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Ministry Of Health

Volume 655: debated on Monday 12 March 1962

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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.