wording of this provision as to precisely where and at what moment of time the charge would lie; and a second point was raised by my hon. Friends, who sought to extend this provision beyond the exemption proposed in the Bill for in-patients in hospital to the wider categories of those who may be under treatment from their own doctor in their own homes, and other cases of that kind. I said on the Committee stage that the provision as it stood in the Bill meant that where an appliance, either glasses or teeth, was supplied to a hospital in-patient while he was in hospital, the patient would be exempted from the charge. There was some doubt whether that was the case, but after taking further advice on the matter I can say that that is the position as the subsection is drafted. That still means that those who are in pay-beds or in disclaimed hospitals are not exempt from the charge; the charge would fall upon them as I explained in Committee. After very careful consideration, we have put forward this Amendment which, we feel, somewhat clarifies the position. It has the effect, of course, of restricting the exemption to the category described by many hon. Members as "comparatively long-stay patients in hospital." It provides that the exemption would apply to a patient who is resident in hospital at the time an appliance is supplied and has been so resident since the examination or testing of sight under Part II which led to the supply of an appliance. What we have sought to do is to make quite clear that the categories of patients which we are attempting to exempt completely and automatically from the charge are those I mentioned during the Committee stage, namely, those for whom the provision of spectacles or dentures is a natural part of treatment in hospitals and all those who are long-stay patients, such as chronic patients in hospitals or mental hospitals, most of whom, as I said in Committee, would in all probability anyhow be exempt under the provisions through which the National Assistance Board takes account of personal hardship. We have attempted to meet at least some of the points raised by hon. Members on both sides of the Committee in order to make as clear as possible the position of the hospital in-patient and avoid creating large numbers of anomalies as between an in-patient and a patient who is treated at home. After careful examination of all alternative ways in which anomalies might be reduced we have come to the conclusion that this is the only proposal we could put forward which really makes the position clearer, having regard to the fact that the categories we were most anxious to exempt were the two I have mentioned, the group whose treatment is being provided in hospital, including the provision of the appliance, and also the long-stay chronic patient for whom we obviously have very special and real sympathy. With regard to other categories of cases of which we would wish to take special care, we discussed during the Committee stage the work of the National Assistance Board and we have broadly agreed that that is the proper instrument for dealing with the possibly many other hardship cases that may arise."who is resident in a hospital at the time when the appliance is supplied and has been continuously so resident since the examination or testing of sight under the said Part II leading to the supply of that appliance."
4.15 p.m.
The purpose of the definition is obvious and, I think, agreed; at least, the purpose of the definition. I should like to ask the Parliamentary Secretary to answer certain questions. The words "under the said Part II" govern the Amendment. I believe I am right in saying that if the treatment is given by a dentist appointed to the staff of the hospital in which the treatment is given or to the group of which that hospital is a part, all will be well under the Amendment. What will be the position when the dental treatment is given by a dentist not on the staff of the hospital but called in for the purpose? As I read it, the words "under the said Part II" will exempt the recipient of dental treatment from the charge if he is receiving the treatment in a hospital to which a dentist has been appointed as a member of the staff but will not do so where the dentist is called in ad hoc from outside to undertake the work. I should be grateful for the observations of the Parliamentary Secretary on that point.
The Committee will wish the Amendment to be as fair and reasonable as possible. Another point which occurs to me, taking dental care as the example, is that where the teeth are removed in hospital and the dentures arrive, with reasonable speed, while the patient is in hospital, the exemption is complete, but that where for one reason or another the patient, possibly because of his or her condition and possibly because of the tardiness with which the dentures arrive, goes home for one or two days between the extraction and the treatment, the exemption disappears. Perhaps that is a point which can be applied with even greater force in the case of spectacles. Where the examination takes place and, because of the ordinary character of the optical defect, the spectacles can be speedily procured, there is no charge, but where, as may happen in a number of cases, the spectacles are slow in coming because of the complexity of the defect—the greater the need for the spectacles—it may well be that the exemption is of no value at all. So while approving the object in defining this, I should like the Parliamentary Secretary to consider whether the words do not involve a gamble, a gamble in which the patient is innocent; a gamble, firstly, whether there is a dentist appointed to the staff, so bringing the case within Part II, and secondly, a gamble whether the appliance arrives during the stay of the patient in hospital. Will the Parliamentary Secretary say what will happen in circumstances in which the delay beyond the patient's control is so great that the appliance arrives after the person has left hospital or where, under the ordinary commonsense arrangements there is an interval in which the patient goes home. I am very concerned—I do not state any of these matters as debating points—lest there should be anything which encourages the relatives to prolong the stay of an old person in hospital for a material advantage. One of the difficulties of our day—let it be plainly stated—is that there is a reluctance on the part of some people to take the old people home, for reasons which we can readily understand. Let there not be added another and a financial inducement to leave old persons in hospital occupying valuable beds when, on medical and humanitarian grounds, they should be returned to their families at the earliest possible moment.I do not wish to import any heat into this matter because my doctors have told me that I must not get excited; otherwise I should feel a little tempted to try the experiment. I want to make the point that on the Committee stage of this discussion, speaker after speaker from this side of the Committee criticised this Clause. From this side of the Committee from 3.30 in the afternoon until 2 o'clock the following morning there were only three speakers who tried to say that, on the whole, they had some sympathy with His Majesty's Government. I am told that I put it 50 per cent. too high but, so far as I know, all of them said they did not like the Bill and, furthermore, that they did not like the Clause. I said I did not, and I voted for it on what I think were constitutional grounds. [Laughter.] I did not expect hon. Gentlemen opposite to understand the workings of democracy.
What is the reply from His Majesty's Government to this criticism? The reply to this criticism of the Clause as being too narrow is to bring, on recommital, an Amendment that narrows it down still further. I say we have a right to resent that and a right to ask for an explanation. As the Clause was drawn without the Amendment, the position is admittedly an anomalous one. A man who goes into hospital with a broken leg could get false teeth while in hospital. I do not defend that, but I do find myself, to my amazed surprise, in complete agreement with the hon. Member for Luton (Dr. Hill) on this matter. So far as ophthalmic cases are concerned, people who go into hospital for an ophthalmic operation of any kind are normally not in for long. It is the kind of treatment—maybe the removal of a cataract—which, unless it is for a serious ophthalmic condition, may very well take a comparatively short time. On the whole it is exceedingly unusual for very complex types of lenses to be available before the patient leaves hospital. Yet the Government come along to the Committee today and say "We want to cut that out." They want to say to the people, "If you go into hospital and are ordered to have your teeth out because you are suffering from a gastric condition, you will have to pay the money if you are discharged from the hospital before the teeth arrive." That is a really serious point. I do not want to use a single word out of place because it was suggested in a highly humorous column that I did not regard His Majesty's Ministers as being in the brotherhood of man. I did not say that. I was only wondering if they had departed from the Socialist brotherhood. With respect, we ought not to have a proposal of that sort from these benches. What is the difficulty? It is that His Majesty's Ministers, with the Parliamentary draftsmen, have considered the difficulty of prescribing a form of words making it clear that the Clause was limited to the sort of case for which it was intended. I think I shall have both sides of the Committee with me on this when I say that the sort of case we have in mind here is the case of the man who goes into hospital for treatment for gastric trouble or facial or jaw trouble involving dental treatment or extraction; or the case of the man who goes into hospital for ophthalmic treatment which may involve the prescription of special lenses or glasses for his use. I should have thought both sides of the Committee would agree in saying that they, at least, would be provided for and that there should not be any exception based upon the date of discharge from hospital. We were in difficulty on recommittal in tabling an Amendment to an Amendment moved by His Majesty's Government, because the Committee stage itself took place only two or three days ago. So far as I know, it has not been on the Order Paper long enough for anyone to table an Amendment. However, while I was listening with great attention to the speech of my hon. Friend on this matter, I wrote out a form of words which I suggest would meet the case, and which might easily be accepted as a manuscript Amendment provided the Chair were prepared to accept it. I appreciate, Sir Charles, that is entirely within the discretion of the Chair, but I respectfully suggest that there are ample precedents for accepting a manuscript Amendment on re-committal if it is the general wish of the Committee and if His Majesty's Government are willing. I ask my hon. Friend to say what is wrong with the following words which I suggest, to make the matter clear, we should add:I have tried to limit it as far as possible."or who is supplied after his discharge from hospital with an appliance prescribed whilst in hospital and so prescribed as part of the medical treatment for the ailment which necessitated his hospital treatment."
I am very interested in this suggested Amendment, but would the hon. Member mind reading it again?
I will read it slowly so that it may get across.
Order. Would the hon. Gentleman try to put it as an Amendment to the Amendment? I cannot accept it as a new Amendment since the Bill is only re-committed in respect of the one Amendment on the Order Paper.
It is an addition to the Amendment, Sir Charles. In other words, if I were putting it on the Order Paper as a manuscript Amendment, I would start by saying, "at end add" and then go on with those words I have read out. In other words, if the patient goes in for treatment with a broken leg and has his teeth extracted, he does not get free teeth, but if he goes in with gastric or jaw trouble and, as part of his treatment it is necessary to take his teeth out, and order dentures, he gets them paid for.
I am sorry to interrupt the hon. Member, but I should like to get at the reasons in his mind because I find it difficult to understand what is behind this. I appreciate that he disapproves of the principle of charges for appliances but, given the fact that the Bill is designed to introduce them, I do not see why a man should have to pay for appliances which are prescribed in the case of, say, ophthalmic trouble which does not require surgery but, if his case does not yield to treatment without surgery and he has to have an operation, he should then get them free. There is not sufficient difference——
I agree entirely. I have said before that I would prefer to see the Bill withdrawn altogether, but we are now considering a limited Amendment by the Government and a simple point made by my hon. Friend the Parliamentary Secretary or the Minister—I forget who it was who opened the discussion—[Laughter.] I was not trying to be funny. I forgot for a moment, and I apologise. What was said from the Front Bench was that the difficulty had been to draft a Clause which would open the door to the proper case but would not open the door so wide that improper cases could come in.
I have concerned myself with trying to draft a form of words which would remove the anomaly to which the hon. Member for Luton drew attention, namely, the man who leaves hospital before the appliance prescribed for him is delivered. My Amendment suggests a tightening—I do not like the tightening, but I am trying to be fair about it—that that should apply only to a prescription which is made for the disease for which the hospital treatment was incurred. If the man goes into hospital for eye treatment and is prescribed spectacles, then he gets them. If he goes into hospital for treatment for gout and decides whilst there to have a pair of spectacles, he will not get them paid for under the Amendment. 4.30 p.m. I suggest that that is a perfectly reasonable Amendment. It covers completely the point made by my hon. Friend the Parliamentary Secretary and, as a test of his sincerity on this matter, I say that it is widening the gate only a little.Oh!
I am not questioning the individual sincerity of my hon. Friend. We are speaking now on behalf of collective sincerity; this is a collective approach.
The words I have suggested would merely mean that a man who is prescribed an appliance as part of the treatment of the disease for which he went to hospital, would not have to pay for it merely because the appliance was not supplied until after he had left the hospital. I suggest, Sir Charles, that you might perhaps consider whether you would accept a manuscript Amendment on that point. It may be that you will consider this after hearing——If the hon. Member submits his Amendment in writing, I will look at it. In any case, of course, it could not be moved until after the Motion "That the words proposed to be left out," had been negatived.
The only reason which prompts me to suppose that there was some error in the argument put before the Committee by my hon. Friend the Member for Luton (Dr. Hill) was the immediate agreement which his views received from the hon. Member for Oldham, West (Mr. L. Hale). It struck me particularly that the hon. Member's constitutional theories were obviously at fault. It may be that his logic in this matter is equally at fault, and when I heard him taking to task his hon. Friend the Parliamentary Secretary and the Government for narrowing down the scope of the subsection, and then heard him solemnly propose an Amendment which would narrow down the scope of the subsection a good deal further, I thought that possibly he was becoming a little confused.
My Amendment does not narrow down the subsection at all—it extends it. It extends it, quite clearly, to people who get their appliances after leaving hospital. That is the only effect which it has.
It has that effect, I agree, but as far as I can see—I may have misinterpreted the purpose of the Amendment which the hon. Member read out——
The hon. Member has misinterpreted it.
—it would exclude those who were chronically sick in hospital——
No.
—and would apply only to that category to which my hon. Friend referred: that is, to those who were to receive dentures or spectacles as part of their treatment.
I emphasise the point made by my hon. Friend the Member for Luton, that as the matter stands, it is impossible to ensure that those who really need and deserve spectacles as part of their treatment—or, indeed, for any other reason of principle that may be advanced either from this side or from the other side of the Committee—should get those spectacles. My hon. Friend says that the matter becomes a gamble—it depends upon the efficiency either of the dental mechanics concerned with the production of dentures, or of the opticians concerned with the production of spectacles. If, as might quite easily happen, there were a considerable decrease in the speed with which, for instance, spectacles were being produced—as a result, say, of rearmament—then it might happen that the Amendment which the Government propose would have no effect whatever. I cannot believe that that was their intention when they put it forward. It does not get to the heart of the problem of definition. The real problem, as I see it, is to define the meaning of "resident in a hospital." What does this term mean in the context of the subsection? Does it mean chronically ill? Does it mean those who are resident for a fortnight, or three months, or three years? If it is to apply equally to everyone who enters hospital, and if this is the definition of "resident," it will leave it open for anybody who is lucky enough, not only to be examined whilst in hospital for his teeth and to have them extracted, but to be examined whilst he is there for spectacles and to get them. I cannot believe that that is the intention of the Amendment. I feel that the reason why we have the Amendment in this form is that the Parliamentary Secretary, when this question was put to him from these benches during our earlier debates on the Committee stage, improvised, not knowing the answer, and then had to produce an Amendment which conforms as nearly as possible to the answer he gave to the Committee. Not only is that most unsatisfactory, but it is adding to the anomalies which already exist in the Bill.I want to deal with the application of the Amendment and the Clause to Scotland. I am sorry that the Secretary of State for Scotland is not present, but perhaps the Minister of Health will be able to deal with this point. When the Clause was under discussion during the earlier Committee stage, the Secretary of State for Scotland justified the charges for dentures under the Clause by the argument that there had been a very considerable and sensational rise in the supply of dentures in Scotland. Hon. Members who were then present will remember that I put some questions to my right hon. Friend about those figures. I suggest that if they are wrong, the argument of my right hon. Friend was wrong.
The argument of the Secretary of State for Scotland, as I understand it, was that the cost of dentures had gone up considerably in the first quarter of this year. I quoted from figures from the report of the Department of Health dealing with dental treatment, which showed that far from a rise in the first quarter of this year, there was actually a considerable decrease.That may be so, but the hon. Member is going beyond the scope of the Amendment.
If you will allow me to expand my case a little, Sir Charles—I will not take up much time—you will understand it is a problem that I should like to have cleared up. If the figures of the Secretary of State for Scotland were correct, that would make a difference to our understanding of the Clause.
We are not dealing with the Clause but with an Amendment.
We are dealing, as I understand it, Sir Charles, with an Amendment to the Clause. During the week-end I have checked these figures in the county of Ayr and I find that they completely contradict the argument of the Secretary of State for Scotland, which would influence me in the way I would view the Amendment. Far from a sensational increase in the cost of dentures in the county of Ayr, I find that for the first quarter of this year there was a decrease of £18,618. If this is right, then the whole argument brought forward by the Secretary of State for Scotland to justify the figures in the Clause disappears.
This Amendment came as a surprise to some of us after the debate initiated by the hon. Member for Tottenham (Mr. Messer). It is quite clear from the wording of the Amendment and it was clear from the speech of the Parliamentary Secretary, that, whether desirable or not, it will normally reduce the value of subsection (2) of Clause 1. I find it surprising that the Government, which reacted with considerable sympathy to the Amendment put forward by the hon. Member for Tottenham, should have so soon and deliberately marched firmly in the opposite direction. The Parliamentary Secretary said that the Amendment proposed by the hon. Member for Tottenham would create more anomalies than the Bill itself. There was certainly truth in that. We knew when we were debating that Amendment that additional anomalies would be created, but precisely the same objection can be made to the Amendment now before the Committee. There is no question that a number of anomalies would be created as a direct result of this Amendment.
It is now proposed that the exemption under subsection (2) should be only in effect for those chronically sick. But last Wednesday a very different story was told from the Front Bench. I will quote a word or two from the Parliamentary Secretary:I need not labour the point, but merely say that we have gone a very long way and, in my view, a long way backwards, as a result of the Amendment now before the Committee. I want to raise one other slightly different consideration. That is the question, which I have not heard answered, of what is a hospital. The question of what is a hospital is not defined in this Bill, and if we read it as defined in the 1946 Bill, we find an extremely wide definition. I will not read it all, but there it is said to mean:"I want to make quite clear that it will apply to any patient under the hospital service who is resident in hospital, whether he is there for a short period or for a longer one."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1298.]
and so on. If that definition is implied in this Amendment, we shall have very considerable difficulty reasonably to apply the suggestion put forward. My hon. Friend the Member for Luton (Dr. Hill) called it a gamble, and so it is. It is a gamble whether the appliance will be finished in time, a gamble whether the appliance needed—and this is of the first importance—is one easily obtainable or not. We have of course the very difficult position in which an appliance may be specially needed, a particular form of bifocal glasses, for instance, which take longer to supply and may, therefore, because of the length of time which such special appliances take to supply, not be available by the time the person leaves hospital. Also, no doubt, it is a regional gamble, for supplies of these appliances vary considerably in different parts of the country. I do not propose to enter what is to a large extent a private war on the other side of the Committee, but I do say that beyond any doubt at all, the Government, who have attempted to define in this matter, have only succeeded in narrowing."any institution for the reception and treatment…and any institution for the reception and treatment of persons during convalescence or persons requiring medical rehabilitation, and includes clinics, dispensaries and out-patient departments"
I do not often find myself in agreement with the hon. Member for Enfield, West (Mr. Iain MacLeod), but I do agree with him about this Amendment. Although I suppose I have not very much influence, if I were able I would go to any length to persuade the Minister to withdraw his Amendment. I can only see difficulties arising from it. It would appear that there is an intention in the Amendment, but it is difficult to understand how that intention can be carried out without greater difficulties arising as a result of it I would prefer to see the Bill in its original form, and such difficulties as may be inherent in it, dealt with administratively.
4.45 p.m. Anyone who knows the sheaves of circulars, memoranda, instructions, directions and advices that the administrative body receive from the Ministry, would realise that there is very little the Minister cannot do by administrative action, unless strictly prevented by the Act itself. When we get to the position where so much depends on the particular circumstances of the case as to what should be done, it is properly a matter for administration. What is going to happen if the Amendment is carried? It may well be that somebody suffering from a condition is advised by a general practitioner to go to a hospital and there they say, "We will have to draw your teeth, but you are the type of case we cannot ask to go to a dental surgeon; it is necessary for you to come into hospital to have it done." If they merely want their teeth out they can have their dentures supplied later and, under the proposed manuscript Amendment, such a patient would get away with it. Under the Amendment they would have to remain in hospital until the dentures were supplied, although the dentures are part of the treatment of the condition. One has sympathy with the long-term case which would be covered by the Amendment, but what type of case would be in hospital when there is the examination of the mouth and then that very long period before the teeth are delivered? There would be very few to benefit from that, but there might be particular types of cases of those who go into hospital, have teeth out and are then discharged and go back to work. They would get an advantage over others. These things cannot be dealt with by Act of Parliament and one of the difficulties of Acts of Parliament determining treatment of this description is the rigidity of the law. Someone has to be vested with a measure of discretion and an Act of Parliament is an instrument which does not itself imply discretion, unless there is power given to certain bodies to use it. I suggest that the Minister should withdraw the Amendment, let the Bill stand as it is and consider by what administrative means he can deal with the difficulties which will arise. I make no apology for having moved an Amendment which created further anomalies. I think the simplest way out, would be to withdraw the Amendment altogether and have everyone treated alike. Strictly speaking I cannot see why someone who is ill at home should not get the benefit which people get when they are ill in hospital. The only way of dealing with these things is to have that degree of elasticity which can be vested in the administrative machine. I beg the Minister, if he does not want to make things more difficult for those managing the job, to withdraw the Amendment.It might be as well if I intervened at this point, because it seems to me that there are one or two matters which have been raised by my hon. Friends and by hon. Members opposite which should be taken into account. The hon. Member for Luton (Dr. Hill) raised the question of what the position would be of a dentist brought in from outside, presumably someone under contract under the National Health Service. If he were under contract under the National Health Service, even though he might not be full-time but only part-time in the hospital, I understand that the position would be that he could provide the service required.
Under Part II?
Part II applies to the hospital itself and to the patient in the hospital. We realise perfectly well the anomalies created as between the patient who is diagnosed for treatment which includes a set of dentures and gets them fitted while in hospital, and one who gets them fitted after he has left hospital and is at home. Then, of course, if we consider the further Amendment suggested in manuscript by my hon. Friend the Member for Oldham, West (Mr. Leslie Hale), we find a further anomaly, and no doubt he had this in mind, as between the person who had been in hospital and had received his dentures, completely free, at home, and someone else, living next door, who had been at home all the time and who had received dentures for which a charge was made.
Let us have this point quite clear. That anomaly is created either by the original Clause or the Minister's Amendment. It has nothing to do with my Amendment. My object was to clear up one obvious anomaly and not to create another.
I am trying to point out that, having made it possible for someone at home, but who had been in hospital, to secure completely free dentures, my hon. Friend would no doubt take the opportunity of insisting on the stupidity of having done that and of leaving out the person who was at home throughout the period of his treatment.
In view of the comments which have been made, including that of my hon. Friend the Member for Tottenham (Mr. Messer) during the discussion on this Amendment, which we have put down quite sincerely as an effort to try to get greater clarification, we feel, on balance, that it might be as well to accept the suggestion put forward by my hon. Friend the Member for Tottenham and for us to withdraw the Amendment and leave the proposal as it stands in the Bill. As I explained, the Bill as it Stands does, in our view, make quite clear the position that any dentures supplied while a patient was in hospital would be free even though his period of stay might have been very short. In view of the comments both of my hon. Friends and hon. Members opposite, I suggest that, by leave of the Committee, I should withdraw the Amendment.The anomaly that has been created is only a small one compared with the many anomalies which the Bill is creating. While the Minister may withdraw the Amendment, I can only say that to my mind what has happened here is most discreditable. Members have referred to the speeches made in last Wednesday's debate on the Clause about just this type of case that we have tried today to rectify. It shows the mean and contemptible frame of mind—some one was going to get through in the process, and then there was to be a re-examination to make sure that if possible no one got through by any process—that is shown all through the Bill.
Even though the Minister is withdrawing this Amendment, it is not because of any generosity on his part. It is only because he sees that the whole thing is so unworkable—that a patient going into hospital with stomach trouble, whose teeth are taken out on doctors' orders, would be deprived of free teeth if he went home before the dentures were ready. Although this Amendment is withdrawn, it has shown all through that mean contemptible kind of attitude, and it is shown right through the whole of the Bill.I am sure that by this time the Minister is asking to be saved from his friends. The result of a great deal of talk on the occasion when we last considered this Measure was that the Minister brought forward an Amendment. His hon. Friends, having examined it, say that it is not satisfactory to them, and they ask that the Amendment should be withdrawn, whereupon the Minister asks leave to withdraw it, leaving all the anomalies of which his hon. Friends originally complained. All of those anomalies are still in the Bill. The whole of that long argument was a beating of the air and meant nothing at all. Hon. Members say: Sooner than accept the Amendment we resile from the position we urged with so much length and eloquence on the House—[HON. MEMBERS: "No."] Indeed they did.
Does the right hon. and gallant Member mean that it is giving way, if an alternative suggestion, which is worse than the original one, is offered, to say that we will have the better of the two?
Surely it is giving way, if after all the arguments brought forward by the hon. Member for Tottenham (Mr. Messer) and the rest, they now lie down to the whole thing and say, "Let us have the Bill as it stood"——
No.
Yes. The hon. Lady who makes rebel speeches and then votes for the question, has no locus standi in this matter. I can sympathise with the fighting rebels and with the sitting rebels, but the rebels who rebel and then vote for what they rebel against, have really no place in this discussion at all.
The Minister is now in the position of remaining completely the master of the stricken field. All the arguments brought forward have gone for nothing. Hon. Members say, "In spite of the mean and contemptible attitude of the Minister, we hand over all this power entirely to him. Parliament cannot define anything, ought not be asked to define anything, is not to be asked to define anything but the same people against whom we launched these denunciations are the people to whom we leave the authority." I hope those hon. Members are proud of the result of their efforts.I had intended to leave the matter where it was, until the hon. and gallant Gentleman the Member for Kelvingrove (Lieut.-Colonel Elliot) made a washerwoman's speech about it. There is no question that in the case of the Amendment which is now being withdrawn we are submitting to any of the proposals suggested to which we take exception. We have taken the steps that we thought necessary to draw the attention of the Minister to what we considered would be the inability to administer this Clause. The suggestion in the Amendment would make its administration more difficult than ever. Now that proposal is being withdrawn, we still say that it is almost impossible to administer this matter on the basis of the Clause as it will be without the Amendment.
The hospital service is experiencing difficulty over beds, and the question of deciding who is going to remain in hospital or who shall obtain the dentures under this Clause by remaining in hospital is still one that requires a good deal of administrative explanation. Many of the matters referred to which might have been discussed if consideration of this Amendment had been continued, have never yet been answered by the Government Front Bench. The anomalies which this Bill creates, and the difficulties which the Bill will create have been raised in debate, but the points have never been answered. We shall require answers when regulations are made dealing with matters arising out of the Bill.I wish to reply to the unnecessary and unprovoked attack made by the right hon. and gallant Gentleman the Member for Kelvingrove (Lieut.-Colonel Elliot), which showed clearly that he has not heard the discussion to which both sides of the Committee have contributed, or, if he has, that he has completely misunderstood it. The hon. Member for Luton (Dr. Hill) might have the right to resent the remarks made by his right hon. and gallant Friend because the hon. Member for Luton first put to the Committee the point now accepted at the request of almost everyone on both sides of the Committee who has spoken.
The right hon. and gallant Gentleman has been in this House for a long time but he does not appear to understand the Rules of the House. We have had the Bill re-committed to us in Committee and we are discussing only the Amendment which is before the Committee. We can discuss only that, and the only question before the Committee is whether we accept the Minister's Amendment. Scotland is famous for its bracken but the right hon. and gallant Member seems to be aspiring to be called the Brendan of the North, without the ability to sustain that modest part. Every Member who has spoken has merely suggested that, on the whole, this Amendment would have meant a limitation of the benefits of the Clause. I desire to thank the Parliamentary Secretary for taking the course he has indicated. I appreciate it.One has now and again to correct the hon. Member for Oldham, West (Mr. L. Hale), who has the reputation of speaking faster than anybody in the House and thinking slower. The fact is that we are now dealing with an Amendment brought forward by the Minister to deal with objections raised by hon. Members opposite. My hon. Friend the Member for Luton (Dr. Hill) drew attention to the difficulties which this Amendment would create, as indeed he did on previous stages of the Bill. But it was hon. Members opposite who made all the fuss about this matter and eventually forced a Division on the Clause itself. The result of all their talk is, as I say, that the Minister remains master of the field, all the talk has gone for absolutely nothing and the hon. Member for Oldham, West, thanks the Minister as a result.
Amendment negatived.
Clause ordered to stand part of the Bill.
Bill reported, without Amendment.
As amended (in the Committee), considered.
New Clause—(Duration Of Certain Provisions)
(1) Subject to the provisions of this section, the following provisions of this Act, that is to say sections one and two, section four (except so far as it relates to expenditure under section three) and the Schedule, shall continue in force until the first day of April, nineteen hundred and fifty-four and shall then expire.
(2) If at any time while the said provisions are in force, an Address is presented to His Majesty by each House of Parliament praying that the said provisions be continued in force for a further period of one year from the time at which they would otherwise expire, His Majesty may by Order in Council direct that the said provisions shall continue in force for that further period.
(3) Subsection (2) of section thirty-eight of the Interpretation Act, 1889, shall apply upon the expiry of the said provisions as if they had then been repealed.—[ Mr. Marquand.]
Brought up, and read the First time.
5.0 p.m.
I beg to move, "That the Clause be read a Second time."
In my speech in moving the Second Reading of the Bill I said that the charges which the Bill proposes need not be regarded as a permanent part of the National Health Service. Further representations were later made, in Committee. Quite naturally and understandably anxieties were expressed by various hon. Members. I undertook to meet those representations by moving a Clause of the kind which is now before the House. The effect of the Clause is quite simple—that unless this House so determines by expressly so resolving, the Act will expire on 1st April, 1954. In other words, if the Government at that time decide that they need for a longer period than that the savings which are being made by the instrumentality of this Bill, they must come to the House and ask for another year's currency of the proposal. I have already explained to the House that in the year in which we now are, the year between the coming into force of this Bill and the end of March, 1952, we cannot make the full savings which we shall need to keep the hospitals going, and that we have, therefore, very reluctantly had to make for this year—ending March, 1952—a very substantial reduction in the hospital estimates. That was done only reluctantly and with great difficulty. In the following year, however, from March, 1952, to April, 1953, we have deliberately planned to have available for the use of the most essential parts of the Health Service, of which the hospital service is by far the principal, the full year's saving of £25 million. If towards the end of the second year, the first full year of the operation of these charges, people thought that the Measure would be coming to an end in 1953, I doubt whether we would get the full savings that we require. In any event, long before April, 1954, the Government will have to review the position, will, as I said in Committee, have to consider all the effects of this Measure and how far the general financial situation enables us to produce some amelioration in these charges. Therefore, it is reasonable and sensible to say that the Act should come to an end in April, 1954, and that thereafter if any Government thinks it is necessary to continue the charges they should come to the House with an affirmative resolution and ask for express renewal for another year.This indeed might be called scorpions' day. The Minister, having chastised the rebels with whips and they having squealed, comes down to the House and chastises them with scorpions. This Clause prolongs the Bill until 1954. Again, the rebels have not won anything at all of any kind.
The right hon. and gallant Gentleman should speak for himself.
The rebels desire the Bill to be weakened or, as they have said, withdrawn. The Minister has said that by 1954 whatever Government is then in office will have to review the situation; another Government will have to review the situation.
This is the organised hypocrisy that the right hon. and gallant Gentleman was talking about.
According to the description of the hon. Member for Ayrshire, South (Mr. Emrys Hughes), this Government is an organised hypocrisy.
The right hon. and gallant Gentleman attributed to me remarks made by one of my hon. Friends. His quotation about organised hypocrisy was one originally used during a Conservative Government by the present Leader of the Opposition.
I apologise to the hon. Member for South Ayrshire. It was the hon. Member for Glasgow, Shettleston (Mr. McGovern) who referred to organised hypocrisy.
I do not mind the right hon. and gallant Gentleman quoting anything I say. I will never run away from it, but I do not remember having said that. If he can quote my remark and if it is in HANSARD, I am prepared to accept it.
Now that he has made these few preliminary observations, I hope that the right hon. and gallant Gentleman will confine himself to the question of the new Clause.
Certainly, Sir. I am not unwilling to take up any challenge from whatever part it comes, but I will leave that question. This Clause which has been put forward as a concession represents no concession of any kind whatever. I think that the hon. Member for Shettleston will agree with me. Hon. Gentlemen opposite are getting nothing whatever out of the Government.
Anybody knows that the position would have to be reviewed before 1954. The Act does not come to an end then, because this matter is not left to come before King, Lords and Commons, but merely to be subject to an affirmative Resolution. It may be continued indefinitely by affirmative Resolution. Obviously, that is not a concession of any great moment. Furthermore, the Minister said that he required this Bill in order to keep the hospitals solvent. Is he bringing forward the suggestion that a great reduction in the cost of the hospitals or of the other parts of the Service will take place before 1954? Is that the proposal which he puts to the House? If not, what is the advantage of the review he offers?indicated dissent.
The Minister says, "I need £25 million in order that hospital treatment may be continued, and I will review this matter in 1954." But he has just said that he has no reason to suppose that in 1954 he will be able to dispense with the £25 million asked for. Again, it seems that the so-called concession is entirely nugatory.
This Clause is simply a piece of crystal gazing. I am always willing to quote the right hon. Gentleman the Member for Ebbw Vale (Mr. A. Bevan). Of some of the remarks he makes, one was most pertinent. He asked, "Why trouble to look in the crystal when you can read the book?" When one sees the Estimates today and considers the course of events, one appreciates that it is possible that the Government in 1954 may take some step which the Minister is not able to divulge at present. The fact is that this Clause does not mean anything one way or the other, and might just as well be added to the Bill as left out.5.15 p.m.
I entirely agree that this Clause gives no concession of any kind. It is more hard and fast than was anticipated when the Bill first came before us. I do not intend to take part in any of the further discussions on this Measure. I said all I had to say on Clause 1. I said that I regarded this as an evil Bill which would have disastrous effects on the common people of this country. I say to the right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot) that his antics in opposing a Clause of this kind are not shared by all the Members of the Opposition. I believe in dividing the House when I am sincere. Other hon. Members do not believe in the same policy, but they are as sincere as I am, though their tactics are different.
If I had my way, I would divide the House on every Clause and on the Third Reading of the Bill. I can only say that I regard not only this Clause but the whole Measure as being evil. If this is a sample of democracy when the overwhelming mass of the Members of my party are against this Bill and the executive insist on putting it through the House, I maintain that it is nearer to totalitarianism than to any form of democracy.I dissent most violently from the view expressed by my hon. Friend. We can have the same interests of the people at heart and yet take a different view, as he readily agrees.
But to say that it is a negation of democracy or something totalitarian, that we should have different views upon a controversial matter does not make complete sense to me. When my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross) put down an Amendment during the Committee stage he had another date in mind. He was thinking of March, 1952. The Minister was unable to accept the Amendment, but he promised to introduce a new Clause, and this is it. While it is not acceptable to many of my hon. Friends we think that it has the advantage that it sets a limit in time and to the intentions of this Government, or any other, to dismantle the Health Service. The great apprehension which my hon. Friend has in mind was that this was a first stage upon what they thought might be a slippery slope. Here, they thought, we are beginning with teeth and spectacles and later we might hear that the whole Health Service was being tackled by a reactionary Tory Government. My hon. Friends had in mind that a limit should be set to this process, and 1952 was suggested. When the right hon. and gallant Gentleman the Member for Kelvingrove (Lieut.-Colonel Elliot) charges us with welcoming something which has no value, he merely misunderstands our position. He seeks to bait us and divide us, and my hon. Friends who are astute politicians recognise that he seeks to make trouble. We can have our several views about this matter. However, I welcome the assurance that while it is in the view of the Government impossible to give us a nearer date when than 1953, there is a date and an intention to put an end to this practice of charging for spectacles, teeth or some other service. Reference has been made to an opportunity to consider the position later to see how the system is working. I do not want to go into the larger context of the national situation, but I would point out that there may be developments in relation to defence and our general budgetary position which might make it possible for this or any other Government to reconsider the whole position. In that event, I take it that it would be the intention not to prolong this scheme any later than 1954—not for one day longer than was considered necessary. I hope that in 1952 and 1953, if it continues so long, we shall have opportunities to review the position and improve the scheme. This is a matter of compromise and, for myself, I am thankful that the Government have appreciated what we had in mind. Although it does not meet the case completely, I have no difficulty in supporting this Clause and considering that it is a real step in democratic procedure.The hon. Member for Stoke-on-Trent, North (Mr. Edward Davies) has justly said that hon. Members on his side of the House can have differing views on this matter. An Amendment was tabled during the Committee stage saying that 1952 would be a good date; a further Amendment said that 1953 would be a good year, but the Front Bench have now decided that 1954 should be the year. This Clause gives the benches behind the Front Bench nothing whatever. The Government have once more merely danced in the face of their supporters, and their supporters are now lying down.
I have not spoken in any of the discussions leading to this stage of the Bill, but I cast my mind back to the General Election of 1931. I remember that various cuts were being made in the social services and in the salaries of people who were dependent upon the Government. I remember well that the salaries of teachers and the police, for instance, were cut by 15 per cent. and then, under pressure, the Government of the day decided that those cuts should be made in two bites. I remember also that Mr. Frank Owen, then a young Liberal Member for Hereford, asked Ramsay MacDonald, the Prime Minister, a question. He asked whether, in view of the fact that the cuts in the salaries of teachers and police had been eased by making the cuts in two bites, the Prime Minister would not also ease the cuts on unemployment insurance benefit. Mr. MacDonald said that the cuts in unemployment insurance benefit were a condition of borrowing from America, and they must remain.
That was very important. There we were accepting dictation from America as a condition of a loan to keep us on the gold standard. Anyone who reads American newspapers will know that the American medical profession are very much against having a free health service there. I know that the Chancellor of the Exchequer went over there in 1950, and when he returned he said, "We have to continue with rearmament and we are expecting some aid from the United States of America." I think a precedent took place in this House some 20 years ago. I should like to understand whether the millions which have been subscribed by the American Medical Association—which I noticed, incidentally, was referred to in passing by my right hon. Friend the Member for Ebbw Vale (Mr. Bevan) as the A.M.A. and I think that several hon. Members did not spot the point—for the purpose of lobbying American Congressmen, have been put to use in some way to bring pressure to bear upon our Chancellor of the Exchequer and the Government here in order to bring about this cut in a free service which is abhorred so much on the other side of the Atlantic? I feel that we are entitled to an answer. I am sure that the Secretary of State for Scotland, if he knows, will give an assurance that the history of 20 years ago is not being repeated now. When we were worried about the situation in 1931, when it was a question of wholesale unemployment and so on, the Government of the day thought that the best thing to do was to reduce the salaries of people; and they started doing that among many of those people dependent upon them. Now we have another crisis, a re-armament crisis, and I should like to know whether they are really going willingly away from their Socialist principles—because clearly they are going away from them—in imposing this charge upon the free Health Service of which we are all so proud and whether that is being done as a condition of American help towards our re-armament. We have a precedent, and I am entitled to ask that question. I hope that the Secretary of State for Scotland will give us an assurance on this most important matter.Do I understand the hon. Member aright? Is he implying that the Americans—the American Medical Association—have given a direct inducement to the British Chancellor of the Exchequer? Is that what he is implying?
I would beg the hon. Gentleman not to misinterpret me like that. What I said was that I know perfectly well, and he probably does too, because he is a big business man—[Laughter.]—I think he has something to do with I.C.I. which sounds international. He may have some knowledge—especially of he reads the American newspapers, because it is clear to anyone who does—that the medical profession in the United States have subscribed masses of millions of dollars for the purpose of lobbying Congressmen against the starting there of a free national Health Service, such as we have here. In 1931 we were told by the Prime Minister of the day that cuts in the Unemployment Insurance benefit were conditions of the borrowing from America, and that they must remain. I am asking my right hon. Friend to tell us whether or not, or to reassure us, that kind of thing did not happen last September or since.
Throughout the years we have become so accustomed to hearing the right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot) making a minute matter appear like the giant Colossus, that we are not surprised that today he has so easily reversed the position, and is trying to make what is a valuable concession appear to mean, to use his own words, nothing at all. I agree that 1954 is not the date that many of us would like to see in this Bill. I confess that I hoped that at the latest we might have a review of the position in 1953. At any rate, it is a recognition of a point which many of us were putting forward, that this Bill should not be put upon the Statute Book with power to operate indefinitely, and that at some future date we should have the right to review the position.
What the right hon. Gentleman did not mention, and no other hon. Member has mentioned, is that not only is 1954 the date of the first review, but any extension of this Bill after 1954 is for 12-monthly periods only; that in every year after 1954, the Government of the day, whatever its political complexion, has to justify the continuance of these charges. To me that is the most valuable concession in this new Clause, and if the right hon. and gallant Member for Kelvingrove does not recognise that, then someone ought to tell him what it is all about. The position which he is setting up is that there is no value at all in the divorce laws of this country, because they give power to terminate the contract of marriage. Because of that they are quite valueless. But no one would suggest that that is so. Here we are being given the right to divorce ourselves in 1954, and at yearly intervals after 1954, from the provisions of this Bill. I admit that I would prefer to divorce myself from them at this very moment, but I shall now continue in an honourable matrimonial state with the Government, and with this Bill, until 1954. True, I shall do so with much anguish of spirit, but it will be in the sure and certain knowledge that, by 1954, if I do not like the partnership any more than I do now, I shall be free to break the association. And if there is any attempt made to continue it, I shall, every year, have the right to break my association with this Measure. I regard that as a very valuable concession and I am pleased that the Government have been wise enough to meet, if not in full at least to some extent, the points which some of us made.I presume the purpose of this Clause is to enable the Bill to be reviewed in 1954, and I can quite imagine what hon. Members of this House will be saying then. I am quite convinced that from these benches will come the very definite statement that this Clause was one of the most stupid and badly thought out Clauses ever put into a piece of legislation by a Labour Government. I believe that the more we go into the nature of this Bill, the more we examine it in detail, the more we are fortified in that assumption. I am glad to see the Secretary of State for Scotland in his place, because I wish to ask him if he still believes in the argument which he advanced on the Committee stage, that this Bill was justified on the grounds that in the first three months of this year there had been a somewhat unusual increase in the cost of dental services in Scotland.
I am delighted that my hon. Friend continues the argument, but let us get it correct. I did not argue; I submitted facts to show that the cost of supplying dentures in Scotland in the first quarter of this year was higher than in any quarter since the scheme was introduced.
I am very glad that the Secretary of State for Scotland has now limited it to this definite point. I will now proceed to examine his contention, because if he fails in regard to my county of Ayr, then surely I am not justified in supporting this Bill, and all my previous arguments are valid. The Secretary of State referred to denture costs. I should like him to explain this mystery. The figure for denture costs——
The only point in this new Clause is whether a limit in point of time should be applied to certain provisions of the Bill. The question of the cost of dentures and details of that kind cannot arise.
As I understand it, the fact of fixing a date of 1954 was simply because the saving in this year is only £13 million. The saving on a full year is £25 million and in order to get the full saving it is necessary to take 1954. If the point which my hon. Friend the Member for South Ayrshire (Mr. Emrys Hughes) is trying to make is that there is not going to be the on-cost for dentures in that period, then the implications of the first quarter of this year have a bearing on that actual point; but I will take the Ruling from the Chair.
I shall not waste the time of the Committee, but I do submit that this argument is relevant to the argument put up by the Secretary of State for Scotland. I have taken the trouble to get out some figures for the county of Ayr, which is a typical Scottish county, and they show that in the first quarter of 1950, the cost of dentures was £58,932, and, in the first quarter of this year, £40,334, a decrease of £18,618. If that picture is right and these figures are correct—and I could give further figures in support of my argument—I submit that the Secretary of State for Scotland has been misleading the House and that his argument falls.
5.30 p.m.
The only point which really arises on this Clause is that of the duration of the Bill. I do not think the Minister was at all happy in the reasons which he gave for his argument that the Bill ought to continue at least until April, 1954. A great many of us think that that date is too far advanced, and that the Bill ought to come to an end much earlier.
What did the Minister say in giving reasons why he could not bring this Bill to an end before April, 1954? He suggested that if the Bill were to end in 1953 or even in 1952, then, of course, if it were only to be in operation for a short period, a whole lot of people who wanted either teeth or spectacles during that period would wait until the end of that period hoping that the Bill would come to an end, and that they would be able to get these appliances free instead of having to pay half the cost if the Bill was still in operation. By inference, the Minister has said that if they have to wait until 1954, they will have to put up with some inconvenience and hardship, or, alternatively, they will have to pay half the cost. It seems to me that when he said that he did two things. First, he admitted that there will be a certain amount of hardship, because if this Bill continues in force a certain number of people will be forced into the unhappy position either of having to go without spectacles or dentures they ought to have, or being obliged to pay half the cost. That is the sort of inconvenience that people might well be expected to put up with for a few months or even a year or so, but it is not the sort of inconvenience which they would put up with for two and a half or three years. I can understand that, but the Minister, having made that argument, also denied that there will be real hardship caused by the Bill. The other fallacy in the Minister's argument is that precisely the same position will arise in a year or a year and a half from now. When we come to the beginning of 1953, the position will then be that there will be equally a lot of people who ought to have teeth and spectacles but cannot afford to pay half the cost, who will be placed in the embarrassing position either of having to make sacrifices they cannot afford to get them, or postponing their acquisition of teeth and spectacles until April, 1954. They will be in precisely the same position as other people would be in if this Bill were now limited to one year or a year and a half. Therefore, the position will be that in 1952 or 1953 there will be a large number of people who will have to gamble on the Bill coming to an end in 1954 and putting off the spectacles and dentures which they ought to have in the hope that the Bill does come to an end, and that they will not, therefore, have to pay half the cost. Whatever date is chosen, it seems to me, from the Minister's own argument, that it will mean that the Government will have to make a decision—and, I should hope, long before April, 1954—about bringing this Bill to an end.There are one or two points with which I should like to try to deal, and I will follow the very excellent example of my hon. Friend the Member for South Ayrshire (Mr. Emrys Hughes), and be brief indeed. I do not know the figures for Ayrshire, but I would be reluctant to accept the argument that Ayrshire is a typical county in Scotland. After all, there is only one county that could claim my hon. Friend.
The figures which I give are unambiguous and unmistakable, and they are a complete refutation of the argument that there has been a downward trend in the demand for dentures. The figures for Scotland of the number of approvals for dentures show that, in the first quarter of 1948, they were 92,000; in the first quarter of 1949, 110,000; in the first quarter of 1950, 109,000; and, in the first quarter of 1951, 126,000. I repeat, for the benefit of my hon. Friend, that 126,000 is the highest approvals figure given in any one quarter, and these are the figures of approvals for dentures.In what parts of Scotland are these figures drawn up, because in Ayrshire the figures have gone down.
I would be reluctant to accept the conclusion that these figures differ from those of Ayrshire. I do not know the reputation of Ayrshire, but, at any rate, I cannot see how my hon. Friend can escape here. I have been trying to recall who was the distinguished Member for Bristol who once argued the difference between a delegate and a Member of Parliament. My hon. Friend must not think that, by regarding himself as a delegate from his constituency, he may be able thereby to escape from support of this proposal. I hope that my hon. Friend and the House will see quite clearly that I never have at any time attempted to mislead hon. Members on this point. There are the figures, and they are a complete refutation of the claim, that, nationally, the figures are showing a downward movement.
I am very grateful to my right hon. Friend for giving way. I would like some reasonable explanation for the divergence in these figures, because, in the county of Ayr there are five constituencies, which represent a good cross-section of Scotland from right to left of its population and its interests, both from the completely rural to the highly industrial belt stretching right along the coast from Ardrossan. These figures are culled from the Ayrshire Executive Council and they are completely accurate, and they show a steep drop in the first quarter of this year as against last year. I wonder if there is some different method of collecting these figures in the areas of other executive councils, because it does seem to me that there is something wrong. We do not differ from the rest of Scotland in this matter—we may be better in some other respects—but we surely make up our figures in the same way.
These figures come from the Scottish Dental Estimates Board, and there is only one Scottish Dental Estimates Board. The figures are strictly comparable and highly reliable. My hon. Friend the Member for Central Ayrshire (Mr. Manuel), if I may say so bluntly, talks so much nonsense when he tries to persuade himself that Ayrshire is not different from the rest of Scotland. We are not asked to accept the conclusion that Ayrshire is, for all purposes, a typical cross-section of Scotland, because, if the incidence of tuberculosis in Scotland was reflected by Ayrshire, we should have no tuberculosis problem on our hands.
Why?
Because there is in Ayrshire air, sunshine, light, milk, a much better history and not the dreadful background of the appalling concentration of slumdom such as we find in Glasgow and in Dundee. I would therefore expect to find a higher incidence of tuberculosis in the over-populated, overcrowded and less well-fed districts than in Ayrshire.
At any rate, I have not attempted to prove that the Ayrshire figures are typical. I have attempted to prove nothing more than the assertion that there has been a downward tendency in the demand for dentures in the first quarter of this year.Is the simple inference to be derived from my right hon. Friend's figures that more and more people are requiring dentures and that we are now going to make it more difficult for the people who need them to get them?
No. I should have thought that if my hon. Friend had any care for statistics at all, he would not rush to such a complex and rash conclusion. I have merely offered the figures for the number of approvals this quarter.
Would my right hon. Friend clear up something that has created dismay in my mind? I presume that during my absence for tea or dinner one evening, this House did not concede Home Rule to Ayrshire, and that therefore this will apply to England as well as Ayrshire?
It is, of course, a United Kingdom Bill, but I must defend my hon. Friend and say that he has exactly the same rights in this House as the most distinguished hon. Member for any English constituency.
May I assure my right hon. Friend that I am grateful to him, and will not follow his bad example by being offensive? Will he oblige me by getting the figures from the Executive Councils throughout Scotland, in the same way as he got them from the Ayrshire Council, and give us an opportunity to examine them?
I hope my hon. Friend did not find me offensive. If I may say so, I have had a little longer experience in this House than he has, although it is a relatively short experience. If people throw their weight about, they must expect to be tripped, even by the kindest persons. I shall be delighted to ask the Scottish Estimates Board for such a break-down of the figures in relation to the different counties of Scotland, and to furnish my hon. Friend with that information as quickly as possible.
A much more important question was addressed to me by my hon. Friend the Member for Nuneaton (Mr. Bowles). I hope he will forgive me if I say quite frankly that I was absolutely astounded that such a question had to be put, because, whatever precedents there may have been, they were not drawn from our party. I want to say quite flatly that neither the Government nor my right hon. Friend the Chancellor of the Exchequer were ever either offered advice or, much less, subjected to pressure from the Government of the United States, or from anywhere else.What does my right hon. Friend mean by saying that I was not drawing a precedent from our party? I certainly was. Ramsay MacDonald and Philip Snowden borrowed money in order to keep us on the gold standard. A condition of that was, as Frank Owen was told, that those cuts had to remain in the Unemployment Insurance benefits. That is precisely what happened. When the majority of the Labour Government could not stand the cuts any longer, Ramsay MacDonald resigned and formed the National Government overnight. Then, of course, we went off the gold standard, but the cuts remained. Ramsay MacDonald himself answered Frank Owen's question.
5.45 p.m.
The operation was effected and justified by a Government which was called "National."
May I ask the Minister this question? When were the last millions borrowed from the Americans? Was it when the Labour Government were in office, or not?
I do not want to become involved in this, but I happen to know a bit about it. The split came about as a result of the stand taken by Arthur Henderson.
I affirm flatly, and without qualification of any kind, that there was no pressure from the United States or elsewhere, and neither was there advice. They did not seek to impose any conditions regarding any military arrangement in which we are partners.
I am much obliged.
The right hon. Gentleman said that these proposals were entirely the responsibility of His Majesty's Ministers.
Who else would be responsible? Who defends them, and who operates them? His Majesty's Government, of course. We have neither sought to shelter behind any one else nor to deny that these are our decisions. We have given reasons for them, and we will defend them.
I would say to my hon. Friend the Member for Shettleston (Mr. McGovern) that it is really a little arrogant of him to claim all this righteousness for himself, and to assert without the slightest evidence, that he has an overwhelming majority to support him.I did not say that. I said there was evidence that an overwhelming majority of hon. Members on this side would have voted against it had they been given a free vote. Therefore, I say it is undemocratic and should not be pursued.
A Government does not function by a free vote. However, that is quite apart from the assertion which my hon. Friend makes, that there is a majority of hon. Members who support him in this. I plead with him not to pull a cloak of righteousness around his shoulders and to decide that everybody else is a miserable sinner for no other reason than that they do not share his point of view.
I did not say that. I said that my means of approach was not that employed by the majority of hon. Members of this party. We have different methods, and I conceived the method of voting against it. Others did not do so. I only claim that, in my estimation, I more nearly represent the working classes on this matter.
That is a very different thing. That is a matter of judgment, and I would not deny my hon. Friend the right to make such a claim, although I would not necessarily agree with him. What I disagreed with him about, was when he said that this was an authoritarian Government—I believe he called it a totalitarian Government—because we disagreed with his point of view. That is the kind of view which in another office I used to hear frequently from some gentleman whom I know my hon. Friend dislikes very much. [An HON. MEMBER: "Mr. Gromyko."]
The right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot) has every right to try to make a political occasion of this and try to foment such division as he may discern or think he discerns on the benches behind me, but it is nonsense to contend that this is not a concession. After the debate developed in Committee many of my hon. Friends indicated that while they did not approve of the principle they would be less unhappy if a term could be put to the procedure. A term has been put to the procedure. My hon. Friend the Member for Islington, East (Mr. E. Fletcher) thinks it is too long and so do some others, but there is a fair reason for carrying it to this length. It is the same term as that identified with our abnormal defence commitments. It is also, as my hon. Friends will agree on reflection, the shortest period which could give us an opportunity of reviewing and debating a full financial year's working, because we would have to debate it, if we were going to do so, before the Budget in April, 1953. This fits in with our general budgetary policy. This will give us an opportunity to review it when we have had a reasonable experience of its working. It is offered as a concession to my hon. Friends and I am fairly confident it is a concession most of them will accept and many welcome.Like some of my hon. Friends, I disagree with this Clause. It has been argued by my right hon. Friend the Secretary of State for Scotland, that this is a concession and that the date might have been much earlier than 1954 had that been possible. I understood that the strong point for 1954 was to give an opportunity to examine the working of this new scheme. That is a reasonable deduction to make.
I say, however, as I said in Committee, that if the opinion is that there is justification for examination of the scheme, then surely the proper course would have been to make a complete examination of the National Health Service. It is bad organisation and bad administration to establish a free National Health Service and suddenly to discover that there is one section of that Service which requires special examination while the rest is left completely out of account. On that basis it is quite possible to introduce a Bill later on restricting the rights under some other part of the Service and to argue again, "We shall only continue this until 1956 because we desire to make an examination of this new branch of the Service." I think a completely wrong approach was made to this matter and that there should have been an examination of the entire National Health Service. We are told that this is a concession, but does anybody suggest that subsection (2) of the Clause encourages us to believe we have a concession? That subsection takes all the necessary precautions to give the Government power to continue these provisions permanently. All they require to do is to pray each year that the Act continues. I say that if the Government put that in, it is obviously because they have in mind the idea that in future there may be justification for continuing these charges. [Interruption.] I do like speaking when people who have already spoken are quiet. Surely there is nothing unreasonable in that. There is evidence in subsection (2) of this Clause that these provisions will be continued permanently. Therefore, it confirms the point we made at the beginning that the Government are making an encroachment on the National Health Service which, two years ago, they would have rigidly denied. They then would have opposed anybody who suggested such a thing. I have no doubt the figures submitted by my right hon. Friend the Secretary of State for Scotland are quite accurate, but we know from long experience that all figures of that kind can be extremely misleading. The figures may be for a single tooth or denture repair. We are entitled to have more detailed information about those figures. One of the strong arguments put forward in favour of these charges is that they are justified because the figures are going up. That is the finest evidence of a means test I can think of. Because there is likely to be a greater demand from people for these services, the Government are going to make a charge. I heard that argument in the old days when it was argued that National Assistance Board scales must be cut down because more people were making demands upon the funds. That is exactly the case made out here—that the Government must be cautious and impose charges because more people are making demands upon the service. I dislike the Bill and the date has not helped me in the slightest degree. I have already made my protest on the appropriate stage in Committee; and when the Bill is passing through the House, I cannot be as happy as some of my hon. Friends—in fact I deeply regret that it is being passed.Question put, and agreed to.
Clause read a Second time, and added to the Bill.
Clause 1—(Charges In Respect Of Certain Dental And Optical Appliances)
I beg to move, in page 1, line 16, at the end, to insert:
I think this Amendment to add a proviso will detain the House only for a minute or two. It was originally designed as a peg on which to discuss Clause 1 (2), but that peg was provided by the Government's Amendment and it is now withdrawn. There is a small point of substance on which I should like to have an assurance which I expect to receive from the Front Bench. The short point is whether patients occupying pay-beds under Section 5 of the principal Act are or are not covered by Clause 1 (2) of this Bill. Quite clearly, there is no doubt about those occupying free beds under Section 3 of the parent Act, and little doubt about those occupying amenity beds under Section 4. It seems to me, however, that Section 5 is not so clear. It is true the full cost of services, accommodation, and other things provided, is paid. These services seem to me to be no less part of the hospital services because they are paid for. It may be that there is a conflict between Section 5 of the parent Act which says full charges should be made, and this subsection which might imply that patients in that category receive free treatment. If there is that conflict the matter should be resolved, because nobody on either side of the House would take it as reasonable that somebody occupying a pay-bed under Section 5 of the parent Act should be able at the same time to obtain exemption or partial exemption of payment for the balance under this Bill. 6.0 p.m. If there is a conflict it should be resolved in some such manner as my Amendment suggests. It may be, on the other hand, that the words in line 14, "under this section" are the key to the question I have raised. It may be that although that brings in a new principle in regard to Sections 3 and 4 of the parent Act, it does not, however, affect the proviso in Section 5 of the 1946 Act whereby the full charges should be made. It is in order to have that point cleared up that I have put down this Amendment."Provided that this subsection shall not apply to any appliance supplied to a patient from whom charges are recovered under section five of the National Health Service Act, 1946, or of the National Health Service (Scotland) Act, 1947."
I beg to second the Amendment.
As I think the hon. Member suspected, it is the case—and I can give him the assurance—that this Amendment is quite superfluous. In fact, I understand that its effect would be one which no one would wish to see—the effect of making the occupant of a pay-bed pay twice for these appliances.
Clause 1 enables the new charges to be made notwithstanding Section 1 of the 1946 Act, and that Section at present requires all services to be free of charge except where the 1946 Act expressly provides otherwise. Section 5 of the 1946 Act expressly provides for charges to be made to paying patients, which should in the aggregate cover the full cost of the accommodation and services. Therefore, I think that, with that quite definite assurance that this point is already fully covered, the hon. Member will be able to withdraw his Amendment.I have no wish to detain the House, and in view of that explanation, I beg to ask leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
Clause 4—(Consequential Provisions)
I beg to move, in page 3, line 19, at the end, to insert:
This proposed subsection stands on the Order Paper in pursuance of notice which I gave during the Committee stage that I should table an Amendment on these lines. It seeks to implement and to carry a stage further—a stage to which I hope the Government will agree—an assurance which was given by the Parliamentary Secretary in Committee, to which perhaps I might refer the House. The Parliamentary Secretary said:(3) Regulations made for the purposes of subsection (1) of section one of this Act may provide that there shall be afforded to every person from whom a charge is recovered in pursuance of this Act upon the occasion of the recovery of the said charge the opportunity to apply for an assistance grant to meet his requirement for the service in respect of which the said charge is recovered.
that is, a claim for relief under Clause 4—"It is important that we should make sure that all those who receive attention from a dentist or an optician are fully aware of the way in which they can make their claim"—
The proposed new subsection which I am asking the House to insert in the Bill requires two things. It requires that upon the occasion of a patient being called upon to pay the charges that can be imposed under the Bill that patient should not only be informed in the clearest possible way that he has a right to apply to the National Assistance Board for partial or complete repayment of that sum, but also that the means of doing so should be automatically afforded to him at the time. The manner in which I would conceive such a provision being put into effect is that a simple form of application to the National Assistance Board for repayment would be included in the document by which the charge is made and is receipted. It might be possible, indeed, to achieve the two objects with the same piece of paper so that all the patient had to do was to fill in the form, tuck in the flaps and post it. This provision, if inserted, will, I believe, meet a large part, though not the whole of the anxieties which were expressed at an earlier stage of the Bill about the operation of the means test under the Assistance Board. When a proposal was made to substitute for the Assistance Board as the reimbursing authority some other machinery there was almost universal agreement on both sides of the Committee that the Board was in many respects unsatisfactory, and the chief objection that was taken was to the alternative machinery proposed. Under this Amendment, although the work of assessment will still fall upon the Board, all those difficulties which were apprehended from the necessity of the patient making a separate, direct and personal application to the Board will be neutralised. Thus I feel that this subsection goes a long way to meet the anxieties which were expressed repeatedly by hon. Members in all parts of the Committee on the last stage of the Bill. That is why I was particularly disappointed to hear that the hon. Member for Shettleston (Mr. McGovern) intended to take no further part in the proceedings on this Bill, because I have been promising myself valuable support and encouragement from him. In the Committee stage, referring to the operation of the National Assistance Board which by this Amendment I propose to modify, he said:"and of how they can get relief in case of hardship. That is a matter which we must very carefully bear in mind as we proceed with this Measure."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1227.]
Under the subsection which I am proposing they will not have to go to the Assistance Board. The making of the application will be an automatic operation which will have no stigma attaching to it, and which will be carried out by the patient if he desires to do so at the time when he is called upon to pay the charges. Perhaps the strongest arguments in favour of this Amendment were advanced during the Committee stage by the hon. Member for Reading, South (Mr. Mikardo), who pointed out that, rather than go to the Board, many persons who were in real need of these appliances would either defer having them altogether or else would resort, as in the past, to purchasing them from quacks. It is precisely that band—if I may so describe it—of demand for these appliances which lies between the regular recipient of National Assistance on the one hand, and, on the other hand, the type of patient who will unquestionably be called upon properly to meet these charges, which this Amendment is designed to meet. I hope that the Government will not resist the object of the Amendment on the ground that the deterrent effect of these charges would thereby be reduced. The only deterrent effect which will be reduced is the deterrent effect upon precisely the type of person whom we do not want to deter. I must say that the information which we have been given on this subject so far has been defective in itself and tends to make one rather uneasy. This matter was raised earlier by my hon. Friend the Member for Luton (Dr. Hill), and I thought he received a most unsatisfactory reply. It is difficult from the information that we have so far received to ascertain exactly what dimensions the Government imagine the deterrent effect of these charges will assume, but I venture to calculate them briefly as follows: I will take the dental service rather than deal with both the dental and the optical services. Taking into account the effect of the Bill, the estimates for dental charges this year for Great Britain are approximately £38 million. We know that the Government estimate that in the current year the savings resulting from the operation of the Bill will be about £8½ million—half what is anticipated in a full year. Thus, the full cost of the dental services in the year 1951–52, without this Bill, would be approximately £46½ million. On Second Reading, we were told by the Minister that about 60 per cent. of the cost of the dental services is referable to dentures, and if that proportion holds good then £28 million would be the cost of the provision of dentures in a full year, without this Bill. In that case, £14 million is the amount which will be saved simply by charging a patient half. In fact, the expected saving is £17 million, so that at least £3 million per annum is expected to be saved by the Government as a result of dentures which are not provided because these charges are imposed. That is to say, there is roughly a 10 per cent. deterrent effect. I suspect, however, that it may be that the calculation has been a higher one; and here I turn to another point on which I feel the House has not had the fullest possible guidance. During the Committee stage the Secretary of State for Scotland was asked whether these calculations——".…all I say in connection with this is that for some people to have to go to the Assistance Board is a humiliation. Therefore, they will not go there, with the result that their standard of health and eyesight will deteriorate because there is no guarantee they will get their teeth or spectacles."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1356.]
I am sorry to interrupt the hon. Gentleman, but I am not clear as to the relevance of this matter to his Amendment, which seems to me to deal with the application for an assistance grant in certain circumstances.
I am sorry if I have not made it clear. The connection is this—that the effect of the subsection which it is proposed to insert in the Bill will undoubtedly be to enable certain persons to obtain dentures and spectacles who otherwise would not do so because it was necessary for them to make a separate and direct application to the Assistance Board. From information which has been given so far, it appears to me that the Government are actually counting upon that deterrent effect in the calculations upon which the Bill is based.
If, of course, they can tell the House that they have no such intention, then a consideration which is relevant to my Amendment will disappear; but so long as we suspect that part of the object of the Bill is to deter persons from obtaining dentures and spectacles by reason of the fact that if they wish to avoid a charge they will have to go to the National Assistance Board, then we have a right to attend to the case of those persons who ought not to be so deterred. I was endeavouring to estimate the rough dimensions of this element of deterrent effect which the Government anticipates. I think that in so far as that consideration is germane, the Government should be able to indicate the weight which they attach to it, for it is a material consideration. I conclude by saying that this Amendment, or certainly the object which it has in view—namely, that a patient should have the opportunity automatically and without stigma of ascertaining whether his means are such that he is entitled to a refund—goes a long way to meet many of the objections to the Bill which have been raised on both sides of the House. The Minister and the Parliamentary Secretary have already shown themselves at any rate partly aware of the difficulties and I hope they will accept the principle which is enshrined in the Amendment.I beg to second the Amendment.
I think everybody would agree that it is most undesirable that a dentist should know which of his patients goes and which does not go to the Assistance Board for help under the Bill. Two categories already exist—the private patient and the National Health patient; but the main category of 97 per cent. or 98 per cent. of the population must not be subdivided in the way which many people fear will take place. The solution offered by my hon. Friend the Member for Wolverhampton, South-West (Mr. Powell), is that the receipt itself should carry on the back a simple extract of the rights given under the Bill, and I think that would meet the objection which has been raised that the dentist would know the circumstances of his patient. It would also do something to remove the fear which exists in the minds of many people that some of those who most need this help will not go to the Assistance Board for it. Those people who have been to the Assistance Board before will no doubt go again. Those who can afford to pay for the appliances will not go to the Board whether they receive a notice on the receipt or not. But those with whom the House is no doubt particularly concerned—those in full-time employment—except in most exceptional cases will not go to the Board where they are earning a reasonable wage which is yet sufficiently low to entitle them to a certain amount of refund from the Board under the Bill. If something on the lines of this Amendment were adopted, we should make it easier for those people to obtain the relief which the Bill affords.6.15 p.m.
We have every sympathy with the intention behind the Amendment and, indeed, in Committee I said that we were anxious that everyone should know how he could claim assistance towards meeting these charges in the event of hardship. But we are by no means certain that this Amendment would help us very much in gaining that end.
This is really an administrative matter and I can assure the hon. Member for Wolverhampton, South-West (Mr. Powell) and my hon. Friends, who I am sure are interested, that we shall take administrative steps to see that those who go to the dentist or to the optician, know how they can make their application for assistance. Already we have drafted a form of words which can be included in a notice to be available in the dentist's waiting room and in the optician's premises or in similar places so that everyone may see just how he can make an application if he desires to do so. The hon. Member for Wolverhampton, South-West, suggested that, in addition, forms of application might be made available at the same place That straightaway raises the danger that the dentist will get to know precisely who is making an application to the National Assistance Board and who is not.rose——
I appreciate that hon. Members may say that the man could take the form away, fill it up and send it to the Assistance Board without anyone knowing. But this is purely an administrative matter. There is no difference between us on this. We all want everyone to know how they can make their applications. We have already gone some way in making preparations to ensure that everyone shall know about it, and we are prepared to consider whether we should provide administratively for some application forms to be available. We will consider whether it will be advisable and helpful or not.
I cannot go beyond that. In fact, the Amendment does little more than say that those who go to an optician or a dentist should have the opportunity to apply for assistance. They already have that opportunity. The Amendment does not help us at all. I appreciate the point of view which has been expressed by hon. Members and which, I am sure, is shared generally in the House. We will take account of it in the administrative arrangements which we make.I appreciate the spirit shown in the hon Gentleman's reply, but I would ask him not to reject out of hand the possibility of providing the patient with the means of preferably a postal application to the Assistance Board. I think he will find that he can do that without there being any possibility of the practitioner getting to know. I agree that this is an administrative matter. We have had a substantial assurance that there is an intention to deal with the matter administratively. Consequently, I beg to ask leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
Motion made, and Question proposed, "That the Bill be now read the Third time."—[ Mr. Blenkinsop.]
6.22 p.m.
I hope the House will excuse me for intruding in the debate for the first time at so comparatively late a stage, but there are one or two general observations which I think are shared on this side of the House and which I may perhaps put briefly to my hon. Friend on the Front Bench. On this side of the House we feel that one of the troubles with the Bill has been that we have so much concentrated on this departure from the Health Service that we have done a great deal to obscure to the world as a whole the very great benefits which still remain. For that reason it is necessary to say, in passing, that we have been looking at this in only a limited sphere and that, however much the Bill may affect the Health Service in a particular degree, at any rate it leaves untouched an immense field of that Service.
Secondly, and on the same theme if I may, my right hon. Friend the Minister of Health throughout the Committee stage and other stages appealed to us all to judge him by his speech on Second Reading. I prefer to judge him not by that speech, to which I shall turn in a moment, but to judge him by his very great and humane work as Minister of Pensions. With a Minister who has acted so ably and so well in those circumstances, it would be very wrong for anyone on this side of the House to suggest that he has not the interests of the service at heart. When I come to look at the details of his speech and the reasons he gave for the Bill, I honestly feel that my right hon. Friend is like a very able and courteous advocate who, out of sheer inadvertence, has accepted two briefs from rival solicitors and then, to his embarrassment, has found that they both relate to the same case, but has nevertheless determined to go ahead and to present both the arguments as well as he could in the same speech. If we look at the arguments which are advanced for the Bill we see that they fall into three categories, each of which seems to be quite distinct. Before we decide to pass the Bill we ought to decide exactly what is the principle upon which the Bill is based. As I understand it, the first point made is that these charges are necessary because there must be some ceiling to the Health Service. We ought to know a little more about the reason why a particular point was chosen for that ceiling. Why was every expenditure held to be satisfactory until we reach precisely the point where we have to pay for teeth and spectacles. Why was that the ceiling which was fixed? What are the principles on which it was determined? To take the second point. If it is alleged that we have to charge for some illnesses to make up for the additional cost in the Service as a whole, or alternatively, as the Secretary of State for Scotland suggested, in order to pay for the excess cost of re-armament, why should we not charge the tuberculosis patients, say, for the cost of re-armament? Why should that fall on the people who need spectacles or false teeth?On the poorer people most.
To take the third point made. How will these proposed charges prevent abuses in the dental and optical services and improve the school dental service? Those are the three main problems which I hope my right hon. Friend will deal with when he replies to the Debate.
The hon. and learned Gentleman will, I hope, relate his remarks to the contents of the Bill. He appears to be going back to the earlier stages of the Bill.
With great respect, the point which I was on, was the reason why we should pass the Bill in the form in which it is amended now. This is a Bill which will impose certain charges. Why are those charges necessary? There are three reasons given, one, that there may be a ceiling; second, that spectacles and teeth are the appropriate things to charge; third that these particular charges will prevent abuses. It is to each of these three points that I was directing my argument.
The first point I want to ask my right hon. Friend is this. Why—on what basis—was it decided to place this ceiling? If we are to have a comprehensive Health Service it does not seem to me that £8 a head is a very big sum to choose for it, but if £8 a head is not the right sum what is, in fact, the right sum to charge for the whole thing from the global point of view? Because under £8 per head we have to include the chronic sick, we have to include maternity and child welfare, we have to include epidemics, and we have to include preventive medicine. The Secretary of State at an earlier stage reproved everyone for not going to the statistics. It is always a little difficult for back bench Members to have access to all the statistics, but I should have thought that, when dealing with the reasons for this ceiling, he would at least have referred to the figures contained in the Registrar-General's report for the last quarter of 1950, which takes a sample of the population and gives the number of times this sample go to their doctors. Unless we know what is the number of times the population as a whole have to go to their doctor we cannot say whether we are paying too much for the whole service or not. If one looks at the sample figures one sees, for example, that in September out of every 100 people 40 men under 65 were going to the doctor in that particular month, and 67 men over 65; of the women over 65, 76 were going out of every 100 in one particular month. What are the causes, then, of this rising cost of the Health Services with which we have to deal? Because it is no use at all passing this Bill unless we deal with the root difficulty—no use saying we make these charges and do not then find a final solution, because, in fact, the rising costs are due to other factors.We must deal with what is in the Bill and not the general background. That was dealt with on Second Reading. Now we are dealing only with what is in the Bill. Therefore, the general aspect of the background and of the cost of the Health Service and so on is strictly out of order on Third Reading.
I appreciate that very clearly. The point I was attempting to deal with was this. If we are to pass the Bill in this form, in which we have provision to review the matter after a number of years, it is proper to know at that time, when we come to review it, whether we shall have to deal with additional charges, and so, whether this will meet the situation put before us. However, I will leave that particular point and come to the second question with which I should like my right hon. Friend to deal.
Why are these charges placed on these particular appliances? Who, in fact, wear false teeth? I do not know what degree of inquiry has been made into this, but just recently, speaking on the Report stage, the Secretary of State for Scotland, answering an argument dealing with the incidence of the need for dentures in Ayrshire, said that: Of course, there were many more dentures needed in Glasgow because people there were not so healthy as they were in Ayrshire. If that, in fact, is so, then, of course, it is true that the people who need them most are——I am sure my hon. and learned Friend is not one to misrepresent me. I think that what I said was that the incidence of caries was unlikely to be higher in Ayrshire than in Glasgow.
I appreciate that, and the reason for caries is that the people in Glasgow do not, or have not in the past, because of poverty, been able to go to the dentists as much as the people in Ayrshire.
Water supplies.
There may be a number of local factors, but, generally speaking, that is so, and I think that if one searches one's own experience one does find that, generally speaking, the poorer people are those who earlier require false teeth. Let me give one personal example. During the war I happened to be concerned with parachuting. In parachuting it is necessary to remove one's false teeth before leaving the aircraft. As one may be in difficulties on reaching the ground, it is necessary in some form, to retain teeth and be able to replace them when one arrives.
Generally speaking, the average age of the people taking part in this was under 30, and yet in the particular units I had to deal with there were amongst the other ranks quite a number of people who had to apply for special celluloid boxes in which to place their dentures. I think that all of us would find, if we searched our own experience, that in a great many cases the people who have false teeth are the poorer people of the community, and that is due to general social maladjustment that we are trying to overtake, though we cannot overtake it all at once. Turning from teeth to the spectacles position, again I do not speak with the medical knowledge of some of my hon. Friends, but I would say that there are a great many defects of vision which are hereditary; and, therefore, if a husband and wife both have to go to the oculist for glasses, the chances are that their children will have to go, too; thus when their children reach a working age, they will form a group upon whom disproportionate burdens will fall. The matter is made the worse because, as I understand the Bill, the figures which we are charging, which the House is now imposing, are average figures, and, therefore, the charge of 10s. a lens may be more than the total cost of any of the particular lenses which may have to be fitted for any member of that particular family. In those circumstances we may be imposing more than the total cost of the spectacles upon a whole family of people who have a hereditary but a simple defect of sight. That does not seem to me, on the face of it, to be a very reasonable way in which to approach this problem. The third argument for the Bill, as I understand it, is that it will check abuses. How will it do that? That is a question to which no answer has been given yet. If a person is advised by his dentist that he needs a set of dentures or by his oculist that he needs glasses, will the fact that he cannot afford to pay for them turn him into an expert who knows whether he needs them or not? That really is the proposition which is put before us, and the test of skill is transferred from the skilled man—from the oculist and from the dentist—to the patient. The only basis upon which the patient is supposed to judge is that the poorer he is, the more strict he will make the test. Other things being equal the poorer a man is, the less able he is to make the test, the less experience he has had of oculists and dentists the more he is likely to be taken in by the type of advice he is given. If he is somebody brought up with a long history of dentist attending, then he may have a hearty contempt for them, but the ordinary person who goes just once in a way has the utmost respect for my hon. Friend the Member for Wolverhampton, North-East (Mr. Baird) and his professional colleagues and is much more likely to take their advice. If, in fact, it is true that there are such great abuses in the supply of dentures and in the supply of spectacles, then this Bill does nothing to check them by placing a charge in this way. Surely there are equal abuses in all the other respects? If there are dentists who are prepared to extract teeth or oculists who are prepared to prescribe glasses when they are not required, surely this is the wrong approach to the whole problem, and we ought to be employed in examining the whole conduct of the people doing these things—and doing these things in respect of other things as well.The other things do not come within the Third Reading of the Bill.
I appreciate that. I was merely using that as an illustration for judging the validity of the arguments given to us.
My final point is on—if I may call it so—the total cost argument. It is the argument which we have had advanced in favour of making all sorts of charges—and, of course, in favour of making a charge for prescriptions when we were dealing with that matter previously; and it has been said that this is going to effect some sort of saving. The general argument which we very often have in this House when discussing this sort of difficulty is that we can afford to use a certain amount of the national product, a certain amount of labour, a certain amount of material for a particular thing. Therefore only by imposing a charge upon it to discourage people from doing this particular thing and to encourage them to do something else, can we restrict its use. Let me take one example which was very familiar to the Parliamentary Secretary in the days of the wider responsibility of the Ministry of Health. He often had to deal with the question of the making-up of roads. There the test was not who were going to pay for it, or whether the money was coming out of the public funds or not, but whether the money should be spent or not. In this case, is it suggested that by imposing these charges we shall ensure that there will be fewer spectacles and that there will be fewer teeth? Is that the argument? Is the argument that there are now people who are wearing teeth and wearing spectacles who have no right to wear the one or the other? Because if that is the argument, it ought to be stated far more clearly than it has been stated up to the present. Is the object of this Bill, in short, to remove abuses of that sort, to prevent people for some unknown reason of obtaining false teeth or glasses when they do not require them? That is generally the reason advanced for imposing charges which discourage use. To continue my illustration from the point of view of roads, it is said that it does not matter whether the charge for roads comes out of the pockets of the people whose houses front on to the roads or out of taxation or from the rates. A limit is set on the amount of money spent on roads. In this case is it suggested that £x is the limit to be spent on teeth and spectacles and that by imposing a charge, it will keep it down to that amount? I think that it is right that, as I am speaking on this side of the House, I should say that whatever may be our view on this, in view of the vociferous way in which we have plunged into this discussion, it would have been better if we had consulted—I hesitate to say it—even with the British Medical Association, because we know from the speech made by the hon. Member for Luton (Dr. Hill) that what they suffered from was not taking the very good advice, which, no doubt, they had throughout all their discussions, of their secretary. A practical approach to these problems and discussions with the profession might have saved us all the heart-searching that we have had on these benches. The Bill now, thanks to the activities of many of my hon. Friends, is a great deal improved, but it does not do away with the lesson that when technical matters of this sort are to be brought forward, we should study them in leisure and with care before we submit them to the rough and tumble of debate in the House.
6.42 p.m.
I am glad that it falls to the Minister of Health and not to me to give a detailed answer to the criticisms of the Bill which have been made by the hon. and learned Member for Hornchurch (Mr. Bing). I believe that there is a detailed answer to many of the criticisms which he has put forward with the skill of an advocate, and they have, I think, sought to find a greater amount of reason in the Bill than its rough and ready provisions admit.
I would, however, make this one comment upon one of the last points made by the hon. and learned Gentleman. He inquired why it was that we had been thrown into the passage of this Bill so rapidly and with so few consultations with the people concerned. It seems to me that if there is to be legislation of this kind, it must be rapid legislation, because, if the Bill is not passed quickly, we shall at once get people who had notice that charges are to be imposed seeking to avail themselves of the services so long as they are free. Whatever criticism there may be, I do not think that there can be proper criticism of the speed with which the Minister is seeking to get the Bill on the Statute Book. I am one of those who support the Third Reading of the Bill, but, frankly, I do so with no particular enthusiasm. I regard this as an unpleasant public duty which, I think, we on both sides of the House, have to assume. It has for a long time been obvious that there are differences of opinion among the party on the other side of the House on many subjects. It has been obvious that there has been a split, but I think that it is regrettable and unfortunate that these differences should have crystallised around the subject matter of this Bill. The result has been that it is the patients of the National Health Service who have been made the shuttlecock in a political quarrel.Nonsense.
That is the result of the circumstances in which the Bill has come to be brought before the House. To me the question which is presented by this Bill is whether this particular charge is necessary in order to keep the Health Service going for the next three years. I say for the next three years because that is the change which has been introduced into the Bill, and I would suggest, Mr. Speaker, that its introduction allows us on Third Reading to go perhaps a little wider than would otherwise be the case.
I have some knowledge of certain parts of the Health Service. I have considered very carefully whether there are not other ways by which the sum of money which this Bill is to secure, could be made available. That the money is needed, I have no doubt at all, because in every direction under the Health Service, the need is infinitely greater than any resources which have yet been put at the disposal of the service. Looking at the administration of the Health Service on merit, I am bound to say that I could find nowhere economies of any size which would compensate for the charges which will be forthcoming if this Bill becomes law. I think that it is perhaps worth quoting a remark—and I hope, Mr. Speaker, that I shall not be out of order in doing so, having regard to the fact that this Bill now refers to the period of three years—which was made by the right hon. Gentleman for Huyton (Mr. H. Wilson), when he made his resignation speech in the House. Referring to the relationship of this particular charge to the total Government expenditure he said:He also said, in another part of his speech,"I should have thought that it would be possible to examine even the current expenditure that is now going on on re-armament. Who can say there is no possible wasteful expenditure there which cannot be pruned without injuring the effectiveness of the programme?"
I think that it is significant that these two obvious sources of obtaining the money needed for the Health Service—sources which must have been examined by the Cabinet—had been rejected by them. I think we must assume that the Cabinet came to the conclusion that over the next three years either the economies could not be made, or, I would prefer to say, ought not to be made in the opinion of the Cabinet, and, therefore, that readjustment of the Budget figures——"Thirteen million pounds out of a budget of £4,000 million is well within the margin of error on any possible series of estimates."—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 229.]
We are not discussing the Budget figures now. The hon. Member is getting too wide in his remarks.
I will do my best to keep within the rules of order, Mr. Speaker, but may I respectfully draw your attention to the fact that we have now imported a period of three years into the Bill, and that possibly we are now entitled to look at the cost of the Bill in relation to the national expenditure over that period? I appreciate your ruling, however, and will do my best to keep within it.
A point which I want to make is that the fact that this Bill has been proceeded with in the light of the considerations that were advanced by the right hon. Member for Huyton must mean that the Cabinet had come to the conclusion that the Health Service had been getting, shall I say, financially out of hand, that it could not be cut, and, therefore, it must help to pay its own way. I would suggest that it is important that that should go on record—that they recognised that the Health Service had been attracting to itself too large a part of the country's resources. Personally, I can draw no other conclusion than that for the presentation of the Bill. Certainly, it is not too large an amount in comparison with the needs of the service, but too large a proportion in comparison with what is available. I think the reason for that state of affairs is that in the introduction of this Service, the right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) took a chance—it may well have been a justified chance—in offering a Service which was based on demand——We are now discussing the Health Service as a whole. The Bill does not deal with the Service as a whole, but with spectacles, false teeth and sanatoria. The Third Reading limits us, in the main, to that.
I will do my best to keep to that, Sir, but I submit again that the amount of income which the Bill seeks to provide is to be used for the general purpose of the Health Service. I will conclude my argument on this particular point by saying that the need for this Bill has arisen from the fact that the original conception of the Health Service was an unlimited demand on limited resources.
I would add, in agreement with the hon. and learned Gentleman the Member for Hornchurch, that it is a pity that the charges could not have been more widely spread over all those to whom the service applies. Where they do fall they fall heavily, and if one looks over the whole field one suspects that the charges could really have been more fairly shared. But it is difficult, when one looks at the operation of the Health Service, to see just where the charges could have been made, and I come to the conclusion, regretfully, that this is a rough and ready way of obtaining within the service certain resources which the service undoubtedly needs if it is to continue, let alone expand. For that reason we have got to accept this as rough justice on that basis. I will sum up my remarks by saying that, as I see them, these charges are a recognition by the Cabinet that the Health Service up to now has had more than its proper share of our resources; that they recognise that it is right that the excess should be met by the user and not by the general body of taxpayers. I would emphasise that it is unfortunate that the charges fall so heavily on two sections only, but in the circumstances I accept that as an unpleasant necessity. In my view these charges are the inevitable result of the policy which has been pursued since the Health Service was introduced.6.54 p.m.
I do not find myself in agreement with the hon. Member for Putney (Mr. Linstead) in his last statement, when he said that the Cabinet had come to a decision that the Health Service was taking too large a share of our national resources. It has worked out at about £8 per head per annum for man, woman and child, and looked at in that way I cannot agree that it is too large a share for important and vital aspects preventive and curative medicine.
However, if I may leave that for a moment, may I say that I listened with great sympathy and with broad agreement to many of the points made by my hon. and learned Friend the Member for Horn-church (Mr. Bing). There is, however, one aspect of his statement which I think should be qualified. He said that poverty and caries ran side by side and that there is an association between them. That is quite true in this country since about 1860, or perhaps since the Industrial Revolution, but it is not true in all parts of the world and should not be used as a dictum for ourselves for all time. New Zealand has a very high standard of life and its children have the worst teeth in the world. That is because of the large quantities of white flour which are used as well as the large amount of sweets made out of sugar. So with a much higher standard of life than almost anywhere else in the world we get the worst teeth. The peasants of Britain in the time of Henry VIII had very excellent teeth, and it will be recalled that Henry VIII was very disturbed when he sought a wife from abroad, because the people in the aristocracy both abroad and in Britain had very bad teeth. He particularly asked his Ambassador to make sure that she did not suffer from halitosis and that comfits were not used to conceal that possibility. That never occurred among normal, ordinary common folk who lived on the produce of the land. It is not only poverty of money which counts, but poverty in legislation that does not understand nutrition.As a matter of interest, would my hon. Friend not confirm that in those days there were no such things as false teeth and dentures?
In those days, looking at the skeletons of our forefathers, there was little need for false teeth, because so many had teeth in very good condition. The expectation of life was not great; it was about 28, but those who survived and did not die from infectious disease and who lived to a ripe old age had very good teeth. It is true that there was no protection, such as we have now, against infectious disease. I do not want to make too great a point of this, but I am sure my right hon. Friend the Member for Ebbw Vale (Mr. Bevan) must agree broadly with what I am saying here.
I have been favourably influenced by the way in which the Bill has been amended. I think two points were of great importance. The first was that there should be inserted in the Bill what is now provided—that the charges cannot be varied in an upward direction. We think that very important, and I am sure we are all grateful to my right hon. Friend the Minister of Health for it. The other point, which is more debatable, is when should the charges be brought to an end. Personally, I think that the term is a year too long, but it may well be that times will improve and we shall get some amelioration before 1954. What we were most anxious about was that the principle should be safeguarded, and we have some safeguards here. There were people like myself, who, in the first place, were really frightened that a Government of another complexion might use this as an excuse for destroying what we think is important in the service.So they will.
My hon. Friend says, "So they will." All the more reason, therefore, to see that they never get a chance. We cannot disguise from ourselves that right hon. and hon. Gentlemen opposite for years past have criticised this Service throughout, and they think that there should be charges in more than one direction—perhaps in all directions. We shall see, if the time ever comes when we have to change sides, what they are going to do about it.
We cannot forget the Anomalies Bill.
At the moment we have some protection that by 1954 these charges will come to an end.
Lastly, may I mention those affected by tuberculosis who will go abroad. We all welcome that provision, but at the same time let us not place too great a reliance in the efficacy of this. I believe the advantage of the scheme lies in the fact that there are beds, nurses, and doctors, who are not fully engaged abroad in treating their own cases as our medical services are here, and in that respect it is a good thing that we are able to take advantage of the sanatoria, hospital beds and personnel. But we should not run away with the idea that other countries have a better technique in treatment than our own. It would not be true to say so. I heard someone say on Second Reading there would be days of extra sunshine. I am not at all certain that this is an advantage in treating pulmonary tuberculosis. Nothing causes a flare up in quiescent tuberculosis more quickly than excessive sunbathing. So far as the operative treatment is concerned, I do not think that many countries are better in that respect than we are. Perhaps there is Sweden. We have used in the Bill the words "treatment outside Great Britain." I am glad that we are not limiting ourselves to any specific country. There is a certain variant of pulmonary tuberculosis that can be well treated in some of the great sanatoria and hospitals in Sweden. I remember someone who was very experienced in the treatment of this disease telling me when I was younger that he could treat pulmonary tuberculosis successfully in a cellar if he had certain things like the right kind of food and an incentive in the patient to live. It is not where we treat but how we treat an ailment that is often most important. This Bill has a number of advantages, although in the House of Commons we are apt to get somewhat myopic about these problems, and sometimes we cannot see the wood for the trees. I have done my best to try to find out outside what people think about these charges. I do not think they are excessively worried, on condition that the principle of the Service is not being tampered with. I feel that we have some safeguard there, and I am very glad of it.7.3 p.m.
The hon. Member for Stoke-on-Trent, Central (Dr. Stross), finished his speech by referring to the advantages of the Bill, but I did not notice in the course of his speech any description of those advantages. He probably feels, with the hon. and learned Member for Hornchurch (Mr. Bing), that the greatest problem which the Bill raises is, "Are people wearing teeth and spectacles that they do not need?" That is an oversimplification of the problem which we have to face this evening in considering whether or not to pass the Bill. It is quite true that people do not wear false teeth and spectacles unless they need them. If we put the problem in that way and we accept that answer, we may say, "That disposes of the matter. The Bill is bad and there is an end of it."
The truth is that a good many people who get false teeth and spectacles can perfectly well afford to pay for them, and indeed are both anxious and willing to do so. I do not think it lies with hon. Gentlemen opposite to suggest that there is a very substantial proportion of people in this country who cannot afford the amount of money which we are here considering, since we have had six years of Socialist Government. The question is grossly over-simplified. While nobody wears spectacles that he does not need, he may very well get himself a new pair before there is any real necessity to do so. The trouble with the Health Service arrangements up to date is that they encourage a person to get new spectacles as quickly as possible when there is the slightest alteration in his sight, without any regard to genuine need, especially when looked at in the whole context of national finance.Surely the decision in getting new spectacles does not lie with the person himself but with the registered medical practitioner. It is only on the practitioner's prescription that the spectacles can be obtained.
The hon. Member is quite mistaken. It is true that in the first place, before getting spectacles, the person has to get a medical certificate, but when he has got it, the matter does not rest with the doctor any longer but with the person himself and with the optician who supplies the spectacles. I do not know whether the hon. Gentleman is suggesting that opticians do not act honestly in the matter.
It is what the hon. Member himself is suggesting.
The truth is that after he has received a certificate from a doctor that he needs spectacles, the person can get new spectacles every time there is the least variation in his sight, and there is no further check upon him.
The hon. Member is certainly right in his statement about the medical inspection and the certificate the first time. If the person then feels that he needs another pair of glasses he goes direct to the optician. Surely it is the duty of the optician to see whether he needs new spectacles or not. If he does not, then an abuse is connived at by the optician merely to make more profit than he should do out of the Service.
In the ordinary way, a pair of spectacles lasts a person a fairly long time. In my own case, I have not had my eyes tested for a matter of five years. I strongly suspect that if I had them tested I should be advised at once to get a new pair of spectacles, but the pair I have in my pocket are adequate to my needs and I have not done so. I have to pay for my spectacles. I believe that if the same were true of people in general there would be a definite falling off in the demand for spectacles, without any burden being placed upon the people.
How far would the hon. Member go over the whole range of the Health Service, in regard to the principle of payment? Would he and his party extend it to the whole range of the Health Service?
If I attempted to do so, Mr. Speaker would call me to order very smartly. We can only deal with spectacles and teeth. I have given a good reason for putting a charge on spectacles at the present time.
Different considerations apply to teeth, but hon. Members know perfectly well that the 10,000 or so dentists in this country are entirely insufficient for our needs. To cover the teeth of the people of this country properly we should need something like 15,000 dentists. We are about 5,000 short. If we are 5,000 short, someone must suffer. It is obvious that someone has to suffer, and the choice which the House has to face is whether we are to continue to allow 61 per cent. of the whole of the activities of the dental profession in this country, as has been the case under the scheme, to be devoted to the provision of false teeth, or whether we are to try to direct those activities to the dental care of the children and nursing mothers, and the general conservative treatment of the teeth of our people. That is the problem, and I have no hesitation in saying that the right choice is to try to divert the treatment away from dentures and towards conservative treatment.The Minister said that 61 per cent. of the cases were for dentures, not that 61 per cent. of the time of the dentists was occupied with dentures. Would the hon. Member tell the House how on earth imposing a charge for dentures is going to help the school dental service?
If imposing a charge will not reduce the number of dentures supplied to people, the whole of the case of hon. Members opposite falls to the ground. If it will bring a reduction, it will relieve a certain number of dentists to do the other more urgent work.
A Bill in some way to impose a limit on the Health Service has been inevitable for a long time past. In his Budget speech two years ago Sir Stafford Cripps indicated that it was essential that there should be no further Supplementary Estimates. That represented the first rumblings of the storm from the Treasury. A year ago Sir Stafford Cripps, in a passage which has been referred to a great many times in our debates on this Bill, laid down quite definitely that there was to be no further increase in the cost of the Health Service. In spite of the Chancellor's firmly declared policy and in spite of the power that the Treasury has over the other Departments, it has not been possible to check in any way the growth in cost of the Health Service——I am quite sure that the hon. Gentleman would not wish to misrepresent the situation. The expenditure on the National Health Service for the year 1950–51 was the first year's expenditure based upon the first year's estimates of the first year's full experience of the Service, and in 1950–51 the expenditure was not only within the estimate but was actually very nearly £11 million less than the original estimate. Therefore, it is quite wrong to say that the finances of the Health Service were out of control. They were kept within the limit—well within it—in the first full year's experience of the Service.
The estimates cover the whole range of the Service and during the course of last year a number of things were done within the Health Service which effected economies in certain directions——
I have not been anxious to intervene in the debate very much because I do not want to raise the temperature, but perhaps I may be allowed to say this. The two services upon which the charge is now being made were the two services where the expenditure has been progressively reduced.
But reduced for this reason, that in each of those services very heavy cuts were made during the course of the years in question, cuts in the emoluments of those concerned——
And reduced use.
—but it was beginning to be apparent that the real trouble was not essentially the overpayment of the professions concerned by the right hon. Gentleman but that the scheme itself was wrong in giving the wrong emphasis to the patients' demand for the treatment provided.
I do not wish to interrupt the hon. Gentleman again, but he is inaccurate. From last year's use of the optical side of the service it was quite clear that the demand for spectacles in Great Britain was beginning to reach the level of the pre-Health Service demand. In the case of the dentists, in some parts of the country dental technicians have been put off because the demand for dentures has been falling. The fact of the matter is that hon. Gentlemen opposite have not had enough faith in the service to nurse it through its initial period.
I hope very much that the right hon. Gentleman will develop these lines of argument in a speech after I have sat down. To return to the point at which I was interrupted, in spite of all the efforts of the Chancellor of the Exchequer and the Treasury it has not been possible to control the great increase in the cost of the service. I do not wish to go into details, but the rise in cost in the last year, as stated by the Chancellor of the Exchequer, was of the order of £30 million, apart from economies to be effected by this Bill. That was the situation, and something had to be done about it, and that is the reason why the Government introduced the Bill.
I want to say straight away that, although the Bill represents a reversal of policy, I regard a reversal of policy in this connection as a bad thing in itself. The one thing we want in the Health Service is a continuous policy so that the professional men, the hospital administrators and the others concerned will know where they stand. I do not wish to use this as an opportunity for attacking the right hon. Member for Ebbw Vale (Mr. Bevan), but I believe that the scheme was fundamentally at fault because it contained in itself the seeds of a great many reversals of policy.That was its value.
My complaint about the Bill is that it is a "hit and miss" affair which deals with only two branches of the Service which are not the largest branches, and I believe that there will inevitably be other Measures of this kind whoever is sitting on the benches opposite. I am quite certain that under the policy as laid down by the right hon. Member for Ebbw Vale the increasing demands will inevitably drive any Government to take steps to see that the Service is not abused and not over-used.
Will the hon. Gentleman give an indication of the other Measures he has in mind? We are most anxious to know what he is contemplating.
I am afraid that the hon. Member is inviting me to go outside the bounds of order. When an opportunity for this kind of argument occurred on Second Reading, the hon. Member did not make points of this sort. As I see it, the objections are that the Bill is piece-meal legislation, that it does not deal with the problem as a whole and that it is in its nature something of a temporary one. Although it is part of an inevitable process, it is only a small part, and sooner or later some Government will have to consider the problem as a whole, and until we get it reviewed as a whole we shall find constant difficulty over the Health Service.
7.17 p.m.
I feel sure that every hon. Member sitting on this side will have listened with very great care to what has been said by the hon. Member for Hendon, South (Sir H. Lucas-Tooth), for, if anything, he has confirmed some of us about the dangers that the Bill exhibits. What it does is to open a door.
I admit right away that when at some future date, if they care to do so, hon. and right hon. Gentlemen opposite come along and say, "We have reached a ceiling, and within that ceiling we shall have to spend just what we can afford, which means that we shall have to make charges," that will be quite logical. They may ask what the difference is between glasses and glass eyes; what the difference is between false teeth and false hair; if it is true that dentures are a form of treatment, what the difference is between that form of treatment and a surgical boot; and what the difference is between a calliper splint and any other form of splint. If that principle is accepted, we shall have two types of patient, those who can make a contribution to the Health Service and those who are unable to do so. If there was any merit in the Service at all it lay in the fact that everybody was treated alike, whether he was a duke or a dustman, a bank clerk or a road sweeper. No matter what his social position was, everybody could come through the wide open door of the National Health Service. It is impossible for us to accept the statements made that this is not any infringement of principle. When once we single out any section of the service for payment, we destroy the Socialist basis of the Service. In the past, under the old educational service, we differentiated between those who were unable to afford to pay for a real education and those who could. We have got away from that. We have evolved a Health Service where everybody whatever they were suffering from, could get treatment without any question as to whether they could afford to pay. No longer was there a premium placed on human suffering. Now there is. We cannot accept everything that is said unless we accept the fact that a charge on dentures means that fewer dentures will be supplied. That can only mean that people who otherwise would have dentures, will no longer be able to get them. Indeed, the hon. Member for Hendon, South, referred to the alarming situation which arose on the destruction of the priority dental service. I agree with him. Everybody deplores the fact that the basis of payment attracted dentists away from the school dental service and from the maternity dental service. I am not sure that we shall get what we want by this method. During the Second Reading debate the Minister of Health referred to the advice given by the Dental Advisory Committee to the effect that by some means there should be a reduction in the supply of dentures. The actual wording of the advice did not mention a charge, although they meant that. They referred to payment. What assurance is there that in making a charge we shall divert dentists to the priority dental services? The hon. Member said that because there are not sufficient dentists to go round, let them go where people can afford to pay for the services of a dentist. Is there not some other way? Is it not possible for even that highly specialised profession to be diluted? Cannot some attention be given to the oral hygienists? I know that some are employed; but cannot there be investigation with a view to seeing how much of the dentist's job can be done by somebody not so skilled as the dentist?It has been started.
Yes, but cannot steps be taken to expand that service so as to make available a larger number of people? Recognising that there is a limited number of dentists, would it not be possible to control the dentists so that they will be used where they are most needed? Perhaps we have given too great a freedom to those who have gone out of a full time service into a service which pays them better.
I hope that my forebodings will not be realised, but I know that a service representing £400 million is the finest target that any Chancellor of the Exchequer can have. Looking to the future, I cannot fail to see that that target will be always there for any Chancellor, and the sooner we take it out of the hands of the Treasury and finance it by other means, the better. I think there is the possibility of that being done. When we can do it, we shall be able to organise this service without always being faced with the fact that here is a ready pool from which the Chancellor can draw. We have been told that £500 million is the ceiling of the service, as though that was a completely new charge. It is not. We forget what the local authorities used to pay before this became a national service. We do not subtract from that £400 million the amount which would be paid if it went back to the local authorities. I am not suggesting that it should, but we must not let it go out that this is £400 million of the taxpayers' money which, if it were not paid for by the taxpayer, would have to be paid by the community in any event. There are considerations which rise superior to the economics of the situation. Those considerations are the well-being of the people. I hope that the principle of a completely free service which this Bill is undermining will be restored. With regard to tuberculosis, my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross) referred to treatment that can be obtained abroad. I am glad to have that Clause in the Bill and that we have been able to take advantage of what is offered abroad, but I have no illusions about the extent to which we shall be able to take advantage of it. I realise some of the difficulties. I realise, too, that limiting it, as the Bill does, to pulmonary tuberculosis in not making the best use of those facilities. It would be wrong of me on Third Reading to go outside the terms of the Bill. I hope that if there is one thing we have started in this Bill which is bad, that there is another which is good, and we should expand that which is good in the interests of the people who can take advantage of it.7.27 p.m.
I do not wish to detain the House longer than is necessary to comment briefly on one or two points raised by hon. Members opposite. The hon. Member for Tottenham (Mr. Messer) said one thing which I thought was significant, namely, that once we admit the principle of charges in the National Health Service, we at once eliminate the Socialist basis of the scheme. That is perfectly true. It is precisely the reason why the Government have been forced now to make this charge. At last it has become apparent to them what I always knew, that a scheme based upon a purely Socialist theory would never work.
The hon. Member for Tottenham said he wanted to see a wide open door through which duke and dustman alike could enter into the Health Service. I do not. I have never done so. I want to see a door which will be wide open to the dustman but, when the duke comes along, I want to see a turnstile with an admission charge. I will tell the hon. Member why. It is because, until we are prepared to recognise that under the present financial system we cannot conceivably provide a decent service for the dustman if we are to provide a free service for everyone else as well, we shall never get a decent free service for the dustman. Surely it must be realised at this stage by all hon. Members that we must face the principle which this Bill introduces. I have never accepted the assurance of the Minister that it did not introduce a new principle. The new principle is a recognition of the fact that the resources available will not provide a proper service for everyone. The hon. and learned Member for Hornchurch (Mr. Bing), in applying himself to the provisions of the Bill, said it was rendered necessary, in the submission of the Minister, by the fact that the resources available could not be increased any further, but the hon. and learned Member said that that could not be true because the resources were only £8 per head of the population.I have been doing my best to keep the debate within some kind of bounds. The Bill deals, as I said before, with teeth, spectacles and sanatoria. Its general principles are really Second Reading points and not Third Reading points.
I fully appreciate that, Mr. Speaker. I was only doing my best to address myself to some of the observations which have been allowed as being in order from the other side of the House.
I did my best to limit them.
I appreciate that, Mr. Speaker. I will therefore remove myself from the border line of the rules of order and confine myself simply to observations on the Bill as it has been amended.
In my submission, right from the beginning of the service the Bill was bound to come, in view of the principles on which the right hon. Member for Ebbw Vale (Mr. A. Bevan) started the service. The rate at which the increases went on made it inevitable. This new principle is dangerous in many ways, and we shall have to watch very carefully to see where it takes us. I do not believe that it makes any particular difference to the sheer financial necessity with which the Minister will be faced, whichever party is in power next year, the year after or in five years' time. The way things are going at present, this problem will face a Chancellor of the Exchequer and a Minister of any party which is in office. This is a belated recognition of necessity. I think it has been introduced without due regard to the merits and needs of the Health Service as a whole. I think it is a money-saving measure, and it ought to have been something much more. It ought to have been something deliberately and precisely conceived to ensure the best Health Service for the people who need it most. I hope that if hon. and right hon. Gentlemen opposite find themselves in power long enough to have to face this question again, as I think they will, they will bear in mind when that occasion arises that the only reason for departing from their principle is to make the Health Service better. They may do so this time by accident. Next time, I hope they will do so on purpose.7.33 p.m.
Before the Bill goes through, it is worth recognising that the debate which we are having on the Third Reading today is a somewhat different kind of debate, and conducted in a somewhat different atmosphere, to a previous debate in the House on a National Health Service Bill. In this debate we have been spared the reasoned Amendment which was put down by the party opposite when we were discussing the previous Bill, and we have been spared the violent speeches which we had from hon. Members opposite when the original Bill went through.
Although we have had no reasoned Amendment from hon. Members opposite, however, it is only fair to say that we have had a number of reasoned speeches from them. They have argued very powerfully that they are strongly in favour of the Bill precisely because they strongly opposed the original Bill when it went through the House. Nobody could say that that is an unfair interpretation of at least the last two speeches we have had from the opposite side of the House, because both hon. Members who have spoken on behalf of the Opposition in the last two speeches have emphasised that they regard the Bill as a first taste, which merely whets their appetite; they are expecting something much bigger and better in the future. I was particularly interested in the speech of the hon. Baronet the Member for Hendon, South (Sir H. Lucas-Tooth), because we have a right to recall that he speaks officially on behalf of the Conservative Party on this matter. On the Second Reading of the Bill, he was put up on the Front Bench to speak officially on behalf of his party. I presume, therefore, that when he was speaking today he was again speaking officially and giving us some indication of what would be Conservative policy on these matters. I was particularly interested also because I remembered that at the time of the last General Election, the hon. Member's leader, the right hon. Member for Wood-ford (Mr. Churchill), came to my constituency, when we asked the right hon. Member precisely what kind of National Health Service Measure he would favour. We did so because the right hon. Member had sought to give the impression to my constituents that the National Health Service Act had been brought into operation by himself in the face of rigid and stubborn opposition from my right hon. Friend the Member for Ebbw Vale (Mr. A. Bevan). We were particularly eager, therefore, to know exactly the sort of National Health Service of which the Conservative Party would be in favour. We did not get an answer from him. We owe a debt of gratitude to the hon. Member for Hendon, South, who has given us some indication of the answer. He said quite clearly that he thinks that if some people can afford to pay for spectacles and teeth, they ought to pay for them. That is the principle in which he believes. Of course, he would apply the same principle to Medresco aids, hospital services, and all the other services which are applied under the National Health Service Act. We are grateful to the hon. Member, because he said that in his view the Bill was only a piecemeal and temporary Measure. He made it quite clear that the official policy of the party for whom he was speaking officially was that they would extend these charges very much further and would apply the same principle to other parts of the Service as the hon. Member, in his argument, applied them to spectacles and teeth.In case the hon. Member should think I am agreeing with what he says, may I say that I totally disagree with the views he has taken of my speech? If he reads it carefully, he will see that I said nothing of the kind whatsoever.
Everyone listened to what the hon. Member said. He said that he thought it was quite right that people should pay for spectacles and teeth if they could afford to do so. If that principle is applied to the rest of the Health Service, we arrive at exactly the same point which I have been making. My complaint against the Government is that they have given hon. Members opposite the opportunity for the first time of supporting a National Health Service Bill going through the House. This is the first main Bill which hon. Members opposite have ever plucked up courage to support, and they do so for the principles which the hon. Member for Hendon, South, has outlined.
The hon. Member made another interesting point when he based a large part of his support of the Bill on grounds which, I admit, have never been advanced as the main arguments by the Government Front Bench: that is, the ground of abuse. The hon. Member made some of this argument during the Second Reading and has continued it on the Third Reading, in which he has claimed that these charges are necessary in order to prevent some form of abuse, although when he is cross-examined from this side of the House he cannot explain how the abuses arise. But the Government have never based their main case on that point. My right hon. Friend the Minister of Health, on Second Reading and when describing very clearly the Clauses which we have been discussing, gave as the main reason for introducing the Bill the fact that he was presented by the Chancellor of the Exchequer with a demand that a ceiling must be provided for National Health Service expenditure. The story, however, was finished too early, because when my right hon. Friend discovered that the ceiling involved what my hon. Friend the Member for Tottenham (Mr. Messer) described as the destruction of the principle of the Health Service, why did my right hon. Friend not go back to the Chancellor of the Exchequer and say, "There is a conflict. You say I must apply a ceiling to the Service. This means that I must depart from the principle for which this party stood at the General Election and ever since the Bill was introduced"? If on previous occasions we had had a Minister of Health who never wished to argue with the Chancellor of the Exchequer on these matters, we would not have had the National Health Service introduced in the last Parliament and an Act which we could defend on every platform in the country at the last election. I do not believe that the explanation which has been given for the introduction of this Bill by the Government holds any water at all. The only explanations for the introduction of the Bill which would hold any water at all have been given to us by the Opposition. They are enthusiastically in favour of this Bill for precisely the same reason that they were enthusiastically opposed to the National Health Service Act when it was originally introduced. When the Government introduced the Bill they had to put some proposal into it which, they hoped, would mitigate the opposition which might arise. We have had one Amendment since. I do not quite agree with my hon. Friend who seems to imagine that the Amendment makes a great deal of difference to the Bill. It apparently proposes that in three years' time when, according to the Government's estimate, expenditure on armaments will be at its greatest, the whole of our expenditure on the Health Service shall be reviewed. I would not call that a cast iron guarantee that we are to get back to the full principles of the National Health Service and I am not very much enamoured of the new Amendment we obtained. There was one Clause put into the original Bill obviously to mitigate such opposition as might be certain to arise. It was put into the Bill in order that the Chancellor of the Exchequer might be able to say in his Budget speech and the Minister of Health could say in his Second Reading speech that despite the imposition of these charges there was going to be no real hardship or distress imposed. That is Clause 4 and in particular as it relates to the possibility that the National Assistance Board might be able to give assistance to people who need spectacles or artificial teeth, even people in full employment. I believe the explanation of this Clause which we have had so far from the Government in the Second Reading and the Committee stage is totally inadequate, for the reason that if the Bill goes through the House of Commons today, as it probably will, no hon. Member will be able to tell his constituents at the week-end whether they will be able to get assistance from the National Assistance Board or not. No one will know. What about my constituents, a large number of whom get about £5 a week, even after a recent wage increase? They are getting nothing else out of the Budget, indeed they are getting further hardships in my view. What am I to say to them supposing they ask, "Am I allowed to go to the Assistance Board and get assistance?" I shall not be able to tell them as the Minister has not yet told us. Regulations are to be issued to safeguard people who might have hardship or distress imposed on them because of these charges, but when the Bill goes through the House of Commons not one hon. Member will be able to say how it applies to his constituents earning £5 a week.May I quote from HANSARD a statement by my right hon. Friend the Secretary of State for Scotland:
"A married man with two children, earning around five guineas a week, would not be expected to make any contribution to the cost of dentures."—[OFFICIAL REPORT, 2nd May. 1951; Vol. 487, c. 1353.]
That is the one statement we have had. I went through the Committee stage debate very carefully. What about my constituents earning £5 a week with one child or with no child? We cannot answer such persons yes or no. I say it is a miserable way to bring in a miserable Bill to bring it in in such a manner that we are to vote on it on Third Reading without being able to tell our constituents how it applies to them and how the regulations are to operate. Why was that necessary?
Would it have hurt the Government so much to have waited two or three weeks to work out the regulations so that we could have had an idea on Third Reading what the regulations were about? If the Secretary of State for Scotland is able to raise one corner of the veil and give half a hint of how the regulations are to apply, would it not have been possible for us all to know how they were to apply to a man earning £5 with one child, or with no child? Today no hon. Member will know exactly for what he is voting, and on Clause 4 we are asked to go into the Lobby and vote for the Government in this respect and wait very kindly to see what regulations they will bring in later on. In fact Clause 4 introduces an entirely new and entirely dangerous principle. It introduces the principle of subsidising wages according to particular needs. This is something we have not had in our legislation for many years. It is something which we have under the old Elizabethan Poor Law and under the Speenhamland system. But it is not a principle we have or expect in our social legislation in this House of Commons or a principle we would have expected when we were debating the National Assistance Act in the House of Commons. Supposing someone had said then, "We will have a new special provision whereby subsidies can be given to people whose wages fall below a certain level." Every trade unionist would have got up and protested and said, "This is a scandalous situation and is not what the National Assistance Board is meant for at all. The Board is there to protect the people who are not protected properly by the system of general insurance." The idea that we should protect the wages of people by a subsidy and say whether they should be penalised or not is a principle which this House——The hon. Member is developing an argument and I take it he will say why he supported this principle in the last Parliament on the question of legal aid?
I think that a very valid point. I am against the National Health Service of this country being run on the same principle as the legal aid service, and certainly every hon. Member on this side of the House would be opposed to that as well. I think it is a perfectly valid interruption. Therefore, if the right hon. and gallant Gentleman's defence of what the Government are doing—and I know he has been passionately supporting the Government throughout the whole Bill—is that he does not mind if this transforms the situation into the same as that of the legal aid service, it is the most damning attack on the Government even from the right hon. and gallant Gentleman.
Of course we do not mind. The hon. Member does not know the arguments. He was not in the discussions on legal aid in Committee upstairs and did not hear us protesting against this principle in legal aid, but if he consults with his hon. Friend the Member for West Ham, South (Mr. Frederick Elwyn Jones), next to him and if he intervenes he will be——
Perhaps before discussing legal aid further, I should remind the House that the discussion must be concerned with matters in the Bill.
I have not discussed the matter of legal aid, although I am perfectly prepared to pursue it. But I do not imagine that the right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot) is trying to persuade us that upstairs, or here, he was arguing for a full legal aid service provided free for everyone, or there would be some point in his interruption. Without that I cannot see the point at all.
Of course, I should be perfectly willing to continue the argument, but I would be ruled out of order, and therefore I say that until the hon. Gentleman reads the debate he is not entitled to say any of these things because he will find he is totally in error in the assumptions he is making.
If the right hon. and gallant Gentleman is able to make interruptions which are out of order, I am entitled to make replies which are out of order. We will leave it there, but I notice that the interruption, irrelevant or not, came from the right hon. and gallant Gentleman and not from the Government Front Bench.
If my hon. Friend will allow me, perhaps I might put a relevant point. What was his attitude to the same principle in regard to the National Assistance Board determining need cases on travelling allowances within the National Health Service?
I do not think the same principle applies at all. The hon. Gentleman is proposing under this Bill that there should be subsidies from the National Assistance Board for low wages, and he is proposing that on terms which he is not even prepared to explain to the House of Commons before the Bill goes through.
The same question of payments to those who may be employed arises in connection with travelling allowances.
It may be that the hon. Gentleman has a valid point and a valid statement there, but it does not alter the fact, which he will surely recognise, that it would be a highly dangerous principle to have the National Assistance Board coming along at a whole series of points in our economy and saying, "We will subsidise wages, here, there and at some other point." That is what is being proposed under this Bill. It is that the National Assistance Board should give subsidies to people who happen to suffer from particularly low wages. But nobody knows how the test of low wages is to be applied. The hon. Gentleman is still working out the regulations. If the Government knew what the regulations were, they could tell us, but they do not know what they are.
It is not only that we are to vote for this Measure without knowing how it is going to work out; the Government do not know either. The reason that the Government have got into this difficulty is that it is a terribly difficult thing, once they start injuring and breaking the mechanism of a free Health Service, to know where they get to next. That is the difficulty in which the Government are at the present time. They are in a particular difficulty because when they decided to embark upon a new principle in relation to this service which involved them in complicated difficulties about the National Assistance Board they decided that not merely would they do that but that they would do it with all possible speed for purely political reasons. That is why they have got themselves in difficulty today. So we shall have to wait to see what these new regulations are to discover whether a man getting £5 per week will have to pay or not, or whether it depends on whether he is to have a child next month or next year as to whether he gets his dentures free. That is a miserable Clause in a miserable Bill, and it should not be introduced in that fashion. The main objection to the Measure, which has been voiced by my hon. Friend the Member for Tottenham (Mr. Messer) and which has come from almost every hon. Member who has spoken on this side of the House during Second Reading, the Committee stage and Third Reading, and a view which has been confirmed by the attitude taken by hon. Gentlemen opposite, is that of course once we have started and put these Measures into operation we do not know how far we shall go in the future. My hon. Friend the Member for Tottenham used a very significant phrase when he spoke of what a target this would be for a Chancellor of the Exchequer who next year and the year after will be faced with possibly greater economic difficulties than those which the Chancellor is facing today: what a target to enable him to say, "If we can tax spectacles and teeth, why cannot we next year tax Medresco aids, etc.?" A Chancellor of the Exchequer, looking at this situation without any principle to guide him as to how to deal with it might, looking at the National Health Service in future, state as General Blücher said, when he looked at London, "What a city to sack." But at least we can say this. The protest that has been made about this Bill on Second Reading, on the Committee stage and on the Third Reading, and which will no doubt be continued when the Government have thought out the regulations under which they are to operate the Bill, may at least be sufficient to protect the Health Service from further inroads being made in future years.7.55 p.m.
I cannot and will not attempt to compete with the vehemence of the hon. Member for Devonport in attacking His Majesty's Government. It fills me with astonishment that he did not find it possible to join that small group of bandits who during the Committee stage voted against Clause 1. It astonishes me also that there is no reasonable expectation of the hon. Member being found in the Lobby against the Government on the Third Reading of the Bill.
In the main part of his speech, he attacked the association of the Bill with National Assistance. He might, with charitable intent to the Opposition, if he can find such charity in his heart, have said that that issue was raised by my hon. Friends on this side of the House. Although I do not find myself in agreement with their conclusion, it is right that we should pay tribute to them for drawing attention to that very important element in the proposals. When he referred to the hon. Member for Tottenham (Mr. Messer) the hon. Member for Devonport supported him in his assertion that a big principle is involved here, that a door is opened. But when one of my hon. Friends says the same thing, virtue becomes vicious. What for the other side of the House is a revelation and an astonishment becomes a wickedness when the same words are used and the same significance is attached to them on this side of the House. I wish to refer to one aspect of the Bill, namely, that of the expected saving or income from these proposals. I should welcome an intervention from the Minister or the Parliamentary Secretary early in my remarks, so that I shall not waste the time of the House. I should like to know at the outset whether the estimate—contained in the Civil Estimates published on 16th February—for the expenditure on the dental services in 1951–52 takes account of the economies or savings which are alleged to be made. I hope that it will be found possible to save me from error or the House from unnecessary words, if I could be told now, in the form of an intervention, whether that published estimate takes into account the economies or savings under this Bill.As has been said before, if I am not mistaken, the Chancellor made it quite clear in his Budget speech that account was taken of these savings.
I am grateful for the intervention. I am about to develop my point, arising from that answer, despite any visible discomfort to the hon. Gentleman, that so early as February the calculation was made of the savings from this service.
I noticed that as between 1950–51 and 1951–52 a saving of approximately £8 million for England, Wales and Scotland is shown. Part of that saving is due to something quite different—the cutting of the remuneration of the dentists. Am I then told that although in the financial memorandum it is estimated that in the current financial year, the saving will be of the order of £8½ million, that adding up the savings by the cuts in dental remuneration, and the £8½ million calculated in the Financial Memorandum, the total saving from the lot is in the region of £8 million? It seems to me that something has gone wrong in this calculation. If it be true that allowance has been made in the £38 million estimate for the £8½ million saving referred to in the Financial Memorandum, then it was expected that next year there would be an expenditure of £46½ million. If the expenditure on the dental service be estimated at £46½ million the 60 per cent. to be devoted to dentures would amount to £28 million. A half of £28 million, if the repayment is to be approximately half, is £14 million. Yet the money to be saved in a full year is £17 million, a difference of £3 million. I suggest that we are now coming to the measure of the saving or the repayment to be effected by the deterrent effect of the charges. I do not pretend to any accomplishment in mathematics, but I think that the House should be told to what extent that calculation is wrong and what is the accurate calculation, for as matters now stand, it seems that, taking a full year, the savings will be considerably less, and are calculated to be considerably less, than the £17 million contained in the Financial Memorandum to the Bill. I would ask that that matter be resolved.I cannot see how the hon. Member can estimate accurately, because there may be increased expenditure by the National Assistance Board, which may affect the figures.
I appreciate that point. I have made allowances on the basis of the payments amounting to half, but to the extent to which the saving turns out to be less than half it becomes difficult to understand. I knew that one half would be recovered, and I knew that I was ignoring mothers and children and the repayments that will go elsewhere as a result of National Assistance.
The hon. Member for Devonport spoke of the enthusiasm on these benches. I suspect that he was counterfeiting an enthusiasm which he purported to see for his own political purposes. The principle involved here is that of a ceiling on National Health Service expenditure. I will not weary the House by repeating what I said on Second Reading, but I am convinced that unless other social services are to suffer it is absolutely essential to create a ceiling related to what the nation can afford on this form of social service. If that principle of a ceiling be accepted, it then becomes necessary, if the scope of the service is not to be touched, to impose charges. But that is no justification, as I said earlier, for any particular set of charges imposed in a slap-dash financial way unrelated to the needs of the service and to the defects of the service. I shall not weary the House by going over the dental field once again, but I wish to thank the hon. Member for Tottenham for the candour with which he faces the dental position. I agree with him that on the one hand there is the method of imposing barriers between the dental service and some sections of the population in order to secure it for others. On the other hand there is, apart from the training of new dentists, the problem of dilution of the dental service. I offer no comment on that now, but I would say that no financial proposal should be put forward without being related to the need so to recast and reorganise the dental service in order to secure once more priority for children and for expectant and nursing mothers. I believe that this proposal goes some way, in a rough and ready way, to do this. What I regret is that it seems to me that the Government have taken hasty decisions and selected two places in the service to slap on a charge in what seems to me to be a Bill put forward by the Chancellor of the Exchequer rather than out of a steady desire, if charges must be made, so to apply them as to secure the best possible service.8.5 p.m.
I will not follow the argument of the hon. Member for Luton (Dr. Hill), although I agree with very much of what he has said. I hope that the Minister will deal with his argument tonight. I want to return to the speech of my hon. Friend the Member for Devon-port (Mr. Foot). In my opinion, the position is far worse than he indicated. He assumed that some new Regulations would be made by the National Assistance Board. I do not know why he assumed that. There is nothing in Clause 4 which indicates that any new Regulations are authorised or will be made and nothing has been said since the inception of this Bill to suggest that any new Regulations will be made by the National Assistance Board.
I agree that this is an important point. It is most unsatisfactory that, as a result of the almost indecent haste with which this Bill has been rushed through the House we are in complete ignorance of what the true position will be in this respect. I agree with everything said by my hon. Friend the Member for Tottenham (Mr. Messer) about the real objections to this miserable Bill, which in my opinion is totally unnecessary and need never have been introduced. The real objections to it are, of course, that it violates the whole conception of a free National Health Service. But it is justified by hon. Members opposite on the ground that there are some people benefiting from the National Health Service who can afford to pay and who can therefore make a contribution to the Exchequer. That is not a reason acceptable to many hon. Members on this side of the House. I return to the other and equally serious criticism of the Bill. I would remind the House that, both in the Budget Speech of the Chancellor of the Exchequer and in the speech of the right hon. Gentleman the Minister of Health on Second Reading, the Ministers sought to make the Bill palatable to the House by saying specifically that it would create no hardship. These were the words of the Chancellor of the Exchequer in his Budget statement:On Second Reading the Minister of Health said much the same thing. He said:"Those for whom the charge involves hardship will receive reimbursement, in whole or in part, from the National Assistance Board in the ordinary way."—[OFFICIAL REPORT, 10th April, 1951; Vol. 486, c. 852.]
The principle on which it was sought to justify this Bill was that there would be no hardship, and certainly no hardship to the lower paid workers. When we came to the Committee stage of the Bill, and my right hon. Friend the Secretary of State for Scotland was here, we were told a different story. He at any rate had the merit of candour. He said:"Finally—and this is important—to safeguard against the imposition of any hardship upon any deserving person, the National Assistance Board is to be empowered to make grants towards meeting these charges to any person who suffers hardship thereby, even though such a person is in work. This may be particularly valuable to lower paid workers who have a number of children."—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 244.]
That is very different from what the Chancellor of the Exchequer and the Minister of Health said. I welcome the presence of the Secretary of State for Scotland on the Front Bench, because we have come in this House to admire the great candour and honesty with which he treats us. He recognised that the Bill would create hardship. I think he was rather optimistic at one stage when he said:"I am not saying to the Committee that there will be no hardship. That is nonsense…."
Then at a later stage, in the early hours of last Thursday morning, the Secretary of State was pressed a little more about this, but not at any great length. He was asked why the position about National Assistance appeared still so obscure. Part of what the right hon. Gentleman said has just been quoted by my hon. Friend the Member for Coat-bridge and Airdrie (Mrs. Mann), but not all of it. This is what he said:"There will not be any kind of hardship visited upon the most hard-up of the community."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1312.]
What are the facts about this mysterious Clause 4 from which it was assumed by my hon. Friend the Member for Devon-port that some entirely new scales would be introduced? As I read it, there will be no new scales. All Clause 4 does is to deal merely with people who are at present in receipt of National Assistance benefits, because they come within the existing scales. Hitherto, those people getting assistance from the National Assistance Board have not been able to get any additional assistance because they required any medical necessities. There is a provision in the National Assistance Act excluding from the operation of the relief given by the National Assistance Board financial assistance for medical requirements. When there was a free National Health Service, no such assistance was required. Now that these 50 per cent. charges for spectacles and false teeth are to be imposed, it follows as a corollary that those who are in receipt of National Assistance benefit are entitled to get reimbursement for the 50 per cent. charges which they would have to pay and which obviously they cannot afford. In addition, Clause 4 does one other thing. If I am wrong I hope the Minister of Health or the Secretary of State for Scotland will correct me, because this is essentially a matter on which constituents not only in Islington and Devonport but everywhere throughout the country, will want guidance. Unless satisfaction is given by the Front Bench on this matter, I fail to see how they will be able to redeem the condition on which the Bill was introduced—that it did not impose any hardship. As I understand Clause 4, it does one other thing. It brings within the class of recipients of National Assistance people who are working full time. Those people who cannot have assistance in the ordinary way can get reimbursement for the half charges for their teeth and spectacles. But it seems abundantly clear to me that the existing scales will apply, and it only means that, whereas at present only people out of work, whether temporarily or permanently, can get relief, in the case of these half charges, people who are within the existing scales, although in full time occupation, will also be able to get this kind of relief. I invite the Minister of Health or the Secretary of State for Scotland to correct me if I am wrong, but there is nothing whatever in the Bill, or in any statement yet made, to suggest that any new special or specific scale will be laid down by the National Assistance Board to deal with the charges imposed by this Bill. If corroboration of that is required, I think that it is to be found in a further sentence which I wish to quote from what the Secretary of State for Scotland said in answer to a question by an hon. Member for one of the Glasgow constituencies. The hon. Member put this pertinent question when asking where the scales started. He said:"I cannot be expected to answer for the Assistance Board—and I have no right to do so—but I ask the Committee to believe that we have looked at this very carefully, and where National Assistance scales are involved, and hardship is caused, there will be no charge."
The Secretary of State for Scotland said:"Does it start with the railway porter earning £4 15s.?"
The right hon. Gentleman was careful to repeat what he said earlier. He said:"Let me give my hon. Friend an approximate example."
I do not challenge his good faith. The right hon. Gentleman said:"I have no right to speak for the Assistance Board, but I offer the example in good faith"—
That was the guess of the right hon. Gentleman who had no right to speak for the Assistance Board. Since the right hon. Gentleman made that statement, I have taken the trouble to verify the facts from the Assistance Board to find out what they think about the matter. It is most unfortunate, but they do not share the view of the Secretary of State for Scotland. I am told on the highest authority that a married man with two children, paying an average amount of rent and earning £4 15s. a week, will not get any benefit under this Bill but will himself either have to pay the half charges for teeth and spectacles or—which, of course, is much more likely—go without them."A married man with two children, earning around five guineas a week, would not be expected to make any contribution to the cost of dentures."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1353.]
Does this mean that the Ministry have been in touch with the Assistance Board and that the Assistance Board have given consideration to the question? If so, have they replied to the Ministry, and why has not an announcement been made in this House?
I cannot answer that. I do not know whether the Ministry have been in touch with the Assistance Board or not. All I know is that the Secretary of State for Scotland attempted to deal with this matter in Committee and, from his own words, I do not think he had been in touch with the Assistance Board. He went out of his way to repeat to the Committee that he could not be expected to answer for the Assistance Board.
As far as I know, there has been no consultation about this subject between the Ministry and the Assistance Board. That may be a good thing or it may be a bad thing, but the result is that this House is left in complete ignorance and complete mystery about the matter. Perhaps we shall be told before this debate concludes. Apart from the abrogation, the departure, from the principle of a free National Health Service, what worries me is that unless we can get some more satisfaction about this before the Third Reading is concluded, I shall not be satisfied that there has been any fulfilment of the specific promise given both by the Chancellor of the Exchequer and the Minister of Health that these charges will not create any hardship. As I understand it, under the Bill as it stands, a person in work earning £4 15s. a week with two children, and paying a normal rent, will not get any benefit at all if he has to have spectacles and dentures. He will be required either to pay the charges under the Bill or go without the spectacles and teeth. It is obvious that he will go without, because a person in that position cannot be expected to make—either for himself or for his family—the sacrifices that he would otherwise have to make in order to get the spectacles and the teeth which he requires. Therefore, there will be no gain to the Revenue. It is for that reason that I am so strongly opposed to this Bill. I think that it will defeat the only object which it has really put forward. It is put forward as part of the general budgetary provisions for raising further money. We all know that the whole framework of the Budget depends on the basic assumption that we have, if we can, to increase our national production by 4 per cent. this year. We can do that only if the people of this country have the best possible health, which includes, where necessary, the best possible sight and best possible teeth. If people have need of spectacles we cannot expect them to do a proper day's work without spectacles. It is obvious that, as matters stand, in view of this provision in the Bill, that a number of people who are expected to do a full day's work with the maximum efficiency and contribute to the national productivity effort which we are trying to increase by 4 per cent. will not be able to do so, because they will go without spectacles. Although I am not qualified, like the hon. Member for Luton, to speak on medical matters, I know from experience that to a person in need of spectacles they are not a luxury. If a person has bad sight spectacles are a necessity.They are a tool.
They are a necessity for his work, which is of national importance, and not a mere matter of luxury or convenience to himself. I have every reason to believe that what is true of spectacles is equally true of teeth. If a person has bad teeth and is entitled to have them out free, as he is entitled to have them out under this Bill, I believe that the best medical advice is that it is much better for him to have a new set of dentures than to do without teeth; although I am quite sure that, as things stand, a lot of people will go without teeth and spectacles.
I beg, whichever Minister is to reply, to do the House the courtesy of giving us the most detailed information as to precisely what provision will be made, if this Bill is enacted, to relieve the very real hardship which will be imposed on people of the class I have mentioned—the lowest paid workers earning £5 a week, or thereabouts—who will be faced with the miserable choice either of having to do without something and make sacrifices from other sources which they cannot afford, or of being deprived of spectacles and dentures which they need.8.23 p.m.
I think the main point which concerned the hon. Member for Islington, East (Mr. E. Fletcher) was the amount of hardship this Bill would cause. Of course, no precise answer can be given to that, but I suggest that there is a clue in the figures put forward more than once from this side of the House on the question of the deterrent effect. The figures show that the difference is between £14 million and £17 million.
There is therefore, calculated by the Government a deterrent effect of £3 million. That £3 million appears to compare with the twice £14 million—£28 million—and is therefore something rather more than 10 per cent. So the Government are calculating that the deterrent effect of this Measure is about 10 per cent., and hon. Members should make their own calculations within that figure of £3 million as to how much hardship there will be. I think that is probably the only guide we have, unless some more intricate calculation is to be presented later for deciding the very important question on which the hon. Member for Islington, East, has been addressing the House. This Bill is of great importance, apart from the civil war which it has caused on the benches opposite. I have no doubt at all that the main importance of this Bill was indicated quite clearly on Second Reading by my hon. Friend the Member for Wolverhampton, South-West (Mr. Powell). What really matters is that a new principle—I believe it to be that—puts the National Health Service Bill for the first time into the category of a means test social service. I think that is the essential point, and almost everybody who has spoken took up that point, including the hon. and learned Member for Horn-church (Mr. Bing), the hon. Member for Devonport (Mr. Foot) and many others. The hon. Member for Tottenham (Mr. Messer) said that this Measure would destroy Socialism or the Socialist basis of the Social Services. I think that he is quite right. Some hon. Members on this side of the House tried to remove—although the hon. Member for Devon-port did not seem to be aware of it—the National Assistance Board from the Bill, but we have it in the Bill in Clause 4, and I am not going over those arguments again. It may be right to have the National Assistance Board in the Bill if it is to be a very temporary Measure—to be torn up soon and forgotten. But is it so temporary? The Government Front Bench have indicated that it should be reviewed again, in so far as one can bind Parliament in these matters, in 1954. I would have thought it surely wrong, if it is to go on for that length of time, or even longer as it may well be, that we should not seek to find an alternative method. I believe the logic to be unanswerable, that while re-armament, or any other such special strain on our resources remains, this Bill has come to stay. Once we accept the ceiling—I think this is the real point—then the Bill follows. I know perfectly well that what one might call the "Opposition" to the Bill from the Government back benches does not accept the ceiling at all. But once that point is given up; once we accept a ceiling for the National Health Service, beyond the slightest doubt this sort of Bill follows absolutely automatically. The hon. Member for Reading, South (Mr. Mikardo), either on Second Reading or during the Committee stage, and many other hon. Members have recognised that. This discussion touched off last Wednesday in Committee as joyous a piece of political "nuts in May" as we have ever seen from those benches opposite. Let me say quite frankly that I believe that those on the other side of the House who object to a ceiling in this Measure are putting forward a genuine Socialist point of view, with which I completely disagree. But let us remember that this ceiling to which so many references have been made—why it should be £400 million——References may have been made, but they were all out of order.
I am sorry. In that case I will not pursue this question of the ceiling, except to say that it is not a new matter which is now being introduced. It has been said of this Bill that it is a Tory Bill. Let me say quite frankly that I do not consider that an unfair description at all. It may be that some of us think it incoherent and muddled, but still a Tory Bill. That is why so many hon. Members opposite hate it so much. It is not surprising that some of us on this side of the House heard with a modified degree of hilarity the declarations of indestructible party unity alternating with fierce denunciation of the Front Bench, sometimes above and sometimes below the Gangway.
Of course we on this side of the House want to see the Bill on the Statute Book. Of course we are delighted that the Chancellor of the Exchequer and the Minister of Health and the Secretary of State for Scotland are at last plodding down the right road. Of course we are quite prepared, now we have them on that road, to urge them on.Since the hon. Gentleman is so delighted about the Bill, would he mind taking the matter up with the hon. Member for Luton (Dr. Hill), who protested so strongly to me when I said there was enthusiasm about the matter on the other side of the House?
If the hon. Member has not read any of the earlier proceedings of the Bill, he should consult my Second Reading speech, if he can bear to do so, where he will find that point dealt with. Let me say, quite frankly, that I think the Bill is full of anomalies. In many ways its approach is quite wrong. I think it is ill-considered. As hon. Members have said, I welcome these charges; I have pressed for them for a long time. [HON. MEMBERS: "And written about them."] Yes, I have even written about them. If these charges can be the means of taking money from less urgent sectors of the National Health Service to reinforce and renew the fight against ill-health in the most important sectors of the Health Service, then I not only welcome the charges but also welcome the Bill. It is only on those grounds that the Government Front Bench can justify seeking a Third Reading today.
8.32 p.m.
I think those of us sitting below the Gangway will be more grateful for the speech of the hon. Member for Enfield, West (Mr. Iain MacLeod) than will those sitting on the Government Front Bench. One might almost describe the hon. Member as an agent provocateur from the Left Wing of the Socialist Party, for he has put the real facts about the Bill with an extraordinary clarity. The difference is that the Government Front Bench are seeking to disguise the implications of the Measure whereas he has sought to bring them out in the fullest possible way.
I must say I was surprised to hear my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross), say that in his view the back benchers on this side of the House have done a great deal to improve the Measure on the Committee stage. If we are frank with ourselves, all we have achieved is a Clause which limits the duration of the Bill to the next three years. It is not an accident that the next three years are the three years of the rearmament plan. What it comes to is that in this Clause, with a candour unusual in the Front Bench on this Bill, the Bill has now been re-named the Rearmament Bill. It is the Bill which openly cuts the social services for the duration of the re-armament programme. To have achieved a certain candour from the Front Bench is, of course, some advantage to one's knowledge but not, I think, anything to the credit of the party to which all of us belong. We now know that for the length of the re-armament period people will pay for dentures and spectacles, as a first instalment. We shall face the Budget of next year very much dependent upon the attitude which the House takes to the debate on this Bill. Many hon. Members opposite and a few poor Front Bench speakers from this side of the House have tried to defend the Bill as a Measure to curb extravagance in the Health Service. I have been very strongly in favour of some sort of Measure for curbing what undoubtedly exists—extravagance in the Health Service; but this Bill, as defended by the Minister, has not been introduced, as some hon. Members suggest, to curb extravagance in the Health Service. There would be quite a different Bill for that purpose. This is openly a money-raising Bill and not an extravagance-curbing Bill. That is precisely the reason why we have so passionately objected to the Bill from below the Gangway. There might have been a case for a Bill to introduce measures of economy into the Health Service. Indeed, I myself have often wondered whether a small token payment has not a great deal to be said for it as a way to encourage people to think twice before they let a dentist take out their teeth. But a 50 per cent. charge is something totally different from a charge designed to discourage extravagance. A 50 per cent. charge has one purpose and one purpose only—to obtain money for re-armament, as we now know from the new Clause, which tells us openly that for the three years of re-armament the money will be taken out of dentures and out of spectacles. If we want to have it confirmed we find it in the Clause dealing with spectacles, as was pointed out by my hon. Friend the Member for Manchester, Exchange (Mr. W. Griffiths), who has great experience of this and whose speech I checked over the week-end. If this was an economy measure, would the Front Bench have decided to make those who need spectacles pay more than the full cost of the lens which will be used? That is not a measure of economy; that is even making a profit out of the unfortunate people. If I calculate correctly, a large number of those who pay what is called a 50 per cent. charge will, in fact, be paying for the cost of the lens, the cost of the frames and the cost of the testing as well. That is not an economy measure; that is a charge designed to make as much money as possible in the easiest possible way out of the most vulnerable section of the Health Service. It is not the best way of curbing extravagance in the Health Service, as the hon. Member for Luton (Dr. Hill) has already very cogently argued. To make a savage charge for the sole purpose of raising money to pay for the rearmament programme is not the best way to get economy or wise spending. I want now to turn to Clause 4. I think the House should be deeply grateful to my hon. Friend the Member for Islington, East (Mr. E. Fletcher) for being the first fully to ventilate what I also regard as a scandal. We are passing the Bill without knowing clearly what we mean. An hon. Member opposite pointed out that we have a precedent already in that the National Assistance Board are responsible for giving free what otherwise people would have to pay for; they provide travelling expenses to hospitals. I understand the Minister has also said that. Let us assume that we can take that as a precedent and that people will be given free dentures and spectacles in the same way as they are given free journeys to a hospital. How does the free journey to the hospital work? There is no special scale as my hon. Friend the Member for Devon-port (Mr. Foot) seemed to think necessary. National Assistance is provided under the subsistence level. It is based on a calculation that if a man's or a family's standard of living sinks below a certain level, that man or that family are destitute, and, therefore, in order to bring the family's income up to that level the Assistance Board is empowered, and entitled, indeed, to pay the amount which is necessary to bring the family's income up to a certain basic minimum below which people starve. In the case of travel to hospitals—the Minister will correct me if I am wrong—unless a man can prove that with his weekly wage, when the charge for the journey to the hospital is added to his other expenses, he will be destitute, he gets not a penny—not a penny. He must prove destitution by National Assistance standards.No.
Who introduced this iniquitous business of charging for payment going to and from hospitals? And was there an outcry against it?
I do not think we should pursue this point. It is not in the Bill.
With great respect, Sir, Clause 4 is concerned with the National Assistance Board and its being entitled on certain occasions to relieve hardship by providing free spectacles. I am providing the only instance we know of. My hon. Friend the Member for Coatbridge and Airdrie (Mrs. Mann) asked me who introduced it. I think it is perfectly correct in the case of travelling expenses, because I doubt whether we should have allowed travelling expenses to be paid in the Health Service. This was an abuse in the Service before this provision was introduced. But it is the only precedent we have got. If it is true we have got one case where the National Assistance Board is entitled to pay, and to enable people to have the service free, I am concluding—unless the Minister tells me no—that in the case of men in factories, for instance, it means that a means test will be applied to know whether somebody is indigent or not—which is already provided for to obtain free travelling expenses to hospital.
I am sure my hon. Friend does not want it to get on the record that it is his view that to obtain assistance from the National Assistance Board one has got to prove destitution.
I am very sorry. We are dealing with the problem of the subsistence level; but do not let us pretend that the subsistence level we have achieved in this country is very elevated with the present cost of living. I accept my hon. Friend's correction. I should have said, "minimum subsistence level." It is unfair to the Board not to make that correction. But what I am pointing out is that one will have to prove that one's income falls below the minimum subsistence level in order to obtain free dentures and free spectacles, and it seems to me grievous that we have to do this because we shall have two scales—National Assistance for the old age pensioners and another for those in work.
It is clear that no Assistance Board could produce a new scale and say, "This is for those in work, and the standard of minimum subsistence, where a man is working in a factory, shall be a bad weekly wage; and somebody who is an old age pensioner or a widower with children shall have something else." Only one subsistence level can be applied in the country. This means that if, having to pay this charge, a man's total income falls below that under which one is entitled, if he is out of work or aged, to National Assistance, an employed man may, in those circumstances, receive National Assistance. On this point I agree with my hon. Friend the Member for Devon-port. This, of course, is subsidising low wages. [Interruption.] Of course it is. If we say that this will be the basic minimum that we provide for men in work, then, of course, we are subsidising those who pay insufficient wages to people to enable them to earn their living. We have the food subsidies, of course, but they are subsidies for everybody; but in this particular case we are saying that somebody who is not earning sufficient wages is able to pay for his spectacles and keep on the subsistence level shall have assistance. I am sorry that capitalists should be subsidised in that way. It is a very striking thing that we do that. In my experience people are still—I think, rightly—reluctant to rely on National Assistance. By and large the scrounger will go to get it. [HON. MEMBERS: "Oh."] Thousands of decent people will not. [Interruption.] I am very sorry, but I would point out that there are many people who will not, in fact, get what they are entitled to under this Bill because they are too proud to do so. I still think it is a grave mistake to impose a means test on men at work before they can get—[HON. MEMBERS: "It is not a means test."] But it is a means test. They will have to submit to a national means test in order to be able to get free spectacles and free service. I say with great respect that this means test exists—but, of course, we have to have it—in National Assistance. What we are doing here is to extend the principle to men in work, and that seems to me a grievous violation of principle. I agree with hon. Gentlemen opposite that this is, in fact, having two health services, one for the top level, and one for the others, and I think that having two services is fundamentally a bad thing even in this beginning with teeth and spectacles. The last point I want to make is this. I cannot believe that many people on this side of the House are proud of this Bill. The only argument in favour of it—the only argument—is that we must have this Bill as a help towards payment for re-armament. It is the only argument that can be introduced, now that we have this new Clause saying that the period shall be at least three years. I do not believe that there was no other way of paying for it. I do not believe that this Bill, enthusiastically received by the other side, is a precedent. I do not pretend that this is what the other side would have done. I say that it is a small example of what they would have done on an enormous scale. Because I do not like our Front Bench doing on a small scale what the other side would do on a big scale, I do not happen to like this Bill. I do not think that anyone else does. If the Bill is a precedent for what might happen in future legislation, a much healthier precedent is the reaction of the benches on this side of the House. I hope that in future it will not be the actions of the Front Bench but the reactions of the Labour back benchers which will be the precedent for future Socialist policy.8.47 p.m.
I have listened with very great interest to the contributions made in this Debate, and I cannot profess to have the intellectual training of the hon. Member for Coventry, East (Mr. Crossman), as an economist who bestrides the world like a Colossus. I wish I were as cocksure of anything as he happens to be of everything. I read his contributions to various journals, and I read in regard to re-armament—and I introduce this, Sir Charles, because the hon. Member has talked very much about it—a contribution which went like this—of course, he was writing for the popular Press: "If we can afford to spend £800 million this year on re-armament, therefore, I say that we can afford to give £50 million to the railways for subsidies." I confess I would have taken an entirely opposite view. If we are thinking of increasing the amount of re-armament, that, I think, would be one reason why we cannot afford this other service.
I should like also to follow up the hon. Member's remarks on re-armament because he said that the amount in the Bill is being taken from the people who need dentures and spectacles to pay for re-armament. Last year without gasping he swallowed the bottles of prescriptions that "cascaded" down the throats of the patients, and he did not protest about the terrific hardship to many of my constituents and others which caused them to pay for travel across Lanarkshire—one woman paying 6s. each visit, three times a week. He and the others swallowed that without a word of protest. In my opinion, they swallowed the camel and strained at the gnat because they have only now raised their objection to something which, I would remind the hon. Member for Islington, East (Mr. E. Fletcher), the Minister himself admitted was a hardship. When the hon. Member for Islington, East, was reading the Secretary of State's remarks that a married man with two children earning about £5 5s. a week would not be expected to make any contribution to the cost of dentures, he stopped there, and he omitted to read on:We are all agreed that it means hardship for some people but we disagree very much on the degree of hardship of the measures introduced last year without a murmur of dissent and the ceiling accepted last year without a murmur of dissent and without there being a Bill of £1,400 million for armaments that year. Why was that accepted? Was it because this poor body in my constituency had no Colossus on the Front Bench to lead a revolt? If he had led it, would we have had all these speeches made about the prescriptions, because when we swallowed the camel last year instead of the gnat this year we were hitting every family and every mother whose child in the middle of the night took a pain. We did not think then of the difficulty of getting public assistance lines. Why did nobody get up then? All that was swallowed last year, is rejected this year because of a certain type of leadership. It is said that this BUI is for the first time introducing an appeal to the Public Assistance Committee. It is nothing of the kind. It was introduced last year with complete silence on the part of those Members who have so much to say about it today. It is also said that this is opening the way to the Tories. Do hon. Members on this side of the House never listen to the party political broadcasts? Do they not realise that the Tories had their policy on this formulated years ago? Only little more than a year ago there was a party political broadcast made by the right hon. Lady the Member for Moss Side (Miss Horsbrugh), who is not in her place tonight. She frankly admitted to the people of Britain that it was the Tory policy only to give dentures and spectacles to mothers and children. It is utter nonsense to say that the Tory Party were waiting on this lead. I wish they were as frank about the other items of their policy as they are about this. I deplore this charge. I deplore much more the principle fixed last year without the excuse of our re-armament commitments and which imposed hardship on the people in my constituency. I deplore and regret that no one then had the courage to stop it, or to say where in the Health Service we should fix a ceiling. The sky is not the limit. Do not let us be hypocrites about that. If someone said, "Where can we introduce economy?" I could think of no one on whom it would fall less hard than on the people who have to wait at least nine months for their gums to harden before they get new teeth. We are fixing a limit of 10s. per lens and 7s. 6d. for the frames, a sum of £1 7s. 6d., and we should compare that with what we know is charged for testing alone without glasses, namely, a minimum of £2 2s. The Government Front Bench deplore that there should be a limit, but if there have to be charges I know of nowhere where they would fall less harshly than they do under these proposals."Let me take this argument a stage further. I have previously admitted that this scheme does mean hardship for some people. It is bound to."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1353.]
8.55 p.m.
I do not wish to say very much in this debate. I have listened to most of it with a very great deal of interest, and to some of it with utter amazement. I heard my hon. Friend the Member for Coventry, East (Mr. Crossman) say when he was referring to the manner in which there will be a means test for the new spectacles or false teeth, that this Bill will subsidise wages. He can only justify some such statement if he knows of any body of workers in the country whose normal wages are on the level of the National Assistance Board scale. If he does not know of any body of workers whose wages are as low as that, he cannot make such a statement and get away with it. Such statements do harm to the party to which he belongs and do no justice to the people who sent him here.
I am amazed, too, that my hon. Friends the Members for Islington, East (Mr. E. Fletcher) and Devonport (Mr. Foot) should make the statement that the Bill introduces the principle of payment in relation to the National Health Service. Why was it that last year there was stopped the payment of travelling expenses for people in rural areas who had to go to hospital to get specialist treatment? If the question of principle depends upon the amount that it costs the patient, why is it that £2 breaks the principle when the wife of an agricultural labourer in my constituency has to pay £2 each time to go to the hospital for treatment? She has had to go many times. For one single payment of £2 patients will be able to get false teeth, or glasses for a less amount. Why is that breaking the principle, when it was not breaking the principle in the case in which it was vital to a woman's continued existence that she should be treated for something wrong internally which, if not treated, would bring her to her deathbed? Why did not hon. Members who represent industrial areas and have hospitals on their doorsteps, protest against the breaking of the principle last year? It is quite untrue to say that we are breaking the principle now. It is true, as the hon. Member for Coatbridge and Airdrie (Mrs. Mann) has said, that when the principle was broken last year we had not before us the great cost of armaments which we have for this year and next year. I fail to see why hon. Friends of mine on this side of the House are making such an attack upon the Government as they are doing today, giving hon. Gentlemen in the party opposite a stick with which to beat us in the country.We have plenty without that one.