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Social Services

Volume 801: debated on Monday 11 May 1970

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

Artificial Kidney Machines(Home Installation)

1.

asked the Secretary of State for Social Services whether he will withdraw his approval of means tests made by local authorities upon patients requiring the adaptation of their homes to install artificial kidney machines, as given in Circular 2/68.

I do not think it would be justifiable to adopt my hon. Friend's suggestion.

Will my right hon. Friend bear in mind that, all the time the local authority is deciding whether to finance help for a patient, that patient is occupying a bed in hospital while 2,000 kidney patients requiring urgent treatment are awaiting admission? This causes a serious delay in the admission of kidney patients to hospital beds.

Yes, I appreciate the disadvantages of the division between the social services, paid for by rates, and the National Health Service, paid for by taxes. This is one of the things which we hope to deal with in our reform of the Health Service.

National Health Service (Complaints)

2.

asked the Secretary of State for Social Services, what steps he is now taking to establish a health commissioner to investigate complaints of maladministration in the National Health Service.

The consultations referred to in the Green Paper are now taking place.

Will my right hon. Friend say what will be the effect of the recent unanimous rejection of the proposal for a health commissioner by the Central Committee for Hospital Medical Services, that is, by the hospital doctors?

I can tell my hon. Friend that others in the Health Service have expressed considerable support for the notion of a health commissioner, and I shall take all the opinions carefully into consideration before making up my mind.

Is the Secretary of State considering extending the powers and functions of the Hospital Advisory Service?

I am not considering that, because the service is working extremely well. We shall need a few more months before we can judge its effect, but within its existing powers it is doing a first-rate job.

Mental Hospital (Personal Case)

3.

asked the Secretary of State for Social Services what action he proposes to take regarding the case of a boy of 10 years, details of which are known to him, who has been intermittently detained with adult male patients in a mental hospital.

The Joint Under-Secretary of State for the Department of Health and Social Security
(Dr. John Dunwoody)

This boy is presently undergoing spells of hospital care alternating with spells at home. I am advised that the nature of his disturbance is such that he cannot satisfactorily be cared for in a children's hospital unit and that his best hopes for improvement lie rather with the emphasis on prolonged social training in a close restricted setting than in specific medical treatment. I understand that there is a possibility that this boy might be found suitable for the first of the homes to be established by my right hon. Friend the Home Secretary under Section 64 of the Children and Young Persons Act, 1969, which is expected to become available by the end of this year.

I welcome the last part of the Joint Under-Secretary's reply so far as it goes, but does not he agree that, as this boy has been detained in a mental hospital for the best part of two years, his chances of ever leading a satisfactory life have thereby been reduced?

It is true that he has spent the larger part of the last two years as an in-patient in a psychiatric unit. Of the services available at present those that were provided for him were the most appropriate. I hope that the new facilities will prove to be even more appropriate.

Seriously Maladjusted Children(Accommodation)

4.

asked the Secretary of State for Social Services what progress is being made with the provision of accommodation for seriously maladjusted children.

There are now 39 special units in hospitals in England, providing 660 beds, and one of 25 beds is under construction. This compares with 17 units with 350 beds in 1964 when guidance on this subject was first issued by my Department.

Other special provision is made in services for which my right hon. Friends the Home Secretary and the Secretary of State for Education and Science are responsible.

Is the Joint Under-Secretary aware that Blackpool Corporation tried to get the boy referred to in my previous Question into 17 different homes, but none of them had the capacity to take him? What is happening to the suggestion that regional hospital boards might get together to provide a special children's unit?

I know that considerable efforts were made by a number of people, including my Department, to place this boy in different accommodation. He suffered from a very severe behaviour disorder and it was felt that only hospital type accommodation would be suitable. We are encouraging the development of these facilities, and the answer I have given showing the well-nigh doubling of the number of beds available over the last five years shows the success of our efforts.

Cigarette Smoking

5.

asked the Secretary of State for Social Services, what further proposals he has to reduce cigarette smoking.

I cannot at present add to my reply to my hon. Friend the Member for Loughborough (Mr. Cronin) on 3rd November.—[Vol. 790, c. 647.]

Is my right hon. Friend aware that, despite the progress made in this matter, it is still pitifully slow by comparison with the magnitude of the problem? Therefore, would he not consider introducing proper labelling on the packets themselves, ensuring that a full examination is made of differential taxes between cigarettes and other forms of tobacco, and even completely prohibiting advertising of this substance, which is causing such slaughter?

I am aware of the seriousness of the situation, and it is precisely because of this that I am anxious to ensure that, when we produce legislation, it is relevant to the major problems and not not deal merely with a side issue.

Is it not time that we in this House set a proper example in this connection? Is it not intolerable that hon. Members who are non-smokers should have to occupy desks in rooms with smokers? Is not this field of smoking and non-smoking the only one in which apartheid is justified?

On that subject, I have nothing to add to my original reply to my hon. Friend the Member for Loughborough (Mr. Cronin) on 3rd November.

Prescription Charges

6.

asked the Secretary of State for Social Services what is his most up-to-date calculation of the net yield of prescription charges in the financial year 1970–71; and how many officers in the country as a whole will be engaged in administering exemptions.

For Great Britain, rather over f17 million after allowing for administrative and other costs. The administration of exemptions is often done by staff employed on other duties but it is estimated that the work takes the equivalent of rather less than 400 whole-time staff.

I recognise the considerable efforts which the Government have made to mitigate the effect of this tax on a wide section of the community, but is it not time to look at this again, particularly in view of the fact that many chronic sick have not gained exemption and that we are wasting these 400 officers, who could be much more usefully employed?

It is true that there are many patients who receive exemption—over 40 per cent. of the population—and half of all prescriptions are exempt. I am pursuing in my Department the possibility of giving further publicity to various methods of either obtaining exemption or reducing the charge by means of a prepayment certificate. There is no reason why anyone should have to pay more than 1s. 3d. a week, even if he requires continuous and heavy medication.

Hospitals (Old Buildings)

7.

asked the Secretary of State for Social Services how many hospitals at present in use in the National Health Service include buildings or parts of buildings constructed in or before the 18th century.

Is my hon. Friend aware that an important hospital in Sheffield, or a section of it, was in danger of collapse because some of its timbers dated back to 1790-odd? Are there standing instructions to hospital management committees or regional hospital boards about the inspection of the physical state of the hospitals under their control?

I know of this episode in Sheffield, involving the Sheffield Royal Infirmary. The inspection of buildings and other property of management committees and regional hospital boards is done as part and parcel of the general maintenance programme. I doubt whether there is any need for additional special instructions.

Has the hon. Gentleman's attention been drawn to the condition of some of the wards in the Sefton General Hospital in Liverpool? Not only are they old and dilapidated, but, from them, patients have to be taken across an open space 70 yards wide in all weather for such things as X-ray examinations.

There are many old hospitals, and many of them are inadequate, but one should not condemn all old properties. It is possible, by upgrading, to improve many of them immensely. It is because we are conscious of these difficulties that we are spending£100 million—more than twice what was spent by hon. Members opposite when they were in power—on new hospital buildings.

Hearing And Noise In Industry

8 and 9.

asked the Secretary of State for Social Services (1) what action he intends to take in consequence of the Report on Hearing and Noise in Industry; and if he will make a statement;

(2) whether he will now prescribe industrial deafness for the purposes of the National Insurance (Industrial Injuries) Act.

My right hon. Friend the Secretary of State referred the research report to the Industrial Injuries Advisory Council for appraisal. In the appraisal, which was published in Cmnd. 4145 the Council indicated that it thought the research findings established that the time had come when it could usefully pursue the problem of whether there are degrees of occupational deafness which satisfy the conditions for prescription laid down by Section 56(2) of the Industrial Injuries Act. My right hon. Friend accepted its view and formally referred the question to the Council, in terms set out in my reply to the hon. Member for Manchester, Gorton (Mr. Marks) on 22nd October last.—[Vol. 788, c. 270–1.]

I warmly welcome my hon. Friend's reply to Question No. 9, which will be well received widely, as well as the action which is being taken about prevention. Is my right hon. Friend aware that, since putting down the Question, I have received a substantial number of letters from people whose personal experience confirms the tentative findings of the report? May we have some preventive action before more people are in a position to confirm this?

I am afraid that prevention is a matter for my right hon. Friend the First Secretary.

Does not that last reply show what a tragedy it is that, in the new proposals in the Green Paper, the responsibility for industrial health is not taken over from the Department of Employment and Productivity?

Supplementary Benefits

10.

asked the Secretary of State for Social Services when he now intends to increase the scale of supplementary benefit payments.

23.

asked the Secretary of State for Social Services whether, in view of the continuing rise in retail prices, he will now increase supplementary benefits.

There is nothing I can usefully add to the reply my right hon. Friend the Prime Minister gave on 16th April in reply to a supplementary question by my hon. Friend the Member for Heywood and Royton (Mr. Barnett).—[Vol. 799, c. 1570–73.]

That reply means, does it not, that there will be some increase in the next few months? Has my right hon. Friend had any representations on the continuing inadequacy, following the publication of the Supplementary Benefits Handbook, which, although it has been widely welcomed, does not yet inform people adequately of their rights, nor of the discretionary powers in the hands of local officers?

I am surprised that my hon. Friend should refer to the handbook, which deals with discretionary payments, whereas we are dealing here with the scale rates. The whole situation is perfectly clear. What is normal is that, in the year when we do not raise National Insurance benefits, we raise the scale of supplementary benefits. I have no reason to believe that the normal practice will not prevail in this year.

In view of the rapid and accelerating rise in the Index of Retail Prices, is the right hon. Gentleman really content not even to begin the process of increasing the rates of supplementary benefit?

There is no process of doing it: one either does it or one does not. What I am saying is that I see no reason to believe that the time when we do it will be altered in this year.

While praising the fact that this Government have done more for old-age pensioners than any other Government have ever done, nevertheless may I ask my right hon. Friend to appreciate—I am sure that he does—the serious problem facing many old people? Therefore, will he speed up this process of giving these extra supplementary benefits in the near future?

I will certainly consider that possibility, but, as at present planned, we would assume that the announcement of the increase would come at the normal time and that the increase would be paid at the normal time.

Is not the rise in the cost of living abnormal? Is it not rising at about 4½ per cent. a year? Does not this mean that those who are most in need should receive help more speedily than has been the case in the past?

Under our new pension plan, we have a biennial uprating at a regular time. Regularity of time has its advantages for the pensioners too.

34.

asked the Secretary of State for Social Services if he will review the basis on which assessments of entitlement to supplementary benefit for owner-occupiers is made.

The Joint Under-Secretary of State for the Department of Health and Social Security
(Mr. Brian O'Malley)

No, Sir. The Supplementary Benefits Commission's powers enable it to provide for any necessary expenditure, other than the repayment of mortage capital which an owner-occupier may incur. We have no reason to believe that these powers are being unfairly exercised.

Is my hon. Friend aware that many owner-occupiers who apply for supplementary benefits receive much smaller allowances than they would receive if they were paying rent for the same premises? Is it fair that people, particularly the chronic sick, should be forced to forgo the fundamental necessities of life to avoid being made homeless?

I should point out that in calculating the amount to be paid to an owner-occupier the Supplementary Benefits Commission is required to take into account his rates and his mortgage interest, but not the mortgage capital repayments. The Commission also makes allowance for ground rent and for the cost of maintenance and repair of the property. It has been the principle under successive Governments that public funds ought not to be provided to enable a person to acquire a capital asset.

Will the hon. Gentleman co-ordinate any action that he takes over this with the Ministry of Housing and Local Government, because I have had several cases in which owner-occupiers, because of increases in old-age pensions, have lost their rate rebate?

35.

asked the Secretary of State for Social Services what limits have been placed on the allowance made for rent in the assessment of eligibility for the payment of a supplementary benefit to applicants living in local authority or privately-rented accommodation.

The Supplementary Benefits Commission, which is required to meet the net rent in full or such part as is, to quote the Act, "reasonable in the circumstances", has not laid down any specific limits. Supervisory staff sometimes however prescribe, for different types of property, limits within which staff must work in making the initial determination as to what is reasonable in the circumstances of each case.

Is my hon. Friend aware that many applicants for supplementary benefit who are living in local authority premises or in premises for which rents deemed to be fair have been fixed are now finding that they are not allowed the full mount of their rent in their claim for supplementary benefit? How on earth are these people supposed to pay the additional amount without sacrificing the basic necessities of life?

I am aware of the problem, and urgent discussions are going on with local authority associations to find a solution to this. My hon. Friend must recognise that this problem, which is of recent duration, springs from substantial increases in rents by local authorities and from the ending of the policy by a number of Tory-controlled authorities of pooling rents. The dispute is also linked with the refusal of many local authorities to pay a rent rebate to supplementary benefit claimants.

Whatever the reason may be, will the hon. Gentleman have another look at this? Is he aware that there are many instances, including some in my constituency, of people suffering as a result of a lack of co-ordination between the Ministry of Housing and Local Government and rent policy and the Department of Social Security and assistance to meet the rents of those on supplementary benefit?

I assure the hon. Gentleman that it is not a matter of having another look. We are already having an urgent look at this. This difficulty has arisen as a result of the policies of a number of local authorities, and we are determined to find a solution to it. While this problem has just arisen, it represents very much less than 1 per cent. of the very large number of people who have their rents paid or contributed to by the Supplementary Benefits Commission.

Will my hon. Friend make sure that his local officers inform tenants in this position that if they are not receiving a full rent allowance from the Department they are usually entitled to a rate rebate?

This is an important point, and we have drawn it to the attention of our local officers. It is a fact that some have estimated that there may be several hundred thousands of people who are entitled to rate rebate but who have not claimed it. Some of the persons concerned might find that their need would be ended were they to make use of their entitlement.

Child Poverty

11.

asked the Secretary of State for Social Services what further steps he has in mind for the alleviation of child poverty.

43.

asked the Secretary of State for Social Services what steps he intends to take to alleviate the position of children living in poverty in families where the father is in full-time work, following his investigations into this matter.

It is clear that there remains a problem of child poverty where the father is in full-time work, where our improvements in national insurance and supplementary benefits do not help. We are working on this. But it would be premature to settle future policy before we have the information we are hoping to get shortly about such families from the data collected for the Family Expenditure Survey.

Does my right hon. Friend recognise that there is a good deal of misunderstanding about the nature and the size of this problem? Therefore, would he consider publishing a White Paper saying what the problem has been and how it has been dealt with over, say, the last 10 years?

We have said this, of course, and I think that the country knows many of the measures which have been taken, including the increases in family allowances and the introduction of rate and rent rebates, which all help the people whom my hon. Friend is concerned about. We must now, I think, see the report of this survey; I will then consider with my right hon. Friend whether any sort of general publication will be helpful.

Now that discussion of negative income tax is once again respectable, will the hon. Gentleman assure us that, in his consideration of the problem, he will not exclude the possibility of using the negative income tax system solely for low-paid men in full-time employment?

I would not exclude this, because the Government have studied different varieties of negative income tax. On our present examination, all have been found to involve substantial disadvantages which are not compensated for by advantages, and the administrative and staff problems are very heavy. But I am keeping this under review.

Does the hon. Gentleman realise that that is a very complacent answer? Does he reject the findings of the Child Poverty Action Group which come from Government-produced figures and suggest very strongly that the poorest section of the community, including children in poverty, is getting worse?

The hon. Gentleman knows that I do not accept those conclusions. I can assure him, as he would have known if he had done his homework, that some of the figures on which the conclusions were based were quite groundless. Comparisons were made with figures which were not comparable, and statistics were used which relate to years past. I do not accept the conclusions of the Child Poverty Action Group.

Departmental Office, Hope

12.

asked the Secretary of State for Social Services whether, in view of the representation he has received, he will reconsider his decision to close his Department's part-time local office at Hope.

No, Sir. The Hope office has been little used in recent years. Only two people on average called for advice on the one day each week on which it was open. A few others called to hand in documents which could have been sent by post. The proposal to close was considered by the Sheffield Social Security Advisory Committee and was agreed by them subject to a review in six months' time.

While I do not seek to deny the facts spelt out by my hon. Friend, may I ask whether he recognises that certain of my constituents are put to serious inconvenience and expense in having to travel to Sheffield? The cost is no mean sum. It is of the order of 5s. One opening a week is perhaps more than is required, but will he consider the possibility of opening the office, say, every other week?

My hon. Friend will have noticed that it has been agreed to review this in six months' time. But I should point out that officials from the Department would be and are prepared to visit people in their homes if the circumstances make that necessary. However, the majority of such cases are and can be dealt with by correspondence.

Autistic Children, West Cheshire

13.

asked the Secretary of State for Social Services whether he will make a statement on the provision of health facilities for autistic children in West Cheshire, with particular reference to the role of Deva Hospital, Chester.

According to their needs such children may receive treatment as out-patients or in hospitals for the mentally ill or for the mentally handicapped. The hospitals ordinarily providing such treatment for West Cheshire are the Chester Royal Infirmary, Moston and Newchurch Hospitals. The West Cheshire (Deva) Hospital does not normally take children.

Does my hon. Friend accept that the incident to which I drew his attention recently sugests that the needs of an autistic child can take second place to the administrative priorities in the hospital service? Does he further agree that decisions which affect the futures of such children should be taken only in the light of expert medical advice?

I have written in some detail twice to my hon. Friend about the case which he mentions. I accept what he says, that the handling of these exceedingly difficult cases and the wide range of problems which they present has to be conducted in the light of medical advice and assistance. We are conscious of the special needs of this group of children, but we must be careful not to assume that their needs are uniform. There may be differing solutions for the different problems of different children.

Mentally Disordered People(Employment)

asked the Secretary of State for Social Services whether he will publish in the OFFICIAL REPORT the estimated number of adult males and females, respectively, who are suffering from such disorders of mind as to make them unlikely to find stable employment; and whether he will make further proposals to devise sheltered employment for such persons on the precedent of the Remploy factories.

The information is not available on which an estimate of this kind could be based. But hospital and local health authorities provide rehabilitation and training facilities for the mentally disordered, and both work closely with disablement resettlement officers of the Department of Employment and Productivity who arrange placements in sheltered and open employment. Further development of these activities seem to me to promise more than the devising of a new form of employment opportunity.

Does not my hon. Friend agree that this is a very large and growing problem? Will he at least consider the possibility of giving matching aid to voluntary organisations which are prepared to raise funds for such purposes as the provision of sheltered employment following the precedent. say, of the provision of youth centres?

This is a large problem. We are going some way towards solving it, though much remains to be done. It is interesting to note that 15 per cent. of Remploy employees and 25 per cent. of those in local authority and voluntary sheltered workshops are in the disability group of the mentally disordered. My Department will consider sympathetically any work done by voluntary organisations, although I would not want to go on record specifically as endorsing my hon. Friend's suggestion.

Is it not regrettable that the statistics asked for are not available? Will the hon. Gentleman consider recommending to his right hon. Friend that the unemployment statistics might be rearranged to include a special category for unemployables of this kind?

As I have said, this is a large problem. We would not get the information that my hon. Friend the Member for Bebington (Mr. Brooks) wanted merely from studying the unemployment figures. We not only have the problem of the unemployables. We have the problems of those who may not be registered for employment at all. It is exceedingly difficult to obtain accurate and worthwhile figures on a national basis.

Retirement Pensions

17.

asked the Secretary of State for Social Services what was the total amount paid by the Government in retirement pensions in the period 1965 to 1969; and what was the comparable figure for 1960 to 1964.

In the five years ending 31st March, 1970, expenditure on retirement pensions was£7,070 million compared with£4,240 million in the previous five years.

Do not those figures finally shatter the myth spread by some hon. Members opposite that it is the Tory Party which cares for the elderly?

That is absolutely right. The figures in my reply show an increase of over 67 per cent. in total expenditure on retirement pensions during the past five years compared with the last five years when the party opposite was in power.

Will the hon. Gentleman now complete the picture and tell us what has happened to prices during that period? Does he accept that, during the past five years, pensions have stood still because pensions have gone up 25 per cent. and prices 24·7 per cent.?

That is not so. If we compare the situation today with that in October, 1964, when this Government came to office, not only have National Insurance benefits increased by more than price increases; they have more than kept pace with the percentage of earnings increases.

Nurses' Pay

18.

asked the Secretary of State for Social Services how much money it is estimated will be spent on nurses' wages during 1970; and what was the comparable figure for 1964.

The estimated total cost of nurses' remuneration in England and Wales for the financial year beginning 1st April, 1970, is£290 million. The comparable figure for the financial year which began on 1st April, 1964, was£170 million.

Is my right hon. Friend aware that a number of hon. Members opposite are driving cars which display posters saying "Fair Deal for Nurses"? Is it not clear beyond reasonable doubt that it took a Labour Government to give them a fair deal for the first time?

I take it that the posters now are expressing thanks to us for what we have done.

Can the right hon. Gentleman say how much of this increase in pay has been taken back in taxes?

I could not say that without further notice, because we have to consider the recent Budget which has been so favourable to people on this kind of income level.

Does that include money spent on agency nurses? If it does, can the right hon. Gentleman say what priority it has? Will he also say whether he is still having trouble with the sister-tutor level finding comparable jobs outside the Health Service at higher salaries?

On the hon. Gentleman's second point, there are problems which have to be considered. On his first point, I have no figures available, but I think that they would be round about 1 per cent., if not less.

Junior Hospital Doctors (Workingconditions)

20.

asked the Secretary of State for Social Services what further action he will take to improve the working conditions of young hospital doctors.

Negotiations are conducted between my Department and the Negotiating Sub-Committee of the Central Committee for Hospital Medical Services, which includes representatives of junior doctors. I have not received any formal representations from the Junior Hospital Doctors' Association about pay and working conditions.

I appreciate that the Government have done much to alleviate the lot of junior hospital doctors. However, is it not still the case that many of them are working excessively long hours, sometimes so long that they could be prejudicial to the safety of patients? Will my right hon. Friend therefore consider increasing the number of posts for junior hospital doctors?

My hon. Friend will appreciate that we have been in lengthy negotiations about the career structure for our doctors, and I am not unhopeful of reaching a successful conclusion.

Will the right hon. Gentleman confirm that some junior hospital doctors are working up to 100 hours a week before they qualify for overtime payment?

I could not go into that matter without having a Question put down about it.

Battered Babies

21.

asked the Secretary of State for Social Services what further consideration he has given to measures to reduce the number of battered babies.

A letter was sent to medical officers of health and children's officers on 9th February with suggestions for action, and a medical memorandum giving more detailed guidance will shortly be issued.

Is my hon. Friend aware that there is now evidence that several hundred babies a year are battered by their parents, about 10 per cent. being battered to death, and that in many cases these babies appear two, three or four times for treatment before effective action is taken? Will he therefore consider whether it is desirable that such cases be notified immediately to an appropriate child protection organisation?

I agree that there is a real problem here. This is particularly true in cases where there is a recurrence of the battered baby syndrome in the same child or in subsequent children in the same family. I am not sure that notification would help towards finding a solution to this difficult problem. At the same time, the advice that we have given to local authorities that there should be co-operation between the different agencies involved—doctors, social workers, children's officers, often the police and the N.S.P.C.C.—is the right way to approach the problem. We are watching the situation very closely.

Is the Minister entirely satisfied that medical authorities are aware of the problem of the battered baby? Surely it needs a great deal more information in order that this syndrome shall be recognised?

There is a general awareness of this problem in the medical profession. We are considering the advisability of particularly drawing the attention of people like casualty officers, who may be the first to come into contact with these difficult cases, to the problem.

Family Allowances

22.

asked the Secretary of State for Social Services what proposals he has for improvements in family allowances.

16.

asked the Secretary of State for Social Services what plans he now has to increase family allowances.

I explained in an earlier reply why we cannot yet commit ourselves to one particular possible solution.

Does the hon. Gentleman accept that a major problem today is the large family of the low earner? Has he any other instrument anything like as effective as the family allowance system for dealing with that real and increasing problem?

The family allowance system has made a great contribution. It is fascinating to bear in mind that there was no increase when the right hon. Gentleman was a Minister between 1956 and 1964 and that family allowances have been more than doubled since this Government came to power.

Is my hon. Friend aware that the right hon. Gentleman reacted rather strongly with a Motion on the Order Paper when his right hon. Friend the Member for Enfield, West (Mr. Iain Macleod) suggested that the family allowance be increased? Whilst on this side many hon. Members feel that it could be electorally unpopular, nevertheless it it a necessary thing to do and my hon. Friend would have full support for increasing the family allowance.

I think that I now understand what the right hon. Member for Enfield, West (Mr. Iain Macleod) meant, because it was explained by what looked like a well informed article in The Times today in which it was suggested, by the political correspondent, that the policy of the Conservative Party, if returned to power, would be that the family allowance would not be paid to those inside the tax range and that there would, by this means, be a saving of£200 million. So it is an unreal offer, unless we hear something different from the Opposition.

Is the Minister aware that my right hon. Friend was suggesting that if tax reliefs were to be made available, one of the highest priorities should be children in poverty, and that the speediest way of doing it was through the family allowance system with claw-back?

My right hon. Friend the Chancellor of the Exchequer did precisely this. By raising the threshold of taxation he has helped a large number of families with very small incomes. If the intention is to raise the family allowance just for those below the tax threshold and to remove it from those above, it would have shattering effects upon those with small and modest incomes.

On a point of order. In order to enable the Minister of State to do his homework and to learn what action we would take, I beg leave to give notice that I shall seek to raise the matter on the Adjournment at the earliest possible opportunity.

38.

asked the Secretary of State for Social Services what consultations he has held with voluntary bodies in regard to the payment of family allowances.

None, Sir. Family allowances are paid through a well-established machinery, and I am not aware of any problem creating a need for consultations on this subject.

Is the hon. Gentleman aware that, although he may not accept the figures of the Child Poverty Action Group, the public is deeply concerned about child poverty and expects the Government to do something about it? Would the hon. Gentleman make an unequivocal statement that the Government propose to take urgent action?

May I give the hon. Gentleman some information? If we make a comparison between 1964 and 1969, we find that the low-wage earners have done substantially better than other sections of the population. Taking account of the Budget, a married couple with two children have 11½ per cent. more money in their pockets than in 1964, a couple with three children have 14½ per cent, more, and a family with four children are 16½ per cent. better off. These are genuine increases in spending power after allowing for all price increases. I therefore cannot accept what the hon. Gentleman says.

Is the hon. Gentleman aware that in almost every one of his replies he has referred to what the Tories did in 1964? Is he aware that since January, we have been told nothing about what the Government propose to do in the unlikely event of their winning the election?

For 26 sittings, the Standing Committee on the National Superannuation and Social Insurance Bill has been considering the Government's long-term social security proposals for the next 20 or 30 years, yet the hon. Gentleman says that we have not presented our proposals. My ears have been pinned back in the hope of getting one clue about what the Opposition have to put in their place.

Dental Treatment

24.

asked the Secretary of State for Social Sarvices what steps he takes to inform dental patients that unless a fresh agreement for National Health Service treatment is made at the beginning of each course of treatment, the patient may find himself liable for private fees for that treatment.

The leaflet issued by my Department on dental treatment under the National Health Service already makes it clear that a separate arrangement is necessary for each course of treatment and the revised edition which is now being ordered will add a reference to liability for private fees when such an arrangement is not made.

Will these pamphlets be on public display in dentists' waiting rooms'? Is it not highly unsatisfactory that mere silence on either side can result in heavy bills for National Health Service patients?

We will be making these pamphlets available to both doctors and dentists who are willing to place them in their waiting rooms. I hope that dentists will place them in their waiting rooms so that patients understand their position. If we have any considerable amount of evidence that patients are still in ignorance, we might have to review the question of the distribution of these pamphlets.

Would it not be better to ask dentists and their staff to point out to each patient what the position is? I have just returned from the dentist. I had to have explained to me this morning that it means 30s. for each course of treatment. It is much safer to have it explained personally than to put it into a leaflet. Dr. Dunwoody: I agree that it helps to have it explained personally. Nevertheless, I believe that leaflets have a real part to play. We should use both methods—and indeed other methods—to ensure that patients understand the position.

Nurses' Pay (London Weighting)

25.

asked the Secretary of State for Social Services if the London weighting extra salary is to continue to be paid under the new salary scales for nurses.

If there is an accepted case for this London allowance, is there not also a case for other large cities where there is a high cost of living compared with rural areas?

I cannot accept that. The London weighting is payable to nonresident nursing staff. It reflects the higher cost of housing and travelling in London. This matter has been agreed by the Nurses and Midwives Whitley Council, which has seen fit to restrict this extra salary to the London area.

Nurses (North Devon)

29.

asked the Secretary of State for Social Services what steps he is taking to overcome the shortage of nurses in North Devon.

Local shortages call primarily for local action but my right hon. Friend has recently launched a national publicity campaign to stimulate recruitment. The North Devon Hospital Management Committee is making great efforts to recruit more student and pupil nurses by means of visits and talks to schools, careers exhibitions and addresses at local meetings.

Will the Minister bear in mind that money is probably not the only reason? Will he inquire into the reason there is a shortage in this area? There is not much point in building a new hospital there if there is not an adequate supply of nurses.

I agree that money is not the only reason, although I think that the recent pay award to nurses will help. This is an area where there has been difficulty in recruitment. Our experience elsewhere in the country is that the building of a new hospital will attract nurses. We find that new hospitals often have much less in the way of recruitment problems than some of the older hospitals. I think that the community can look forward to some help when the new hospital is completed.

North Devon Hospitals(Waiting List)

30.

asked the Secretary of State for Social Services why the waiting list for North Devon hospitals has increased by 25 per cent. in the past year; and what steps his Department is taking to assist the regional hospital board to reduce this list.

Admissions to the North Devon Infirmary were restricted to urgent cases while wards were being refloored. The wards are now in commission and a new theatre has been opened. The position is expected to improve quickly throughout the group.

Will the Minister bear in mind, again, that it is not only in Barnstaple but, indeed, in Bideford that there is a 25 per cent. increase in the waiting list? This is a serious problem which is partly due to the fact that there are new indutries there and a vast increase of elderly people coming into the district, so adequate facilities must be provided.

The new industries in the South-West are something which the hon. Gentleman and I welcome. I agree that there is a problem in Bideford, and it is related to the problem in Barnstaple. We hope that the situation will improve quickly throughout the whole group, not only in Barnstaple and Bideford. I should tell the hon. Gentleman that all urgent cases are admitted without delay.

Homeless Mentally Sick People(London)

31.

asked the Secretary of State for Social Services whether he will initiate a survey into the number of homeless mentally sick people in the London area.

It would not be practicable to do precisely what the hon. Member is suggesting. But I have recently asked the Institute of Psychiatry to carry out research into the problems of homeless men passing through the Camberwell Reception Centre. The results should be useful in deciding what more can be done to help homeless mentally sick people.

Is the hon. Gentleman aware that it is estimated that about one-third of patients discharged in the London area have no homes to go to? Many go to reception centres, but at the moment these centres have no psychiatrically trained workers. Is not this, therefore, the first priority?

We are considering whether there is any wider research that we can do into the question of homeless people, but I think that we shall discover a great deal from the research that is being conducted now. It is being done by a psychiatrist and a social worker. The number passing through the Camberwell Centre is substantial, and I hope that a lot of light will be thrown on the problem as a result of this research.

Mental Hospitals(Schizophrenic Patients)

32.

asked the Secretary of State for Social Services how many schizophrenic patients have been released from mental hospitals since the Mental Health Act, 1959.

Discharges of patients with a diagnosis of schizophrenia have averaged about 34,000 a year since 1964. Figures for previous years are not available.

Can the hon. Gentleman say how many of these patients have been readmitted.

I could not without notice say how many. I think that it would be a comparatively small proportion of the number. We need not be too concerned. The fact that we can get so many more patients out of hospital means, inevitably, that some relapse and require further treatment. These are patients who, in days gone by, were doomed to spend their days entirely in hospital.

Abortion Act, 1967 (Section 4)

33.

asked the Secretary of State for Social Services whether, in view of the difficulties experienced in certain parts of the country in obtaining terminations of pregnancy, he will seek to amend Section 4 of the Abortion Act, 1967, so as to require doctors who decline on grounds of conscience to recommend terminations of pregnancy to refer patients to other doctors who have notified him of their willingness to carry out terminations in all circumstances.

No, Sir. Such matters are the professional concern of the doctors involved. I understand that doctors who have a conscientious objection to abortion would regard it as normal practice to consult colleagues who have no such objections whenever this is necessary in the patient's interest.

My right hon. Friend says that this is normal practice, but may I, nevertheless, draw his attention to a particularly outrageous case in Sheffield of a rubella pregnancy which was not terminated, and where the lady concerned was told by a consultant, a Mr. D. C. A. Bevis, that if she underwent an abortion—she was two months' pregnant—she stood a 50–50 chance of dying? The pregnancy went to term, and the child subsequently died. Would not my right hon. Friend agree that that is an outrageous case? The doctor in this case is hiding behind the Section of the Act, and it needs amending.

I should not have said that the Sheffield case, which I personally greatly regret, is sufficient proof that the Act needs amending.

Retirement Pensioners (Home Helps)

36.

asked the Secretary of State for Social Services what steps he now proposes to take to assist the recruitment of home helps for pensioners.

I met representatives of the local authority associations last week to consider the findings of the recent Government Social Survey report which made suggestions on recruitment and other measures for improving the home help service, and I shall be pursuing these matters further with them.

That is encouraging as far as it goes. Is it not the case that the current shortage of home helps is one of the most unfortunate results of the financial restrictions which local authorities have recently been suffering? Can the right hon. Gentleman assure us that the Government will in future give more help and encouragement to local authorities so that this service can be expanded much more rapidly?

If the hon. Gentleman studies the report he will agree with me that that is an over-simplification. There are areas of the country, as I found from the delegation which came to see me, where they have the money, but they cannot recruit the staff. It is not simply a shortage of money, and what we are looking at now is whether there are other forms of organisations, including voluntary organisations, which can fill this gap. I do not think that we should rely exclusively on the home help.

National Insurance (Benefits)

37.

asked the Secretary of State for Social Services which benefits under National Insurance for which beneficiaries become entitled by the payment of contributions are only payable subject to a test of means.

Is the hon. Gentleman aware that his Department's proposals for introducing a means test for unemployed men receiving occupational pensions are unpopular and also introduce a highly unacceptable principle? Will he undertake to withdraw his proposals and come forwad with another recommendation which does not conflict with the whole basis of national insurance?

I assure the hon. Gentleman that I shall not give that assurance. He is aware that the matter has been carefully considered by the National Insurance Advisory Committee which, with only one dissenting voice, made its recommendations, which have been much modified by my Department. When the hon. Gentleman says that they are unpopular, he should remember that there is also unpopularity in the country with that section of society who have retired and who are receiving substantial occupational pensions while at the same time drawing unemployment benefit.

Is it not a fact that the one dissenting member of the National Insurance Advisory Committee was Lord Collison, whose experience in social welfare is unrivalled? Should not his views be respected? The Order has been floating about for weeks, and, although the hon. Gentlemen will not give an assurance, is not that an indication that it will be quietly dropped?

I think that the right hon. Gentleman will find that he is wrong. It is true that the one dissenting voice is a very distinguished and very experienced voice. But the experience and weight of the majority are distinguished, too. It is strange to argue that the minority should always have its way. I can assure the right hon. Gentleman that the matter will come before the House very shortly.

South Shields General Hospital

39.

asked the Secretary of State for Social Services when a new maternity unit will be provided at South Shields General Hospital.

I understand that the Newcastle Regional Hospital Board, in reviewing its programme, will consider bringing forward this scheme.

Is my hon. Friend aware that there is great interest in the initiative shown by his Department in bringing forward this special type of unit? We are eager to get it started and into operation.

I realise that the community in South Shields is eager to have the unit functioning. There are, however, many other problems for which the Newcastle Regional Hospital Board is responsible. The question of priorities in its region is best resolved by the board.

40.

asked the Secretary of State for Social Services what action is being taken to overcome the shortage of nurses and other staff at South Shields General Hospital.

The shortages in recent months have been mainly of nursing staff. The management committee has arranged visits to schools and careers conventions as well as Press advertisement, and following a new intake of student nurses on 1st May the total number of staff in post is now less than five below establishment.

In view of local publicity, would my hon. Friend give an absolute assurance that no kind of financial restriction is involved?

There is no question of financial restriction. There has been a problem about recruitment, but the hospital management committee has gone quite a long way towards solving its difficulties.

Child-Proof Pill Container

41.

asked the Secretary of State for Social Services if he will now introduce a child-proof pill container, following the analysis of the study by the Medical Care Research Unit.

The analysis of the field work by the Medical Care Research Unit is not yet complete. The results of this study, when available, will need to be considered together with those of other related inquiries mentioned in my Answer on 14th April to my hon. Friend the Member for Harrow, East (Mr. Roebuck).—[Vol. 799, c. 229.]

But since 10,000 children a year are accidentally poisoned, of whom 40 die, is there not a strong case for urgent action to take advantage of containers which are already available, even if they are not 100 per cent. effective?

I agree that there is a problem, and my Department is urgently considering what additional steps it can take to reduce it. The essential safeguard is to keep all medicines out of the reach of children, preferably under lock and key. I have personally examined so-called childproof containers, and I am not convinced that they are necessarily an enormous step forward. Some of those I have seen could be opened by a considerable number of intelligent three-year-old and fouryear-old children.

Would the hon. Gentleman agree that, in addition to persuading people to keep all medicines and drugs out of children's reach, it would be helpful if he could persuade people not to hoard medicines and pills which they have finished with for some future unspecified occasion but to throw them away?

I agree. The practice of hoarding drugs is a potentially dangerous and foolish one, and I advise patients not to do it. I would urge them strongly to throw medicines and drugs away or, preferably, to return them to the pharmacist from whom they came.

Hospital Doctors (Extra Duty Allowances)

42.

asked the Secretary of State for Social Services whether he is satisfied with the way doctors' overtime is assessed under the National Health Service; and if he will make a statement.

A system of extra duty allowances for intermediate and junior grades of hospital doctors has been agreed between my Department and the profession's representatives, including representatives of junior doctors. The agreement is not based on the usual overtime principles; additional payments will be made only when there is encroachment into the minimum time off-duty recommended for these grades.

Can the right hon. Gentleman answer the question which he was unable to answer earlier? The extra payment does not come into operation until a senior hospital doctor has done 108 hours a week on duty and a junior hospital doctor has done 104 hours a week. Does not the right hon. Gentleman think that this situation should be changed as soon as possible?

Although there has been some opposition, I am, on the whole, content with the agreement reached.

Hospitals (Day-Patient Treatment)

45.

asked the Secretary of State for Social Services what plans he has to enable more patients to be treated without staying in hospitals.

There is constant expansion in the provision of day-patient treatment in the fields of geriatrics and psychiatry, while an increasing number of minor surgical and diagnostic procedures are being carried out on this basis. I am confident that this development will lead to a reduction in the length of stay in hospital, or even avoid admission altogether in some cases, though the rate of progress will depend to some extent upon the availability of adequate domiciliary services.

While welcoming the tendency towards community care rather than institutional case, may I ask the right hon. Gentleman whether he has any plans for helping financially since most of the cost will fall on the ratepayer rather than on the taxpayer and the Government have reduced the rate of increase in rate support grant and cut back the local authority health and welfare services?

If the hon. Gentleman looks at my answer, he will see that the suggestions I made do not bear on the ratepayer, because day-patient treatment in hospital is a Health Service responsibility.

Doctors' Remuneration

46.

asked the Secretary of State for Social Services whether he is satisfied with the present method of remuneration for doctors; and if he will make a statement.

Methods of remuneration are kept under review in consultation with the profession and if the hon. Member has particular points in mind I shall be glad to consider them.

It is the junior hospital doctors who are mostly in contact with the public and who therefore tend to work very long hours. To what extent is the burden of dealing with the public, particularly in emergencies, apt to fall on tired and overworked men?

I would say that there was substance in that criticism. It is something which we must bear in mind when assessing remuneration. That explains my reply to the previous Question.

Old Persons (Residential Homes)

47.

asked the Secretary of State for Social Services what is the average net marginal cost to public funds of caring for one aged and infirm person in a local authority old persons' home.

I assume the hon. Member has in mind the cost to public funds of care in a residential home compared with care in the community. This information is not available.

Stratton Hospital (Clinical Assistant)

48.

asked the Secretary of State for Social Services what discussions he has had with the South Western Regional Hospital Board about filling the post of clinical assistant at Stratton Hospital; and if he will make a statement.

I understand from the South West Regional Board that it hopes soon to fill the post. It is aware that it needs special authority to continue to employ a practitioner over the age of 70 and I understand that it is seeking a younger candidate.

Is the hon. Gentleman aware that this post has been vacant for at least six months, to my knowledge? The person who was practising in this post up to six months ago is over 70 years of age. Is it not monstrous that the people of Bude should be denied this service simply because somebody is a few months over the statutory age laid down by the Ministry?

I realise that there has been a vacancy for a period, but I do not think that the situation is monstrous. The regional board is seeking a younger candidate. I hope that it will succeed, and that the services to the community will be provided.