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Commons Chamber

Volume 655: debated on Monday 12 March 1962

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House Of Commons

Monday, 12th March, 1962

The House met at half-past Two o'clock

Prayers

[Mr. SPEAKER in the Chair]

Private Business

Zinc Corporation Bill Lords

Read a Second time and committed.

City Of London (Various Powers) Bill (By Order)

Second Reading deferred till Monday next.

Selection

Order read for resuming adjourned debate on Question [ 7th March], That Mr. Edward Short be added to the Committee of Selection.—[ Mr. Hughes-Young.]

Question again proposed.

The debate stood adjourned

On a point of order Mr. Speaker. I should like your guidance. I shouted "Object", Sir.

Therefore, I asked if there were any Instructions—that is, as to which date the Order should go—and I was told that there were none.

Oral Answers To Questions

Hospitals

Cancer (Treatment)

1.

asked the Minister of Health when he expects every regional hospital board to have installed a linear accelerator for the treatment of cancer.

Does this not mean that there has been very dilatory progress in providing this megavoltage apparatus? Does it not mean that many hundreds and possibly thousands of cancer patients recommended for treatment which requires this apparatus are not able to get it now and will not be able to get it for some years?

No, Sir, because megavoltage treatment is also given by the cobalt machine and at least one of these is available in every region which has not got a linear accelerator.

10.

asked the Minister of Health how many hospital units and similar institutions are available under the National Health Service for the specialised treatment of inoperable cancer; and what is the average size of these specialist institutions.

In England and Wales there are 64 hospitals where radiotherapy for cancer can be given. Chemotherapy is available in any larger general hospital.

Will my hon. Friend agree that in specialist institutes which are specialising solely in inoperable cancer there is a great opportunity for practical research by doctors into methods of treatment, and does she agree that we are lagging behind some other countries, notably America and West Germany, in the provision of these facilities, and will she and her right hon. Friend take steps to increase the number of complete specialist units rather than just departments of hospitals?

Medical opinion in this country does not favour concentrating such patients as my hon. Friend has in mind in specialised units. As I have explained, there are facilities within the hospital service for the treatment of these cases.

Nurses

4.

asked the Minister of Health what representations have been made to the Whitley Council as to the question of the recommendation of increased salaries for nurses and when they were made.

32.

asked the Minister of Health what advice he gave to the management side of the Nurses' and Midwives' Whitley Council prior to 13th February regarding the nurses' pay claim; and why the Whitley Council was not permitted to consider this claim on its merits.

Early in February I asked the Management side to have regard to the terms of Command Paper 1626. I do not accept that this precludes consideration of the claim on merits.

Is the right hon. Gentleman aware that the Parliamentary Secretary told me on 11th December that a claim for increased nurses' remuneration was under consideration at that time by the appropriate Whitley Council; that since then I have been in undated with letters suggesting that pressure had been put on the Whitley Council not to agree to an increase, that the Government's intention had clearly been made known and that a decision had virtually been arrived at before 11th December?

No, Sir. The guidance which I have mentioned was given by me to the Council at the beginning of February when I drew its attention to the Command Paper.

Is the Minister aware that the representatives of the staff side say that this offer of 2½ per cent. was made after taking the Minister's advice? How can he possibly reconcile this with the terms of the circular that he sent to Whitley Council chairmen last August saying that claims should be negotiated on their merits and that there was a reservation solely on the question of the time of the implementation of an award? Why does the right hon. Gentleman single out the nurses for this treatment in view of the disastrous nursing situation in the National Health Service today?

Nurses are not singled out for treatment. The nursing situation is not disastrous in view of the fact that the nursing force today is at its highest point ever. I do not for a moment accept that one can have regard to the merits of a claim in complete isolation from the economic situation, and I am glad that the Whitley Council took account of the terms of the Government's White Paper.

5.

asked the Minister of Health if he has yet received from the appropriate Whitley Council their decision on the claim that was pending, as at 11th December, for an increase in the rates of wages of nurses; and if he will make a statement.

That may be, but is it not ingenuous of the Minister and his Parliamentary Secretary to try to convey to the House that the Whitley Council is considering the whole position of this very under-paid, over-worked and valuable section of the community—at a time when, presumably, nursing sisters in the Army will be having rises—and that it is entirely a matter for the Whitley Council, although he writes to the Council and says that he hopes that the Chancellor's views will be borne in mind in respect of nurses if not in respect of many other classes of the community?

No, Sir; on the contrary, it would be disingenuous to suggest to anyone that wage claims can be considered without regard to the economic circumstances.

Is my right hon. Friend aware that there will be a big nurses' meeting tonight called by the Royal College of Nursing, and is he aware of the reaction among nurses to the offer of 2½ per cent. overall without consideration being given, apparently, to the whole structure of salaries in the nursing profession? Are we to understand that the pay pause—which I have always supported as a basis for Government policy—affects not only just the amount of an increase which should or should not be given but precludes consideration of salary structure? Is my right hon. Friend aware that nurses are thoroughly dissatisfied with their salary structure as a whole? When will something be done about their salary structure so that when the new hospital programme comes into operation there will be the people to staff the hospitals?

As I have explained before, the new hospital programme should in itself assist rather than otherwise the nursing position. There is no reason at all why the salary structure should not be taken into account within the terms of the Government's White Paper.

Is the Minister aware that, quite apart from the meeting this evening at the Royal College of Nursing which is to be chaired by his hon. Friend the Member for Tynemouth (Dame Irene Ward), the nurses' trade union is under great pressure from its members and branches to take action following the Minister's decision, and will he bear in mind when the claim comes forward again to the Whitley Council, as it undoubtedly will, that his past decision has caused considerable disturbance within the profession?

Yes, but what has to be borne in mind by everyone is the overriding necessity and common sense of the Government's policy as set out in the White Paper.

Does not the Minister realise that his attitude has caused the gravest concern among nursing staffs? Are we to take it that when the management side meets tomorrow it will be faced with exactly the same position as on the previous occasion?

As I have told the House, I have given my advice to the management side, who took it into account.

26.

asked the Minister of Health the present ancillary basic rate of pay for a male ward orderly in a London hospital; what additional payments are made above the basic rate; and what is the pay of a third year student nurse and of a staff nurse in charge of a award after seven years' experience.

The rate is £10 0s. 8d. a week; additions for overtime, shift, weekend and night duty; £346 or £356 a year, if non-resident. Staff nurses are normally in charge of wards only in the absence of the ward sister.

Does not that Answer show clearly that ancillary workers who were brought in as dilutees are getting inevitably higher remuneration than the skilled workers in the service? In view of this, will not the hon. Lady and her right hon. Friend take heed of those of us who urge that there should be a review of the scales for all nurses in the profession?

The hon. Member makes the common mistake of people who compare salaries of ancillary workers with those of trained workers. The ancillary worker has a different scale. Men and women, for instance, do not have equal pay. The hon. Member put down his Question in relation to male ward order lies, but female ward orderlies get less than males. In any event, by comparison with the nurse or the nurse in training, the nurse is on a progressive incremental scale. She also enjoys better holidays and better sick pay conditions. That is the real comparison which should be made.

Is the hon. Lady aware that, however she juggles the figures, they point clearly to one thing: that there can be no justification whatever for an offer as low as a 2½ per cent. increase in the salaries of nurses at the present time?

33.

asked the Minister of Health what consideration he has given to the need for a reserve of nurses to be available to the Health Service; and if he will take steps to provide for this.

Hospital authorities are asked to keep lists of nurses willing to return at times of difficulty. Members of the National Hospital Service Reserve often give help in emergency.

Would the Minister not agree that it would be a good thing if centres were set up within certain areas or regions where the reserve could be kept and that in times of emergency or when nursing staff were needed they could be drawn from this reserve?

It seems to me that the present arrangements have the effect which the hon. Member has in mind.

34.

asked the Minister of Health the cost now being incurred in advertising vacancies in the nursing services; and what was the total cost during 1961.

While the hon. Lady regrets that the information is not available, would she not agree that the amount of money that is spent on advertisements for nursing personnel for our hospitals must be tremendous? Would it not meet the position if the salaries of the nursing profession were made more attractive, so that there would be no need for so much advertising?

Hospitals are not required to show the figure separately; that is why I am not able to give it. In reply to the main point of the hon. Member's supplementary question, in a country where there is full employment and where there is great competition for girls and young men with the right educational qualifications, it is necessary to advertise so that the opportunities may be made known to them.

46.

asked the Minister of Health whether he is aware that the excess of student nurses over qualified nurses has been reduced from a figure of 5,000 on the appointed day in 1948 to approximately nil at the present time; and if he will institute an inquiry into the recruitment position of the nursing profession.

47.

asked the Minister of Health if, in view of the present number of 25,000 vacancies for nurses in the hospital service, he will institute an inquiry into recruitment problems.

Trained nurses are now a larger proportion of a bigger total. I do not think an inquiry is called for.

Does the right hon. Gentleman think, as he said previously, that the production of his hospital plan is sufficient to attract sufficient student nurses to the profession, or does he not rather agree that the present salaries are so low that girls—and men even, but girls in particular—are certainly not going to be attracted to the nursing profession, and that the old idea of Florence Nightingale and the angels and all that sort of thing is no longer operative?

—and the number in post in the Service whole-time and part-time is higher than ever it has been. The number of student nurses is not quite at its peak. The peak so far was in March, 1960, but the latest figures I have suggest that the numbers are rising again.

When the Minister says that trained nurses constitute a higher proportion, surely he does not mean a higher proportion of the nursing staff including unskilled nursing assistants? Because, if so, I would submit to him that the proportion has dropped steadily since the appointed day.

The hon. Lady's Question referred to the ratio of student nurses to qualified nurses. I am glad to say—and it is a natural concomitant of an expanding total of the nursing force-that that proportion has fallen.

I did not mean to imply that nurses were not angels. I think they are. They are marvellous people to come into such a difficult profession. However, the fact does remain, does not the right hon. Gentleman think, that something more will have to be done to attract young girls, who have many more jobs available to them today besides nursing? So that the only way to get them is to give them a higher salary for the training which they have to undertake and for the very difficult job with very difficult, long hours which they have to undertake. Will he not again look at this question of salaries for the nursing profession?

There is nothing in the trend of recruitment to indicate that salary scales are a deterrent to the recruitment and staffing up of the service. There are a good many aspects to the recruitment of nurses and a great many things quite apart from salaries in which the profession can and ought to be made more attractive.

Is the right hon. Gentleman aware that angels in the Kingdom of Heaven neither buy, sell, eat nor drink—

—and while he may say they are angels, may we give up this angelic humbug and pay them the salaries they deserve?

I do not recollect the text from which the hon. Member was quoting, but I must point out again that the general conditions of the nursing profession are such as are consistent with a steady increase in staffing.

Overseas Doctors

7.

asked the Minister of Health how many doctors from overseas are employed in the British hospital service.

On 30th September, 1961, there were in England and Wales 3,503 junior hospital medical and dental staff, including part-time staff, who were born overseas. There is no information for the senior staff.

Has the Minister any idea what the likelihood is of these doctors staying in England? Has he any experience to go on to show what that number really represents as an addition to our total medical staffs?

The figures I have given represent something under 40 per cent. of the junior hospital medical staff. I have no reason to think that the desire of doctors from overseas to serve and gain experience in these appointments will fall off at any rate at all rapidly.

Nottingham

16.

asked the Minister of Health how many new hospitals will have been built, and how many hospitals will have been rebuilt or remodelled, by 1975 in the Nottingham area, under his hospital plan for England and Wales.

I am not surprised that the hon. Lady is ashamed to give the answer in public. Is she aware that the answer to the first part of the Question is "None" and that the answer to the second part of the Question is "None"? Because the Minister has chosen to list in his Blue Book a whole series of desirable and necessary projects for building and rebuilding hospitals which are not to be included in his plan, many people, including members of hospital management committees, have been misled. Will the hon. Lady ensure that the true facts are made public so that the nature of the callous and cruel fraud on the people of south Nottinghamshire, many thousands of whom are waiting to get into hospital beds, is made known and understood?

That is a nonsensical statement. My right hon. Friend and I are very proud of the Hospital Plan. Far from deserving the terms which the hon. Gentleman has used, it is a progressive and stimulating document. I do not propose to take up the time of the House in saying what is being done in Nottingham, because all that is contained in the document.

Physiotherapists

20.

asked the Minister of Health what steps are being taken to overcome the present shortage of physiotherapists in the Nottingham hospitals.

The regional hospital board intends to open a school of physiotherapy in Nottingham.

Is there not something very wrong when in Nottingham we have posts which have been vacant for up to three years and when wounded ex-Service men, who are supposed to have priority treatment, are unable to get it? Would not the hon. Lady agree that, however successful the hospital building programme and the new projects may be, they will be of no avail unless we build up the essential human fabric of the hospital service, and that this means a drastic overhaul of the system of the remuneration of people in professions supplementary to medicine?

The shortage of physiotherapists is not confined to Nottingham, but it does affect that region. It is the case that the numbers in post have fallen in the last few years in that region in spite of the general increase of physiotherapists throughout the country. We are looking into the matter, and we believe that a training school is part of the answer. I have already dealt extensively with the question of salaries.

May I ask my hon. Friend, when she is opening this new school in the Nottingham area, how she will provide teachers for the school? If she is opening a new school in Nottingham, why is it that the school in the northern region of the Newcastle Regional Hospital Board is to be closed down because we have not the teachers?

A shortened course for teachers was started last autumn in conjunction with the Chartered Society for Physiotherapists. It should produce more teachers quite quickly. We hope that this will help in due course with the project in the Nottingham region, and I hope that it may help in the region in which my hon. Friend is interested.

Oldham Boundary Park Hospital (Mrs Watson)

22 and 23.

asked the Minister of Health (1) if he will institute an independent inquiry into the circumstances in which. Mrs. Watson, an inpatient of Oldham Boundary Park Hospital, was missing from the hospital from Wednesday, 20th December to Wednesday, 28th December last, when she was found by the police in a seriously distressed and frost-bitten condition; and if he will make a statement;

(2) why Mr. Watson was not kept informed of the circumstances of Mr. Watson's absence as an in-patient from Oldham Boundary Park Hospital from 20th December to 28th December last; if he is satisfied with the internal security arrangements at the hospital; and whether there is effective and expeditious machinery, where it is necessary, to seek the help of the police and other outside agencies.

Is the Minister aware that this unfortunate lady has now lost both feet by amputation, that until Friday afternoon last her husband had not been informed of any of these circumstances, and that there is physical evidence, as recorded by the doctors, of this lady being molested during the time that she was missing from the hospital? Does the Minister think that public anxiety arising in this case will be satisfied with an internal hospital management board inquiry? Does he not think that at least an inspector from his Department might be added to the inquiry so that the public anxiety will be allayed?

The inquiry is not by the hospital management committee; it is by the board, which would be the normal form of inquiry in these circumstances, and obviously I must not comment, in view of this, on what the hon. Gentleman has said.

Laboratory Technicians And Medical Photographers

27.

asked the Minister of Health what will be the remuneration of a medical laboratory technician and a medical photographer after 1st April as compared with the matron of the same hospital.

Is it not a fact that in many hospitals the remuneration of a laboratory technician, and certainly of a medical photographer, would be higher than that which is received by the matron?

There are so many variables that it is extremely difficult to make a comparison. The matron's salary depends on the number of beds in the hospital. The salary of the senior grade of medical photographer depends on the size of the department. The hon. Member asks me whether it would happen in the same hospital. The answer is, "No".

Does not the whole situation as revealed by Questions this afternoon show how very haphazard the whole of these scales are? Does not this prove beyond doubt that there is need for an inquiry into the whole basis of the scales in the whole of the medical services?

No, Sir. This is properly a matter for the machinery which has been set up to deal with it—the Whitley Council.

North East Metropolitan Hospital Board

39.

asked the Minister of Health what progress has been made in providing adequate convalescent accommodation for patients in the North East Metropolitan Hospital Board area during the last five years; how many patients have been refused immediate convalescent treatment because of lack of accommodation; what further steps are being taken to provide adequate accommodation; and to what extent the difficulty is that of securing staff.

I am not aware of difficulties in finding staffed beds for patients from this area who need convalescent treatment.

Would the hon. Lady make further inquiry into this matter, for the information which I have received is that there is a certain amount of delay in certain cases in giving adequate convalescent treatment to patients who have been recommended for it? In these circumstances, would she not make further inquiry?

If the hon. Gentleman has a particular problem in mind, I shall be very glad to look into it, but in fact a standing joint advisory committee on convalescence was set up by the four Metropolitan hospital boards some time ago to look into this question of convalescent facilities. The committee is examining the position at present. It is looking for the potential demand in two hospitals and is prepared to extend that to other hospitals. In general, the demand is falling.

40.

asked the Minister of Health what relation the proposed internal administrative reorganisation of the North East Metropolitan Hospital Board has to the proposed Greater London local government reorganisation; and when the regional board's re organisation is to be initiated and completed.

None, Sir. I am considering proposals for regrouping which the board has just submitted.

Do I understand from the Minister that it is purely a coincidence that this regrouping and reorganisation is taking place at the same time as consideration of the local government reorganisation now taking place?

Ministry Of Health

Welfare Foods

2.

asked the Minister of Health what stocks of orange juice, cod liver oil and vitamin tablets were held in England and Wales at the end of 1961.

Following are the figures:

Bulk concentrated orange juice2,760 tons
Bottled orange juice1,823,128 bottles
Cod liver oil481,188 bottles
Vitamin "A" and "D" tablets357,328 packets

3.

asked the Minister of Health what proposals he has to eliminate stocks of cod liver oil, orange juice and vitamin tablets in England and Wales.

Cannot my hon. Friend run down some of these very large stocks which are held in the country? Surely it is a little unnecessary to keep these welfare foods in this modern age? Are they not a relic of the past and should they not be buried once and for all?

Welfare foods are still available to those mothers who wish to make use of them. In fact, the existing stocks of bottled orange juice, cod liver oil and vitamin tablets will be used up in the months ahead. The disposal of the bulk orange juice will take a little longer.

Is the hon. Lady aware that many hon. Members would like to take exactly the opposite course to that proposed by the hon. and gallant Member for The Hartlepools (Commander Kerans)? Will the hon. Lady consider this suggestion? In addition to young children getting these welfare foods, could not old-age pensioners who need them badly also be considered in this connection?

I will consider that suggestion, but some of these things are really out of context. They are, in fact, for expectant mothers.

Pronor

9.

asked the Minister of Health if he will make the drug pronor freely available through the National Health Service for the treatment of certain cancer conditions.

I understand that this preparation is available only from the private laboratory of a doctor in the United States, but it can be ordered.

Since the circumstantial evidence points to the possibility that this drug had a decisive influence on the spinal cancer of my constituent Mrs. Windsor, whose stout courage my hon. Friend knows all about, will she take steps to make sure that the availability of the drug through the National Health Service is more generally known in medical circles?

It is not the proper function of my right hon. Friend to bring particular drugs to the notice of the medical profession. It is a professional matter. The usual method is the publication of articles in scientific journals.

Lung Cancer (Cigarette Smoking)

12.

asked the Minister of Health what further action he will take to supplement the efforts of local authorities in publicising the danger of lung cancer due to cigarette smoking.

38.

asked the Minister of Health if he has studied the new evidence contained in the report of the Royal College of Physicians, a copy of which has been sent to him, on the connection between cigarette smoking and lung cancer; and what action he now proposes to take to deal with the problem of lung cancer.

43.

asked the Minister of Health, in view of the new evidence on smoking in relation to cancer of the lung contained in the report of the Royal College of Physicians, a copy of which has been sent to him, what further action he now proposes to take to deal with lung cancer.

44.

asked the Minister of Health, in view of the new evidence on the relation between smoking and health contained in the report of the Royal College of Physicians, a copy of which has been sent to him, what action he now proposes to take to safeguard health in this respect.

51.

asked the Minister of Health if he has studied the report of the Royal College of Physicians entitled "Smoking and Health", a copy of which has been sent to him; and what action he proposes to take to deal with the problem of lung cancer in the light of this new evidence.

55.

asked the Minister of Health, in view of the concern of tobacco workers in Nottingham, following the publication of the fresh information contained in the report of the Royal College of Physicians on smoking and lung cancer, a copy of which has been sent to him, what steps he now proposes to take to implement the report's recommendations on health education.

My right hon. Friend the Secretary of State for Scotland and I are asking local health authorities to use all their channels of health education to make the conclusions of the report widely known and to make clear to the public the dangers to health of smoking, particularly of cigarettes. We shall be giving them guidance and providing them with publicity material. We are also consulting with the Central and Scottish Councils for Health Education about ways in which they can help. As regards health education in the schools, my right hon. Friend the Minister of Education is answering a Question today.

That is the same kind of evasive reply as I had when I raised the matter on the Adjournment on 1st March, 1957. In the light of the devastating report by the Royal College of Physicians, should not the Government be doing much more practical work to discourage youngsters from starting smoking, and is it not a farce to expect the local authorities on a few hundreds of £s a year to counteract the £11 million worth of tobacco advertising carried on every year, much of which is specially directed to persuading young people to smoke?

There is no direct com parability between the sum spent by local health authorities and the sums spent on advertising—

I said that there was no direct comparability, and I am glad that the hon. Member agrees—but this report is undoubtedly an extremely valuable and powerful weapon in the hands of health education which the Government will now be actively supporting. The other suggestions made in the report of the Royal College are under consideration by the Government.

Does the Minister think that the cigarette manufacturers spent this £11 million a year on advertising without it having some effect? Will he urge within the Cabinet that the report's recommendations be supported and carried out? I understand that the effects of the recommendations are being carried out in Sweden.

The control of advertising is one of the suggestions in the report, which I have said are under consideration.

May I ask the Minister two questions arising from his reply. First, bearing in mind that £5,000 was spent over the past five years on warning people of the dangers of smoking compared with £38 million spent on advertising the virtues of smoking, can he tell us a little more about the likely scope of the publicity which he will make available to local authorities? Secondly, can he assure us that his Ministry will step up its investigations into anti-smoking tablets, which can be procured under the National Health Service?

I shall be providing local health authorities with free publicity material, and I shall be in consultation with them and with the Central Council for Health Education as to the most effective form which that material might take. I have under consideration the suggestion of anti-smoking clinics which is made in the Royal College's report. I have in mind that experiments might be made in that direction.

Am I right in assuming that my right hon. Friend accepts the report unreservedly? If so, in the guidance which is to go out from his Department to local authorities, is he asking the local authorities to let him know what action they are, in fact, taking? Are we to have a little more evidence given to us about what action is taken as a result of the guidance and not just have the matter left as a nebulous statement that he has issued the guidance?

I will keep closely in touch with local health authorities on this matter. The Government certainly accept that the report demonstrates authoritatively and crushingly the causal connection between smoking and king cancer and the more general hazards to health of smoking.

Did the Minister notice the observation in the report that the public has not taken this threat seriously in the past very largely because of the results of Government action? Will the right hon. Gentleman bear that in mind in future and not leave local health authorities to do the educational work out of their limited resources? In addition, is the right hon. Gentleman aware that he is particularly responsible in dissuading young people from contracting this habit? Will he discuss with the Postmaster-General the possibility of controlling television advertising on smoking, which is directed at young people?

The question of television advertising, as of advertising generally, is dealt with in the suggestions made in the report which, as I have said, are under consideration by the Government. I have no doubt, however, that, apart from the steps to be taken by my right hon. Friend the Minister of Education, the health education work of local health authorities will have young people very much in mind. Health education work is undoubtedly one of the most effective channels for getting this message over in the right places, and I shall certainly give it every support I can.

Has my right hon. Friend noticed in the report the comparison between the growth of smoking in a country which does not permit advertising and in this country which does permit it? Would not he agree, however, that in the last five years, despite the excellent material put out by the Central Council for Health Education, many local health authorities and local education authorities have not done what they should have done? Finally, does my right hon. Friend agree that the best method of propaganda is parental example?

I noticed the reference in the report to the example of Czechoslovakia. Obviously, that is one of the things which has to be taken into consideration in regard to the suggestion of the Royal College. There is no doubt about the importance of parental example or about the desirability of the health education effort being, at least in part, directed towards parental example. I believe that the publication of this report will give a great impetus to the work of health authorities in this matter, which T have said I intend to support in every way I can.

Since so much of the propaganda in favour of smoking is directed towards teen-age schoolchildren, will the Minister consult the Minister of Education with a view to circulating a summary of this report to senior forms in schools?

Perhaps the hon. Gentleman will look at the reply of my right hon. Friend, which I foreshadowed in my Answer.

On a point of order. This is the first time for many days that I, no doubt like other hon. Members, have seen the sun. Why is it that it has now been shut out by the blinds being drawn?

I suspect that it is to assist the accuracy of my eye, in which it shines.

Phenylketonuria

13.

asked the Minister of Health how many local medical committees are having a diagnostic test for phenylketonuria performed on all children born in their administrative areas.

I assume my hon. Friend refers to local health authorities. Over 100 carry out extensive tests, many aiming at complete coverage.

Is it not a fact that this test is a very simple one, and that if it were carried out by all local health authorities it would probably result in preventing about 40 babies born every year from becoming mentally defective? Will my hon. Friend consider the possibility of publishing a list of local health authorities which do not carry out such a test so that pressure may be put upon them to carry it out?

It is estimated that there might be 20 to 40 new cases in a year. But the number of local authorities providing this service is steadily growing. Now 108 out of a potential of just over 140 local authorities carry it out. I believe that it is extending. I should like to see the coverage progressively extended.

Can the hon. Lady say what progress has been made in the hospital field in this matter? Has she any figures about the number of hospital management committees, for example, which carry out this test as a routine matter?

No, not without notice. However, if the hon. Gentleman tables a Question, I will obtain the information for him.

Brucellosis

14 and 15.

asked the Minister of Health (1) how many cases of brucellosis occurred during the last convenient period of twelve months; and

(2) what steps he is taking to safeguard the public against the danger of contracting brucellosis as a result of drinking milk which has not been heat-treated.

One hundred and one cases were reported in England and Wales in 1961. Medical officers of health have full powers to control the sale for human consumption of milk infected, or suspected of being infected, with this disease.

In view of the number of milk-vending machines and advertisements advising people to drink another pint of milk a day, will my hon. Friend take steps to make it quite clear to the public that tuberculin-tested raw milk is not completely safe and that it is not necessarily free from the brucella germ? Will she substitute an advertisement saying, "Better not drink a pint of milk a day unless it has been heat-treated"?

That is not a matter for me. However, 94 per cent. of the milk in this country is heat-treated.

School Dental Officers

17.

asked the Minister of Health if he will take further steps to improve the pay and conditions of school dental officers in an endeavour to overcome the present shortage of such officers.

The pay and conditions of these officers are negotiated between the local authorities and the profession on the Dental Whitley Council.

Would not my hon. Friend agree that there is a grave shortage of school dental officers? Is she aware that in my constituency a post has been advertised and unfilled for five years? Does she not think that it is time that the Government stepped in and did something about this, and will she consult the Whitley Council and the local authorities to see if something can be done?

Recruitment to the school dental service is the responsibility of my right hon. Friend the Minister of Education. On the question of increased pay, increases in pay amounting to 12½ per cent. were agreed to in the Dental Whitley Council and published in January, 1961, with effect from 1st October, 1960.

Is the training of dentists not the responsibility of the Minister of Health, and ought he not to be rather anxious that we should be encouraging a number of the young men and women coming out of the schools to train for dentistry? Surely it is high time that we had more drive from the Minister to get more people to train in dentistry and so fill all the vacancies that exist not only in the school dental service but in the general dental service?

That is another question, but, as the hon. Gentleman knows, the number of places for the training of dentists is being increased.

Would the hon. Lady consult with the Minister of Education to see if they could co-operate in a campaign to prevent the incidence of caries in children's teeth, which is a problem accentuated by the shortage of school dentists?

Older People (Clinics)

19.

asked the Minister of Health what steps he is taking to promote special clinics which provide preventive health services for older people.

Local health authorities have power to provide such clinics, and, with my approval, some are doing so, but at present they are largely experimental.

Is the Minister not aware that malnutrition among elderly people today is as serious as it was among children in this country thirty years ago, and that while the cause is mainly poverty and the apathy which often goes with it, none the less these experimental clinics have produced remarkable results in rehabilitation and rejuvenation by early diagnosis and advice on health and dieting? Is it not the Minister's function actively to promote clinics of this sort instead of just leaving it to the local authorities?

The result of these experimental clinics will certainly be interesting and may be important, but I cannot agree that at this stage it would be advisable to generalise this provision. I think that there are many things more important for the care of the old.

Will the Minister bear in mind that these old people have not too long to play with, and will he, therefore, look urgently into the question, because while he is considering and watching the experiments old people are dying?

These are mainly advisory and not treatment centres. I am not saying that they may not be useful, but I am saying that other forms of specific provision for the old have a higher priority, certainly at present.

Smallpox (West Germany)

21.

asked the Minister of Health whether he is aware that the World Health Organisation has declared Aachen in West Germany an infectious area for smallpox; and what steps he is taking to prevent the entry of smallpox carriers from that area into this country.

Is the right hon. Gentleman aware that the Belgian authorities are now demanding vaccination certificates for all travellers coming from Western Germany in view of the outbreak of smallpox there, and that the B.M.A. in its journal last January criticised the Government's laxity in protecting the people of this country against smallpox brought in by travellers? In view of this, will he take some decisive action to protect the British people?

As the hon. Lady knows, Aachen is on the Belgian frontier, but I am advised that it can be assumed that all suspects in this outbreak can be relied upon to be under surveillance or in isolation. In those circumstances, I would not be justified in recommending port health authorities to take exceptional measures.

Cancer (Records Bureau)

24.

asked the Minister of Health if he will give an estimate of the cost of establishing a complete and effective cancer records bureau in each hospital region.

Is it reasonable for the Minister to wait until June before he has a look at this matter which, whether or not an estimate is available, can cost only a very little sum of money in comparison with the immense amount of good that it could do? Is the Minister aware that there are many research workers who look forward to getting complete and reliable statistics of this nature to help them in the fight against cancer?

I do not think it unreasonable to wait until June to receive the returns which we have asked all hospital authorities to provide.

Are the records which are kept sufficient to show the relationship between badly fitting dentures and wounds caused by badly fitting dentures and the increasing incidence of cancer of the mouth?

That is an entirely separate question. I would be grateful if the hon. and learned Member would put it down.

Locum Tenens

25.

asked the Minister of Health if he will consider the establishment of a central bureau under the National Health Service to provide general practitioners with locum tenens.

Is the Minister aware that, owing to the shortage of doctors consequent upon the disastrous Willink Report, this problem is becoming more acute each year? Will he consider establishing a working party of the profession with the idea of having a more rational way of dealing with the problem of holidays for hard-pressed general practitioners? In that respect, would he consider the possibility of using this as a means for hospital doctors to act as locums in general practice and for G.P.s to do locum duties in hospitals and so help to amalgamate the two services?

There are existing arrangements and agencies for obtaining what, I suppose, should be called loca tenentes, and the British Medical Association itself has a bureau for the purpose. I do not think that anything would be gained by the addition of a Government bureau.

Will my right hon. Friend bear in mind that this is becoming an increasingly difficult problem for the doctor who is practising on his own in country districts? Does he not think it likely to lead to the doctor who is on his own becoming less efficient by being unable to take a holiday? Will my right hon. Friend seriously reconsider the matter?

Even in the country districts, I cannot believe that the addition of a Government bureau would be helpful, but undoubtedly this is one of the minor factors which are helping to lead to the spread of group practice, which is an entirely desirable aim.

Doctors (Private Patients)

30.

asked the Minister of Health what assessment is made of the total amount received by general practitioners within the National Health Service in respect of private patients.

Will the Minister bear in mind that the Pilkington Report advocated that should there be much rise in the amount of private practice by general practitioners, the sums should be included in the central pool? If there has been a rise, is it not possible that doctors have had an increase much higher than the 2½ per cent. which the Minister has tried to pay to other people?

What the Report recommended was that no attempt should be made to calculate or allow for annual fluctuations in the sum unless there was reason to believe that the alteration had been substantial. I am not aware of any reason for believing that there has been substantial alteration.

Is the Minister aware of the claim by the British United Provident Association of a great increase of the number of people paying private fees to doctors? If that is so, does it not mean that there is a case for a substantial increase?

Medical Conferences (Official Receptions)

31.

asked the Minister of Health to which international or European medical conferences he or his predecessors have given official receptions during the last five years.

In the meantime, will the Minister tell the House how those bodies qualified for the distinction, by what method they were chosen for it, and why this facility has been refused to the international conference of Catholic doctors which is to meet in London in July?

There are a large number of applications, even within the field of my own Department, for Government hospitality. On an average, it has been found possible to fit in only about three a year. The application to which the hon. Member refers was very carefully considered.

Following is the list:

Date

Organisation

1957International Congress on "The Circulation" Harvey Tercentenary.
Seventh World Congress of the International Society for the Welfare of Cripples.
1958Eighth Congress of the Medical Women's International Association.
National Association of the Prevention of Tuberculosis 5th Commonwealth Chest Conference.
1959International Society of Plastic Surgeons Congress, London, July, 1959.
British Commonwealth Medical Conference.
European Society of Haematology Congress.
International Congress of Proctologists.
International Union against Venereal Diseases and Treponematoses.
1960Fourth International Goitre Conference.
First International Conference on Congenital Malformation.
Conference for Scientific Aspects of Mental Deficiency.
1961Third International Congress of Dietetics.
International Optical Congress.
Seventh International Congress of the Permanent Section on Biological Standardisation of the International Association of Microbiological Societies.

Leukaemia

35.

asked the Minister of Health whether he will give the figures for the incidence of leukaemia in Britain for the past five years to the latest available date.

I would refer the hon. Member to Chapter VI of the Chief Medical Officer's last Annual Report.

Does not the Report, which I have read carefully, show that the incidence of leukaemia has increased by three times during recent years? In view of this sinister increase, which shows a connection between man-made radiation and the incidence of the disease, in view of the fact that the effect of radiation in causing this disease takes something like eight years to build up and in view, further, of the fact that the soothing reports about the effects of the Russian tests can only be considered soothing because the full noxious effect cannot yet be assessed, will not the hon. Lady urge the Government not to add to the total of the world's harm which is caused by man-made radiation by asking the Government to discourage the United States from proceeding with its nuclear tests?

That does not arise on this Question. The figures are available and, as the hon. Member has said, he has studied them.

Prescription Charges

37.

asked the Minister of Health if he will take steps to arrange for old-age pensioners and others, who at present have to travel to the National Assistance Board to have their prescription charges reimbursed, to obtain their prescriptions free at the time of dispensing.

No, Sir. Refunds can be obtained at a post office by anyone drawing a regular allowance from the board there. In other cases they can be obtained by post.

The Minister must know that there are some very sad cases. Would it really be so difficult to devise a system which would end all this unnecessary travel, fares, expense, worry and embarrassment? Could not, for instance, the doctor be supplied with a special prescription form which he could supply to patients on production of their National Assistance book?

I have pointed out to the hon. Member that travel to the National Assistance Board is not necessary in any event. Certainly, it would not be right or practicable to place upon the doctors the duty which rests upon the National Assistance Board. If the hon. Member has any particular case in mind, I should be glad to look at it.

Is it not perfectly clear that the person receiving a prescription from the doctor and who is in receipt of National Assistance can produce a current book of payments, and would it not simplify the whole procedure if the doctor could write out a prescription exempting the patient from the need to reclaim money paid either through the Post Office or through visiting the National Assistance Board? It is really quite simple.

That is only one form of placing on the doctor what is not his job—verification of the economic position of his patient.

Bala Clinic

41.

asked the Minister of Health what ante-natal facilities up to consultant level are available at the Bala Clinic for patients resident in Bala.

Radioactivity

45.

asked the Minister of Health if he will consult the Minister of Housing and Local Government and Minister for Welsh Affairs with a view to ensuring that information regarding the existence of radioactive materials and any local radiation hazards should automatically be communicated to county medical officers of health and to county district medical officers of health as soon as it becomes available.

I understand that this point will be fully met when the Radioactive Substances Act is brought into operation, and that in the meantime medical officers of health are being kept informed in all cases where there might be a hazard.

But is not the Minister aware that medical officers of health are very disturbed about the present position, and that they are complaining that they do not get information as they should, and that their only alternative will be to set up their own monitoring system, which will be extremely expensive and an unnecessary duplication, unless better means can be found of letting them have the information?

If there is any particular case which has given rise to the Question, perhaps the hon. Lady will let me know.

Could the Minister say whether the draft regulations include full information of this type wherever the material is and whenever it is in transit?

Tonsillitis And Tonsillectomy

48.

asked the Minister of Health how many persons died of tonsillitis and tonsillectomy, respectively, during the past 10 years.

In 1951–60, 672 deaths were attributed to acute tonsillitis or to hypertrophy of tonsils and adenoids. In 291 of these tonsillectomy or adenoidectomy was mentioned on the certificate.

Do I understand from that Answer that more people have in fact died from tonsillitis than from tonsillectomy? Will this information be conveyed to those people who think that operations on tonsils are exceedingly bad and result in more deaths?

No. The hon. Gentleman has not understood correctly, because this expression, hypertrophy of tonsils, relates to the thickening of tonsils, as I understand it in non-technical language, and this must be linked with the tonsillitis cases in considering the figure of 672.

Is not the position really this, that this operation, which was universally done on very many people in the past, is now suspect, and that it is important to make an inquiry to make certain what the true position is?

I was not aware of that, but I will pursue the hon. Gentleman's question.

May I ask how much it cost to get that Answer and what was the use of it?

Farmer's Lung

49.

asked the Minister of Health how many oases of farmer's lung have occurred during each of the past five years; whether it is now possible to tell with certainty that this disease is not tuberculosis; whether complete cures have been effected in all cases; and whether those concerned have been fitted into other employment in view of the fact that this is an industrial disease due to dust connected with their work, to which they cannot return

I am advised that fanner's lung, which is a chest condition affecting farm workers and others, is clearly distinguishable from tuberculosis. I regret that the further information requested is not available.

Is the hon. Lady satisfied that every step is being taken to provide proper facilities for a different occupation for those who suffer from this disease, and does she know how far the disease has in fact been cured in the cases which have come to her notice?

The question of occupation is, of course, for my right hon. Friend the Minister of Labour. In fact this is not a disease. It is a condition to which farm workers are subject, and facilities for its treatment are available under the National Health Service.

When she gets a Question of this nature, does not the hon. Lady think it advisable to consult her fellow Ministers with a view to ascertaining what exactly the position is? Why push it aside on to another Minister?

No. Employment is a matter properly the responsibility of my right hon. Friend. To consult only means yet another channel of getting for the hon. Member the information he requires.

British Army (Incident, Stahnsdorf)

asked the Minister of Defence whether he will make a statement about the incident at Stahnsdorf, on 10th March, when a British R.A.F. corporal was wounded.

While returning by car to Potsdam from a routine tour about midnight 10th–11th March, Lieut.-Colonal Brown and Corporal Day, of the British Military Mission to Soviet Headquarters in East Germany, were fired upon by East German frontier police at Stahnsdorf. They were in an unrestricted area and the East German frontier police opened fire for no apparent reason and without warning Corporal Day was seriously wounded and taken to an East German hospital.

Colonel Brown was held by the East German police until released by a Soviet officer. The Soviet authorities have expressed regret for the incident. The Head of the British Military Mission has been instructed to raise this matter urgently with Soviet Headquarters and to register a strong protest.

Her Majesty's Government will consider what further action may be called for in the light of the detailed report of the incident and of the discussions with Soviet Headquarters by the Head of the British Military Mission.

May I express our sympathy with Corporal Day and with his family?

Is this the first time that such an incident as this has occurred, British soldiers being fired upon in East Germany? Will the right hon. Gentleman tell us in due course what further measures he and the Government are contemplating? Is the evidence so far that this was an isolated act of indiscipline, or is there reason to think that it was more serious than that?

I understand from newspaper reports that the excuse given was that the East Germans did not identify the car. Would the right hon. Gentleman consider getting further means of clear identification of our cars by day and night agreed with the Soviet authorities?

As the right hon. Gentleman says, this is a matter between the British and Soviet Governments. The cars in which the members of the Mission go about—and, of course, they are accredited to the Soviet Commander-in-Chief—have special number plates. The number plates were on this car and they were clearly identifiable. The question of mistaken identity does not arise.

Yes, Sir, and it was a public highway, where the car had every right to be. It was not in any forbidden zone.

I am grateful to the right hon. Gentleman for his kind wishes, which I am sure the House supports, to Corporal Day. My latest news is that he is a good deal better and that he will be moved to a British hospital as soon as it is considered medically safe to move him.

I should prefer not to comment in detail on the broad issue until we have had a report from the Head of the British Mission, after he has had talks with his Soviet opposite number. Until then, it is difficult to say whether it was a mistake, or a piece of provocation, or something else.

Do we not expose ourselves to acts of provocation of this sort so long as we keep British troops stuck out in the centre of Europe? How long will it be before the Government come to an arrangement over Berlin and bring our troops home?

This has nothing to do with the British garrison in Berlin. This is a British Military Mission to Soviet headquarters in East Germany. As I am sure my noble Friend knows, there is a counterpart Soviet Mission in West Germany. This is an interchange which, I think, is valuable, because it enables each side to keep on eye on what the other is doing.

Will the right hon. Gentleman make a further statement when he has later information?

Complaint Of Privilege

I desire to raise a matter of Privilege, Mr. Speaker. The Sunday Telegraph dated yesterday, carries on its front page a story which it heads:

"Firms' Anger at Leipzig muddle M.P.s Criticised in Trade and Politics Mix-up"
In the course of the article reference is made to the activities of a number of hon. Members of this House and with your permission, Mr. Speaker, I should like to quote four brief extracts to illustrate my contention that this may be a matter of breach of Privilege.

The first extract reads:
"It was the presence of the M.P.s and the activities of some that caused most resentment among British exhibitors. It was certainly degrading to hear a British M.P. touting for business orders and to see the sycophantic attitude some adopted towards the East Germans. I know of one concrete case, and there are certainly others, of a British firm agreeing to pay a quarter per cent. commission to an M.P. if he could arrange an order."
The article goes on:
"Equally, I have no doubt that the reason Mr. Sternberg and Mr. Drayson are so anxious to bring M.P.s out is to build up a pressure group at Westminster sympathetic to East Germany…. One big steel company has refused to show at Leipzig because of the undue influence they feel was exerted by some M.P.s in previous years…. There is no doubt that the collective presence of a group of M.P.s creates the impression of an official delegation."
I submit that while this article is critical of those hon. Members who attended the Leipzig Fair it is, in its sense and essence, derogatory to the whole House and I therefore submit it to you as a breach of Privilege.

Copy of newspaper handed in.

I am obliged to the hon. Member. I will take the 24 hours which I am allowed for consideration and will rule upon his point tomorrow.

Bill Presented

International Monetary Fund

Bill to enable the United Kingdom to take part in arrangements under which the International Monetary Fund may borrow supplementary resources from its members presented by the Chancellor of the Exchequer; supported by the Prime Minister, Mr. Erroll, and Mr. Anthony Barber; read the First time; to be read a Second time Tomorrow, and to be printed. [Bill 77.]

Orders Of The Day

Supply

[8TH ALLOTTED DAY]

Considered in Committee.

[Sir WILLIAM ANSTRUTHER-GRAY in the Chair]

Air Estimates, 1962–63

Vote A Number For Air Force Service

Motion made, and Question proposed,

That a number of officers, airmen and airwomen, not exceeding 154,000, all ranks, be maintained for Air Force Service, during the year ending on the 31st day of March, 1963.

3.37 p.m.

In introducing the Air Estimates I will not attempt to cover all the ground surveyed in the Memorandum. I want, instead, to try to restrict myself to those points which have been the subject of controversy, or to those which are new.

The right hon. Member for Smethwick (Mr. Gordon Walker), in his speech in the defence debate the other day, urged us to abandon the independent deterrent in favour of an increase in our conventional forces. The right hon. Gentleman was frank enough to tell us that he did not know the facts about the build-up of the V-force, but it is rather important that we should put a little more precision into his views on this subject. The right hon. Gentleman spoke of the tapering off of the V-force, but I am not sure what he meant. Would he cancel the V-bombers at present on order and not yet entered into service? Would he cancel Blue Steel? Would he contract out of the Skybolt programme?

I know the difficulties in answering these questions when one is not in office and one has not the information, but I hope, all the same, that the hon. Member for Sheffield, Park (Mr. Mulley) can enlighten us a little on this subject, for the policy of tapering off the deterrent is, I understand, only one leg of the policy. The other leg is the reinforcement of our conventional forces, and unless we can have a rough idea of the time-scale in which the right hon. Gentleman is speaking it is difficult to know what he means.

The V-bombers that we have on order, the Blue Steel that we have on order and our present plans for Skybolt will carry us well into the 'seventies. If this is something that the right hon. Gentleman accepts, there is not much difference between us. If, instead, he is urging cancellations or contractions, this is a very different story.

The right hon. Gentleman said that those weapons would carry us through into the 'seventies. The White Paper says "through the 'sixties".

The right hon. Gentleman is adept enough in these matters to know that the difference is marginal. If we carry on to the end of the 'sixties, we are into the 'seventies.

This is not the occasion to dwell on the political or moral implications of the deterrent.

I thought the Committee would agree that this was an occasion far discussing the purely military aspects of the subject. The defence debate was the occasion for discussing the other aspects. The great bulk of the criticisms which were made—

On a point of order, Sir William. Is it within the competence of the Minister to seek to limit the debate in the way in which he is now doing? He has suggested that we should be concerned purely with the military aspects of defence now. Is that to be the order of procedure?

I think that the hon. Gentleman would be well advised to make his speech and see how he gets on in due course.

What I was anxious not to do was to try to cover the whole field of defence policy. I think that traditionally these Estimates debates have been an occasion to discuss the Service aspects of the problem.

On a point of order, Sir William. I apologise to the Minister for interrupting him a second time. This question of order arose in a previous debate, and I think that it would be advisable if it could be cleared up at the beginning of this debate rather than that we should have varied points of order during each of the speeches.

It is quite true that in these separate Service Estimates there is a great deal of interest in what one might call the technical aspects of them, and it is also true that a great deal of the debates from year to year have been devoted to the technical aspects, but I am sure that we should all like to have your Ruling, Sir William, as to whether we are, in fact, limited to the technical aspects, or whether we are entitled to consider how far these Estimates, if the Government get them, would or would not help the Government to carry out the defence policy of which they form part. That seems to many of us the only interest that the debate has.

Further to that point of order, Sir William. I was not seeking to limit the debate—

I am speaking further to the point of order. I was not seeking to limit the debate as far as other right hon. and hon. Gentlemen are concerned. I was only saying that, from the Government's point of view, we judge that this is an occasion to discuss the technical aspects of the matter rather than the political and moral implications. If I carry the hon. Member for Nelson and Colne (Mr. S. Silverman) with me to that extent, I will go on with what I have to say.

Further to the point of order. I apologise to the right hon. Gentleman for intervening again. Nobody contends for a moment that the technical aspects could conceivably be out of order in the debate. The question is whether we are limited to them. I quite agree that the Minister, or any other hon. Member, may devote the whole of his speech to them if he wishes, but what I was putting to you, Sir William, was the position of the rest of us who are not so much interested in the technical aspects of the matter, but are much more interested in the aspect of the contribution to the security of this country. I should like to know whether we are entitled to deal with that aspect of the matter.

I think that I must now reply to the points of order which have already been raised. According to my understanding of what will be in order, I do not think that hon. Members will find themselves unduly limited when they come to make their speeches.

As I was saying, all I am trying to explain is the point of view from which I shall approach the subject. The defence debate was the occasion that my right bon. Friend the Minister of Defence and my right hon. Friend the Minister of Aviation took to go into the broader aspect. Nevertheless, the defence debate also showed another thing, that the great bulk of the criticisms made of the independent deterrent, of Bomber Command, were geared not to its political or moral side, but to its effectiveness and military value. It is, I think, my duty to answer the charges, for they were nothing less, which were made against Bomber Command by right hon. Gentlemen opposite and my right hon. Friend the Member for Birmingham, Hall Green (Mr. Aubrey Jones).

Will the right hon. Gentleman allow me to deal with one misinterpretation? No one attacks Bomber Command. The whole of the attack, which I hope later also to develop, is against the political heads of the Ministry of Defence and the Air Ministry. I hope that the right hon. Gentleman will not start this debate, as his right hon. Friend is so inclined to do, by trying to push proper political attacks on to his military advisers and on to the men in the Services.

I can quite understand the strong feelings that the hon. Gentle man has about this, but if one says that Bomber Command cannot get off in time, if one says that it cannot, as the right hon. Member for Huyton (Mr. H. Wilson) did—