Question again proposed. "That the Bill be now read a Second time."
I should like to conclude the point I was making which I myself and, I think, most hon. Members would regard as one of very great substance, that is, that now that the State is entering into either direct or indirect contractual relationship with so very many people, it ought not to put so large a proportion of the Budget outside its control and leave some outside body or person to decide the Chancellor's Budget for him.Indeed, this was discussed, as I said earlier, at some length, and hon. and right hon. Gentlemen opposite, who were then in opposition, withdrew their own suggestions and Amendments in consideration of what I then said:
in fact this division was made in order that the doctors might not become civil servants and suffer Civil Service disabilities—"I specifically said yesterday that by the division we had woven into the 1946 Act the doctors were not in contract with the Crown;"—
I said then that the Minister could not be indifferent to the demands made upon the Chancellor of the Exchequer by an arbitrary decision over so wide and important a field. It is not a question of the Crown. It is not, therefore, a mere matter of a constitutional quibble, but when we bring in so many as 400,000 people into direct contractual relationship with the State, the only way in which we can hope to get the finances of the nation under proper control is by always reserving the right of the Government to refuse to accept any recommendation made by an outside body. It is to my mind lamentable that we should now be faced with an enormous bill of this description which makes nonsense of our discussions here. I am not saying that the general practitioners were not entitled to an advance; I think they were. I myself said when I was Minister of Health that if any funds were available for the improvement of the situation in any part of the National Health Service, the general practitioners had the first claim, but there is all the difference in the world between providing a reasonable increase in their remuneration and adding this enormous sum which would be an irritant in every industrial negotiation in Great Britain. The fact is that the gap between professional awards and manual workers' standards is getting too wide. It also should be borne in mind that we now have a different situation from what we had before, because very large numbers of professional workers are now educated at the expense of the State. They no longer have to give up earning money for many years in order to equip themselves, because while they are undergraduates they are kept by the State in better conditions than many of the manual workers providing the grants for them. So the judge and those bodies who are arbitrating on professional standards are really arbitrating on their salaries, because what they are attempting to do is to maintain their own status and own standards. But the constitutional implications for us are exceedingly serious. The reason I brought the Treasury into this matter so clearly was because—I will be quite frank with the House—we have been the victims of this Treasury behaviour. I said last year, and I was attacked for it by some of my own friends, that when I accepted the 1s. prescription charge I was manoeuvring, but I would rather manoeuvre to have Socialism than manoeuvre to destroy it. What was the situation when we discussed the Bill? I made it so clear that hon. Members opposite thought that I was not quite serious about my proposals. Neither was I. I will tell the House why. Once more all that the Treasury—all these clever gentlemen—had done was to look at the number of prescriptions and then to say, "Now, if we charge 1s. for each of them we shall get £10 million." Any fool could have done that. It means just so many prescriptions, a bob for each one and so much money for the Treasury. It was no good arguing with them. It has been no good arguing with them since then because the physical and administrative implications which lie in the field of the spending departments do not preoccupy the Treasury. They just arrive at the simple sum and then demand it. There is a way of saving money on the Health Service which has no administrative complexities, although I do not approve of it. The simple logical thing to do is to put a certain service outside the Health Service. We can say, for example, that we cannot afford to provide any dental treatment and that we cannot afford to provide any drugs, and then put them outside the Health Service. It is easy. Let the public pay. Mark this, I do not approve of it. I am only pointing out that we ought to begin to get some administrative sense into this and the Treasury ought to get some; but what we cannot do is to have a service half in and half out, because, once we start that, all kinds of administrative difficulties arise. When we discussed the Bill behind which the Government are now so eagerly sheltering, I said that there were difficulties which are inherent in the regulations. I said that I had been asked a number of questions as to how I proposed to use the power which imposed the charge on prescriptions. I pointed out that if I could give the answers, there would be no excuse for my not having had the regulations ready, but I did not then know all the answers and before the scheme could be made a practicable one it would have to be discussed with representatives of the chemists and the doctors to see how it was to be worked out. What we were faced with was a demand from the Treasury, which, as my right hon. Friend has just said, turned out to be so administratively complex that it was not worth going on with, which is exactly what we thought all the time. There was no legerdemain and no concealment. I explained all that to the House. Indeed, the hon. Gentleman who is now the Parliamentary Secretary to the Board of Trade and the Joint Under-Secretary of State for Home Affairs saw that what I was saying was a defence against imposing the regulations. So it was. We realised that we could not charge old age pensioners; we could not invoke all the massive machinery of the Assistance Board in order to decide whether an old age pensioner, an unemployed person or a sick person was 1s. this or the other side of a line. But that is what the Government are proposing to do. They do not know how much money they will save. They have not told us, and they do not know. All they know is that millions of people will be plagued, tormented and humiliated quite unnecessarily merely in order to give the Conservative Party another excuse to invade the National Health Service, which they have wanted to do all the time. It seems to me that the whole scheme with which we are presented is based upon a mean-spirited attitude towards the social services. I do not know why hon. Members in all parts of the House, even on the other side of the House, do not take a pride in what is happening. After all, this was a very great experiment, one of the greatest experiments in human behaviour that the world has ever seen. It was said, "It is too dangerous to trust poor folk with free this, free that and free the other; they will abuse it, bring it down in ignominy and destroy it." What are the facts? The first full year's experience of the National Health Service enabled us to predict the medical behaviour of 46 million for the next year—after only one full year. It is true that we had Supplementary Estimates in the first two years, but we had not had one full year's experience at that time. After only one year's experience I was able to give an Estimate to the Chancellor of the Exchequer which held good for the whole of the next year's expendi- ture In other words, the British people had disclosed a predictable pattern of behaviour after only one year's experience. Yet, instead of people being proud of it, and instead of our saying, "Here are fine people who are beginning intelligently to use this free service," the scheme has been spat upon and abused ever since without any justification at all. In 1950–51 the expenditure on the dental service and the ophthalmic service was falling, and it had been falling for some time. In other words, the level of the expenditure had merely been due to the fact that we were working off arrears of neglect. The same thing was true of artificial limbs. It was not true of the pharmaceutical side. We know many of the reasons for that; my right hon. Friend has given many of them. In the first place, it is because the medical profession is an ill-disciplined profession. I say that advisedly, with more experience of it than most. That is not entirely the reason for the rise on the pharmaceutical side. Suppose the amount is £4 or £5 million a year; that is £4 or £5 million a year out of a gross expenditure of £450 million. Is that any reason for destroying the essence of the Health Service? The reason for the increase on the pharmaceutical side in the last few years lies mainly in the enormous increase in the use of anti-biotics, streptomycin, auromycin, and penicillin; not only the sulphonamides but also the anti-biotics. Very expensive new drugs are coming into existence, and they are very largely responsible for keeping a number of old folk alive, and also young folk as well. What is being said by some writers on medical finances? They are saying that the nation cannot afford this. They say, in effect, "Let us have a selective list of dying. Let the poor die first." That is what right hon. and hon. Gentlemen opposite say. The order of their priorities is, "If you cannot keep all of them alive, keep only the well-to-do alive." That is what they did before, and it is what they will do now. That is exactly what is behind all this. I thought that a mistake had been made last year, but there was something to be said for what the Labour Government did. They decided to put a term to this. They said, "We will keep it on until 1954, and then we will end it, because we believe that by then we shall be out of our troubles." What are this miserable crowd doing? They are keeping it on permanently. They put hoardings all over the country a few years ago saying, "We fought for the Health Service." Who are they fighting now? They are fighting the poor. At a moment when unemployment is growing all over Great Britain, these health charges are being imposed. People look only at one side of the balance sheet all the time. They are always looking at the expenditure side. They cannot see the other side of the balance sheet. The other side is to be found in growing productivity year after year in Great Britain because our people are healthier. I beg hon. and right hon. Gentlemen opposite to consider what is going to happen when these Regulations are in operation. It would be sheer demagogy to suggest that we ought to consider only the electoral results of what we do. I believe that Members of this House should consider first what is in the nation's interests and afterwards what the electorate will think about it. Do hon. Members really believe that they can convince this nation that paupers should be victimised while at the same time millionaires are let off from taxation? Is that on their order of priorities? There is no majority for that in this country. If the Conservative Government went to the nation tomorrow on this they would be decisively defeated, not because the people want something for nothing, but because the people were beginning to take a decent sense of pride in the fact that every person in this country had access to the best that medical knowledge could provide without let or hindrance of cash. That was something of which everybody, including the Conservatives, were beginning to be proud. Now the Conservatives are proceeding to pull it down. Where it will stop, I do not know. We have heard a lot of nonsense about the school dental service. More rubbish has been talked about that. Hon. Members opposite do not seem to realise that a large number of children are going to the dentist in the ordinary way, which is what we wanted to happen, for the school dental service was not what it was cracked up to be; it had grave deficiencies, which was one of the reasons I always intended to assimilate it into the wider scheme, keeping the dental inspectors in the schools to report on the school children. We are told that there are not enough dentists, but we did not have enough even when the curve was rising. I am informed that many dentists are not now even fully employed. I am informed that for some time the lists have been falling. Once more the Treasury have got it wrong, because once more the little men were adding up their silly sums and not realising that from the start off it was the physical facts which came first of all. Then they could work out their sums afterwards. That is why it is ridiculous to take this step for the sake of saving money. How much is going to be saved? We do not know, because nobody knows. At a time when we are spending £1,500 million a year on making weapons of war, we cannot afford £20 million a year to keep a free Health Service going. It is nonsense. It does not make sense. In fact, the arms programme of Great Britain is now being made by the Conservative Government into an excuse to dismantle the Welfare State. As everyone knows who cares to look up this matter at all, one of the reasons why in this country we have a sound Parliamentary democracy and why the Communist Party does not grow here is because we have introduced into our social life a greater sense of equity than on the Continent of Europe. The party opposite are taking the first long step in establishing in this country the beginnings of the end of British Parliamentary government."that they were in contract with the regional hospital boards and the executive councils."—[OFFICIAL REPORT, 29th June, 1949, Standing Committee B: c. 1727.]
I want to deal closely and with relish with the vulgar, crude and intemperate speech to which the House of Commons has just listened. Before I come to the speech of the right hon. Member for Ebbw Vale (Mr. Bevan)—and I acknowledge freely that he represents what I may call the real opposition to this Measure—there are one or two matters to which I should like to call the attention of the House.I am told that apart from the Socialist Opposition, the Liberals are to oppose this Bill. I expect that in the course of the evening we shall have a speech from the Liberal benches. I should like to remind the Liberal spokesman of something and I should like him to deal with it when he speaks. When I knew that the Liberals were to oppose the Bill, I looked to see what part they took on the National Health Service Bill last year. For many hours we debated it on Second Reading, in Committee, on Report, and on Third Reading. Nine minutes of that time was occupied by the Liberals. There was one Liberal speech on Second Reading. It was described as a very helpful speech and it supported the Bill. Turning up the Liberal candidates' handbook for the General Election on 1950 I found this paragraph about the health charges:
"Until expansion would be financially possible partial charges could be made to adult patients, reduced in cases of need for some services such as the general dental service (reserving a free priority service for expectant mothers and children), for spectacles, use of ambulances and hospital board and lodging."
Tell us what the Tories said.
I will do that, too. I should like the Liberal spokesman to explain if that still represents Liberal policy.I want to deal first of all with the opposition which comes from the Opposition Front Bench. The right hon. Lady the Member for Fulham, West (Dr. Summerskill), who opened this debate, is not in her place, but I can address these questions to the right hon. Member for Middlesbrough, East (Mr. Marquand), who I understand is to speak. He must have read very unhappily the speeches that he made a year ago in this House. He knows perfectly well a year ago he received the full support of this side of the House for his Bill. We knew exactly where he was going, and those who sat behind him knew perfectly well, too.
I know perfectly well that I explained in detail why a prescription charge was not merely unworkable but undesirable, and I know perfectly well that I explained why a charge on appliances would be inhumane as well as thoroughly undesirable. As for a charge for dental treatment, that never entered my head. I never thought that anyone could think of anything so insane.
I am grateful to the right hon. Gentleman, and I will deal with all those points one by one. The right hon. Gentleman is not going to be allowed to escape the dilemma in which he is now. Does he not remember a year ago coming to this House and explaining that the gap was £30 million; that the Chancellor could only give him £7 million; that he had a gap of £23 million left and he hoped first of all to cut the forecasts for the regional hospitals boards by £10 million—incidentally, he went into the Lobby on Tuesday against the Minister of Education for the same thing—that he found himself with a deficiency of £13 million and that he wanted money for the hospitals? That is a clear summary of his case, and he then said it would be self-deception and deception of the House of Commons to say that this money could be found elsewhere than by charges.The right hon. Lady the Member for Fulham, West, and the right hon. Gentleman who is to wind up for the Opposition have not so far attempted to argue that there should not be a limit on the National Health Service. They have not dared to argue that the ceiling placed by Sir Stafford Cripps, before Korea, maintained by the late Chancellor of the Exchequer in the surplus year 1950, and maintained by my right hon. Friend the Chancellor of the Exchequer in this year should go. But the logic of events presses just as closely on my right hon. Friend the Minister of Health as it did on the right hon. Gentleman opposite a year ago. Last year, the right hon. Gentleman wanted £13 million for the Health Service and he wanted to spend £15 million more on hospitals. He found that money by charges. This year, my right hon. Friend wants to spend, even taking into account certain fairly small cuts in the capital account of the hospitals, £20 million more. Governments can change in a year, but logic cannot, and the problem that confronts my right hon. Friend is exactly the same as that which confronted the right hon. Gentleman opposite a year ago. I invite the right hon. Gentleman opposite to answer a question when he winds up for the Opposition. In these circumstances, following the thesis he put to the House a year ago, what exactly would be do to get this £20 million? There are only two places—and he knows this perfectly well—where the money can be found in the National Health Service. The first is in what is called the "hotel charge" in hospitals. The second is by a fee for consultation with a doctor. We should dearly like to know from the right hon. Gentleman tonight which of these solutions, or what alternative solution, he would choose. He can consult the speech of his hon. Friend the Member for Tottenham (Mr. Messer) of a year ago, because that hon. Gentleman saw the dilemma coming and expressed it very nearly in the terms in which I have expressed it. We want to know from the right hon. Gentleman what he would do, and where he would find the £20 million. The history of the charges in the National Health Service is by no means complicated. Here I want to come more closely to the right hon. Member for Ebbw Vale (Mr. Bevan). I would like before I start to say that I am delighted that he has recovered sufficiently to be at this debate today. My hon. Friend the Member for Bolton, East (Mr. Philip Bell), who quoted Shakespeare today will agree that to have a debate on the National Health Service without the right hon. Gentleman would be like putting on Hamlet with no one in the part of the First Gravedigger. Let me deal first with the problem with which the right hon. Gentleman dealt, in passing, that this Measure is connected with the Chancellor's Budget. He said that in some ways it is a miserable Budget, because it makes the rich richer. It really does not lie in the mouth of a member of a party whose Budgets for successive years were the delight of the speculator and the joy of the spiv, to say that. The first mention of charges in this connection was, as the right hon. Gentleman will remember, in the 1949 Budget speech of Sir Stafford Cripps, when that right hon. Gentleman said:
my right hon. Friend has quoted this—"There is, indeed, a very good argument for imposing some special charge or tax. …"—
Now we come to 24th October, 1949, the beginning of the proposal of the charge for prescriptions. The Leader of the Opposition, who was Prime Minister at the time, announced in this House—no "ifs," no "buts" about it—that they were going to save £10 million, with certain exemptions, from the pharmaceutical service. He added:"but … we should await the outcome of another year."—[OFFICIAL REPORT, 6th April. 1949; Vol. 463, c. 2093.]
The right hon. Gentleman has quoted it, and said he shuddered to think of the cascades of medicine that were pouring down our throats. He has been shuddering for 28 months, because it has been going on all the time. It is just not true that the cost of drugs is the major influence in the cost of the pharmaceutical service. The cost of drugs has gone up, in the period that we are discussing, from £35 million to £50 million or £51 million, and the number of prescriptions has gone up from 202 million, to 207 million, and now to 229 million. The case for the shilling charge is much stronger now than it was then. The right hon. Gentleman reminded the House of what happened on Friday, 9th December, 1949, when this charge was put on in another place and was brought to this House, when there was an attempt to shuffle it through without any discussion at all. There was a vote at the end, and it was 138 to nine. The debate is worth reading. The right hon. Gentleman has quoted what he said. I recommend every hon. Member of this House to turn up his speeches. It is true that if we read now we can find, like raisins in a bun, arguments put forward by the right hon. Gentleman why this charge was impracticable; but he knew something at the time that nobody else did. He knew that he was going behind the back of his Cabinet and his leader to defraud the House of Commons."The purpose is to reduce excessive and, in some cases, unnecessary resort to doctors and Chemists."—[OFFICIAL REPORT, 24th October, 1949; Vol. 468, c. 1019.]
That really is a most unworthy statement. [HON. MEMBERS: "Cheap."] In point of fact it was the Treasury Committee which was appointed to try to work out the practicability of the proposals that reported them impracticable.
I have nothing to withdraw. The right hon. Gentleman has been a long time in this House and I do not think that he objects to this form of debating at all.I want to take up his next point. In the Budget speech of 1950, Sir Stafford Cripps said:
He was referring to the Cohen Committee. He went on:"It is not proposed to impose any charge immediately … since it is hoped that a more easily administered method of economising … can be introduced shortly."
The Cohen Committee has now become the official alibi of the Socialist Party for their muddle over the prescription charges. The Leader of the Opposition, in a most extraordinary statement to the Rouse—I gave him notice that I would raise this point—on 31st January, 1952, gave as the most important reason why this charge was not introduced, that the Cohen Committee was set up and was managing to restrict from the drugs which could be prescribed a great many things which were not drugs. He said:"The power to charge will, of course, remain so that it can be used later if it is needed."—[OFFICIAL, REPORT, 18th April, 1950; Vol. 474, c. 60.]
Let us look at how they got a closer hand on it. The right hon. Gentleman did not seem to be aware—I know that the hon. Member for Ebbw Vale is—that the Cohen Committee was set up not after October, 1949, when we had this proposal but in July, 1949, and it had been going for four months at the time of this proposal. The Committee's first Interim Report, which has not been published, was in December, 1949, and there have been four other reports since. The terms of reference of the Cohen Committee bore not the slightest relationship to the main problem which was before the House at the time. It was the right hon. Member for Ebbw Vale himself who said, in the debate of 9th December:"We did get a closer hand on it."—[OFFICIAL REPORT, 31st January, 1952; Vol. 495, c. 380.]
The terms of reference of the Cohen Committee had nothing to do with that sort of problem. The Cohen Committee have not succeeded as we know, in reducing in any way the flow of drugs or the money spent on drugs, but the Cohen Committee have succeeded in doing admirable work in excluding from the National Health Service such things as glucose, whole-meal bread, disinfectants, toilet preparations and the like. That is the contribution which is being made, and if that is what the Leader of the Opposition calls getting a closer hand on it then no wonder the pharmaceutical service and other things are in the mess they are."It is aspirins, bandages and so forth, costing less than a 1s. which in a large number of cases could have been purchased by the patient. … That is where the abuse Lies."—[OFFICIAL REPORT, 9th December, 1949; Vol. 470, c. 2263.]
Before the hon. Gentleman leaves that point, he has pointed out clearly to us that there has been a great and steady increase in the numbers of prescriptions issued in the service. Would he, at the same time, give corresponding fall in self-medication, both in cost and numbers, if he has any conception of it?
The fall in self-medication is not something that can be gleaned from the Estimates, but I am not dodging that point. I will come back to it in a few minutes because I appreciate the importance of dealing with that matter.The history of the dental charge is much more simple. Here I want to put an inquiry to the right hon. Gentleman. I am not doing so in any hostile spirit. It is something I genuinely want to know and have always wanted to know. The Coalition White Paper in February, 1944, in words similar to the ones which the right hon. Gentleman used on Second Reading in 1946, said that a full dental service remained a proper objective, but that there were not enough dentists. On Second Reading the right hon. Gentleman used these words:
That seems to me to be about as good sense as has been talked about dentistry, in this House of Commons or anywhere else, but it also seems to me to be a proposal that there should be a half in and half out service which the right hon. Gentleman condemned in his speech tonight. Everything that has happened in the Dental Service stems from the failure to obey what the right hon. Gentleman said on Second Reading. It is from that that the cuts in remuneration came; it is from that the School Dental Service reduction has come; it is from that that an honoured profession has become a music-hall joke; it is from that the 1951 Act and the 1952 Bill come. I want to ask the right hon. Gentleman to tell the House why it was that he failed to carry out the undertaking he gave to this House about the dental services on the Second Reading of the Act."We have not enough dentists and it will therefore be necessary for us in the meantime to give priority treatment to certain classes—expectant and nursing mothers, children, school children in particular, and later on we hope adolescents. Finally we trust that we shall be able to build up a dental service for the whole population."—[OFFICIAL REPORT, 30th April, 1946; Vol. 422, c. 45.]
I anticipated that point in the statement I made. It was discovered that dentists were leaving the School Dental Service not merely on account of the National Health Service. They were leaving it long before the National Health Service came into operation, because the outside dental profession was much more attractive than the School Dental Service. I could not in fact have provided the priority services without taking over many functions from the local authorities. I should have had to take them over entirely. It was therefore much simpler to take the whole population into the dental service and work off the hump, and the hump has been worked off.
I am grateful for that explanation but it is entirely inaccurate. [Interruption.] Oh, yes, certainly it is. First, the figures of the right hon. Gentleman about the School Dental Service are inaccurate. The right hon. Gentleman made a great reputation in the previous two Parliaments by always speaking at the end of the health debates and never answering any points. He is much less effective when he comes down into the arena. First, he does not know the figures. In 1939 there were 866 dentists in the School Dental Service. It is true that the figure now is not much less, 40 or 50 were the last figures I saw. But the figure at the end of 1947, before the pull of the National Health Service drew the dentists and the potential dentists away from the School Dental Service, was about 1,060, and it is from that figure down to the low one of 810 we have now that is the measure of the failure of the right hon. Gentleman to carry out his guarantees.
Just a moment. I appreciate that the right hon. Gentleman is in need of care and protection.
No. Will the hon. Gentleman give the school population at the same time?
At the end of 1947 the number of dental officers was 1,063, equivalent to 921 full-time officers. Up to that time the number had been increasing rapidly. At the end of 1948, when the National Health Service started, it was down to 1,026 and by the end of 1949 it had dropped still further to 884—
Before the hon. Gentleman leaves that point would he—
I am dealing with the right hon. Gentleman—
But the hon. Gentleman is assuming all the time that the children who were formerly dealt with by the school dental officers were not dealt with. Very large numbers of them were dealt with in the general Health Service itself.
That is utterly ineffective. [HON. MEMBERS: "No."] Of course it is. The right hon. Gentleman simply does not know what he is talking about. When I deal with the effect of these charges I shall deal with that point as well. For the moment I will only say this to the right hon. Gentleman: He went down about a month ago to explain his conduct in this House to his constituents—something which I gather is in the nature of an annual event. Unless "The Times" of Monday, 10th March, misrepresented him, he said this:
Nobody can complain about the enthusiasm with which the right hon. Gentleman started to carry out his plans, because he made it quite clear that he was not going to be restrained even by the commitments he made himself."When we come to debate the National Health Service cuts, I assure you I will not be restrained by any previous commitments made by anyone."
The hon. Gentleman is not doing himself justice, and he is misleading the House. He knows quite well that the School Dental Service was always the Cinderella of the dental profession and that we had never had an efficient school dental service in this country. He also knows that a large proportion of the children today are being treated by the ordinary dentist in his surgery and the health of the schoolchildren today is higher than it was before.
Of course the health of the schoolchildren is higher today—[HON. MEMBERS: "Dentally."] Dentally, medically and in every other way. So it was last year and the year before and throughout the century.Of this question of the School Dental Service and whether these proposals will be effective, which is in my view, the main justification for these proposals if there is one, I will speak later. I want to come to the 1951 Bill. Mr. Speaker, do you recall that on the occasion of that Bill the Opposition held on the Floor of the House one of what are laughably referred to as their private Parliamentary meetings? This was a great convenience for hon. Members because, although explanations of these meetings in the Press are unusually full, they are rarely verbatim and they do not include the Division lists. But we can see exactly what happened at the end of the day a year ago when these proposals were before the House. We can see exactly how much the froth and the speeches were worth. The general tenor of hon. Members who spoke against the Bill was, shortly, that they disliked the Bill a great deal but that they preferred the Bill to a Tory Government.
I am glad the hon. Gentleman agrees, because it has obviously escaped him that he has ended with both the Bill and with a Tory Government. The Bill, as was the case last year, is to some extent dominated—
It being Seven o'Clock, and leave having been given to move the Adjournment of the House under Standing Order No. 9, further Proceeding stood postponed.