Skip to main content

Orders Of The Day

Volume 499: debated on Thursday 24 April 1952

The text on this page has been created from Hansard archive content, it may contain typographical errors.

National Health Service Bill

[1ST ALLOTTED DAY]

Considered in Committee [ Progress, 9th April].

[Colonel Sir CHARLES MACANDREW in the Chair]

4.11 p.m.

On a point of order. Mr. Speaker having just given a very important Ruling and having now left the Chair, I should like to make this comment on his Ruling, for which I am sure the Committee is very grateful and would no doubt accept. Is it not a very odd circumstance, and a reflection upon Mr. Speaker, that the Government should apparently have anticipated Mr. Speaker's Ruling by having printed on today's Order Paper today as the First Allotted Day, without knowing what Mr. Speaker's Ruling would be? Second, is it not also a great reflection on the rights of the House and on the responsibilities of Mr. Speaker that the Leader of the House should have announced as part of next week's business that the House will proceed to the consideration of this Bill on the Report stage, on the assumption that Mr. Speaker would give a Ruling of which the Government could not possibly have had any knowledge?

That is certainly a very interesting point, which I cannot possibly answer. It is not a point of order.

Clause 1—(Charges For Certain Drugs, Medicines And Appliances)

I beg to move, in page 1, line 11, after "provided" to insert:

"at a colliery medical centre or."
I should like first to thank the Minister for his courtesy in sending me a letter about certain Amendments standing in my name and that of my hon. Friends. I agree with him when he says in his letter that there may be some misunderstanding, and my Amendment should enable the right hon. Gentleman to clear up the points in question in a very short time. I should like to read from the Minister's letter the passage to which I am referring. He says:
"Taking first colliery medical centres, these are, as I understand it, provided by the Miners' Welfare Commission and are in no sense a part of the Hospital Service provided under the National Health Service Act. Clause 1 of the Bill provides for charges only to patients getting medicines, etc., as hospital out-patients in the National Health Service, and no question could therefore arise of a charge under this Clause at a colliery medical centre."
4.15 p.m.

Will the Minister give an assurance that, if any workman sustains an injury in or about a mine and attends a colliery medical centre but does not attend or is not detained in a hospital, he will be able to receive a truss, an elastic stocking, bandage or knee cap, or any other appliance free of charge? Judging from his letter, I should think that the right hon. Gentleman will be able to give me that assurance.

We agree with the other portion of the Minister's letter, in which he says that a hospital under Section 79 of the 1946 National Health Service Act includes a convalescent home and a rehabilitation centre. We therefore agree that the Amendments dealing with that are fully covered. If the Minister can give me the assurance for which I ask, I shall not detain the Committee any longer.

This Amendment seeks to remove some doubts from our minds. It is not my intention to deal with colliery medical centres, which have grown up consequent upon the improvement made in connection with what we call first-aid attendance, but there is another factor I wish to put to the Minister. If he is not able to include this in the Bill, I hope he will at least draft the regulations so that men are not made chargeable for drugs. It will be well-known to mining Members that, unfortunately, some men are pinned underground, either by machinery or by falls, of rock, and so on.

In recent years, consequent upon the intensive mechanisation in the mines, there have been cases where a man who has had the misfortune to be caught in machinery has been injected with morphia—which is a very expensive drug which has to be administered by an expert—so that the doctor, who has had to go underground, could amputate a limb before the man could be released. In the event of any man being so trapped underground as to necessitate the administering of morphia before an amputation, will the Minister give us an assurance that, whatever quantity of morphia is administered, the drug will not have to be paid for by the man?

I am much obliged to the hon. Member for Durham, North-West (Mr. Murray) for what he has said. It struck me that as there were several Amendments which we are not discussing now on the same point, and that, so far as I could see, they had nothing to do with the Bill, because the Bill did not touch them in any way, I thought it might save him and his hon. Friends trouble if I gave him the information which I sent to him.

The point which I must emphasise in the first part of my letter was that—as is clear if one carefully reads the first part of this Clause—all that is referred to in the Clause is hospital and specialist services under Part II of the principal Act, that is to say, services which come within the National Health Service and anything that is without that Service is, therefore, not affected in any way by this Bill.

It is quite clear, I understand, that colliery medical centres are altogether outside the Health Service and, therefore, they do not come within the ambit of this Bill. These centres, I understand, are provided by the Miners' Welfare Commission—although it has had, I think, a new name recently or is about to have a new name; the Bill is not yet through so we do not know whether it has a new name or not—but, in the meantime, we all know the body to which I am referring which provides these medical centres and anything that goes on there will not be affected by this Bill.

With regard to trusses and the various other items to which the hon. Gentlemen referred, and which are provided at the centres by the Miners' Welfare Fund, they do not come within the Bill. These centres are not hospitals within the meaning of the Bill. What the Bill does is to charge for appliances at hospitals. These are not hospitals and, therefore, the Bill cannot authorise any charge for them. That, I understand, is the answer to the questions.

I am prepared to look at the matter again and make myself quite certain that that is the case. The hon. Gentleman was good enough to ask me about this point a quarter-of-an-hour ago and that is the best information I can give him at the moment. I think that what he wants is secured, but I will certainly make myself fully satisfied about it. On the point about morphia being injected, I do not think that there can be any question at all of payment, because the colliery medical centre does not come within the Bill. I cannot, therefore, accept the Amendment because its insertion would be out of place.

I am obliged to the right hon. Gentleman for his statement, but I wish he could have gone a little further, because trusses and other appliances are not supplied by the Miners' Welfare Commission, and that is why we are anxious about this point. However, since I have the assurance—

I thought that the hon. Gentleman said that they had been. It was on that basis that I was answering. If I misunderstood him, I will look at it again from the point of view he has put.

In drawing up his regulations would the right hon. Gentleman make specific reference to the administration of morphia to men trapped underground?

I think that that is hardly necessary. It is free treatment. I do not think this would be necessary, because that point is amply safeguarded.

Since the Minister has given an assurance that he will again look at this matter and endeavour to meet us on this point, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

I beg to move in page 1, line 12, after "hospital," to insert:

"or is a person who is receiving benefit, or is a dependant of a person receiving benefit, under the National Insurance Acts, 1946 to 1951, or any statutory modification thereof."
It will be obvious to the Committee that this is an Amendment of some substance. If we were not following the present arrangement, I should want to take some considerable time to develop my argument. The effect of the Amendment is to provide that the people falling under the National Insurance Acts should be exempted from the charges applicable under this Clause. The reasoning is very plain. There are several special sections of people who ought to receive particular attention.

I am glad to see that the right hon. and gallant Gentleman the Member for Kelvingrove (Lieut.-Colonel Elliot) is in his place, because I remember that when we were discussing a similar provision in 1949, the right hon. Gentleman went so far—I am summarising what he said, but I shall not misrepresent him—as to say that we had an implied contract to some 12 million people under the National Health Insurance Acts who had previously received all drugs and medicines free. Now we are in the curious position that the situation has become much worse because the same people are now paying much more in actual contributions but will receive much less. I cannot argue to the Committee that there is a contract, but I am arguing that there is an implied contract with a great range of people all of them falling under the National Insurance Acts.

Let me point to another example. Under Section 75 of the National Insurance Industrial Injuries Act, 1946, the Minister may make arrangement to secure the provision and maintenance free of charge or at a reduced charge of equipment or appliances for any person otherwise under the Act. I am again summarising the position. In this event, the Act did not operate, but that Clause was written in, and it was written in by agreement. It was not even discussed in Committee. It was written in because the whole Committee at that time recognised that they could not forsake the practice in relation to the provision of appliances to men sustaining industrial injuries.

The practice had been that under the Act many of the employers' insurance schemes provided appliances, but, as many of my trade union colleagues will be able to tell us from their own experience, often a limited insurance meant that appliances were not supplied and the employer would make an ex gratia payment to provide them. There was sometimes an underlying reason for that. The employer had an interest in seeing that an injured man had such an appliance because that, in turn, reduced the compensation because with the appliance he could undertake work and without it he could not.

4.30 p.m.

At this stage, I suggest that history and reasoning is scarcely germane to our conclusions. The point is that if this Clause goes through in its unamended form we shall take a leap back of 40 years. We shall penalise people who, for some 40 years, have had provision made for them, first, by their employers, then under the old workmen's compensation scheme and, later, under the 1946 Act. I suggest that the Committee will not lightly commit itself to such an obvious injustice. The argument can be developed for any person falling under any of the National Health Acts. We plead with the Committee to accept the Amendment to make sure that a highly improper penalty is not imposed upon these people by the Bill.

I should be glad if the right hon. Gentleman would answer one point, which I raise for elucidation. The sort of speech that he has made is not new. On other occasions these identical points were put by my hon. Friends to the right hon. Gentleman the Member for Ebbw Vale (Mr. A. Bevan). I believe that my right hon. and gallant Friend the Member for Kelvingrove (Lieut.-Colonel Elliot) put precisely these points to him. The reply of the right hon. Gentleman the Member for Ebbw Vale was that there was nothing whatever in them. Does the right hon. Gentleman the Member for Greenock (Mr. McNeil) accept that we were right then or that his right hon. Friend was correct? He cannot have it both ways.

If the hon. Gentleman had not been so keen to impose a Guillotine Motion on the Committee I might have had time to argue this. I can only say that, at this stage, I am not concerned, and I know that my right hon. Friend the Member for Ebbw Vale (Mr. A. Bevan) would not want me to be concerned, with an old part of history or with my reputation. I am trying to save people who will suffer a gross injustice under the Bill.

I support the Amendment moved by my right hon. Friend the Member for Greenock (Mr. McNeil). Many of the persons who come under the National Insurance Act, particularly those suffering from prolonged sickness and permanent incapacity, depend for their maintenance upon the benefits under the insurance scheme and it will be apprepriated that in view of the increased cost of living the charges will mean a heavier burden for them and will create considerable hardship.

In seeking to justify the charges now sought to be imposed, the Minister of Health, on Second Reading, stated that the charges must be related to what he termed "obvious abuses to be rectified." My hon. Friends have very effectively answered the charges about abuses, and, although abuses may exist here and there, one of the most important things to emerge from the debate was that very little responsibility for abuses lay upon the individual patient. If any doubts still linger in the minds of the Minister or the Parliamentary Secretary about so-called abuses perhaps some of us in the few minutes we have on this proposal can disabuse them about the position.

I want to refer, in particular, to the industrially disabled. Where can the issue of abuses arise in connection with injured workmen? I want to follow through the procedure from the time the workman is injured until he gets his treatment.

I do not want the Guillotine to fall on my head. I wish to deal with this point, and I cannot give way, for the time is too short.

From the time he is injured the workman comes within the Industrial Injuries Act. He is tied by the provisions of the Act. He has first to report the accident, then he has to have medical attention, then a report has to be made to the Ministry of National Insurance—

On a point of order, Sir Charles. The hon. Member is referring to industrial injuries and disablement. I submit that it does not arise on the Amendment, which refers only to persons, or dependants of persons, receiving benefit under the National Insurance Act. Is not the hon. Gentleman out of order in referring to persons coming under the Industrial Injuries Act?

Yes, Sir Charles, the Industrial Injuries Act is part of the National Insurance Act and these people come within the National Insurance scheme.

To revert to what I was saying, a report is submitted to the Ministry of National Insurance, so there can be no doubt that the man is suffering from a disability due to and arising out of his employment. I am particularly concerned about the position of a man who has been on industrial injury benefit for six months and is suffering a permanent incapacity. He comes up for examination by a medical tribunal with regard to his eligibility for disablement pension.

In such cases many medical assessors have recommended injured men to receive treatment at local hospitals. The tendency of recent legislation has been to try to get workmen back into employment at a reasonably early date and every facility has been given to men to get back to work without charges being imposed upon them. That has been the tendency even with insurance companies in the last 10 to 15 years.

Employers in the mining industry assisted men to get back to work at a reasonably early date. To impose a charge on a workman injured in an accident due to and arising from his employment is a vicious principle to adopt and something which has been alien to the men in the mining industry for many years.

I will cite one or two types of case that arise in the mining industry. Thousands of men are suffering from dermatitis owing to exposure to dust and liquids and the filth and dirt underground. There were 7,763 successful claims in the industry in six months in 1948 from men suffering from this disease. Often when these matters come before the assessment board the men are immediately advised to get certain lotions at the local hospital.

If this Clause remains as it is such injured workmen will have to pay the 1s. charge very frequently to obtain the treatment for an industrial disease arising out of and in the course of their work, something which they have never experienced before. When the miners realise that a charge is to be put upon them in relation to a disability arising out of and in the course of their employment there will be a wave of bitterness in the coalfields.

Many men are suffering from beatknee—many miners working in low seams get inflammation of the knee—and they often attend local hospitals for treatment. If the Clause is not altered they will be charged the prescription fee. Particularly in South Wales, there are also thousands of men suffering from pneumoconiosis. I do not know whether the Parliamentary Secretary has seen any of the seriously disabled pneumoconiosis sufferers struggling up the hills of our valleys, panting for breath, to get relief in the form of drug or medicine from the local hospital.

Many cases arise daily in South Wales, and these men are now likely to be charged the prescription fee for the drug or medicine which they get to ease their pain as a result of a disease arising out of and in the course of their work. It is not a question of obvious abuses; it is a question of our indebtedness to the miners who hew the coal upon which our national economy depends.

I would put it to the Minister and to the Parliamentary Secretary that they should weigh very carefully, even at this last moment, the advantages of this so-called financial retrenchment on the one hand, and losing the good will of the nation, at least so far as the miners are concerned, on the other. They should weigh this so-called saving of a few million pounds against the possibility of creating hostility in the trade union movement of this country. I would ask them to consider this parsimonious miserable, niggardly policy and the possibility of losing out-put from the mines as a result of it.

Reference has been made to abdominal belts. Many men in the mining industry suffer from forms of hernia and strain due to their employment underground, and a charge is now to be made for the abdominal belts they need. That will create considerable feeling among the people in the coalfields. I would refer the Minister and the Parliamentary Secretary to Section 75 of the National Insurance (Industrial Injuries) Act, 1946. I do not know whether the hon. Lady has had any consultations with the Minister of National Insurance on this matter, but that Section empowers the Minister of National Insurance to supply appliances to injured workmen out of the Industrial Injuries fund. That has never been exercised because the responsibility has been carried out under the Health Scheme.

I want to know whether, if we fail on this Amendment, we can receive an assurance from the Parliamentary Secretary or the Minister of National Insurance that the Government will put into operation the Regulation for which power is given under Section 75, which reads as follows:
"The Minister may make arrangements to secure the provision and maintenance, free of charge or at a reduced charge, of equipment and appliances for any person who, by reason of the loss of a limb or otherwise, is in the need of them as the result of any injury or disease against which he was insured under this Act, and in connection with the provision or maintenance of any equipment or appliances for any person under this Section may pay to that person such expenses incurred by him as the Minister may determine."
Here is a Section which gives the Minister of National Insurance power to assist the industrially disabled. I would point out that the industrial workers of this country, and particularly the miners, have met their obligations. Many of them have sustained accidents while working on a Saturday as they were called upon to do by the nation. They have met their obligations and I want the Minister seriously to consider the position. If the industrial workers are to be called upon to pay this charge for appliances, or to pay the shilling for prescriptions, there will be a feeling of bitterness and resentment among them. Here is a golden opportunity for the Minister to rise to the occasion and to assist these men who deserve from the Government all the help they can get.

4.45 p.m.

The arguments which have been advanced are most interesting and all the more so since we have had them argued in the opposite sense. The right hon. Member for Greenock (Mr. McNeil) did give me notice on a previous occasion that he would refer to that. It is very interesting, because we have had the opinion of, not the last Minister of Health in the Labour Government—that transient and embarrassed penitent—but of the right hon. Member for Ebbw Vale (Mr. Bevan). He brought up the fundamental change which, he states, he made in the Health Service by moving from a contributory to a largely non-contributory basis and it is from that that all this difficulty stems.

That is certainly true. I will quote in a moment the words of the ex-Minister of Health on the matter. It is on that that the Minister of Health relies in repudiating the very conditions of the contractual obligations to which the right hon. Member for Greenock referred. Let us take the reference, which was on 9th December, 1949. On examining the proposals I had been struck by exactly the same contention which right hon. and hon. Gentlemen opposite have been putting forward. It seemed to me that tuberculosis patients were being put in a worse position than before. The right hon. Member for Ebbw Vale repudiated this in the strongest possible terms he said:

"Nor is it true to say, as the right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot) said, that we are putting the National Health Service contributor in a worse position than he has been in since the beginning of the National Health Service Act."
That was when the House was debating this very proposal that the charge should be prescribed by Regulation by the Minister of Health of the day. The right hon. Member for Ebbw Vale went on:
"That is not true."
It was not true, he said, that the power to impose these charges and the imposing of these charges put a beneficiary in a worse position than he had been in before.
"What is actually happening at the present time is that the National Health Service is giving him a far wider range of services than he had under the National Health Insurance Act; therefore, even if this were imposed, what would be left to the National Health contributor would be a far wider range of service than was ever available before."—[OFFICIAL REPORT, 9th December, 1949; Vol. 470, c. 2261.]
There was a slight interchange between us at the time as to whether this proposal to impose these charges was a popular or an unpopular move with the voters and, particularly—oddly enough—with the local government voters of the country. The right hon. Member for Ebbw Vale contended that it was a popular move with the voters of the country. He went on:
"It is not correct to say it is only on the side of bottled medicine that some of the abuse has taken place—it is aspirins, bandages, and so forth, costing less than a 1s., which, in a large number of cases, would have been purchased by the patient—… That is where the abuse arises."

Well, I am only quoting some of the arguments which were adduced to the Committee, particularly by the hon. Member for Bedwellty (Mr. Finch). The right hon. Gentleman went on to say:

"It is no use my hon. Friends telling me that this is not the case, because"—
and this deals particularly with the last point about out-put and so on raised by the hon. Member for Bedwellty—
"this proposal has not, in fact, been received with much indignation, as it is generally accepted that there is an awareness of the abuse which had been taking place."—[OFFICIAL REPORT, 9th December, 1949; Vol. 470, c. 2263.]

I leave that to the right hon. Gentleman who made the speech. It was he who referred to the charge he was about to impose by Regulation. I am anxious not to take up the time of the Committee—[Interruption.] If the hon. Member wishes the debate to go on I am perfectly willing to take him on at length. I am quoting the right hon. Member for Ebbw Vale on the point we were discussing—

The right hon. Member was talking about hospitals.

We were discussing the general question. The right hon. Member for Greenock raised the general question of whether a contributor was being put in a worse position by this than he was in before, and he said that he was. I am quoting the right hon. Member for Ebbw Vale, who said that he is not. And I say, finally, that all these things arise out of the fact that the Committee is not here discussing the actual proposal but the power to make such a proposal.

The proper moment at which to raise points—no doubt very interesting and important—such as that which was raised by the last speaker as to the particular allowances to be made for those injured in the course of industrial warfare, is when the Regulations are laid. The House of Commons will have an opportunity of doing so. We all recognise that there are casualties in industrial warfare which are as deserving of sympathy as the casualties in other fields of struggle and endeavour. The general principle has already been argued. Powerful and cogent arguments were brought forward by the then Minister of Health in the quotations which I have given, to show that the contention which has since been adopted by my right hon. Friend the present Minister of Health is the right one.

The situation is not really as confused as the right hon. and gallant Gentleman has represented it. He is right in saying that what we did was to substitute a non-contractual scheme for a contractual scheme, and a non-contributory scheme for a contributory one. It is also true to say that under the National Health Service Act, as it was conceived and carried out by the Labour Government until last year, the range of benefits given was infinitely wider than was ever provided under the old National Health scheme. There is no doubt about that.

I have said on many occasions that one of the reasons why the Regulations were never made under the 1949 Act was that, in respect of certain of the benefits, they would have put the old insured contributor in a worse condition than he had been since the formation of the National Health Service Act. I have explained that before, but hon. and right hon. Gentlemen opposite always go back to the instance where power was taken to frame the Regulations, and never to the precedent subsequent to that, that the Regulations were never framed. If all they are anxious to do is to give me the flattery of imitation they will take these powers and will never make the Regulations.

I return this to right hon. Gentlemen opposite: whatever may have been said about the abuses of the chemist's shops—and I am not prepared myself to say that there are not even now, and will not be for a very long time, abuses in the chemist's shop—the question is whether this is the most effective way of dealing with them. They can be dealt with in other ways. It does not seem to me that the most effective way is to punish the helpless patient. Quite often the general practitioner is responsible.

It was never in my mind that we should apply this principle to the hospitals. We are dealing here with drugs and appliances provided under the Hospital specialist service. We have already asked the Parliamentary Secretary a question about this, and we have not had a reply. She is under an obligation to tell us whether there is any evidence of abuse by the specialist service in the hospitals. It seems to me disastrous to compel industrially injured persons, or any other persons who have to go to the hospitals for drugs or appliances, to pay for them. That does set the clock back. Indeed, it has no other object except a purely punitive one.

We cannot reduce abuses in this way, unless the Parliamentary Secretary is prepared to tell the Committee that the Ministry of Health have information that, in the hospital service itself, the specialist abuses the service by giving unnecessary appliances and medicine. If she says that, will she provide the Committee with instances where it has occurred? Furthermore, has she reported those cases to the Central Health Services Advisory Council for advice, so that they may advise the Minister how to deal with these abuses, if such have occurred? If one or two instances can be shown to have happened, it is the clumsiest possible remedy to punish all those who have to use the specialist service, in order to deal with a few specialists and stop an abuse—if there are such cases.

I am very anxious not to talk too much about this matter, and I would not have spoken if I had not been challenged. One of the reasons why I did not proceed with those Regulations was because of my experience, which is not very limited in this matter. Long before I became Minister of Health we used to have local schemes to supplement National Health Insurance. In my native town of Tredegar we had one of the pioneer schemes in Great Britain. It was one which employed Dr. Cronin, although he afterwards abused it; I do not mean professionally, but in literature.

We had those schemes—why? Because the range of benefits provided under National Health Insurance was too limited. All over the country miners and other workers devised local supplementary schemes. When the National Health Service came into operation most of those schemes were wound up because the range of benefits under the Health Ser- vice was much wider and had assimilated all those local schemes. If we are now to play fast and loose with the National Health Service, these men may have to consider whether they ought not themselves to resurrect some of those schemes to assist people who will have to make these payments to the hospitals. Once more we shall be getting back to the situation in which the industrial workers will have to pay twice, once through the taxation system, and, of course, through the 10d. contribution which still remains, and they will have to provide these supplementary schemes themselves.

Although the Minister may not feel it possible at the moment to accept the Amendment—I hope he does—when he comes to frame the Regulations he is under no obligation to include these people at all. He can leave them all out. The right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot) is not correct in saying that the time to raise these points is when the Regulations come before the House. We shall not be able to do anything but accept or reject the Regulations. I am not quarrelling with that position, but I am pointing out that that is not the time to raise these points because we shall not be able to amend the Regulations. If hon. Members opposite are enthusiastic about precedents which I have set they can follow my precedent and let the Regulations fall.

In 36 minutes the Guillotine will fall on this Clause. I wonder whether I might plead with the Parliamentary Secretary that it might be for the convenience of the Committee if she could now reply and say whether she can accept the Amendment. We can move on in that case. If she does not accept it, we can make good use of the time that remains.

5.0 p.m.

I shall not detain the Committee for more than two minutes, but I am sure it is the feeling of every hon. Member here that, working, as we are, under the Guillotine, we should now, at this stage, take note of real Committee points. [HON. MEMBERS: "Oh."] The point I want to bring to the notice of the Committee is to suggest an alternative to what the right hon. Member for Ebbw Vale (Mr. Bevan) had to say about the difficulties with which we are undoubtedly presented now, and have been presented in previous Measures.

We should allow, in the benefits which are to be paid under the Industrial Injuries Act or under the National Insurance Act, those benefits which will take charge of the additional costs which we all recognise are coming. That would have the advantage of our being sure that those benefits will go to those most in need because they are drawing benefits from those schemes. That is an alternative to everyone benefiting, and it can be done by adjusting the benefits under the general National Insurance Act.

This Amendment is centred around those people who are covered by the National Insurance Acts, and, we heard yesterday both from the right hon. Member for Greenock (Mr. McNeil) and also from the right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan), a reference to the old Insurance Act and the assertion that these new charges would be breaking an obligation. I suggest that even though the former Government may not have implemented the Act which they passed on the 1s. prescription charge, it does not in any way invalidate what we believe is an equally sound argument today, namely, the one quoted by my right hon. Friend when he insisted, we believe quite rightly, that the new noncontributory arrangement could not honestly and fairly be compared with the old contributory one.

In the first place the old benefits were for the insuree alone and not for his family. The new benefits cover his family. They are much wider, and only 10d. of the 9s. 5d. paid by an adult male and his employer in the weekly insurance contribution goes towards the National Health Service. So it is in no sense an insurance, and only a very small contribution is paid towards the Service. There is a further point against the suggestion in this Amendment: that those who draw benefits depend on having fulfilled certain contribution conditions, and if they do not qualify and, therefore, do not get their benefit, they would be far worse off, or, if they are people not covered by insurance, they would be far worse off than those whom this Amendment seeks to exempt.

There was the third point raised about industrial injuries. I can assure the Committee that my right hon. Friend has been in full consultation with the Minister of National Insurance on this point. The question arises whether the powers of Section 75 of the National Insurance Industrial Injuries Act should be used to meet wholly or in part any charges that are made under these provisions. This was presumably considered by the previous Government in connection with the charges for teeth and spectacles, and that Government evidently decided not to use the powers so provided. We have held that there has never been any differentiation in the matter of treatment or appliances between the industrially injured and other sick industrial workers, whether a man was injured either in the course of his employment or outside, or whether he was under the old Workmen's Compensation Act.

As the right hon. Gentleman said, Section 75 of the Industrial Injuries Act was put in to meet a possible gap before the National Health Service Act came into operation, but, in fact, that did not arise and it was not necessary to implement those provisions. However, it was not put in, as we believe from the records of the drafting of those provisions, as a matter of principle to provide that better facilities should be available to the industrially injured than to those injured in other circumstances.

We recognise that those who suffer industrial injury already draw higher benefits by virtue of their industrial injury insurance. They draw higher benefits than the ordinary sick or disabled who may be suffering the same disability, the same hardship, the same pain, but have not been in that position by virtue of their industrial employment. They draw their ordinary sickness benefit but not the higher industrial injury benefit.

Therefore, to make a dispensation in regard to those who are drawing higher benefits to the detriment of those who are drawing lesser benefits is not wholly justified in our view. We believe that throughout these regulations—and, indeed, the regulations imposed for charges last year by the previous Government—the principle of hardship and the right of need as the means by which a concession should be made, which is decided by the National Assistance Board, should continue to operate under this Clause. For those reasons we do not feel we can accept the Amendment.

I am much obliged for the statement made by the hon. Lady, but she has failed to make it clear to the Committee that those unfortunate men who draw benefits under the Personal Injuries Act are paying extra contributions over and above other people. It is as well that this should be made known, because the hon. Lady is misleading the Committee, I hope unintentionally.

Amendment negatived.

The following Amendment stood upon the Order Paper:

In page 1, line 17, at end, add:

"except in cases where it can be shown that the replacement or repair is due to a fault in the appliance."

This is so obvious an Amendment that I know it will be accepted, and I will not trouble to move it.

Motion made, and Question proposed, "That the Clause stand part of the Bill."

The Minister has told us repeatedly that the object of these charges is to save money, so that more can be spent on the National Health Service. I suggest that between now and the Report stage he should consider economising in the Service and having more money to spend as a result. I suggest also that where appliances are prescribed while the patient is in hospital there shall be no charge paid. I believe the right hon. Gentleman would save money in that way, because patients would be able to leave hospital much more quickly than would otherwise be possible.

Medicine is not an exact science. No doctor can say that a patient was not fit to go to work yesterday or is fit to go today, or is not fit to go today but will most certainly be fit to go tomorrow. A lot depends on the condition of the patient, where he is going, and on the patient himself, and whether he really wants to go or not. If a heavy charge is to come upon the patient should he leave hospital tomorrow or a little later, but not if he remains there, he will tend to keep his place in hospital longer than otherwise would be the case.

Let me, briefly, give an example. These things happen every day in hospital. Imagine that a person has a severe injury to his foot and needs a surgical boot. Until the foot has healed, the boot cannot be ordered. But if the patient is to be told that by staying a little longer in hospital he would save £3, he would be very much inclined to stay a little longer if he can persuade his surgeon to allow him to remain.

The same thing applies to other appliances. After a severe illness, people sometimes lose all their hair. The Parliamentary Secretary will be very well aware of how a woman in that position would feel and how reluctant she would be to leave hospital until a wig was provided. But if, in addition to leaving hospital without a wig, there is to be added the cost of £2 10s. or something like that, such a person would be induced to try to persuade whoever is responsible for her care in hospital to keep her a little longer.

I put these suggestions very briefly—we are short of time—to the Parliamentary Secretary as a means by which, without being in any way hard on a patient, money can be saved for the provision of extra facilities in the Service.

A good deal of the discussion which has taken place on four days on this first Clause has been concerned with special types of hardship which might arise by virtue of the charges which it enables to be imposed. As each separate category is contemplated, whether it be the tuberculous, the diabetic or those we have just been considering, whose power of earning is temporarily or permanently at an end by reason of sickness or disablement, a very strong case appears to be able to be made out why they should be exempted from the charge.

Nevertheless, I believe that my right hon. Friend has taken the right course, and, indeed, the only practicable course, in setting his face against any type of special exemption. We can never draw a boundary line on one side of which there will be hardship, and on the other side of which there will be no hardship, by endeavouring to define the type of case. It is only by ascertaining where hardship in practice, arises in the individual circumstances of the person upon whom the charge is imposed, that the impact of these charges can, where necessary be alleviated.

There is a means test involved, as I shall show the hon. Lady in a moment.

5.15 p.m.

I shall be discussing that in a moment.

For example, to consider the chronically sick patient who often requires medicine from an out-patient department, at regular intervals, it may well be that the regular necessity of paying the prescription charge would involve hardship. But it involves hardship not because of the chronic nature of the sickness, but because of the circumstances of the individual patient. Therefore, I believe that my right hon. Friend has been right in using the machinery which was already provided for this purpose.

When, in the first day in Committee on the Bill, I pointed out that hon. and right hon. Gentlemen opposite had themselves commended the National Assistance Board for this very purpose, the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop), sought to draw a distinction between the use of the Assistance Board where a single payment or a largish payment had to be made—as for spectacles and teeth—and the use of the Assistance Board to alleviate hardship arising out of payments for prescriptions.

That brings me to a very interesting and important point, on which I should like to secure the help of the right hon. Gentleman the former Minister of Health. We are all familiar ad nauseam with the statement that the charges for prescriptions under Part IV of the principal Act were introduced in 1949 either with no intention that they should ever be implemented, or else that it was subsequently found impracticable to implement them. That is the standard position of right hon. and hon. Gentlemen opposite.

What I want to ask the right hon. Gentleman the Member for Middlesbrough, East (Mr. Marquand) is this. Why, when he came to the House, 18 months after the Lords Amendment of 1949, with the Bill which is now the 1951 Bill, did he then take powers to enable the Assistance Board to make payments in respect of charges for prescriptions? He did that, not in the first flush of his enthusiasm for the Amendment which had been sent down from another place at the end of 1949, but after 18 months' investigation of the administrative possibilities.

The right hon. Gentleman then still believed both that it was administratively practicable—otherwise he was wasting the time of the House and overloading the Statute Book with nonsensical provisions—and that the Assistance Board was the appropriate means of dealing with hardship arising out of the necessity of payments for prescriptions.

Unless, therefore, the right hon. Gentleman and those who supported him—those who voted Section 4 into the 1951 Act—can give another explanation of what that provision is doing, they agree with my right hon. Friend that the Assistance Board is the right way, and the only right way, of dealing with any hardship which may result under the Clause.

We have had a very detailed analysis by the hon. Member for Wolverhampton, South-West (Mr. Powell), who considers himself an expert on this subject, of how to tackle hardship. He has told us that the Government believe that they must do this in a practical way; that the only thing to do is to look at hardship as it arises and to deal with it.

But during our long debates on the Clause, we have had from this side of the Committee case after case brought before the Minister of Health of where hardship is arising. We have had no answer whatever. We have had the very practical point of the patient on the waiting list, who cannot get into a hospital and who, because of that, has to pay for any drugs, medicines or appliances that he might need while waiting, through no fault of his own. What answer have we had on that practical point of hardship?

The Guillotine is the practical answer to our practical cases of hardship.

We have had the point made by my hon. Friend the Member for Barking (Mr. Hastings), a very practical case of hardship, in which he has pointed out that if a patient vacates hospital in order to leave a bed for someone else he has to pay for an appliance he would get free if he were able to remain in hospital. Are these not practical points? Can the Minister say that he is a practical man in dealing with this question of hardship? So complicated is the problem of sickness and health and of human need, that we cannot draw a line in a devious way like this. The simple answer is that we should not have the Clause at all, because it is a complete indictment of the whole attempt to deal with the problem.

I wish to raise a very practical point on hardship and ask for a specific assurance from the Minister of Health. He made a statement on Second Reading, and I want to tell him that, although he may not be aware of the fact, that statement is untrue; I hope he will give an assurance that he will look into the matter. I hope he will also look into the points about hardship which have been raised by hon. Members on this side of the Committee who know where the shoe really pinches.

I want to raise the question of persons receiving National Assistance. It has always been argued by hon. Members opposite that when they did their cheeseparing on the social services they would never allow the burden to fall on the most severe cases. Therefore, in the Second Reading debate we had the Minister giving us the following very specific assurance:
"There will be no charge for hospital appliances in the case of children under 16 or in full-time attendance at school or to persons in receipt of National Assistance."—[OFFICIAL REPORT, 27th March, 1952; Vol. 498, c. 850.]
If the right hon. Member had not been in such a hurry with the Guillotine, this is a point of interpretation which some of us on this side of the Committee would like to have clarified by specific Amendments to the Clause. I was prepared, when the right hon. Gentleman gave the assurance, to accept that it was expressing his intention, but the trouble with all the debates on this Bill has been that hon. and right hon. Members opposite really do not know anything about the Health Service or how it works, or the financial arrangements of less well to do members of the community. They are arguing in ignorance, and the right hon. Gentleman is arguing in ignorance, just as the hon. Member for Wolverhampton, South-West (Mr. Powell)—whom I understand always refuses to debate the question in his constituency with my hon. Friend the Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop)—is in ignorance.

The position unless the right hon. Gentleman issues new Regulations or a substantial administrative instruction to the National Assistance Board, is that it is not true that persons on National Assistance automatically will get appliances free. It is true that in the Bill machinery is provided whereby they can get their prescriptions reimbursed and a person on National Assistance, having got a receipt from the chemist, can take it to the post office to get his bob back, but it is not true that persons on National Assistance automatically will get a surgical corset, an elastic stocking, or a wig free.

Under the Determination of Need Regulations a certain amount of capital may be ignored when assessing hardship, and a widow may have £100 in the bank as her last resource, the last safeguard of her independence, a sense of reliance and of decency, perhaps a wee nest egg to use if her children need something. But, if she has £100 in the bank, she will have to pay out of that capital for the appliance. I ask the right hon. Gentleman what steps he intends to take to honour this specific assurance he gave the House on Second Reading. It is a great blot on this country if, in a period when relaxations are being given in regard to Income Tax and financial relaxations here and there to people who are not down to their last £100, these inroads should be made into the savings of widows and others on National Assistance.

I hope the right hon. Gentleman does not mean that to happen and will see that it does not happen. I hope that if the hon. Lady the Parliamentary Secretary replies she will be able specifically to redeem the honour of her right hon. Friend in this matter and let us have a guarantee that, at any rate on this question, hon. Members opposite will do something to retract their reputations on this question of hardship, because their reputations are already so tarnished that they cannot stand this further blot.

I wish to call attention to Clause 6 (2), which deals with hardship questions and National Assistance—

The hon. Member should not take time to make another speech.

I am sorry that I mis-timed the peroration of the hon. Lady the Member for Blackburn, East (Mrs. Castle), and she will not expect me to deal with the relative ignorance of myself and my hon. Friend the Member for Wolverhampton, South-West (Mr. Powell). I wish to ask for an answer from the right hon. Gentleman—

On a point of order. Is the hon. Member speaking in order to protect the Parliamentary Secretary?

The hon. Lady has asked a specific question of my hon. Friend the Member for Wolverhampton, South-West, and I wish to put a question. It makes a nice change, as it leaves the right hon. Member for Ebbw Vale (Mr. Bevan) in the clear. As far as hon. Members opposite are concerned, the real villain of the piece is not the Minister of Health but the Chancellor of the Exchequer, because all this arises from the decision—and I agree firmly with it—of the Chancellor of the Exchequer and so of Her Majesty's Government that so much money, and so much money only this year, can be given to the hospitals. It is a small point in relation to hospitals in this Clause, but a much bigger point in relation to other things to which we are coming, and the total is something like £20 million. If that money is not found, the hospital service and the tuberculosis service and everything else in the National Health Service will go short. It is that dilemma to which hon. Members opposite have not addressed themselves, and it is that dilemma in respect of which sometime on this Clause and on all the other Clauses we must demand that they give an answer.

5.30 p.m.

I will take only two minutes—I know it is very vexatious. The hon. Members for Enfield, West (Mr. Iain MacLeod) and Wolverhampton, South-West (Mr. Powell), have once more deployed their philosophical approach to the social services. What they say is that if any public funds are available, if the public authority is to intervene between a citizen and the vicissitudes of life or the circumstances of the market, the individual should establish his claim to that assistance. That is their position.

There is something to be said for that as a philosophy. I profoundly disagree, but there is a great deal to be said for the argument, that if public action is required to assist an individual the individual should establish his claim to that assistance. Society has created the National Assistance Board in this country in order to investigate the position of the individual. It is an attractive proposition. It ought to be applied all round if it is to be applied at all.

There is the question of £52 million for the farmers; there is the fertiliser subsidy. There is a lot to be said for the view that a farmer should go to the Assistance Board and establish his claim before the public authority intervenes on his behalf. I understand that to be the position taken up by the hon. Members opposite. As I say, it is an attractive proposition.

For example, compensation is not given to a shareholder, it is given to a citizen. It is an attractive proposition that before compensation should be given, before a person who has shares in the gas or coal industry should be able to obtain compensation money from the State, he should go to the Assistance Board and establish his title to it. It is a very attractive proposition. We should pursue it further.

I am afraid not now. I have only two minutes. I am perfectly prepared to take the matter up at any other time. We on these benches have never considered that compensation for expropriated property is any other than a political expedient. There is no natural right to it. Therefore, let an entitlement be claimed.

It is a most revolutionary principle and doctrine. I am not always loath to accept revolutionary principles. Therefore, I hope that the hon. Members will pursue the matter further. It is a most popular cause to have taken up. I am prepared to help them to apply it all round and see how much more Lord Woolton will be able to collect from their friends when the application is really made.

It is a delight to reply to the specific points raised by the hon. Lady the Member for Blackburn, East (Mrs. Castle). She challenged my right hon. Friend about how he proposes to fulfil the pledge he gave in the Second Reading debate on the Bill, when he said that children under 16 years and people in receipt of National Assistance contributions or pensions in respect of war injuries should not be charged for appliances.

In the case of those receiving National Assistance, if they have a National Assistance

Division No. 97.]

AYES

[5.37 p.m.

Aitken, W. T.Boothby, R. J. G.Cooper-Key, E. M.
Allan, R. A. (Paddington, S.)Bossom, A. C.Craddock, Beresford (Spelthorne)
Alpert, C. J. M.Boyd-Carpenter, J. A.Cranborne, Viscount
Amory, Heathcoat (Tiverton)Boyle, Sir EdwardCrookshank, Capt Rt. Hon. H. F. C.
Anstruther-Gray, Major W. J.Braine, B. R.Crosthwaite-Eyre, Col. O. E.
Arbuthnot, JohnBraithwaite, Sir Albert (Harrow, W.)Crouch, R. F.
Ashton, H. (Chelmsford)Braithwaite, Lt..-Cdr G. (Bristol, N. W.)Crowder, John E. (Finchley)
Assheton, Rt. Hon. R. (Blackburn, W.)Bromley-Davenport, Lt.-Col. W. H.Crowder, Petre (Ruislip—Northwood)
Astor, Hon. J. J. (Plymouth, Sutton)Brooke, Henry (Hampstead)Cuthbert, W. N.
Astor, Hon. W. W. (Bucks, Wycombe)Brooman-White, R. C.Darling, Sir William (Edinburgh, S.)
Baker, P. A. D.Browne, Jack (Govan)Davidson, Viscountess
Baldook, Lt.-Cmdr. J. M.Buchan-Hepburn, Rt. Hon. P. G. T.Deedes, W. F.
Baldwin, A. E.Bullard, D. G.Digby, S. Wingfield
Banks, Col. C.Bullock, Cant M.Dodds-Parker, A. D.
Barber, A. P. L.Bullus, Wing Commander E. E.Donaldson, Cmdr. C. E. McA.
Barlow, Sir JohnHerden, F. F. A.Donner, P. W.
Baxter, A. B.Butler, Rt. Hon. R. A. (Saffron Walden)Doughty, C. J. A.
Beach, Maj. HicksCarr, Robert (Mitcham)Douglas-Hamilton, Lord Malcolm
Beamish, Maj. TuftonCarson, Hon. E.Drayson, G. B.
Bell, Philip (Bolton, E.)Cary, Sir RobertDrewe, C.
Bell, Ronald (Bucks, S.)Channon, H.Dugdale, Maj. Rt. Hon. Sir T. (Richmond)
Bennett, F. M. (Reading, N.)Churchill, Rt. Hon. W. S.Duncan, Capt. J. A. L.
Bennett, Sir Peter (Edgbaston)Clarke, Col. Ralph (East Grinstead)Duthie, W. S.
Bennett, Dr. Reginald (Gosport)Clarke, Brig. Terence (Portsmouth, W.)Eccles, Rt. Hon. D. M.
Bennett, William (Woodside)Clyde, Rt. Hon. J. L.Eden, Rt. Hon. A.
Bevins, J. R. (Toxteth)Cole, NormanElliot, Rt. Hon. W. E.
Birch, NigelColegate, W. A.Erroll, F. J.
Bishop, F. P.Conant, Maj. R. J. E.Fell, A.
Black, C. W.Cooper, Sqn. Ldr. AlbertFinlay, Graeme

book they will produce it at the hospital and will receive their appliances without further charge. In respect of those people who so make a needs claim, but are not in receipt of National Assistance benefit, the same procedure will operate as now operates for dentures. If the claim is accepted, a cheque is received from the Board to pay the charges. There will be no charge at all for appliances to children.

How will the identity of the person showing a book be determined? Identity cards are now abolished.

The hon. Member is no doubt aware that no hospital deals with a patient without having records of that patient, his treatment, name, age and address, which will tally with the records entered in the National Assistance book. In addition, there are penalties for any fraudulent misuse of the books. The records maintained in the hospitals are, we feel—

It being Twenty-four Minutes to Six o'Clock ( the House having resolved itself into the Committee at six minutes past Four o'Clock), The CHAIRMAN proceeded, pursuant to Order [12 th April], to put forthwith the Question already proposed from the Chair.

Question put, "That the Clause stand part of the Bill."

The Committee divided: Ayes, 305; Noes, 285.

Fisher, NigelLeather, E. H. C.Remnant, Hon. P.
Fleetwood-Hesketh, R. F.Legge-Bourke, Maj. E. A. H.Renton, D. L. M.
Fletcher, Walter (Bury)Legh, P. R. (Petersfield)Roberts, Peter (Heeley)
Fletcher-Cooke, C.Lindsay, MartinRobertson, Sir David
Fort, R.Linstead, H. N.Robinson, Roland (Blackpool, S.)
Fraser, Hon. Hugh (Stone)Lloyd, Rt. Hon. G. (King's Norton)Robson-Brown, W.
Fraser, Sir Ian (Morecambe & Lonsdale)Lloyd, Maj. Guy (Renfrew, E.)Rodgers, John (Sevenoaks)
Fyfe, Rt. Hon. Sir David MaxwellLloyd, Rt. Hon. Selwyn (Wirral)Roper, Sir Harold
Gage, C. H.Lockwood, Lt.-Col. J. C.Ropner, Col. Sir Leonard
Galbraith, Cmdr. T. D. (Pollok)Longden, Gilbert (Harts, S. W.)Russell, R. S.
Galbraith, T. G. D. (Hillhead)Low, A. R. W.Ryder, Capt. R. E. D.
Gammans, L. D.Lucas, Sir Jocelyn (Portsmouth, S.)Salter, Rt. Hon. Sir Arthur
Garner-Evans, E. H.Lucas, P. B. (Brentford)Sandys, Rt. Hon. D.
George, Rt. Hon. Maj G. LloydLucas-Tooth, Sir HughSavory, Prof. Sir Douglas
Glyn, Sir RalphMcAdden, S. J.Schofield, Lt.-Col. W. (Rochdale)
Godber, J. B.McCallum, Major D.Scott, R. Donald
Gomme-Duncan, Col. A.McCorquodale, Rt. Hon. M. S.Scott-Miller, Comdr. R.
Gough, C. F. H.Macdonald, Sir Peter (I. of Wight)Shepherd, William
Gower, H. R.Mackeson, Brig. H. R.Simon, J. E. S. (Middlesbrough, W.)
Graham, Sir FergusMcKibbin, A. J.Smiles, Lt.-Col. Sir Walter
Gridley, Sir ArnoldMcKie, J. H. (Galloway)Smithers, Peter (Winchester)
Grimston, Hon. John (St. Albans)MacLeod, Iain (Enfield, W.)Smithers, Sir Waldron (Orpington)
Grimston, Sir Robert (Westbury)MacLeod, John (Ross and Cromarty)Smyth, Brig. J. G. (Norwood)
Harden, J. R. E.Macmillan, Rt. Hon. Harold (Bromley)Snadden, W. McN.
Hare, Hon. J. H.Macpherson, Maj. Niall (Dumfries)Soames, Capt. C.
Harris, Frederic (Croydon, N.)Maitland, Comdr. J. F. W. (Horncastle)Spearman, A. C. M.
Harris, Reader (Heston)Maitland, Patrick (Lanark)Speir, R. M.
Harrison, Col. Harwood (Eye)Manningham-Buller, Sir R. E.Spence, H. R. (Aberdeenshire, W.)
Harvey Air Cdre, A. V. (Macclesfield)Markham, Major S. F.Spens, Sir Patrick (Kensington, S.)
Harvey, Ian (Harrow, E.)Marlowe, A. A. H.Stanley, Capt. Han. Richard
Harvie-Watt, Sir GeorgeMarples, A. E.Stevens, G. P.
Hay, JohnMarshall, Douglas (Bodmin)Steward, W. A. (Woolwich, W.)
Head, Rt. Hon. A. H.Marshall, Sidney (Sutton)Stewart, Henderson (Fife, E.)
Heald, Sir LionelMaude, AngusStoddart-Scott, Col. M.
Heath, EdwardMaudling, R.Storey, S.
Henderson, John (Cathcart)Maydon, Lt.-Cmdr. S. L. C.Strauss, Henry (Norwich, S.)
Higgs, J. M. C.Medlicott, Brig. F.Stuart, Rt. Hon. James (Moray)
Hill, Dr. Charles (Luton)Mellor, Sir JohnStudholme, H. G.
Hill, Mrs. E. (Wythenshawe)Molson, A. H. E.Sutcliffe, H.
Hinchingbrooke, ViscountMonckton, Rt. Hon. Sir WalterTaylor, Charles (Eastbourne)
Hirst, GeoffreyMoore, Lt.-Col. Sir ThomasTaylor, William (Bradford, N.)
Holland-Martin, C. J.Morrison, John (Salisbury)Teeling, W.
Hollis, M. C.Mott-Radclyffe, C. E.Thomas, Rt. Hon. J. P. L. (Hereford)
Holmes, Sir Stanley (Harwich)Nabarro, G. D. N.Thomas, P. J. M. (Conway)
Hope, Lord JohnNicholls, HarmerThompson, Kenneth (Walton)
Hopkinson, HenryNicholson, Godfrey (Farnham)Thompson, Lt.-Cdr. R. (Croydon, W.)
Hornsby-Smith, Miss M. P.Nicolson, Nigel (Bournemouth, E.)Thorneycroft, R. Hn. Peter (Monmouth)
Horsbrugh, Rt. Hon. FlorenceNield, Basil (Chester)Thornton-Kemsley, Col. C. N.
Howard, Gerald (Cambridgeshire)Noble, Cmdr. A. H. P.Tilney, John
Howard, Greville (St. Ives)Nugent, G. R. H.Turner, H. F. L.
Hudson, Sir Austin (Lewisham, N.)Nutting, AnthonyTurton, R. H.
Hudson, W. R. A. (Hull, N.)Oakshott, H. D.Tweedemuir, Lady
Hulbert, Wing Cmdr. N. J.Odey, G. W.Vane, W. M. F.
Hurd, A. R.O'Neill, Rt. Hon. Sir H. (Antrim, N.)Vaughan-Morgan, J. K.
Hutchinson, Sir Geoffrey (Ilford, N.)Ormsby-Gore, Hon. W. D.Wakefield, Sir Wavell (Marylehone)
Hutchison, Lt.-Cm. Clark (E'b'rgh W.)Orr, Capt. L. P. S.Walker-Smith, D. C.
Hutchison, James (Sootstoun)Orr-Ewing, Charles Ian (Hendon, N.)Ward, Hon. George (Worcester)
Hyde, Lt.-Col. H. M.Orr-Ewing, Ian L. (Weston-super-Mare)Ward, Miss I. (Tynemouth)
Hylton-Foster, H. B. H.Osborne, C.Waterhouse, Capt Rt. Hon. C.
Jenkins, R. C. D. (Dulwich)Partridge, E.Watkinson, H. A.
Jennings, R.Peake, Rt. Hon. O.Webbe, Sir H. (London & Westminster)
Johnson, Eric (Blackley)Perkins, W. R. D.Wellwood, W.
Johnson, Howard (Kemptown)Peto, Brig. C. H. M.White, Baker (Canterbury)
Jones, A. (Hall Green)Peyton, J. W. W.Williams, Rt. Hon. Charles (Torquay)
Joynson-Hicks, Hon. L. W.Pickthorn, K. W. M.Williams, Gerald (Tonbridge)
Kaberry, D.Pilkington, Capt. R. A.Williams, Sir Herbert (Croydon, E.)
Keeling, Sir EdwardPitman, I. J.Williams, R. Dudley (Exeter)
Kerr, H. W. (Cambridge)Powell, J. EnochWills, G.
Lambert, Hon. G.Price, Henry (Lewisham, W.)Wilson, Geoffrey (Truro)
Lambton, ViscountPrior-Palmer, Brig. O. L.Wood, Hon. R.
Lancaster, Col. C. G.Profumo, J. D.York, C.
Langford-Holt, J. A.Raikes, H. V.
Law, Rt. Hon. R. K.Rayner, Brig. R.TELLERS FOR THE AYES:
Redmayne, E.Mr. Butcher and Mr. Vosper.

NOES

Acland, Sir RichardBacon, Miss AliceBevan, Rt. Hon. A. (Ebbw Vale)
Adams, RichardBaird, J.Bing, G. H. C.
Albu, A. H.Balfour, A.Blackburn, F.
Allen, Arthur (Bosworth)Barnes, Rt. Hon. A. J.Blenkinsop, A.
Allen, Scholefield (Crewe)Bartley, P.Blyton, W. R.
Anderson, Alexander (Motherwell)Bellenger, Rt. Hon. F. J.Boardman, H.
Anderson, Frank (Whitehaven)Bence, C. R.Bottomley, Rt. Hon. A. G.
Attlee, Rt. Hon. C. R.Bann, WedgwoodBowden, H. W.
Awbery, S. S.Benson, G.Bowen, E. R.
Ayles, W. H.Beswick, F.Bowles, F. G.

Braddock, Mrs. ElizabethHobson, C. R.Porter, G.
Brockway, A. F.Holman, P.Price, Joseph T. (Westhoughton)
Brook, Dryden (Halifax)Holmes, Horace (Hemsworth)Price, Philips (Gloucestershire, W.)
Broughton, Dr. A. D. D.Holt, A. F.Proctor, W. T.
Brown, Rt. Hon. George (Belper)Houghton, DouglasPryde, D. J.
Brown, Thomas (Ince)Hoy, J. H.Rankin, John
Eurke, W. A.Hubbard, T. F.Reeves, J.
Burton, Miss F. E.Hudson, James (Ealing, N.)Reid, Thomas (Swindon)
Butler, Herbert (Hackney, S.)Hughes, Cledwyn (Anglesey)Reid, William (Camlachie)
Callaghan, L. J.Hughes, Emrys (S. Ayrshire)Rhodes, H.
Castle, Mrs. B. A.Hughes, Hector (Aberdeen, N.)Roberts, Rt. Hon. A.
Champion, A. J.Hynd, H. (Accrington)Roberts, Albert (Normanton)
Chapman, W. D.Hynd, J. B. (Attercliffe)Roberts, Goronwy (Caernarvorishire)
Chetwynd, G. R.Irvine, A. J. (Edge Hill)Rogers, George (Kensington, N.)
Clunie, J.Irving, W. J. (Wood Green)Ross, William
Cocks, F. S.Isaacs, Rt. Hon. G. A.Schofield, S. (Barnsley)
Coldrick, W.Janner, B.Shackleton, E. A. A.
Collick, P. H.Jay, Rt. Hon. D. P. T.Shawcross, Rt. Hon. Sir Hartley
Cook, T. F.Jager, George (Goole)Shinwell, Rt. Hon. E.
Corbel, Mrs. FredaJeger, Dr. Santo (St. Pancras, S.)Short, E. W.
Cove, W. G.Jenkins, R. H. (Stechford)Shurmer, P. L. E.
Craddock, George (Bradford, S.)Johnson, James (Rugby)Silverman, Julius (Erdington)
Crosland, C. A. R.Johnston, Douglas (Paisley)Silverman, Sydney (Nelson)
Crossman, R. H. S.Jones, David (Hartlepool)Simmons, C. J. (Brierley Hill)
Cullen, Mrs. A.Jones, Jack (Rotherham)Slater, J.
Daines, P.Keenan, W.Smith, Ellis (Stoke, S.)
Dalton, Rt. Hon. H.Kenyon, C.Smith, Norman (Nottingham, S.)
Darling, George (Hillsborough)Key, Rt. Hon. C. W.Snow, J. W.
Davies, A. Edward (Stoke, N.)King, Dr. H. M.Sorensen, R. W.
Davies, Rt. Hon. Clement (Montgomery)Kinley, J.Soskice, Rt. Hon. Sir Frank
Davies, Ernest (Enfield, E.)Lee, Frederick (Newton)Sparks, J. A.
Davies, Harold (Leek)Lee, Miss Jennie (Cannock)Steele, T.
Davies, Stpehen (Merthyr)Lever, Harold (Cheetham)Stewart, Michael (Fulham, E.)
de Freitas, GeoffreyLever, Leslie (Ardwick)Stokes, Rt. Hon. R. R.
Deer, G.Lewis, ArthurStrachey, Rt. Hon. J.
Delargy, H. J.Lindgren, G. S.Strauss, Rt. Hon. George (Vauxhall)
Dodds, N. N.Lipton, Lt,-Col. M.Summerskill, Rt. Hon. E.
Donnelly, D. L.Logan, D. G.Swingler, S. T.
Driberg, T. E. N.MacColl, J. E.Sylvester, G. O.
Dugdale, Rt. Hon. John (W. Bromwich)McGhee, H. G.Taylor, Bernard (Mansfield)
Ede, Rt. Hon. J. C.McGovern, J.Taylor, John (West Lothian)
Edelman, M.McInnes, J.Taylor, Rt. Hon. Robert (Morpeth)
Edwards, John (Brighouse)McKay, John (Wallsend)Thomas, David (Aberdare)
Edwards, Rt. Hon. Ness (Caerphilly)McLeavy, F.Thomas, George (Cardiff)
Edwards, W. J. (Stepney)MacMillan, M. K. (Western Isles)Thomas, Iorwerth (Rhondda, W.)
Evans, Albert (Islington, S. W.)McNeil, Rt. Hon. H.Thomas, Ivor Owen (Wrekin)
Evans, Edward (Lowestoft)MacPherson, Malcolm (Stirling)Thorneycroft, Harry (Clayton)
Evans, Stanley (Wednesbury)Mainwaring, W. H.Thurtle, Ernest
Ewart, R.Mallalieu, E. L. (Brigg)Timmons, J.
Fernyhough, E.Mallalieu, J. P. W. (Huddersfield, E.)Tomlinson, Rt. Hon. G.
Field, W. J.Mann, Mrs. JeanTomney, F.
Fienburgh, W.Manuel, A. C.Turner-Samuels, M.
Finch, H. J.Marquand, Rt. Hon. H. A.Ungoed-Thomas, Sir Lynn
Fletcher, Eric (Islington, E.)Mayhew, C. P.Usborne, H. C.
Follick, M.Mellish, R. J.Viant, S. P.
Foot, M. M.Messer, F.Wallace, H. W.
Forman, J. C.Mikardo, IanWatkins, T. E.
Fraser, Thomas (Hamilton)Mitchison, G. R.Webb, Rt. Hon. M. (Bradford, C.)
Freeman, John (Watford)Monslow, W.Weitzman, D.
Freeman, Peter (Newport)Moody, A. S.Wells, Percy (Faversham)
Gaitskell, Rt. Hon. Maj. G. LloydMorgan, Dr. H. B. W.Wells, William (Walsall)
Gibson, C. W.Morley, R.West, D. G.
Glanville, JamesMorris, Percy (Swansea, W.)Wheatley, Rt. Hon. John
Gordon Walker, Rt. Hon. P. C.Morrison, Rt. Hon. H. (Lewisham, S.)White, Mrs. Eirene (E. Flint)
Greenwood, Anthony (Rossendale)Mart, D. L.White, Henry (Derbyshire, N. E.)
Greenwood, Rt. Hn. Arthur (Wakefield)Moyle, A.Whiteley, Rt. Hon. W.
Grenfell, Rt. Hon. D. R.Malley, F. W.Wigg, George
Grey, C. F.Murray, J. D.Wilcook, Group Captain C. A. B.
Griffiths, David (Rother Valley)Nally, W.Wilkins, W. A.
Griffiths, Rt. Hon. James (Llanelly)Neal, Harold (Bolsover)Willey, Frederick (Sunderland, N.)
Griffiths, William (Exchange)O'Brien, T.Willey, Octavius (Cleveland)
Grimond, J.Oldfield, W. H.Williams, David (Neath)
Hale, Leslie (Oldham, W.)Oliver, G. H.Williams, Rev. Llywelyn (Abertillery)
Hall, Rt. Hon. Glenvil (Colne Valley)Orbach, M.Williams, Ronald (Wigan)
Hall, John (Gateshead, W.)Oswald, T.Williams, W. R. (Droyisden)
Hamilton, W. W.Padley, W. E.Williams, W. T. (Hammersmith, S.)
Hannan, W.Paget, R. T.Wilson, Rt. Hon. Harold (Huyton)
Hardy, E. A.Paling, Rt. Hon. W. (Dearne Valley)Winterbottom, Ian (Nottingham, C.)
Hargreaves, A.Paling, Will T. (Dewsbury)Winterbottom, Richard (Brightside)
Harrison, J. (Nottingham, E.)Pannell, CharlesWoodburn, Rt. Hon. A.
Hastings, S.Pargiter, G. A.Wyatt, W. L.
Hayman, F. H.Parker, J.Yates, V. F.
Healey, Denis (Leeds, S. E.)Paton, J.Younger, Rt. Hon. K.
Henderson, Rt. Hon. A. (Rowley Regis)Pearl, T. F.
Herbison, Miss M.Plummer, Sir LeslieTELLERS FOR THE NOES:
Hewitson, Capt. M.Popplewell, E.Mr. Pearson and Mr. Royle.

Clause ordered to stand part of the Bill.

5.45 p.m.

I beg to move, "That the Deputy-Chairman do report Progress, and ask leave to sit again."

I cannot accept that Motion under the Guillotine. I am operating now under a Resolution of the House, and I cannot deal with such a Motion. We must now proceed to Clause 2.

I accept that position and, having accepted that, I want to add that we have scandalous grievances of which the people are not yet aware. What redress have we now to ventilate those grievances in this Committee?

I would remind the hon. Member that I am bound by the orders of the House, and it is my duty to carry them out.

I was getting some legal advice, but on all these matters we do not need legal advice now. My point is that under the National Health Insurance Acts our people are paying millions of pounds into the Exchequer for the purpose of these services, and if we part with this Clause without—

The Clause is now passed. We are finished with it. The hon. Member may have other times and opportunities for commenting on it, but he cannot comment on it here and now.

Let me make it quite clear that I respect the occupant of the Chair and that there is nothing personal in this, but we have got to consider the position of millions who have paid millions of pounds—

Would it be possible to display the actual guillotine here by having it flown over from Paris?

Clause 2—(Charges For Dental Treatment)

I beg to move, in page 2, line 8, to leave out "or."

I do not know if it would be for the convenience of the Committee to take this Amendment and the one in my name to line 10.

Although there is another Amendment in between, I think we can discuss them together.

The first Amendment is really drafting. It omits the word "or" so that the Clause will read when the second Amendment is inserted (a), (b), (c) and (d). The main object of the second Amendment is to exclude from any charge the clinical examination which a patient may have and the report on it.

It struck me, as I further studied this matter and heard the different views on the subject, that it really was a reasonable proposition to say that, as we are trying to do our best for the general health of the nation in all this, it was wiser, if a charge had to be imposed, which is the object of this Clause, that the examination, at any rate, which might lead to work being done, should be free. It would encourage people to see their dentists and have the examination, quite possibly, more frequently than if they had to pay for it.

The mere fact that a person does go regularly to see a dentist, knowing he will not be charged for the examination, might prompt him to go more frequently, and the experience which we have personally, not being dentists, is that the oftener one goes, the less likely is it in the long run that any remedial action will be necessary.

I announced this change as the decision of the Government when I made my speech in the Second Reading debate, and I hope it will be acceptable to the Committee.

Amendment agreed to.

I beg to move, in page 2, line 9, to leave out from "bleeding," to the end of line 10.

Whatever its merits as an Amendment, I think we can all agree that this Amendment has a panache about it. In fact, it so excited one of my hon. Friends that he has composed a "Ballade of Parliamentary Draftsmen," of which the "punch line" at the end of each stanza is:
"Leave out from 'bleeding' to end of line 10."
The point here is a small but a very real one, and as we have a practicing dentist in the House, perhaps he will give his views upon it. It has been put to me by a number of dentists that bleeding, in this sort of case, is not always caused only by the extraction of teeth, and, as we are seeking to give an exemption in this part of Clause 2, obviously, the more we narrow the exemption by definition, the worse perhaps it is for some of the patients.

I therefore suggest that we should take out the narrowing and limiting words:
"caused by the extraction of teeth"
and simply leave the exemption to cover the cases, rare though they be, which, I am assured by the dentists and others, are not due to the extraction of teeth.

I agree with what the hon. Member for Enfield, West (Mr. Iain MacLeod) has said, and I am very glad that he has paid attention to the dentists who have been advising him on this matter. I think it is a great pity that he did not pay attention to them on the subject of this charge, which, as every dentist knows, will ruin the teeth of the people of this country.

My hon. Friend who moved this Amendment has been very persuasive and, as he is supported by the technical experience of the hon. Gentleman opposite, who am I, as a layman, to say "No"? I am very happy to accept the Amendment.

Amendment agreed to.

Further Amendment made: In page 2, line 10, at the end, to insert:

"or
(d) the clinical examination of a patient and any report thereon."—[Mr. Crookshank.}

I beg to move, in page 2, line 10, at the end, to insert:

(d) a service for which the current authorised fee is not more than one pound.
This is the first opportunity we have had to discuss Clause 2 at all, and here we are making remarkably rapid progress. I hope that we shall continue in this way. When the right hon. Gentleman said just now that he was glad to listen to the expert professional advice of my hon. Friend the Member for Wolverhampton, North-East (Mr. Baird), and asked who was he, as a layman, to contradict advice of that kind, I was hoping that he would take the same attitude about the Amendment which I am now moving.

I am still in doubt about the origins of the proposal for the charge for dental treatment. It really did come to us as a great shock, and we heard the announcement with considerable astonishment. How it ever came about that anyone advised the right hon. Gentleman to make a charge for dental treatment, in view of the vast amount of advice which already existed on this point, from some of which I quoted when I spoke on Second Reading, we really could not imagine.

One thing is certain amid the obscurity, and that is that the dental profession itself objected very strongly and strenuously indeed to the proposal. Particularly did they object to charges for dental treatment, as we on this side of the Committee object to them, being made by the method selected; namely, the charge for the first £1 worth of treatment which was necessary, or the amount, less than £1, which might be necessary, saying, in effect to the patient, "If your teeth have been neglected for sufficiently long, and you have acquired more than £1 worth of damage, you need not pay for the additional damage, but, if your teeth are in such a state that they need less than that amount of attention, we will charge you."

The dental profession made representations to the right hon. Gentleman. Indeed, they made representations to every hon. Member of this House, so upset, surprised and consternated were they by this proposal. One must in fairness admit that the right hon. Gentleman has paid some attention to some of these representations. He himself agreed to exempt from the charge at first persons under 16, and later on, in response to further representations, under 21, so that they will not have to pay for the first £1 worth of dental treatment. That showed that the right hon. Gentleman was responsive more and more to suggestions. This afternoon he has been responsive to still further suggestions in this direction.

I should like to know whether the dental profession, having received from the right hon. Gentleman this concession for which they had asked, having secured from him the undertaking to raise the age of exemption to 21, are now satisfied. Have they made further representations to the right hon. Gentleman? Have they indicated to him in any way whether they approve of this charge? I shall be very surprised indeed if they have.

Have they not asked him if he will go further—because the opinion which we on this side of the Committee have received from the professional associations and those who are expert in this field is that, if a charge is to be made at all, it should be made in such a way as to give an incentive for the care of the teeth and to encourage people to seek treatment. An examination which will not be charged for is, of course, some incentive, but the adoption of the proposal which I am putting forward would be a far greater incentive indeed.

6.0 p.m.

The dental health of this country is still very far from satisfactory. We have had before us many times the evidence collected by the Teviot Committee in 1944. That is only eight years ago. No doubt there has been some improvement since then—indeed I am sure there has been since a universal free service was provided from 1948 onwards. But we cannot be satisfied with the state of the dental health of our people. We know very well that there are not enough dentists to meet the needs of everybody requiring dental treatment.

I think that to adopt the proposal which I made this afternoon would be one way of ensuring that scarce dental skill is used at those times and places when it can give most benefit to the nation as a whole by improving the dental health of the people, which is so important to their general health. We must make improvements, even in bad things, if we can. We should devise a charge which would encourage people to undertake early treatment as quickly as possible.

If the dentist advises people that there is some small matter which needs immediate attention and from which they will benefit, let him not have to say that it will cost them 12s. 6d. or 15s. but rather that if they let him do it at once it will never cost them anything at all. The right hon. Gentleman has provided a concession this afternoon. Let him take full advantage of it and go a step forward and encourage people, especially young people, to come forward for treatment.

I know that he has raised the age of exemption to 21, but there are large numbers of young people above that age who are still earning comparatively small incomes, who are still, shall we say, in a comparatively irresponsible stage of their development, and who do not attach the same importance as older people to the care of their teeth. Let the Minister, therefore, take full advantage of the concession he has made, improve upon it, and make his device as complete as he can in the circumstances in which he finds himself.

I rise to support this Amendment standing in the name of my right hon. Friend and myself because I believe it gets right to the basis of the dental charges. The first argument put forward in favour of these charges was that they would help to stop some of the many abuses. With regard to the dental aspect of the Bill, there can be no basis for that argument because nobody goes to a dentist to have a tooth extracted or filled unless it is necessary.

I believe that one of the major reasons for imposing charges on dental treatment is because a large number of hon. Members on both sides of the Committee have the idea that the dental service is simply one of the frills of the National Health Service, and is not as essential as some others. But I submit to the right hon. Gentleman and to the Parliamentary Secretary that the dental service is an integral and important part of the National Health Service and that, if it is undermined to any great extent, the effect will be to undermine the health of the people.

A septic tooth can cause many diseases. Daily, doctors are sending many cases of all kinds to practising dentists who quite often find on examination that the cause of the infection is in the mouth. Therefore, if the teeth of the people deteriorate as a result of these charges, there is a danger that their health will also deteriorate.

Those of us who come from industrial areas, as many on this side of the Committee do, know what happened in those areas in the bad old days. We in the dental profession have been fighting against it for generations. We had a two-tier system of treatment, one for middle-class patients, who could afford to pay for conservative treatment, and another for the great mass of people who, because they could not afford to pay for such treatment, only came to us for extractions and artificial teeth. Dentists in those areas flourished by manufacturing dentures.

My right hon. Friend the Member for Ebbw Vale (Mr. Bevan), when Minister of Health, deliberately tried to force down the price paid to dentists for dentures and to force up the price of conservative dentistry in order to save teeth rather than manufacture dentures. He was proved right, and the dental health of this country has been improving during the last three years at a tremendous rate. But the imposition of this charge is going to put the Service back to where it was before 1948. I will read the Committee a quotation from the "British Dental Journal" of 4th March, and nobody could say that that was a Labour publication. The following is what they say is going to happen as a result of these charges:
"A reasonable expectation would he that the demand rate will settle down at a figure more nearly approximate to that which obtained under the old dispensation of dental benefit under the National Health Insurance Acts."
The dentists anticipate that, owing to these charges, based on last year, we shall get back to the dentistry we had before the National Health Service was introduced.

As a dental surgeon, I have been very unpopular with my professional brothers on many occasions because I have told them in this House when I thought they had been unethical. I see that the gallant and sanctimonious right hon. Member for Kelvingrove (Lieut.-Colonel Elliot) is in the Chamber. I remember during a debate on the National Health Service, when I protested on behalf of some of my constituents who were being misused by certain members of the dental profession in my area at the time—they could not receive attention without paying for it—the right hon. and gallant Gentleman accused me of making a foul speech and of fouling my own nest because I attacked certain members of my profession. It is well known that hon. Members on both sides received numerous letters at the beginning of the Service complaining that dentists were refusing to give emergency treatment under the scheme, and I was proved right.

As a result of my protests in this House and the leaders of the dental profession being able to bring their influence to bear on the unethical members of the dental profession, that practice was stopped, and today we have a service which is running very well indeed. But if this charge, which is chiefly a charge for emergency treatment, is imposed, we shall go back to what happened in the early days of the service. Emergency treatment of all kinds will he carried out outside the scheme and the person requiring such treatment will have to pay for it, perhaps at a time when he can least afford to do so. I know that in such circumstances many of my professional brothers would give the treatment without charge, but that is not the way to approach the problem. This service is not a charity; it is a right.

There is one other small technical point to which I hope the Minister will try to reply. He has not attempted to reply to any of my technical points up to now. Since the scheme came into being, we dentists have tried to save teeth rather than take them out. Every day patients come to us wanting extractions. I find that if one puts in a dressing one may be able to bring that patient back in a week or so for a filling. When we carry out this treatment that is a temporary dressing, we get a fee of 7s. 6d.

But if this scheme is carried through, the patient will have to pay the 7s. 6d., or whatever the dentist charges. The patient will pay 7s. 6d. for the dressing and then the dentist's fee for filling when he comes back for treatment in a week's time. Therefore, there will be two fees for the same treatment. The patient who has not been educated to the conservation of teeth will tend to say, "No, let me have the tooth out and be done with it."

I am grateful to the Minister for the compliment when, referring to the Amendment moved by the hon. Member for Enfield, West (Mr. Jain MacLeod), he asked, "Who am I to disagree with hon. Members who are experienced in the profession?" I really hope the right hon. Gentleman will listen to me again, as I am speaking professionally here. Who advised the right hon. Gentleman on this method of paying these charges? Quite frankly, I am against all charges in the dental service; but if charges are to be imposed, surely the profession should have been consulted before they were fixed. I know there were consultations afterwards. But were the British Dental Association consulted before the method of imposing the charges was introduced? Does the hon. Member for Enfield, West agree that that is the best method of raising the money? I will sit down if he will tell us.

The hon. Member's method of conducting debates is tediously familiar. I have not the slightest intention of intervening to suit his convenience.

This is the silliest method of imposing a charge because it will be a charge on the sensible patient who comes regularly to his dentist. The "British Dental Journal" for 15th April states:

"The method of requiring patients to pay up to the first £1 on each estimate for treatment is still, however, open to the objection that it will operate unfairly to the disadvantage of those who attend regularly for treatment. They will, inevitably, be called upon to pay for the greater part of their treatment, whereas those who only make occasional visits to the dentist will he called upon to meet only a small proportion of the cost. This is bound, in the long run, to act as a deterrent to regular treatment—the one thing which should be the aim of a well-conceived health service to encourage."
Again—and on this I have put down an Amendment which I am afraid will not be called—the "British Dental Journal" makes a suggestion to the Minister. It goes on to state:
"A percentage charge on all estimates would not be open to this objection. Under such a system, a patient who had one small filling done on each of four half-yearly visits would be called upon to pay the same charge as a patient who had four larger fillings done during one course of treatment at the end of two years, whereas under the proposals in the Bill, the first patient would pay the whole cost of his treatment and the second would only have to pay £1."
Why is it that the Minister has paid no attention to his professional advisers? It is only because this Bill was ill-conceived and hurriedly introduced for petty political motives and not to bring any advantage to the National Health Service. The hon. Member for Enfield, West, who made a very feeble return in his speech yesterday, took the line that these charges are ethically and socially justified because they will bring a better balance to the Health Service and will have a restraining influence on the scheme.

They are having a restraining influence all right. The Act introduced last year is already having a tremendous effect. The demand for dentures has dried up and there are hundreds of dental mechanics unemployed and a large number of dentists not fully employed. Does the hon. Member want that? If these new charges are imposed, it will mean there will be less and less demand for fillings and conservative treatment. If these things were being abused then let us by all means impose these charges. But are they? The demand for dentures has dried up, and the British Dental Association is worried because now there will be less demand for conservation treatment. As I said before, we are imposing a two-tier system—one type of dentistry for the wealthier classes and another for the poorer. We are putting the clock back to earlier days.

6.15 p.m.

I believe there is a Dentists Bill ready for discussion, which has passed through all stages in another place, if the Leader of the House can find time for it. Its aim is to deal with the alleged shortage of dentists. I entirely disagree with the view that there is a shortage of dentists today. Let us not think that these proposed charges are a minor matter. I knew from my own practical experience that patients coming in week after week, and month after month, have really appreciated this free dental service. I speak with all sincerity as one who spends more time on his practice than in this House—though perhaps I ought not to do that.

I have heard the hon. Member for Enfield, West, and the hon. Member for Wolverhampton, South-West (Mr. Powell), suggest that these charges are socially justified. If they said those things in their own constituencies, they would be hounded out of the town. If these charges are imposed, we shall go back to a type of dental treatment and service that we had before the great National Health Service was introduced.

The reason I would recommend my right hon. Friend the Minister on this occasion not to take the advice of the practising dentist to whom we have just listened is that I believe that, from beginning to end of what he said, the hon. Member for Wolverhampton, North-East (Mr. Baird), was entirely wrong.

On the Second Reading of this Bill, I put two propositions to the House, both of which have been referred to at inordinate length not only by the hon. Member for Wolverhampton, North-East, but by other hon. Members opposite. I said that, as far as the gleaning together of a small amount of information went—and there was no official information at the time—the charges had a serious deterrent effect. I said, secondly, "I believe you can justify this sort of charges if the result of a drop in the demand for dentures is an increase in the dental school service, and only if that happens."

The hon. Member for Wolverhampton, North-East, as he always does, went off like a soda fountain about that and he has been bubbling about it ever since. He appears to be unaware that a large number of people in his profession do not agree with him, and I am alarmed at what will happen on the day when he realises that it is not the rest of the battalion but little Willie who is not in step.

Is the hon. Member talking about my views or the facts of the situation? There is not a considerable number of dentists drifting back.

If I were talking about the facts of the case, I could not conceivably be talking about the hon. Member's views. I give him that straight away. At the time when I put these views to the House, there were shouts of "Nonsense" from the hon. Member. He repeated that there is no considerable drift back. Three days after I made that speech the Department of Health for Scotland issued a report for 1951, which I have here. I will not go into all the details, but it confirms that the figures that I gave from estimates only, and from such information as a private Member can gather, were completely accurate and that there had been such a drop in the provision of dentures that there had been a considerable deterrent effect. Two figures are most impressive. In January, 1951, 61.1 per cent. of the total payments to dentists represented fees for dentures. The corresponding amount in December, 1951, represented only 32.2 per cent. On that issue we are agreed. There has been a deterrent effect.

Now let us come to the second point. What improvement has there been in the school dental service? Perhaps I may read this paragraph to the hon. Member.

Yes, and these figures will also be confirmed in the English Report when it comes out. I spoke to the Secretary of the British Dental Association on this matter only the day before yesterday. The paragraph states:

"One important consequence of the drop in applications for dentures along with the negotiations for improved salary scales in local authority employment was an increase in the number of dentists in the school dental service. By the end of the year, taking account of dentists with engagements to start work early in 1952, half the ground lost by the school service after the introduction of the National Health Service in 1948 had been recovered. There was every reason to expect that this trend would continue."
How dare the hon. Member come to the House and make that sort of suggestion? He must have seen that statement that half the ground lost by the miserable tactics of his Government had been recovered—tactics which, far from helping the dental health of the people, helped the non-priority classes and rotted the children's teeth. If we on this side of the House are to be accused in that phrase by the right hon. Member for Ebbw Vale (Mr. Bevan), I throw it straight back at him. I do not see how the hon. Member for Wolverhampton, North-East, dares, as a professional man, to come to the House and say that there is no considerable evidence, because the evidence which I hold in my hand is the official evidence of the Ministry. It consists no longer of the estimates of a back bench Member, as it did on Second Reading.

There are two points that I should like to raise. First of all, to say that the dental health of school children is now lower than it was is completely unfounded, and no responsible dental body would suggest it. Had I known that the hon. Gentleman was going to deal with the school dental service on this Amendment, I would have referred to it myself earlier. We have never had an efficient school dental service, and I say that there is no possibility that by these charges we shall get a flow into the school dental service so as to provide an efficient service.

It is happening now, and the Secretary of the British Dental Association told me so less than 48 hours ago.

I cannot give way to the hon. Member. I am dealing entirely with the hon. Member for Wolverhampton, North-East; it is more courteous to concentrate on him. In my view, the evidence is abundant, and I say that if the only result of a deterrent charge was that dentists and dental mechanics were unemployed, I would loathe that charge. I do not like charges for the fun of it. I like charges either because they are economically essential or because I believe—I freely grant that one can be wrong on this—it is possible to get a list of priorities. If that be so, then these charges are going to be justified if the health of the children is better looked after.

As any parents can tell the hon. Member—and I myself have young children—it is quite true that it is becoming increasingly possible to get appointments for the dental treatment of one's children either in emergency or for conservative treatment, which is more closely concerned with this Amendment. The reason for that is that less dentures are being made and dentists have more time. These things stem from the charges introduced a year ago. I do not say that this is the best method of introducing them—I do not know what negotiations there have been—but on those grounds, and on the principle that a dental charge in itself is not abhorent, I stand absolutely firm.

I do not want a deterrent charge so that dentists become unemployed; heaven forbid. I am deeply concerned with the dental profession, as I think the hon. Member for Wolverhampton, North-East, will agree, although we differ widely on so many other matters. Only in education is it more silly to be dogmatic than in matters of health. It is wrong to say flatly that such and such a thing must happen. All I say is that the evidence so far shows the truth of the views which I have consistently put to the House, for if I have ever been single-minded about anything I have been single-minded about these charges, and I have stated my views all over the country. I retreat from nothing.

I genuinely believe that, quite apart from the economic outlook, there is nothing whatever between the point of view of the Minister of Health and myself or between the front and back benchers on this side of the Committee on this issue at all. Because one speaker emphasises the economic aspect of the problem and another the social aspect, it does not mean that they fail to recognise the strength of the other's point of view. I believe that these charges will find their justification in time. If they do not, I shall be the first to say that as soon as possible they should be reduced or withdrawn. I say that seriously.

I ask my right hon. Friend the Minister of Health not to take too much account of the views of our only dentist in this matter, because, as the Department of Health for Scotland have proved, and as the Ministry of Health for England and Wales will prove in due course, he just simply does not know the real implications of what he is saying.

May I put this point for the sake of getting it on the record? Will the hon. Member tell me what he thinks the establishment of the school dental service should be in order to give an efficient service?

I am prepared to answer the question, though goodness knows why the hon. Member should ask me this sort of question. Probably the figure which has been given in the House on many occasions, of between 2,000 and 3,000, is correct.

For England, Wales and Scotland—provided that dentists themselves in the public service also have time to give of their skill. One does not know the precise figure because we simply do not know to what extent the lag in conservative treatment has left a backlog of ill-health. I suspect that it is very considerable indeed. I do not believe that a flat answer can be given.

May I ask one or two questions? I was not very impressed by the last two or three sentences that the hon. Gentleman uttered. He said that if it is proved that he is wrong—by that I suppose he means if it is proved in the next year or two—that people's teeth are deteriorating and that, therefore, the Government have made a great mistake, he will be prepared to withdraw all that he has said today.

6.30 p.m.

The hon. Member has set himself up in this Chamber—and perhaps there is some justification for it—as an authority on social reform. Is it not a curious attitude to take in respect of dental caries, to say that, if the teeth of the people deteriorate, he is prepared to admit to us that he was wrong? Surely he is not going to pursue that argument and wait for the teeth of the people to deteriorate? It might be a valid argument if he were discussing something not quite so serious, but I hope that he will explain to the Committee that he did not mean exactly what his words conveyed, certainly to those Members on this side of the Committee.

With great respect to the right hon. Lady, she is on a false point. She would be on an accurate point if everything in the garden were lovely at the moment, but she knows very well that the numbers in the school dental service deteriorated enormously under her administration.

I am not asking the hon. Gentleman only about the school dental service. I am also thinking of the teeth of the young men and women who are over 21—between 21 and 25—whose teeth are very vulnerable. I am thinking of men and women in the lowest income groups. The hon. Gentleman is prepared to tell the Committee that he is ready to wait to see if their teeth deteriorate under this scheme and, if they do, he will then be prepared to withdraw his argument.

I wish to support this Amendment, but before dealing with it precisely there is one question which I should like to have answered. It is a question that has been exercising the minds of all Scottish Members on this side of the Committee, particularly since Question time on Tuesday. Then, in answer to a supplementary question from my hon. Friend the Member for Fife, West (Mr. Hamilton), the Secretary of State for Scotland said:

"That is rather a different point and perhaps is for those in charge of the National Health Bill."—[OFFICIAL REPORT, 22nd April, 1952; Vol. 499, c. 204.]
That answer surprised us very much indeed, since the same right hon. Gentleman's name is attached to this Bill.

But since he has made that statement and since the Second Reading, during the whole of the long Committee stage of this Bill, not one of the five Scottish Ministers who have a right to sit in this Chamber has said anything at all about these Amendments. Our Scottish Members are wondering whether the Government have decided to accept at least one major Amendment, that standing in the names of six of my hon. Friends—in Clause 4, page 3, line 29, to leave out subsection (3). I hope that whoever replies will give me a specific answer to that question, because we did feel that when two extra Ministers were added to the Scottish Office they would at least let Scotland's voice be heard more often from the Government Front Bench. What we are discovering is that on United Kingdom matters, in spite of the extra Ministers at the Scottish Office, Scotland's voice is being heard less and less.

I want to come to some of the points made by the hon. Member for Enfield, West (Mr. Iain MacLeod). It did not seem to me that he was speaking to this Amendment at all. The whole of his speech seemed to be bent towards proving that what he had said in the past was absolutely correct, because his main argument was that, by opposing this Amendment, we were providing a deterrent to the misuse of dentists. What does he mean by a deterrent? The Amendment which we have moved is asking that any conservative work that costs £1 or less ought to be free. Does he want to deter conservative work? If he does not want to do that, the whole of his speech goes for nothing.

When we had our National Health Service Act on the Statute Book, I felt that one of the finest provisions of that Act was free dental treatment, particularly in relation to conservative treatment. In this matter of the conservation of teeth, there was a really class division inside this country, because it was just impossible for the parents of many people from working-class homes to find the wherewithal to pay for conservative treatment for them and the hon. Member for Wolverhampton, North-East (Mr. Baird), was perfectly correct when he said that in our big industrial areas, at a very young age, our men and women had dentures and not one single tooth of their own in their heads.

It is for those reasons that I, who come from an industrial area, feel that this Bill is going to have very serious repercussions not only on the care of teeth but because, although children or young people under 21 are still going to have it free, at the present time we have a National Service Act under which the young people, either at 18 or at 20 years of age, must go into the Services for two years. These may be young people who are apprentices or who are at universities. It means that all these young men are going to be much older than 21 before they have any chance whatever of earning what will keep them in a reasonable way of life.

These are the young people who, until the age of 21, because of our National Health Service Act, will have learned to go to the dentist regularly and will have taken a pride in the care of their teeth. When they become 21 years of age, still students or apprentices and still earning very little or nothing at all, this vicious Act—because I can describe it in no other terms—is going to make it impossible for them to get the conservative treatment that all reasonably-minded people would wish them to have.

If it were for that reason alone—to take care of these young National Service men—then I would plead with the Minister that this might be one Amendment that he could very easily accept. It is not only that we are afraid of what will happen to the teeth of these young persons; it is not only dental disease of which we are afraid; but many diseases diagnosed by doctors can be traced to the lack of care of teeth in earlier years, so that by this miserable saving in this part of the Bill we are piling up great expenditure to be borne not only by the men or women but by the national Exchequer.

This is a vicious Clause and I would say, for the reasons I have adduced, that it is also a very stupid Clause. I should like to suggest to whoever is to reply that he should give serious consideration to the points made by hon. Members on this side of the Committee. We are making no cheap party points on this Amendment. We are doing our level best to ensure, first of all, that conservative treatment will be continued for young people when they are over 21 years of age, and that the general health of our people will be preserved.

With the concluding sentences of the remarks of the hon. Lady the Member for Lanarkshire, North (Miss Herbison) I am sure we should all agree: that we are not trying to arrive at a party decision over this matter. We are trying to hammer out the solution of what is, admittedly, a very difficult problem. It is the problem of how to make an insufficient supply of dentists—of skilled men—go round where it will be most effective.

The White Paper of the Coalition Government said that there were not enough skilled people to introduce a comprehensive Health Service. It was decided, rightly or wrongly, to introduce a comprehensive Health Service, and great difficulties flowed from that and great tensions, one of the tensions being the falling off of the conservative treatment, especially of the young people, to which the hon. Lady has just referred. We are trying to deal with that in the Clause.

I fully sympathise with the point made by my hon. Friend the Member for Enfield, West (Mr. Iain MacLeod), that if these charges did not have the redistributive effect to which we all look, they would have failed greatly in their object; and I myself would be opposed to them. I can say that with a certain amount of past record, for, after all, the foundation of the whole of this conservative treatment is the health of the schoolchildren's teeth. On that I think every practising nutritionist would say that the ration of milk to the schoolchildren is the foundation stone upon which the whole thing is built. I do not need merely to appeal to opinions here. We have the two Mellanby Reports, which showed that, as we said, the introduction of a ration of milk into the schoolchild's diet was followed by an improvement both in the structure and in the resistance of the teeth.

The danger that we have all seen is the danger of the falling off of the school dental service. It is true that the right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) takes a contrary view. He says that the schoolchildren were being looked after by—were being merged into—the general dental service. [Interruption.] I am doing my best not to make any party point. That is a line which could reasonably be taken. The right hon. Gentleman said that the school dental service—this specialist service—was a poor thing and that it would have been better looked after by the general dental facilities which were open to the whole population.

The sinister thing is that that is not happening. Quite apart from the falling off in the numbers of dentists, to which my hon. Friend referred, we have the most interesting statistics in the Scottish Report and the recovery in the number of dentists. But these, it may be said, are theoretical points; how do we know that a smaller number of dentists meant a diminution in the health of teeth, and how do we know that a larger number of dentists will make an improvement in the teeth? We have not any direct evidence for the second, but we have for the first.

Recent reports—and this is the thing to which the Committee should give attention—have pointed out that in the last two years there is evidence that the previously satisfactory state of the schoolchildren's teeth was going back; that the teeth of the schoolchildren were not as good as they had been. That may be due to, I do not know what—a dozen things. At any rate, there is no doubt that there is an association; that what we thought was likely to happen is happening. Whether it is due to the shortage of dentists and dental treatment, I do not know, but the two things are going in parallel. There has been a falling off in the school dental treatment and, still more, in the school inspections, and there has been a falling off in the health of the teeth.

6.45 p.m.

Those two things make it very necessary to work together to try to change that balance. I fully sympathise with what the hon. Lady said: that one may be penny wise and pound foolish in this: that a penny spent on conservative treatment may save a pound later. But surely, of all places to begin conservative treatment, the teeth of the growing child is the first place.

If we are to believe the official reports which we have seen, that there is a falling off in the dental health of the schoolchildren, we must treat that as a failure at the beginning of our conservative treatment, at the beginning of the very foundation of the whole process, and then make every effort to see what can be done to remedy that before we give attention to the later stages.

It was that which weighed with me very much when I introduced the school milk. I could not see that within any reasonable time we were going to be able to get sufficient dental treatment to deal with the very bad state of the dental health in our industrial centres, of which the worst, I suppose, is Glasgow—the city which the hon. Lady and I know so well and which produced that vigorous figure the hon. Member for Wolverhampton, North-East (Mr. Baird). It is a city where the dental health is, perhaps, worse than in any other.

I certainly thought we had got to begin on the schoolchildren, and we did so. We got the improvement in the Mellanby Report, and the improvement in the second Mellanby Report. That improvement is beginning to be lost now.

I appreciate the point which the right hon. and gallant Gentleman is making, but has he any idea of the number of dental officers who were available at the beginning of 1950, 1951 and 1952, and the whole-time equivalent that they were spending upon school services? If he had those figures, I do not think he would be able to make the argument that he is now presenting. What about England and Wales?

I quote the right hon. Member for Ebbw Vale, who has made repeated speeches in the House saying that he had established, as he thought, a priority for the school dental service, but that the thing had gone the other way and the priority in the school dental service was falling off. It is common knowledge amongst us all that it has been more difficult to get school dentists than it was before. Indeed, during the debates on the education Estimates, most vigorous attacks were made by certain hon. Members from the other side of the House on the ground that certain local authorities were not making provision for school dentistry; and it was found later, on going into the matter—

Notice taken that 40 Members were not present;

Committee counted, and 40 Members being present

There is something rather disgraceful and very disgusting in trying to count the House out on the Health Service, and it shows how much authority we should give to the claims of sympathy which come in such nauseating profusion from certain hon. Members on the other side. It is particularly noticeable that the Member for Wolverhampton, North-East, has not troubled to come to keep the Committee in progress while his own subject, on which he himself had spoken and on which he professes such terrific enthusiasm, was being debated.

I say that hypocrisy has scarcely been more shockingly exhibited than in the action of an hon. Member on the other side of the Committee in calling the count.

I am already on my feet. The hon. Member must give way. I must ask the hon. Member to withdraw that remark about "slimy hypocrisy." I cannot allow it.

Sir Charles, do I take it you are calling on me to withdraw a remark made to you or to somebody else?

That is not the point. I am not going to allow that remark to be made in the Committee, and the hon. Member must withdraw it.

If it is out of order, I will certainly withdraw it; but it was meant to apply to the tactics being employed.

We can leave it, then. It was a comment upon the tactics that are being employed, and we can leave it to HANSARD to show who first employed those tactics. I do not wish to enter upon any acrid discussion with the hon. Member for Central Ayrshire. It may be that, both belonging to a somewhat turbulent race, we became slightly heated in the exchanges.

I would only say that the subject which we are discussing—and I do not wish to go into it at any length—is whether the place at which to begin conservation is not at the growing point of the teeth, and that brings us to the question of the redistribution of the dentists that has taken place. As to that, one need not go further than the statement made by the right hon. Gentleman the Member for Greenock (Mr. McNeil) when he was responsible. He said last year:
"Before the Health Service Act came into operation there were in Great Britain about 50 per cent. more dentists in the dental educational system than there are at present."
The hon. Gentleman the Member for Leicester, North-West (Mr. Janner) interrupted me a moment or two ago. May I have his attention? It is a little difficult to carry on debate when none of the hon. Members opposite is listening. I was referring to the hon. Member for Leicester, North-West, who challenged me.

Yes, well, it slows the Debate a little if one has to interrupt private conversations before we can get the public debate carried on. I was speaking of the question of the school dental officers, and drawing attention to what the right hon. Gentleman for Greenock said when he was responsible for this service only a year ago. He said:

"Before the Health Service Act came into operation there were in Great Britain about 50 per cent. more dentists in the dental educational system than there are at present. There have not been fewer dentists trained in the interval. The drain off has taken place almost exclusively to the National Health Service. We have made cuts—cuts which I think were completely justified and which, of course, arose from impartial examinations; still, we did not fill the gap in that service. Today, we have some 800 in the service. We could quite easily employ twice that number. …"—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 335.]
It seems to me that that is evidence of a very considerable gap, and gives full force to the point I was making—not at all an unreasonable point, and well within the knowledge of the Committee as a whole—that there has been a falling off of the dentists in the school dental service, and that more could be employed there with advantage. We need a reflux towards that service. I do not think that that is an exaggeration or an over-statement of the case. Our official reports show that at the growing point of the teeth, at the point of the health of the teeth of school children, special care must be taken. Unless we can do something about that, we shall not carry out the conservative treatment which we regard as the fundamental objective we are trying to secure.

A debate like this could go on for a considerable time. Nutrition was my original love, and mineral metabolism, and particularly calcium metabolism, was one of the subjects in which I wrote my thesis for my D.Sc., but there is nothing worse than a technician beginning to prate about the details of the technicalities of his subject to a lay audience, and, therefore, I only say that I am not bringing any of these things into the argument, but that I am only bringing forward a general argument, and I say that to proceed on these lines is a good and sound thing, and they are precisely what the right hon. Gentleman has put before us today.

Although I have never been a practising dentist I have spent my professional life dealing with troubles in adjacent regions, and, therefore, I have had occasion to take a considerable interest in the teeth and diseases of the teeth and the adjacent regions. If I understand the arguments from the other side aright, they are something like this, that charges for dental treatment in adults may be an advantage if they succeed in increasing the treatment being given to school children and younger children. I hope that that is not to misinterpret them.

I agree entirely—I think that we shall all agree—that the most important thing is conservative treatment, and that it is most important in the case of children. So far, I think, we are on common ground. But I would not assume—I do not think we ought to assume—that conservative treatment for those over 21 is of no value. I am considerably over 21, and I have a good many of my own teeth left, but that has been achieved only by continuous conservative treatment. Nor must we assume that the use of dentures in place of carious teeth, poisoning the system, is not a great advantage. Medical treatment, and time spent on the care of the teeth of adults, though I agree that it is of less importance than that spent on the care of children, is in no sense wasted.

What I was going to say was, that we are not going to drive many dentists from the treatment of adults to the treatment of children, and for this good reason, that the treatment of children, in medicine or dentistry, needs a special type of mind—a special experience, a special adaptability—which all people have not got. I know dentists who tried to enter the school dental service and who made a complete failure of it because they had not the type of mind required. Therefore, I suggest that we are not going, desirable as it may be, to drive as many dentists as we should like from the general dental service to the school dental service—and if we do, there will, at any rate, be some very evil results to follow.

Just one word about these charges. These charges which will tend, in whatever form they are, to prevent people seeking dental treatment as soon as it would be good for them to do. I do not think, as has been suggested, that many people go to the dentist without need for it. No one ever goes to a dentist without advantage. When teeth are examined it is astonishing how many unsuspected small spots of trouble are found by the dentist. We do not want to keep people from going to dentists if we can avoid it. Especially we ought not to prevent people going to dentists if they have toothache and bad pain, because pain is an indication of dental disease which means that treatment is necessary. What will be the effect of the imposition of charges on those people who have dental pain?

7.0 p.m.

It is suggested in the Bill that they will have to pay £1, but they will think twice about going to the dentist when they can go to their doctor and get treatment for nothing. People with dental pain will be driven by this charge to going to their doctors, who, being kindly people who want to do the best for their patients, will probably try to remove teeth which need not be removed, or could be saved. My experience is that it is disastrous when a doctor tries to remove teeth; a good many break off the teeth, and the condition of the patient is worse than it would otherwise have been. I maintain that any dental charge, at any age, which prevents people going for treatment as soon as they feel they need it is most undesirable.

Almost all that can be said on this subject has, I think, already been said.

I was speaking hopefully.

I wish to draw attention to an aspect of this Clause which we have tended to overlook in the criticisms that have been made, and which it is as well we should not overlook when people for whose opinions we have considerable respect, such as those of the hon. Lady the Member for Lanarkshire, North (Miss Herbison), refer to the whole Bill as a vicious one. It is true that in this Clause we are doing something which is clumsy and crude, but we are doing it in an attempt to remedy a defect in the original National Health Service Act.

It is too easy for hon. Members opposite to forget that the dental service part of the National Health Service scheme was launched on the basis that there were two priority classes, the children and the expectant mothers, who would be specially catered for in respect of their dental needs. As the National Health Service has worked out, it is those priority classes who have been left without adequate dental treatment, and in this amending Bill we are endeavouring, in however clumsy a way, to remedy a defect in the parent Act—the defect that the priority classes have not been getting the priority they were promised.

Having said that, I now wish to draw attention to the Amendment, and to ask hon. Members opposite whether they have appreciated the precise terms they are asking the Committee to endorse. At the moment the provision is for a series of charges with a "ceiling" at £1. If this Amendment is accepted we take out the series entirely, with the result that either £1 is paid or nothing is paid. I do not know whether hon. Gentlemen opposite wish to see that incorporated in the Bill, so that either £1 is paid or nothing.

But that is not what this Amendment would achieve. The effect of accepting the Amendment would be that the charge will be either £1 or nothing; there is no gradation at all; and I am asking hon. Gentlemen opposite whether that is what they want to achieve.

The hon. Gentleman will find on the Order Paper varying proposals—though whether or not they would have been called is another matter—by which various alternative proportions of the total sum above £1 might have been charged.

At the moment we are discussing only this Amendment, by which we are invited to put into the Bill this very curious provision which says, in effect, that if the cost of the treatment is 20s. nothing is paid, but that if the cost is 20s. 6d. £1 is paid. I merely wish to draw the attention of the Committee to that, and again to ask those responsible for the Amendment whether that is the result they want to achieve?

I should like to try to get into focus the position of the school dental service as I know it in Scotland. While the right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot) made an assertion about teeth going bad, he did not indicate whether he was referring to Scotland or to England and Wales. I can only deal adequately with the school dental service and the condition of children's teeth in Scotland.

As one who was a member of a local authority, who was for many years the public health convenor of a large county council, and on the education committee of that county council, I found that, in trying to build up a good school dental service in Scotland in the years prior to the National Health Service Act, we were constantly under the handicap of not being able to recruit the necessary dentists to provide the sort of service we wanted.

The reason for that, in the main, was that, in the outside service—and this was more accentuated once the National Health Service started—there were better conditions, with a far higher salary range. Consequently, long before the Act came into operation, there was a denuding of the school dental service, and the dentists whom we were getting in the school dental service were the tail end of the dental profession, whether we liked it or not. Our school children in Scotland, therefore, were not getting a dental service which provided all the attention it ought to the conserving of their teeth, mainly through the combination of the two circumstances to which I have referred.

The cream of the dental profession was not within the school dental service and it had not the numbers because they were drawn into the general service. I thought, as a father myself, that, after the Health Act came into being, gradually the school dental service would go completely out. I thought that it was a double-tier placed on the general Health Service on the dental side that would become completely obsolete, because the provisions of the Act itself gave every man, women and child in the country the right to all the dental attention that was necessary. While we wanted the transitional period to be easy because people had accustomed themselves to having their children treated within the school dental service, I thought that it would gradually have passed out.

Now we have a statement by the right hon. and gallant Member for Kelvingrove that because there was a denuding of the school dental service, children's teeth have been getting worse. I am not accepting that for Scotland because I am not accepting that slight against our Scottish mothers, that they are not keen enough about their children's teeth to send them to the family dentist. The hon. Gentleman the Member for Enfield, West (Mr. Iain MacLeod), said that he had a family. Do I take it that he was not utilising the service for the conservation of teeth within the Health Service which his children could have had, and that he was solely dependent on the school dental service which had become practically nonexistent?

I am interested in this point. My hon. Friend the Member for Enfield, West (Mr. Iain MacLeod), who is out of the Chamber for a short time, as is inevitable in a long sitting, said that he found as a father that it was easier to get appointments for his children with a practising dentist now, because the practising dentists were not run off their feet making dentures.

My knowledge of my district in Ayrshire is that this has not been so. We have found the family dentists extremely considerate, and they give all the attention necessary to the children. I am thinking of children in my own particular street, and I know that numbers of parents are going to their family dentists and making appointments four times a year for their children to have their teeth examined, and that is going on constantly. If this new service is part of the Health Service, surely all that we need in the schools is to see that proper examinations take place and that the children are then directed to the family dentists.

I am not accepting that in Scotland people in the majority are neglectful of their children's teeth. I say that all that is necessary is that there should be some sort of dental examination in the schools, and that if conservation is necessary, the children should get it from their family dentists.

Will the hon. Gentleman carry on the argument with the right hon. Member for Greenock (Mr. McNeil), who said that a year ago we had 800 dentists and he would like to have double that number?

In the school dental service? There are only 90 in the whole of Scotland.

I am quoting the right hon. Member for Greenock. I have chapter and verse for it. Everyone knows these figures. They were quoted at length by my hon. Friend the Member for Enfield, West.

There are 899 school dental officers in the country today. The figures have risen by 40 since the charges were imposed. The hon. Member for Enfield, West, said that we want between 2,000 and 3,000 dentists for an efficient school dental service.

The right hon. and gallant Member for Kelvingrove has put in a lot of little speeches today, and I hope that he will allow me to continue.

Does not the hon. Gentleman really imagine that if we had only inspections in schools, we would have a very inferior type of dentist who would do nothing else but inspect teeth in schools?

7.15 p.m.

My case is that the Act is giving full cover to everybody, if they go for it. I am not prepared to accept that parents in Scotland, and, I believe, throughout Britain, can be placed in the category of not wanting to do the best for their children so far as dental treatment is concerned. If there were any parents of the type suggested by hon. Gentlemen opposite, we should have the protective service of examinations in the schools to find this out. I feel that it is an extravagance that we should have this whole dental service built up. Most parents are delighted with the attention which is given to their children's teeth, since the Act came in, by their own family dentists. I do not think that we should try to denigrate the value of the Health Act in relation to dental health.

The hon. Member for Enfield, West, is willing to hang arguments on to anything he can in order to try and scrimp money at the expense of conservation of teeth or anything else. He is against this Amendment which would allow of the conservation of our young people's teeth over school age up to £1. If he has his way, we shall not have this conservation unless there is payment, so it is not our young folk's teeth that he is concerned about; it is what he can get by this deterrent in a monetary way.

I very nearly not into trouble through talking about hypocrisy, but I am prepared to say that there is a great deal of hypocrisy in the arguments coming from the other side. I am not prepared to say that this is a slimy hypocrisy because that is the easier type—this is rough-hewn hypocrisy. I hope that we shall have less of this type of thing from hon. Gentle- men opposite and a realisation that we ought to conserve people's teeth in the best way we can. I think that we can do that by strengthening the Health Act and by not mutilating and destroying it, as the present Bill is doing.

During most of his speech the hon. Member for Ayrshire, Central (Mr. Manuel) has developed a very interesting case for the euthanasia of the school dental service—for its reduction merely to an examination system. I do not propose to go into that interesting speculation, because it is not a point of view which is shared by the great majority of his hon. and right hon. Friends or by my hon. Friends. I see that he agrees with that.

I will begin by considering rather narrowly what I apprehend to be the effect of the Amendment if it were inserted in the Bill together with the consequential Amendments which appear later on the Order Paper. Although my hon. Friend the Member for Putney (Mr. Linstead) perhaps exaggerated the evil effects by taking the Amendment in isolation, nevertheless I believe his argument was substantially sound.

The result would be to substitute for charges which rise to a maximum of £1 and then cease to rise altogether, a charge which starts to be imposed when the work costs £1 and thereafter mounts pro rata. The effect of that would coincide with some of the effects about which the hon. Member for Barking (Mr. Hastings) was fearful—poor patients and their dentists deliberately undertaking the less effective and often less conservative type of work in order to avoid a charge. I hope hon. Members will consider that aspect before they press the Amendment.

Throughout the arguments for the Amendment emphasis has been upon conservative work, as though all dental work which costs only £1 was automatically conservative work. But dental work which costs up to £1 might just as well be devoted to extraction as to conservation. The effect of the Amendment is not to put a premium upon conservative work; it is to destroy the financial basis of the Clause. The financial effect alone would necessitate its rejection by my right hon. Friend.

The Opposition will then no doubt say, "We are back again in the old dilemma. On which leg are you standing? Are you saying that the Clause ought to be in the Bill because it represents a saving of so many million pounds, or are you saying that it ought to be in the Bill because it produces this or that valuable effect within the Health Service?" I repeat that this is an entirely false dilemma. There is no contradiction at all between a Measure which results in a financial saving and a Measure which also produces an effect which is desirable in itself.

I shall pray in aid of that contention evidence of hon. Members opposite which bears very closely upon the Amendment. The late Minister of Health during the Committee stage of last year's Measure said, when dealing with the insertion of a time limit:
"The purpose is to make savings in these parts of the National Health Service—the provision of dentures and spectacles—to meet the rising expenditure on more important parts of the Service, such as hospitals."
That is a very rational and sound financial argument. One must save money in one place in order to use it in another. But the right hon. Gentleman did not thereby debar himself from justifying his Measure by the positive effect which it would produce within the dental service. He elaborated some of the questions which he would be asking himself after a year or two's operation of last year's Act. He said:
"… how far have the charges—after this period has elapsed—been beneficial in improving the service for children?"
That shows that when the right hon. Gentleman last year imposed charges on dentures he had as his acknowledged object the improvement of the school dental service. I recommend that observation to the hon. Member for Barking who, as many others have done, argued that there was no natural connection between the manning up of the general dental service and the manning up of the school dental service. One of the questions which the right hon. Gentleman was going to ask himself when he came to review his Act was whether there had
"… been any improvement in the numbers of school dentists."—[OFFICIAL REPORT, 2nd May, 1951; Vol. 487, c. 1311–2.]
He must have been gratified by the evidence produced this afternoon of the success which he has already achieved through last year's Act.

What the hon. Gentleman always forgets is that, at the same time as his right hon. Friend says that he wants in this way to increase the number of school dentists, he and the Government make sure by financial measures that not enough funds are available at the Ministry of Education to provide the jobs.

I am sure the hon. Member knows that there has been a substantial increase in the Education Vote under the head of the school dental service. Figures have been given to show—

I am going to finish this part of my argument. It is generally acknowledged that during the last two years the numbers of school dentists have again begun to show a rise. They have risen over the country as a whole from a figure in the 700's to a figure in the 800's. We have additional financial provision in the Education Estimates for this year for the school dental service. We are thus applying the finance which we are in part obtaining from this source to the improvement of the school dental service.

If the hon. Member who is speaking will not give way other hon. Members must resume their seats.

This point, which I believe to be of crucial importance, namely, that the financial effects of a Measure and its practical ameliorative effects hang together and are not contradictory, really goes back to the father of all these changes in the Health Service, the Leader of the Opposition himself. When he announced the first of these charges on 24th October, 1949, he said:

"We propose to make a charge … The purpose is to reduce excessive and, in some cases, unnecessary resort to doctors and chemists. …"
That was the ameliorative effect. He went on to say:
"The resultant saving will contribute about £10 million, although this is not the primary purpose of the charge."—[OFFICIAL REPORT, 24th October, 1949; Vol. 468, c. 1019.]
So the Leader of the Opposition recognises that we can have a Measure that is devoted at one and the same time to a financial purpose and to a practical purpose.

I pass finally to the immediate question of the school dental service within the National Health Service as a whole. I want to focus the attention of the Committee upon a very remarkable statement—it has already been quoted, but I do not think it has yet been fully explained—by the right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) on the Second Reading of the National Health Service Act in 1946. On the 1946 Act, which in this respect was unamended, he used the following words:
"We have not enough dentists and it will therefore be neccessary 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."—[OFFICIAL REPORT, 30th April, 1946; Vol. 422, c. 45.]
The right hon. Gentleman there forecast exactly the form of the National Health Service Act as amended by this Bill, because after the passage of this Bill that service for the first time gives dental priority to expectant and nursing mothers, children—school children in particular—and adolescents. The ambition which the right hon. Gentleman the Member for Ebbw Vale laid claim to back in April, 1946, is now to be fulfilled by my right hon. Friend.

7.30 p.m.

It may strike hon. Members opposite, as it strikes me, that it is most remarkable that those words should have been used by the Minister in introducing a Bill which gave no priority whatsoever, but which threw free dental treatment open to the population. I was, therefore, hopeful when my hon. Friend the Member for Enfield, West (Mr. Iain MacLeod), invited the right hon. Gentleman for Ebbw Vale to explain how that priority had been secured in the 1946 Act. The reply was this:
"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."—[OFFICIAL REPORT, 27th March, 1952; Vol. 498; c. 897.]
This is a new conception of priority. Priority was given to school children, nursing mothers and adolescents by leaving them at the end of the queue and dealing with everybody else in front of them.

I must ask the hon. Member for Wolverhampton, North-East (Mr. Baird), to resume his seat for—

When everyone else in front of them in the queue was dealt with, then at last priority was secured for the priority classes.

If that is what was meant by the words which I have quoted from the Second Reading speech of 1946, it is a most extraordinary description for throwing open the dental service to the whole population, to "work off the hump."

I am going to offer to the Committee—because this is a very important and puzzling matter—the only explanation I can think of as to how these words came into the right hon. Gentleman's Second Reading speech. They applied to a Bill which he found in the pigeon-holes of the Ministry of Health when he came into office in 1945 which would, in fact, have assured priority to those people by waiting until they were served before throwing the service open to the general public. That was the intention of the Coalition Government. He found that Bill and the Second Reading speech in draft. This paragraph, but not the accompanying provisions of the Bill, were taken over in extenso into his Second Reading speech. I offer that solution to hon. Gentlemen opposite for their personal and private study in the coming weeks along with the necessary documents.

We claim that by the provisions of this Clause my right hon. Friend for the first time is securing to these priority classes the priority to which everyone gives lip service. That is because that priority will be destroyed if this Amendment and the consequential Amendments are accepted that they must be rejected by the Committee.

I am not. It is the Amendment of the hon. Gentleman's party and it is not for me to withdraw it. I am not closing the debate. We have had an interesting debate and a fairly wide one, a good deal wider than I anticipated.

I am not speaking to you. I did not mean any disrespect to you, Sir Charles, but I expect some respect from those who sit on the other side of the Committee, and I am alluding to hon. Gentlemen there.

If the right hon. Gentleman could see what goes on behind him, he could keep control.

I was saying we have had a very interesting and rather wider debate than I had anticipated, but the speech which has just been made by my hon. Friend the Member for Wolverhampton, South-West (Mr. Powell), has brought us back to what is of real significance in the subject which we are discussing, and that is the means of getting the priorities right. He has pointed out that this Clause, when eventually passed with the Amendment which I hope we will adopt later, should give priority to mothers, schoolchildren and adolescents. I am grateful to my hon. Friend for what he said about the drafting of the Bill, and I shall be very happy, as a result of this Bill, to see that come about.

Let us for one moment consider what is being done here. If the fees are under £1—and that is apart from the clinical examination because of our previous Amendment which is now incorporated in the Bill—the whole cost will be payable. If the amount is 15s., 17s. 6d. or whatever it may be for the course of treatment, it will have to be paid for by the patient, but if it is over £1 payment is limited to £1. The cost under the 1951 Act and under this Bill combined cannot exceed £4 5s.

The argument which this Amendment raises is whether that is the right way round to do it. If the fee is under £1, should the whole cost be payable by the patient or should the treatment be free up to £1 and then the patient pay all above it? That is the argument between us, but we must not overlook the fact that we are concerned here, quite apart from the important aspect of the priority classes, the conservative work and the purely dental side, to assist—I am sorry to say this again because I know how it irritates hon. Members opposite—in the recovery of our financial and economic situation. [HON. MEMBERS: "Ah!"] I knew that would set hon. Gentlemen off, but we must not lose sight of the fact that that is one of the elements of the argument we are presenting to the Committee. It is quite certain that if the Amendment proposed by the right hon. Gentleman were adopted, it might well mean the loss of the greater part of the estimated saving under this Bill.

I do not want to delay the Committee and there are several others who want to speak.

It is a fact that if the Amendment were adopted, the greater part of the estimated savings—and they are considerable, for they are estimated at £6 million during a full year—would be lost, and it is one of the objects of this Bill to secure those savings. In point of fact, the amount charged would, if the Amendment were adopted, largely be for the expensive crowns and inlays. If the first £1 is free, there would be a strong inducement to patients to have only part of the necessary treatment done.

Only part of it. Patients would tend, human nature being what it is—I am not blaming anyone—to have treatment costing up to £1 and then they would stop. They would go again another time and have treatment up to nearly £1 and then stop. They would have a whole series of treatments free, each one after some interval of time, and each aggregating less than £1. It has surely always been the object of dentistry to persuade patients to make themselves fit dentally, but the cost of a whole series of partial treatments would largely be wasted and would not serve the purpose that those who go to dentists should have their teeth properly looked after.

I cannot follow at all the argument of the right hon. Gentleman. Is he suggesting that people should have dental treatment and pay for it, or that there are not enough dentists to give that treatment because they have to look after the younger people? I do not see the point of his argument.

I am sorry, but I am trying to deal with the Amendment of the right hon. Gentleman opposite to the effect that the first £1 should be free. I am saying, in reply, that there would be a strong inducement for people continuously to try to have treatment which did not exceed £1 every time they went for it. [Interruption.] I wish the hon. Member for Leicester, North-West, (Mr. Janner), would not keep interrupting. I am replying to the argument of his right hon. Friend by saying that there would be an inducement to people to continue to have short courses of treatment and never a complete course.

There is an Amendment in my name subsequently, suggesting that over £1 the proportion of one-tenth should be levied on the patient.

I really cannot get myself out of order and lead the Committee astray beyond the argument which the right hon. Gentleman opposite put before us. I think it might be assumed that the cost of a series of partial treatments would largely be wasteful expenditure. To keep on going to the dentist and not getting the whole thing done at the time when it ought to be done would be wrong. By our suggestion that anything over £1 should be free we would get a situation that once that expenditure had been passed, there would be no deterrent on, or disincentive to, the person whose teeth ought to be attended to from going on and having them properly looked after. I quite agree that it is a matter of argument as to which course might in the long run end in the better conservation of teeth, but I think our way would do it better.

7.45 p.m.

That is not the only consideration that I have in mind. We are attempting to deal with the financial situation as well. The Amendment would take away a great amount of what might be collected by this system.

Do I understand the Minister to say that it is the financial situation which dictates policy and not the question of proper treatment for patients?

It is a combination of factors which come into this matter, but by arranging the charges as we propose, we hope to achieve the priorities which the right hon. Member for Ebbw Vale (Mr. Bevan) referred to long ago and which have been mentioned by my hon. Friend. That is the issue between us. If it is true that some form of charge would act as an incentive for a better dental service, as the figures about the Scottish situation may or may not show—[Interruption.] They certainly show an increase in the school dental service.

Yes, certainly. The charges may or may not be a factor, but we have to build up after we have destroyed. We cannot destroy and then build up, except gradually. If, therefore, charges do turn out, when all these figures and other considerations have been taken into account, to have the effect of improving the school dental service, as they may well have—I am not saying it conclusively because there are many unknown factors in the situation, but it looks as if it might be the case—and if we still want to benefit the priority classes and provide incentives which are directed to conserving the teeth of young children, which we all agree ought to be the highest priority of all; and if, as the right hon. Gentleman opposite says, his Amendment brings about greater incentives—those were his words—for older people, then the Amendment fails in its objective. By means of his Amendment the right hon. Gentleman would produce far smaller charges and pro tanto as charges help to bring about a better and larger school dental service, as in the Scottish case may be true, it seems to me to be an argument against the right hon. Gentleman's Amendment.

I am sure that the right hon. Gentleman would not want to mislead the Committee. The position is that since the charges for dental work were imposed, the number of school dentists has risen over the past year by 40. They now stand at under 900. In order to get an efficient school dental service we have been told that we need between 2,000 and 3,000 dentists. How long have we to wait? There is no proof that by the method proposed by the Government we shall get that establishment.

Of course, there is no proof, but as my hon. Friend has just said, we are moving up instead of moving down. Never mind whether the change is by an amount of 20, 30 or 40. If it is a change in the right direction, we should encourage it. The position was getting worse, but it is now getting better, and we want to see it get better still. I really cannot take the right hon. Gentleman's evidence as completely conclusive. It was he who said just now that dental health in our schools was better ever since the Health Service started, but that is completely contradicted by others who have spoken. In the last two years the teeth of school children have got worse owing to the priorities having gone wrong. We want to see them get better. Of course all these things are not capable of proof for years to come. We can only observe tendencies today, but the tendencies are in the direction I have indicated.

I recommend the Committee not to accept the Amendment. Frankly, I do not think it would have the effect which any of us want to bring about, excepting, of course, that it would enable a far larger number of adults to continue to get free treatment. That in itself may or may not be a good thing, but there is no incentive in it towards a priority system. The right hon. Gentleman the Member for Ebbw Vale said he wanted to get his priorities right, and I think we all do. We feel on the whole that the suggestions we have made in this Clause should have that effect. As I say, that is not capable of proof now, but it is a move in the right direction. Because I do not feel that the Amendment is a move in the right direction, having to recommend a choice one way or the other, I ask the Committee to accept our solution.

Before the Minister sits down, will he give me a reply to my question? We do not yet know whether this Bill is to apply to Scotland. We have doubts if it is to apply, because I am certain that the Joint Under-Secretary of State for Scotland, who has attended most of these debates, could have dealt with some of the Amendments much better than the Ministers who have dealt with them. Could we have an answer to that question?

I am not satisfied with that. I have adduced reasons why it seems to this side of the Committee that the Amendment we have down should be accepted, with the result that Scotland will be excluded. Is that Amendment to be accepted or is it not?

I have listened with great amusement to Members in various parts of the Committee, especially to the hon. Member for Enfield, West (Mr. Iain MacLeod), whose volubility was great but whose knowledge of the subject on which he was speaking was very small. I do not profess to be a dentist, neither do I profess to be a doctor, but I have some knowledge of the working of the Insurance Acts from 1912 to 1948, having administered them nationally. We have had quotations today from books. I shall give quotations from life dealing with those who came to get treatment. Older hon. Members will remember—not younger Members, because they do not know anything, even today—the "ninepence for fourpence" when the Lloyd George Act was first introduced. That is going back a long time. When we consider the great benefits derived, not only by those who were compulsory contributors but also by those who were voluntary contributors, we find that the nation was much better for the treatment.

The right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot) seems, like myself, to be getting the worse for wear. If he would only reason as he did in his younger days, it would be much better for the Committee. I admit we are both getting past the mark, but we ought to be able to speak a little common sense to younger Members. Therefore, I hope I may be able to refresh his memory. The Act of the Liberal Party of that day was meant to benefit the whole nation—

It is no good the hon. Member for Wolverhampton, South-West (Mr. Powell), wagging his head. He has been doing nothing else all day.

No, I have sat here for four hours and I want to have my say. The hon. Member has had enough to say. That Act was passed to give benefits to the people through a health service, and I know the great benefit which it provided in the great industrial area of Liverpool. Our infirmaries, our hospitals, our surgeries were packed with people day and night wanting medical treatment simply because the dental service they had been receiving was either inadequate or non-existent.

How many people in poor areas ever had treatment for teeth? I know that children in decent homes were taught to use the tooth brush, but in the homes of the poor they did not know what a tooth brush meant. They were more likely to use a sweeping brush to clean their teeth. But, as they were gradually educated, we found a better standard of health amongst the children in those areas. Instead of hon. Members quoting from journals and books, let them admit that the general health of our people is better than ever before.

It is a hard admission to make, but I admit that the Minister of Health knows his subject. I wish he did not. He knows what it is he is dealing with. When I put a question to the right hon. Gentleman, he replied, "Finance." Is not that what we are discussing? Is the system being abused? When I intervened I was asked whether I meant they should get a free service. There was no ambiguity in my reply, which was, "Yes, a free dental service for all who require it, because it is absolutely essential for the welfare of the people." I know that there is a difference of opinion in the Committee. Hon. Members talk about "conservation" and "priorities." It would be better to use words that the man and woman in the street can understand? Would it not be better to say, "We are giving no more pounds to the poor. If they want their teeth, let them pay for them. If they want attention, let them pay for it. We have paid enough and we will not give them any more."

That would be an honest statement of fact. I say to hon. Members of the party opposite that I do not classify them as knowing nothing. They do know. They are trained in business. I wish our people knew how to take care of things as well as they do.

8.0 p.m.

I want our people, when they work and toil—in the field, in the factory, in the mines or in the ships—also to get the benefits of the wealth which they create: and if they are not able to pay, I want the State to pay for the things that are absolutely essential for the life of the man, woman and child. Therefore, it is a fair proposition to say that if a home which has a low income and which has children growing up, can find children for the Army or for the Navy, for the defence of our land—I am not against having an army; but I want men and women to be healthy in order to be able to defend all that we hold sacred—attention should be paid to those who require our assistance in order to make them healthy.

I say this not for propaganda for the Labour Party, but from the viewpoint of investment. If parents, whether they be Tory or Labour, who have children are unable to pay for the care of them, the State should pay. I know that the plane of thought on the other side of the Committee is different. Those with wealth do not know what it means to those who are badly handicapped in life to have to part with a pound or two. The children of those who support the party opposite mean as much to the nation as do those of us on this side, and therefore my remarks apply to all, and not merely to one section of society.

From 35 years' experience I say that our best investment is to meet these incidental expenses. Members opposite say that we cannot afford the expense and that the charges are extravagant, but, surely, they have the power to regulate prices, as they have done with optical and dental treatment and dentures.

I am sorry that the Minister has stated that he cannot accept the Amendment. It is designed to meet a want which will be felt very greatly in thousands of homes, and especially by those in receipt of small wages. The outlay of £1 by homes whose income is only £5 or £6 a week will be a very heavy burden. The poor are found not only amongst the Tories, but with the Labour Party, and every parent will be anxious to know whether they are to be hit by this extra expense.

We on this side advocate that if the cost of treatment is up to £1, there should be no charge. That is simple enough, and that is the service I want to see. The nation would benefit as a result, and I trust that the Minister will accept our proposal, even though I have been, perhaps, a little vociferous and vehement, because I am earnest in what I say and I have seen these things and know what this added expense means to those who are poor. I know the difference between people who are happy and contented and those who are downcast. If the Minister wants a healthy nation, he would be well advised to accept the Amendment.

I wish to correct an injustice which I unwittingly did to the right hon. Member for Greenock (Mr. McNeil), whose speech at Greenock in April of last year I quoted. When I quoted it first, I did so correctly in saying:

"there were in Great Britain about 50 per cent. more dentists in the dental educational system than there are at present."
Afterwards, in an interchange, I gave the figure, which the right hon. Gentleman had quoted, of 800 as applying to Scotland. The first time I quoted the right hon. Gentleman, I did so correctly as applying to Great Britain. In my second quotation I did him an injustice, which I wish to correct.

We ought to direct our attention to the remarks that have been made by the Minister. I gathered that he was deeply concerned about the health of these children. He was also very deeply concerned about the financial gain that he would obtain from the Clause, and I am not altogether sure whether his concern was balanced more on the side of saving the money than on the side of saving the children's teeth.

If I were asked to explain the purpose of the Bill, I should answer that it was not to save the health of the people. It is to save a considerable sum of money at the expense of the health of the people. If the Minister wants to save the dental health of the country, why cannot he spend this money to provide more facilities for educating dentists and for giving more opportunity for training in the dental schools? He would then have available a larger number of dentists to deal with the children about whom he says be is so concerned, and he would not neglect those about whom we are concerned, including the children.

No one will be misled by the specious arguments that have been used by Members on the other side of the Committee to cover their tracks in this matter. They are out to reduce the amount that should be available for the benefit of the health of the people, and they are out to use for their purposes certain sums of money which would otherwise be available for benefiting the people's health. They are trying to find ways and means by which they can cover their tracks, so that they will be able to argue that they are not reducing the benefits to the people, but that by taking away from them these vast sums of money they are creating priorities in the Health Services which are of such importance that they are of an overwhelming nature.

That will not do, and for many reasons. First, the statements of hon. Members opposite with regard to the numbers of the increase of dental surgeons who are available for children is not correct. Here I come to the argument of the right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot)—the right hon. and gallant Gentleman, but "friend" I should prefer to call him—who has gone entirely wrong in this matter. I should like to give him the figures about which I made an intervention when he gave way.

Early in January, 1951, the number of dental officers available in the school dental service was 856; in January, 1952, it was 899, but that is not the end of the story. The whole-time equivalents were 690.22 as against 712, which is a difference of only 22, and the whole of the Government's argument has been based upon that increase of 22 dental surgeons who are available for that particular service. Why has not the right hon. Gentleman told us that there is a Bill about to be introduced into this House—I do not know what its success will be—to increase the number of people available to deal with the country's dental service?

Why does he not tell us that there are still dentists with very high qualifications whose services were utilised during the war, but who, because they happen to have foreign qualifications, are not allowed today to take part in either the school dental service or any other? Why does he tell us about these 22 people, about whom he is so concerned, when, if he utilised the services of these qualified practitioners of very many years' experience, who were used in our hospitals and elsewhere during the war and who are still available today, he would gain as many, or possibly even more, in numbers than he is going to do by this method?

What is very unhappy is the fact that a large number of people who are going to be affected adversely by this Clause, ought to have treatment which they will not be able to afford. We have not had a single concession from the Government yet in this Bill with regard to the variety of people in different positions in life who ought to be looked after and who ought to receive the fullest facilities for obtaining dental treatment free. Let me quote just one set of people concerning whom I had hoped earlier to be able to move an Amendment, and who do come within the scope of this charge which is now to be made. I am talking about those people who, by the unanimous decision of the House of Commons in 1944, were considered, and ever since have been considered, as very deserving cases.

When the Disabled Persons (Employment) Act, 1944, was being enacted by this House, there was unanimous approval that it was a Measure of tremendous value in order to improve the conditions of men and women who had been disabled and who came within the definition of "disabled person "in that Act—
"… a person who, on account of injury, disease or congenital deformity, is substantially handicapped in obtaining or keeping employment, or in undertaking work on his own account, of a kind which apart from that injury, disease or deformity would be suited to his age, experience and qualifications; and the expression 'disablement,' in relation to any person, shall be construed accordingly."
These persons are now going to be asked, in the same way as everybody else, to pay the first pound for the dental service. It is taking money out of one pocket and putting it into another, because, in addition to the fact that they would be called upon to pay, what the Minister overlooks is that they would have to appeal to another quarter to receive the money with which to pay.

8.15 p.m.

I have only one other point to make. Does not the Minister realise that, by means of the suggestions which I have made, and other suggestions which might emanate from his own fertile mind, the £6 million saving could be used to the advantage of the dental service of this country in a way which would bring not only health, but a considerable amount of happiness, to the whole of the community. Why is he attempting to deprive people of it?

He tells us that he is going to send people for clinical observation to the dentists free of charge and that he wants to encourage them to keep their teeth healthy, but what on earth is the use of him sending people to dentists to be examined free of charge if he will not give them the facilities for being treated afterwards? The right hon. Gentleman is sending the people to be examined, and I assume he expects them to be treated if they need treatment. If they are treated, the services of dental surgeons will be used, and, therefore, the services of those dental surgeons to this extent will not be available to the children. If they are available for the children, they will not be available for the other persons.

Why cannot he give the people the opportunity of being examined free and facilities for free treatment? He cannot have it both ways. If he wants people to be treated, and he is inviting them to be examined free, he must give them the chance of being treated. If he gives them the chance of being treated, he must use the services of dental surgeons, whether the patients pay or they do not pay, and, if he employs dental surgeons for this purpose he cannot employ the same surgeons for the children, at the same time.

I put that to him, and I ask him to think again, in order to give the people of this country the opportunity of continuing to receive the treatment they require, without cutting down the educational system or reducing the opportunities for students, and I am sure that he will get a dental service capable of doing what is necessary in the country, instead of robbing the people of important services as he now proposes to do.

After listening to the speech of the hon. Member for Leicester, North-West (Mr. Janner), one feels that, after almost years in which this question of the finances of the National Health Service has been debated, both in health debates, Budget debates and Finance Bill debates, there seems to be almost no limit to the capacity of hon. Members opposite to listen to the facts without absorbing any of them at all.

It seems altogether incredible that the hon. Member for Leicester, North-West, still believes that what my right hon. Friend is seeking to do in this Bill is simply to take this money from patients in order, apparently, to devote it to something outside the Health Service altogether. If the hon. Gentleman has understood what the last two Labour Chancellors of the Exchequer and his right hon. Friend the Member for Middlesbrough, East (Mr. Marquand), have been saying in the last Parliament, he should by now have got it into his head that the purpose of the financial policy of the late Government—and of this Government—is to maintain the ceiling on the Health Service Expenditure at the figure at which it was fixed by the late Sir Stafford Cripps.

Since expenses in every branch of the service have been and still are steadily rising, if charges are not imposed in some directions in the service, then it will inevitably follow that the services provided will have to be reduced in other branches of the National Health Service. It is no good the hon. Member for Leicester, North-West, talking about the £6 million which could be used profitably in the dental service. He has got to show how, if this Amendment was carried, he would find the £6 million within the ceiling of the Health Service. Neither he nor any one of his hon. and right hon. Friends has told the Committee whether they would reduce the provisions of the hospital service.

May I interrupt the hon. Gentleman? If he will read my speech in the debate on the Bill, he will find that I suggested ways by which that money could be saved.

I remember the hon. Gentleman's speech, and I withdraw that remark in his case. But, of course, the hon. Member for Leicester, North-West, has no such alibi. It is perfectly obvious from his speech that he has not listened to any of the arguments used, and he has entirely misconceived the purpose of the Bill. The hon. Member for Liverpool, Scotland (Mr. Logan), to whom we always listen with great interest and respect because of his obvious sincerity, has failed to grasp the points at issue. He referred to the 1911 Act and stated quite erroneously that it applied to the whole population. He got on by easy stages to the 1948 Act and, as I understood him, suggested that a means test should be imposed upon anybody who could not afford to pay for the health services.

In addition, the hon. Member said that it was desirable that the Health Service should be entirely free—a slightly inconsistent statement. But he still did not explain how he voted in favour of the charges on dentures and spectacles in the 1951 Bill. It surely should be obvious to him and to the hon. Member for Leicester, North-West that the action taken by the Government and by them in the course of debates and Divisions on the 1951 Bill make it entirely nonsensical for them to give us their tales of suffering tonight.

They must realise the purpose of this Bill. They must realise, as my hon. Friend the Member for Wolverhampton, South-West (Mr. Powell) and my hon. Friend the Member for Enfield, West (Mr. Iain MacLeod) have repeatedly stated, that it is perfectly possible for a financial provision of this kind to be consistent with, and indeed directed towards, improving a part of this Service. That is the point of this Bill, and if this Amendment were carried it would make complete nonsense of this Clause.

The speech of the hon. Member for Ealing, South (Mr. Maude) was probably the first we have heard from the other side of the House which had in it the authentic voice of Toryism, because there was in it none of the delightful and pleasant irrelevances about boosting up the school dental service and there was nothing about getting the priorities right.

The hon. Member says it is simply a matter of raising money and saving money here in order to apply it to elsewhere.

I took down precisely the words the hon. Member used, but he must have forgotten them or could not have been paying attention to what he was saying. He said that the purpose of the Bill was to save money on the Health Service in order to spend it elsewhere.