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Ministry Of Health

Volume 640: debated on Monday 15 May 1961

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Death Certificates

29.

asked the Minister of Health whether he will introduce legislation to make it compulsory for doctors to see the body of a patient after death, before issuing a death certificate.

I am not satisfied that sufficient grounds for legislation exist, but shall be glad to consider with my right hon. Friend the Home Secretary any information bearing on this matter which my hon. Friend may wish to bring forward.

While thanking my right hon. Friend for that reply, may I ask whether he is aware that at least one body out of four which is buried in this country is not inspected by a medical practitioner? Is this not an unfair burden, particularly in view of our ageing population, to place on the survivor of two elderly persons the responsibility for informing a medical practitioner that death has occurred? Surely this anomaly in the law should be eradicated. There should be no hardship on medical practitioners throughout the country inspecting bodies before a death certificate is issued.

In the great majority of the 25 per cent. of cases which my hon. Friend mentioned, death takes place in a hospital. A change in legislation here would be a substantial addition to the duties imposed on doctors, and my right hon. Friend and I am not satisfied on the present information available that this would be justified.

Poliomyelitis

31.

asked the Minister of Health what percentage of the population of the United Kingdom has now been inoculated against poliomyelitis since the introduction of the vaccine.

Is it not regrettable that such a large number of mature adults should willingly run the risk of contracting paralytic poliomyelitis when preventive medicine is available at no cost and at very little personal inconvenience? Is my right hon. Friend satisfied that the publicity on the effectiveness of this vaccine is wholly adequate?

Of course, it is the priority classes for whom immunisation is particularly important, and there the proportions are much better. For example, of those up to 18 years of age nearly 80 per cent. have obtained immunity. I would certainly not overlook any opportunity of stressing the importance to those at risk of obtaining immunity if they have not already got it.

Will the right hon. Gentleman confirm that the overwhelming majority of those persons who contract poliomyelitis are those who have not been inoculated?

Can the right hon. Gentleman say what proportion of the total population is at present eligible for immunisation?

41.

asked the Minister of Health what information he has received from the United States of America and the Union of Soviet Socialist Republics concerning the value of oral vaccine against poliomyelitis.

I understand that oral vaccine has only been used experimentally in the United States of America but has been widely used in the Union of Soviet Socialist Republics. All information available about experience in these countries was taken into consideration by the Joint Committee on Poliomyelitis Vaccine in its recent advice to me.

Is it not a fact that the Sabin vaccine used in the United States has been administered in hundreds of thousands of cases and has given complete immunity, and that in the Soviet Union a Sabin-type vaccine has been used in millions of cases and has given complete immunity? Will he not make a special study of this vaccine, for which it is claimed at any rate that a single oral dose will give complete immunity?

The Joint Committee to which I referred has this in mind, of course, and is studying it. It will, no doubt, advise me further, but its present advice to me, by which I must be guided, is that the vaccination programme should continue to be based on the killed vaccine.

42.

asked the Minister of Health what loss would accrue to his Department if oral vaccine against poliomyelitis were used in substitution for the existing methods of vaccination.

My present advice is that oral vaccine is not a substitute for the existing methods.

Will the right hon. Gentleman define more closely what he meant by "immunisation" in reply to a Question from the hon. Member for Acton (Mr. Holland)? Is it not a fact that it is now considered that four inoculations have to be given before immunisation is complete? In the circumstances, will not he give very urgent attention to the question of substituting the oral vaccine which, it is claimed at any rate, gives complete protection after a single dose? Further will he give an absolute assurance that commercial considerations of any kind will not be permitted to stand in the way of the introduction of the oral vaccine if it can be established that the oral vaccine gives speedier and better protection?

The answer to the last part of the hon. Gentleman's question is an unqualified "Yes". He referred to "immunisation" as I had used the word in a former reply. His right hon. Friend the Member for West Bromwich (Mr. Dugdale) pointed out that the vast majority of cases of polio occur where there has not been vacination by the existing methods. My present advice, by which I must be guided, is that those existing methods are the best available for securing the highest possible personal immunity.

Prescription Charges

34.

asked the Minister of Health what reply he has sent to the resolution on prescription charges unanimously adopted by the Health Executive Council for Southampton on 21st March, 1961, which has been sent to him.

Is the Minister aware that this executive council, which comprises voluntary and professional workers of all political parties experienced in and devoted to the Health Service, has expressed its alarm at the damage which might be done to the Health Service by the new prescription charges? Is he aware that the bulk of the voluntary and professional workers in the great Health Service which he leads will welcome the day when he sees the light and brings the Health Service back into the state in which it was?

I am to see a deputation from the Executive Councils' Association later this week. I shall, of course, direct my mind to anything that it has to say to me.

How many communications has the Minister had from executive councils in Great Britain protesting against these prescription charges?

I cannot say without notice, but I have no doubt that what the Executive Councils' Association has to say to me later this week will be broadly in line with those communications.

40.

asked the Minister of Health whether he is aware that, since the increase in prescription charges, an increasing number of people are unable to afford prescribed items from chemists immediately; and what information he has received from chemists dispensing under the National Health Service as to the extent of this delay between presentation of prescriptions and the collection of medicines.

Is the Minister aware that in certain areas this is causing grave concern and also is causing a great deal of trouble to chemists? If I send him the necessary information, will he take due note of it?

Yes. It is only on the basis of concrete cases that any appreciation can be gained.

Coronary Heart Disease

36.

asked the Minister of Health if he will give information about the tests with cod liver oil being officially made for the relief of coronary heart disease.

Why not? Is the Minister aware that cod liver oil is our richest indigenous source of unsaturated oils, that it is a valuable by-product of the British fishing industry, and that the American Heart Council has stated quite categorically that it is effective in this type of disease? In the circumstances, should not tests be undertaken?

It is not for me or for my Department to indicate what medical investigations should take place.

Is not the Minister making a quite unreliable statement? Is it not his duty to see to it that the best provision is made to deal with various diseases? Why on earth does he not take note of the very many indications given that tests of this kind should be undertaken at once?

It is my responsibility to secure that there is provision for whatever treatment the medical profession thinks right and wise, but it is not my responsibility to indicate the most promising lines of medical research.

Is there not a gap in medical provision in this country if there is no central body which can be authorised and instructed to investigate certain lines of treatment and recommend them to the medical profession?

"Authorised" and "instructed" are two different things. As to "authorised", the answer is "Yes". As to "instructed" by a member of the Government, the answer is "No".

On a point of order, Mr. Speaker. In view of the wholly unsatisfactory reply which the Minister has given, I beg to give notice that I shall raise the matter on the Adjournment at the earliest opportunity.

Mental Nursing Homes (Inspection)

37.

asked the Minister of Health what instructions he has issued to local health authorities regarding the inspection of mental nursing homes in accordance with S.I. 1960, No. 1272; and whether he will require local authorities to employ suitably qualified persons to report upon the treatment provided for patients in such nursing homes.

I expect registration authorities to ensure that the persons inspecting are suitably qualified. This and other points are dealt with in Circular 18/60, of which I am sending the hon. Member a copy.

Does not the Minister agree that private nursing homes are unique in having a direct financial interest in retaining patients as long as possible? Does not this factor make it all the more necessary for inspection to be thorough and searching, and will the Minister agree that this can hardly be done unless a trained psychiatrist is employed by the local health authority when carrying out inspections? Further, is it not a fact that many of these homes give patients little or no treatment, and ought not this to be looked into?

Undoubtedly, inspection is a very important safeguard here. That is why it has to take place every six months. As I said, inspection cannot serve its purpose unless it is carried out by suitably qualified persons, and I have emphasised this to the authorities concerned.

Drugs (Purchase)

39.

asked the Minister of Health what the saving would be if, based on the total usage for the last 12 months, supplies of chlorothiazide, tetracycline and chloramphenicol at £5, £37 5s. and £27 per 1,000 tablets, respectively, were bought from continental instead of British manufacturers.

Is my right hon. Friend aware of any reason for this considerable difference in the prices charged by continental and British manufacturers? Does he think that it would act as an incentive to British manufacturers to reduce their prices if we purchased more from the Continent?

My hon. Friend's Question asks what the saving would be, on certain assumptions. The purchase of these articles from abroad involves several issues, including that of royalty payments.

Can the Minister say when supplies officers may expect clear instructions from his Department about the purchase of drugs from the Continent?

Doctors And Dentists

44.

asked the Minister of Health whether he will publish the names of doctors and dentists who are fined by local health executive councils.

Even if this is about the only official secret which the Government are able to keep, is it not nevertheless a public scandal that doctors and dentists who are paid out of public funds and who let the public down, should be covered by this conspiracy of silence? Is he not aware that public opinion is very strongly in favour of these guilty persons being named?

Where it is held by the National Health Service tribunal that, in the public interest, a practitioner should not continue to practise under the Health Service, then the name is published. But in the cases where the name is withheld, which the hon. Gentleman has in mind, what has happened is that there has been established a breach of contract between the practitioner concerned and the executive council. In a case of that kind it is not the practice that names should be disclosed. Any remedy, either civil or criminal, against the practitioner is unaffected.

Does not the Minister appreciate that to the public at large it is rather mysterious why a doctor's moral lapses should nearly always obtain the widest publicity whereas professional shortcomings, which may well affect the life or health of a doctor's, or dentist's patients, are shrouded in anonimity? Does not he think that the situation might be looked at again?

When matters are brought to light in the course of these disciplinary cases which should be investigated by the General Medical Council or the General Dental Council, they are brought to the attention of these bodies, which are the appropriate ones for that purpose.

Is the right hon. Gentleman aware that there is considerable concern about this matter, particularly among the public who want to have the option of going to reputable dentists? Does not he agree that the vast majority of reputable dentists, particularly in Birmingham where we have had a very bad case recently, very much resent the fact that suspicion is put on everybody? How can the public be protected? Where do they come in in the Minister's estimation?

If the professions concerned wish to represent to me that names should be published, I will take account of their point of view.

Would the right hon. Gentleman consider the desirability of publishing the names of people who commit a second offence and of making it clear that they are in breach of contract so that, although it is not a criminal offence, the public will be in a position to judge the worth of their work?

That is met by my earlier answers, in which I pointed out that, when it is undesirable that a person should continue to provide services in the National Health Service, the name of the practitioner concerned is published and he is taken off the list. Secondly, where it appears prima facie that there are matters which ought to be brought to the attention of the General Medical Council or the General Dental Council they are brought to their attention.

The right hon. Gentleman said that if the professions represent to him that the policy should be changed he would take account of that representation. Does not he consider that the public, the patients, have an interest in this matter? My hon. Friends are representing the public interest. Will he take that into account?

The hon. Member for Birmingham, Small Heath (Mr. Denis Howell) said that the profession in Birmingham——

I was answering that part of his question. I have been dealing with the concern of the public in all the answers which I have given. The hon. Gentleman drew attention to what he said was the point of view of the profession. I replied that if the profession believed that the names ought to be published, naturally I would pay attention to that view.

On a point of order. In view of the completely unsatisfactory nature of the Minister's reply, I hope to raise the matter on the Adjournment as soon as possible.

Motor Tricycles

46.

asked the Minister of Health whether it is possible to convert single-seater all-weather propelled tricycles, other than petrol-powered tricycles, to enable an additional person to be carried.

As it is quite impossible to convert these invalid carriages, will the right hon. Gentleman undertake to give disabled people who are not war-disabled the same kind of car which is given to war-disabled people to enable them to have company when they go out on journeys on their vehicles?

That is a very different matter and one which was fully debated on 30th June last. I have nothing to add to what my predecessor then said.

The right hon. Gentleman will be aware that the trade union movement has requested this and that he has been asked to receive a deputation. I hope that his mind is not made up on this matter and that he will receive the deputation with an open mind and will listen to a very sound argument.