asked the Minister of Health whether, in view of the shortage of chiropodists in Staffordshire for the implementation of an extended service for young people there, under the County Council's prophylactic foot-care scheme, he will permit chiropodists who have failed to achieve State registration but who have been in practice for 10 years prior to the beginning of the registration scheme, or who have worked satisfactorily for Government Departments, to be now employed locally by the National Health Service.

No, Sir.

Is the hon. Member aware that in Stafford today we are being denied the extension of a scheme for the foot care of the young and, at the same time, that because of the regulations at least one chiropodist is now on National Assistance pay? Surely this is entirely wrong. One man is being deprived of his livelihood and the whole area is being deprived of his services. Surely the Minister will make the concession that I have asked for.

We are not aware of any shortage of chiropodists in the employment of Staffordshire County Council and I understand that demands for treatment are generally being met. I think that the hon. Member will agree that State registration is desirable. It was introduced by the previous Minister. I am not prepared to comment on a case arising out of a Question of this kind.

asked the Minister of Health if he will withdraw contraceptive pills from general circulation until the investigation of the Dunlop Committee into their possible side-effects has been completed.

I see no ground for asking the manufacturers to do this. The Committee has recently advised that, after reviewing the available evidence, it does not feel justified in objecting to the marketing of oral contraceptives.

Will my right hon. Friend bear in mind that the Interim Report of the Dunlop Committee did not exclude the serious possibility that these drugs may be having serious side-effects? Does he not therefore consider it wise to withdraw them from circulation until a definite verdict has been arrived at?

No, Sir, the Committee is, of course, continuing to watch this position closely, and if it thinks that any further advice is desirable, it will, no doubt, give it. It discovered that there had been 16 deaths due to thrombo-embolic episodes in women taking oral contraceptives in the year ending 31st August. It estimated that the figure of 400,000 represented the number of women who had been taking them with reasonable regularity during that time and the official mortality figures indicated that 13 out of a similar number would normally have been expected to have died from the same cause.

Has the Minister any evidence that sterility has been caused by taking these pills?

No, Sir.

Would my right hon. Friend make it plain that the benefits derived from the widespread use of the pills at the moment clearly outweigh any risk of danger?

Certainly, I should have thought that the benefits are self-evident.

Would the Minister not agree that there is some evidence that if these pills are taken over a very long period the possible danger increases? Is this not something upon which women should be reassured by some evidence which the Dunlop Committee can look into?

I can assure the hon. Gentleman and the House that the Dunlop Committee is very alive to all the possibilities and is looking into them as a matter of urgency.

asked the Minister of Health how many cases of venereal disease were reported among school children in the past school year; and how many have been reported in the current school year.

In 1963 in England and Wales 1,319 new cases of gonorrhoea and 39 cases of syphilis (other than congenital syphilis) were reported in persons under the age of 18, including 233 and 2 respectively in persons under the age of 16. The corresponding figures for 1964 were 1,441, 32, 233 and 6. Figures for school children by school years are not available.

Does the hon. Gentleman realise that, although the figure of 1,400 represents a minor increase in 1964 over the figure for 1963, it is still far too high a figure? Secondly, could he tell the House what special steps his Department is taking to halt this rise, since it is obviously continuing over a period of years and clearly must be tackled as a matter of seriousness and urgency for our young people?

I agree that there has been a very disturbing rise: any rise in these figures is very disturbing. However, it is a very difficult problem, as the hon. Lady will know. It is a question of getting people to enter into treatment voluntarily. We pursue normal health education and normal advertising as far as we can, but this is one of those subjects in which there is some difficulty in knowing precisely how to get people to register and be treated, rather than merely acquainting people with the dangers.

Is it not clear that the presents figures indicate that there is an increasing trend towards venereal disease in schools? Would the hon. Gentleman take some much more dramatic steps to deal with this in the cases when it occurs in schools among children of school age? Is it not possible that some method of checking could be introduced for children at school between the ages of 15 and 19?

It is very easy to talk about taking dramatic action on an issue of this kind. It is doubtful if it would be right to make compulsory the medical examination of school children between 16 and 19 over a small number of days, because the incubation period is so short. It is very difficult to start introducing procedures of this kind without interfering too much with the treatment of the individual.

asked the Minister of Health if he will make a statement on the report of the Brain Committee on Drug Addiction.

I would refer my hon. Friend to my reply to my hon. Friend the Member for South Shields (Mr. Blenkinsop) on 25th November.

While I understand the need for consultation in dealing with this spreading sore of drug addiction, does my right hon. Friend understand the extent of public anger at the ease with which young people can obtain drugs from drug addicts and the need for quick action on this? How soon will he be making a statement on measures he intends to take to implement the Report, and how quickly will he take them?

I agree with my hon. Friend that this Report discloses a disturbing situation. However, I think that it would be premature for me to make a statement of the Government's intentions before the consultations with the medical profession are completed. But I am fully aware of the urgency of the matter.

While understanding that the right hon. Gentleman cannot make a statement at the moment, can he say how long it will take to complete these discussions and whether he will be able to make a statement early in the New Year to allay some of the disquiet which is felt?

Certainly, I hope that early in the New Year at least I can make a further statement. The consultations are already under way and we are treating them as a matter of urgency.

asked the Minister of Health what discussions he has had about the immediate setting up of an advisory committee to review the whole problem of drug addiction, as recommended in the Second Report of the Interdepartmental Committee, published on 25th November, 1965.

The consultations referred to in my reply of 25th November to my hon. Friend the Member for South Shields cover this as well as the Committee's other recommendations.

asked the Minister of Health what progress has been made with a national cervical cancer screening service for all women at risk.

By June this year almost 51,000 women a month were being tested in hospital, local authority and family planning clinics and by general practitioners. There were 283 pathologists and 383 technicians trained in cytology working in hospital laboratories and another 29 pathologists and 131 technicians undergoing training. About a third of the laboratories which propose to provide a cytological service should be able to support routine screening in the areas they serve by the end of this year.

While I thank my hon. Friend for the figures and appreciate his interest in this question, is it not a fact that progress is still much too slow in dealing with this scourge which could be eliminated entirely, and which is so disturbing? In view of the wastage from marriage and other causes, could he launch a drive to encourage fully qualified married women laboratory technicians to return on a part-time basis to their local hospitals?

I will consider what my hon. Friend said about part-time married women technicians. We need a great many more part-time women in many branches of the Health Service. We need about 500 whole-time equivalent technicians for the national screening service. The 514 I mentioned in my Reply do not spend all their time in cytology and I understand that they represent the equivalent of 310 working full time.

asked the Minister of Health what progress has been made in Kent in obtaining qualified staff for routine screening for cervical cancer.

Progress continues. All the hospital management committees in Kent, save Tunbridge Wells, have extra staff trained or nominated for training.

While thanking my hon. Friend for that reply, may I ask him if he will now consider the possibility of organising mobile clinics where clinics cannot be provided in set centres in Kent?

I understand that there would be considerable difficulty in providing mobile clinics for this purpose.

asked the Minister of Health if he will review Ministry of Health Circulars H.M. (68) 104 and H.M. (63) 37 and remove the discrimination contained therein against second-year nursing cadets.

I do not think there is unfair discrimination, but I will keep the matter under review.

Is my right hon. Friend aware that a second-year nursing cadet loses some £30 a year from her salary if she spends two days in college and three and a half days in hospital? Does he not think that this is an unfair discrimination against the older nursing cadets—the girl who already has one year's experience and who presumably is doing more responsible work in the hospital? In view of the need to encourage more girls to come forward into nursing, does he not think that this niggardly deduction could be removed at very little cost to the National Health Service?

I am aware of the situation which my hon. Friend has described, but I regard it rather differently. I would say that it is discrimination in favour of certain categories of first-year nursing cadets who enjoy a concession which is extended to no other young staff. But, as I have said, I am keeping the matter under review.

asked the Minister of Health in view of the misleading and inaccurate information distributed widely by opponents of fluoridation of water supplies, whether he will grant sufficient money to the Central Council for Health Education to allow the Council to correct this effectively.

I fully accept the need for wide dissemination of factual and objective information about fluoridation, but I am not satisfied that this would be the most effective method in present circumstances.

Is the Minister aware that no fewer than 50 local authorities have already gone on record against fluoridation, misled by this kind of rubbish from otherwise well-meaning people? If he is not prepared to use the services of the Central Council for Health Education, would he please tell the House at an early date which service he proposes to use?

I share my hon. Friend's disappointment, but I remind him that about 90 authorities have decided in favour of fluoridation. I feel that fluoridation is one of the most useful preventive health measures which medical and dental science has so far made available to us in our fight against dental decay. In those circumstances, I feel it right that I as Minister should take the initiative and accept full responsibility for ensuring that the true facts are disseminated as widely as possible.

Will the Minister tell the House which methods he is using to make the advice which he is giving to the House known to the public and the nation at large?

My advice is primarily directed towards the local health authorities. I have acquainted them with all the scientific information in favour of fluoridation. My Department has produced a considerable amount of material to counter the irresponsible propaganda against fluoridation which has received an unduly wide circulation.

Dr. Kerr.

On a point of order. May I have your guidance, Mr. Speaker? In view of the fact that I described fluoridation as sodium fluoride, which is a virulent poison, being added to our water, am I guilty of misleading the nation?

Order. The hon. Member is wasting time at Question Time by arguing under the guise of raising a point of order.

asked the Minister of Health if he will give an estimate of the extent of anti-fluoridation opinion in the country.

The lists circulated with my reply to the hon. Member for Chigwell (Mr. Biggs-Davison) on 22nd November indicate that among local authorities the weight of opinion is predominantly in support of fluoridation. Leading professional opinion is almost entirety in favour.

Is the right hon. Gentleman aware that although personally I am fully in favour of fluoridation and a great supporter of his policy, I find that a considerable number of my constituents are not? In fact, an unofficial local poll revealed 85 per cent. against it. In view of this—which may be common throughout the country—is there any way by which people can express a personal opinion on a very personal matter?

I do not know whether the hon. Member is suggesting that there should be something in the nature of a referendum in local authorities. That would be a new constitutional departure. The fact is that almost all existing opposition to this proposal stems from the very small but very vocal group of people who bombard local councillors with propaganda which is both unscientific and irresponsible.

asked the Minister of Health to what extent it is the policy of Her Majesty's Government that decision by individual local authorities is the best way of implementing the fluoridation of water policy.

The statutory function of making arrangements for fluoridation of water supplies rests with the local health authorities under Section 28 of the National Health Service Act, 1946. In my view it is best that the decision should be theirs.

What bothers me a little is that local authorities have no mandate to decide the matter as far as I am aware. Does not the right hon. Gentleman agree that it has never been fully debated in the House and that therefore there has been no express approval by Parliament of it—although, I say again, personally I am greatly in favour of it.

I would welcome a debate in the House on fluoridation and I very much hope that some private Member who is lucky in the Ballot will put it forward as a subject for debate.

Is the Minister aware that we on this side of the House wish him the best of luck in his campaign and hope that it is thoroughly successful?

asked the Minister of Health what representations he has received from local health authorities on the compilation and use of an At Risk register; and what advice he has offered on the subject.

We have had no representations and issued no recent advice.

Is my hon. Friend aware that at the recent conference of the Health Visitors Association at Cheltenham some very critical observations were made about the use in certain local authorities of the At Risk Register? While the principle was in no way discounted, it was felt that some guidance might be needed in certain areas.

We are not aware of the criticism which was made. If my hon. Friend will let me have details I will look at it.

asked the Minister of Health what plans he has for the provision of birth control appliances and advice as part of the National Health Service.

This matter is under review, but I am not yet in a position to make a statement.

Is my right hon. Friend aware that there would be widespread approval of a decision by the Minister to make this advice and treatment available through the National Health Service?

I have already said in the House that I regard family planning as a proper and important part of health education. However, to provide advice and treatment free of charge generally in cases where there is no medical need would require changes in the present statutory provision and, of course, would be costly.

asked the Minister of Health if he will undertake a national campaign against obesity.

I am not satisfied that any such campaign is likely to be effective.

Is the Parliamentary Secretary aware that about two-thirds of the people in this country are overweight and that this leads to heart disease, arthritis, postural backache and flat feet? Does he not think that it would pay dividends if his Department undertook a campaign of this kind, which would relieve the National Health Service of a good deal of the problems which are caused by overweight? Is he also aware that large numbers of children are overweight and that if he were to——

Order. The hon. Lady must learn to slim her questions.

I fear that you anticipated the very comment I was about to make, Mr. Sneaker. After the points made in question form by my hon. Friend, perhaps I now know the reason why I sometimes feel so ill. Experience of obesity clinics, both in this country and the United States, has proved very disappointing indeed. It is not just a question of getting off weight. It has been found that people who reduce their weight often do not have the same strength of character as my hon. Friend to continue with the slimming process.

Would the Parliamentary Secretary agree that the hon. Lady's campaign got off to a good start as a result of the activities of the bakers' union?

asked the Minister of Health whether in the interests of encouraging economy in prescribing, he will put a limit on the period covered by any one prescription, save in exceptional circumstances.

While I do not think it would be right to impose a fixed limit, I wrote to all family doctors at the beginning of the year reminding them of the advice of an independent committee that no more than one week's supply of drugs should be prescribed at a time during the first two weeks of illness and thereafter no more than a fortnight's supply, save for certain chronic illnesses.

I thank the Minister for that reply. Is he able to indicate any further action which he may be able to take to reduce the area of waste in prescribing?

I am watching the position. There is some evidence to show that the doctors have taken note of my suggestion in that while the number of prescriptions went up following the abolition of prescription charges, the quantity of drugs per prescription decreased compared with the average in 1964.

asked the Minister of Health how many merit awards to consultants have been withdrawn since the inception of the awards scheme.

None, Sir.

Is the Minister satisfied that a system which appoints a considerable number of people to a position of advantage and yet removes none of them is working satisfactorily?

If the work of a consultant deteriorates unacceptably the question which surely arises is that of fitness for further employment rather than that of his continuing to hold an award. The put back The award continuing after the consultant remains in his post beyond the normal retiring age has been the subject of discussion with the profession, but no decision has yet been reached.

asked the Minister of Health if he will review the present methods employed by his Department to keep general practitioners fully informed of new drugs.

Various methods are in use and they are under constant review.

Would my right hon. Friend give serious thought to the possibility of making available an adequately financed central information service? Is he aware that although in 1962–63 the drug houses spent £8·3 million on research they spent considerably more than that on the promotion of medicines, which, in the end, the Exchequer must pay?

The question of the sales promotion activities of the pharmaceutical manufacturers is firmly within the terms of reference of the Sainsbury Committee, and I am sure that that Committee will give urgent attention to the matter.

asked the Minister of Health what representations he has received regarding the delay in building a new junior training centre for mentally-handicapped children in the Wellingborough area; and if he will authorise the building of the centre to proceed as planned without delay.

The county council has asked for authority to proceed with this scheme at once, but my right hon. Friend is not satisfied that the circumstances justify exemption from the current general deferment of local authority capital projects.

Is the Parliamentary Secretary aware that there has been delay in building this centre, which was planned previously? Is he aware that this was put back behind other centres in the Northamptonshire area because of questions involving the acquiring of land. As this is now designated, will he now reconsider his decision on this matter?

We recognise that this is an eminently desirable project in itself, but other factors must be considered, particularly that of its urgency in relation to the Government's policy of deferring health and welfare building projects generally. However, I wish to impress on my hon. Friend that the deferment is only of a temporary kind.

asked the Minister of Health what action he proposes to take to protect general practitioners from formal complaints made against a deputy acting within authorised arrangements.

Agreement with the profession on a new contract for general practitioners will result in new arrangements for accountability of deputies on the lines set out in Section 5 of the first report of my discussions with general practitioner representatives on the Family Doctors' Charter. A copy of this report is in the Library.

I thank my right hon. Friend for that reply, which will be greatly welcomed in places like Ilford, where the emergency services are being threatened by the fact that if a deputy fails to do his duty the patient is reluctant to take action against the principal.

asked the Minister of Health how many residential homes for mentally-subnormal children are under the charge of his Department; where they are located; how many children were in them at the latest convenient date; and what number of staff, qualified and unqualified, were employed at that date.

On 31st December, 1964, local health authorities in England and Wales provided 42 such homes, and 564 mentally subnormal children were resident. Four new homes have been opened this year with 80 places. As the list is long, I will with permission, circulate it in the OFFICIAL REPORT. I regret that the information about staff is not available.

As the hon. Gentleman says that the list is long, will he now

asked the Minister of Health whether he will take steps, in the case of disabled National Health Service patients who buy cars at their own expense without surrendering the invalid tricycles issued to them by the National Health Service, to pay them maintenance grants for such cars as well as the cost of adaptation.

No, Sir. My right hon. Friend does not intend to introduce

I am very sorry, but I cannot do that without delaying the House too greatly at Question Time.

If, as I think, I am right in believing that the concession described in my Question is already made to war disabled patients, what justification can there be, 20 years after the war, for not extending it to all National Health Service patients?

The point is that the cases referred to by the hon. Gentleman in his Question come under the National Health Service Acts, which do not empower the Minister to make cash grants, or to improve upon the vehicles, as an alternative to the present arrangements. We are looking very closely at the problem, but I do not of necessity say that we shall be able to accept what the hon. Gentleman wants, as other problems are involved.

Is the Parliamentary Secretary aware that there is a great deal of hardship under the present regulations, and a great deal of distress, particularly among married families in this category? Can he assure the House that this is an urgent review, which will report as speedily as possible on what action can be taken to alleviate those cases of hardship of which I know the Parliamentary Secretary is aware?

It is not necessary for the hon. Gentleman to impress upon me the difficulties that arise from this problem. How quickly we shall be able to review the position, in the light of the improvements made last year, I am not too sure, but the hon. Member can rest assured that, if it is humanly possible, we shall improve the position. The difficulty is that we have to assess the relative priorities not merely for the allocation of vehicles of this kind but also for that of monetary resources.

asked the Minister of Health what is the total sum now outstanding for the ultimate settlement of all claims for medical practices compensation under Section 36 of the National Health Service Act 1946; and how many practitioners entitled to compensation are over the age of 70, between the ages of 65 and 70, and between the ages of 60 and 65, respectively.

At 31st October, 1965, the total sum for Great Britain was £23·1 million. Of those entitled to compensation, 448 doctors will, at the end of this year, be aged 70 or over, 931 aged 65 to 69, and 1,644 aged 60 to 64.

Is my right hon. Friend aware that these figures indicate that a considerable number of elderly doctors have not yet been paid this compensation; and that, in many cases, payment would mean that very straitened circumstances might be improved?

The National Health Service Acts provide that compensation shall be paid only on retirement or death, except in such circumstances as may be prescribed. The regulations provide for advance payments on grounds of hardship, and these payments are made where the doctor makes an application and I am satisfied that the payment is justified.

asked the Minister of Health if he will inquire into the reason why an ambulance from Whiston, a distance of some five miles away, was sent to a motor cyclist injured during the weekend of 12th November, 1965, at Penketh Lane Ends, Warrington, when there was an ambulance depot nearby at Longshaw Street, Warrington.

I am informed that this area is normally covered from Widnes, but their ambulance was already out. Lancashire ambulance control then judged it would be as quick to send the ambulance from Whiston as to invoke their mutual aid arrangements with Warrington.

Has the Minister been told that this man as a result lay for 20 minutes in the frost? Does he appreciate that this is a problem of general application? Will he do what lies in his power to end the nonsense by which authorities which have ambulances near to the scene of accident make use of ambulances from a much further distance because of the cost factor? Will he see that in future the nearest ambulance is sent and trouble about payment shall he settled between the authorities after the person has been taken to hospital?

I am perfectly sure that the cost factor did not enter into this matter at all. In view of what my hon. and learned Friend has said, the House had better hear what actually took place. A 999 call was received at one minute past midnight and the ambulance from Whiston station arrived at 12 minutes past midnight. Both the motor-cyclist and the passenger arrived at Warrington Hospital at 22 minutes past midnight. Both were slightly injured and neither was detained.

asked the Minister of Health what action is being taken to support the research into the refinement of large and expensive hospital kidney-treatment machines into small, compact and cheap home units.

I am giving financial support to research aimed at assessing the conditions in which artificial kidney treatment can be provided safely in a patient's home. My officers are keeping in close touch with this research.

I thank my right hon. Friend for that reply. Will he give all encouragement to doctors in Queen Elizabeth Hospital, Birmingham, in particular those working with a local firm to produce a small compact home unit, because this would assist those cases and relieve pressure for demand for beds?

Yes, I certainly will, but I should point out that it is not right to assume that a small compact edition of expensive equipment would necessarily be cheaper. The reverse frequently applies.

asked the Minister of Health how many applications for group practice building grants he has received within the area of the South-West Regional Hospital Board; and how many of these he has accepted or refused in the last 12 months.

I take it the hon. Member is referring to group practice loans. On that assumption the Answer is 95, of which seven were approved and three refused in the last 12 months.

I apologise for the fact that I referred to building grants. Will the Minister accept that conditions are extremely difficult to satisfy in some areas? Will he look into the matter again on these lines with the desire of increasing group practices?

This scheme may well be superseded under the new contract which I am negotiating with general practitioners, but the figures, even for the South-Western Region, hardly bear out what the hon. Member has said because 54 of the 95 applications were approved, 19 only were rejected, 16 withdrawn, and six are still under consideration.

asked the Minister of Health if he will take further action on cigarette advertising, particularly with regard to methods involving free distribution, details of which have been sent to him.

This is under active consideration, but I am not in a position to make a statement at present.

Will my right hon. Friend have another look at the appalling figures for lung cancer, particularly in Scotland? Will he keep in mind that the television advertising expenditure of the cigarette companies appears to be transferred to the Press, to free gifts and free sampling methods which I have shown to my right hon. Friend? The Imperial Tobacco Company told us that it does not know if it is involved in this practice. I think we should find out and stop the practice.

The information sent to me by my hon. Friend appears to relate to market research and not to advertising as such, but I deprecate the free distribution of cigarettes by or on behalf of manufacturers.