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Social Services

Volume 887: debated on Tuesday 25 February 1975

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

Eec Social Action Programme

1.

asked the Secretary of State for Social Services what action she has taken to implement those parts of the EEC social action programme which fall within her Department's responsibility.

The Minister of State, Department of Health and Social Security
(Mr. Brian O'Malley)

The United Kingdom has secured approval for payments from the European Social Fund towards the cost of schemes to rehabilitate handicapped persons. Commission proposals concerning other parts of the programme affecting my Department are still being discussed within the Community or are awaited.

I am grateful to the Minister for that reply. Can he give an indication of the level of funds available at the moment for that and also what voluntary bodies in this country are working in co-operation with his Department to further these pilot schemes?

The total level of expenditure from Community funds as they are envisaged for a two-year period is £1 million. Second, there is an advisory committee which was set up directly through the EEC by a number of individuals who are in other ways connected with voluntary organisations. My Department is in contact with that advisory committee.

Apart from one's attitude to the Common Market, would my right hon. Friend agree that this is a bold and imaginative programme which is being conducted by the EEC? How can he make these support grants better known in this country? How many people are involved, particularly among the physically handicapped?

I should make it clear that the whole of this social action programme is in the very early stages. Perhaps my hon. Friend will put down a separate Question on his second point. I should want notice of it.

Haemophiliacs (Drugs)

2.

asked the Secretary of State for Social Services if she will now consider making adequate supplies of Factor VIII (AHG) available to the National Health Service so that it is self-sufficient in this product for the benefit of those suffering from haemophilia.

I have authorised the allocation of special finance of up to £500,000, about half of which would be recurring, to increase the existing production of Factor VIII, especially in the form of anti-haemophilic globulin concentrate (AHG), within the National Health Service. The first effects of this will, I hope, be felt by the end of the year.

I welcome that reply. Does my hon. Friend accept that one of the major problems in relation to Factor VIII is that the purchase of this drug rests with the regional health authorities and that it has to compete with many other requirements within those authorities? Will he also accept that this is far and away the best treatment for haemophilia? Will he accept too that in those circumstances it might be possible for the National Health Service to purchase the drug centrally as it does with L-dopa? Will he seriously consider recommending that the drug should be available to people at home and not only in hospitals, as many people have to travel many miles either for treatment or to obtain the drug?

I confirm that in most cases I think it is the most desirable form of treatment, but one cannot avoid the fact that this is one of the many costly treatments which are competing on priorities. The present system whereby a doctor can persuade his local area health authority that his patient needs this form of treatment most is the best way of proceeding, and not by central allocation. If we were to go to all-commercial purchase of this factor, it would cost an additional £1½ million to £2 million annually.

Does not the hon. Gentleman agree that under-treatment of children with this drug causes unnecessary suffering and terrible disruption of family life if a young child is involved? Cannot he go a stage further and give slightly more of a lead to the regional health authorities really to do something about this?

They are aware of our concern and have had ample demonstration of it by the fact that we are prepared to divert scarce resources to make the National Health Service self-sufficient, but I concede that it will take two or three years before we are at full production. During that time I am sure that they will weigh very carefully the individual cases and will be sympathetic to the sort of hardship which can arise.

While one welcomes the extra expenditure which my hon. Friend has announced, and of which I am aware in view of the recent case I brought to his attention, may I ask whether he does not agree that we still lag behind in this matter, particularly compared with small countries such as Israel, which is doing much more than we are in this respect?

I know my hon. Friend's concern, but hon. Members must face the fact that with limited resources we have to choose, and these are very difficult choices and priorities. When confronted with an ill child, everyone wants to get the best that is available, but there are many other aspects of child care which also have priority and we are not always able to meet all the demands.

Family Allowances (Eec Countries)

3.

asked the Secretary of State for Social Services what is the level of family allowance payable to first or only children in the nine countries of the EEC.

As the answer contains a table of figures, I will, with permission, circulate it in the Official Report.

As the Government's family endowment scheme was, I think, seen by many as the entry price for this country to the European league of paying a family allowance to the first child, and as that scheme now seems to have been indefinitely postponed, will the right hon. Lady consider, at the relatively meagre net cost of £11 million, extending the family allowance scheme to the first or only child of one-parent families? Would not that mean that the Government would then be accepting one of the principal recommendations of the Finer Report?

The hon. Gentleman is wrong on both his premises. The child endowment scheme of the Labour Party was worked out when we were in opposition as part of our total social policy, completely unrelated to any question of membership of the Common Market. After all, in the Common Market France has no automatic payment of family allowance for the first child. Therefore, it is by no means completely universal there. Nor is the hon. Gentleman right in saying that our child benefit scheme has been indefinitely postponed. An announcement on all these matters can be expected before too long.

To get a true comparison between the United Kingdom and the EEC countries when the record is available, may we be told all the ages of the children and the duration of each allowance? May we also know whether, in the various countries for which information is given, we may learn about the availability or otherwise of free milk, and, again, at what ages?

The hon. Lady is quite right that the payment of the family allowance or the level of the family allowance is not the complete index of family support. There are many other matters of great importance to the family—not least food and housing subsidies, whether there is free medical care, and the level of ante-natal and post-natal care. I entirely agree with the hon. Lady about that. With regard to her request for this detailed information to be made available, I do not think that it is in the table we have prepared for publication in Hansard today, but I shall look into the matter and see whether we can extend the information for her.

Is not my right hon. Friend bewildered by Opposition Members who from time to time demand a levelling-up of social service and any other benefits to compare with those in Common Market countries but at the same time scream murder when our wage-earners, the miners who work at the coalface in particular, try to level up their wages to those paid in the Common Market?

My hon. Friend has made a valid point. But I am even more bewildered that any questions about the need to increase or extend family allowances should come from the Opposition, remembering that the Conservative Party fought the 1970 election on a promise to increase family allowances and promptly broke it.

If I may disregard the fact that in the reply the right hon. Lady overlooked our family income supplement, may I ask whether she is aware of the disappointment in many quarters of the House that she has ducked another opportunity of making her position clear about the family endowment scheme and Child Benefit Bill, which were part of the Government's proposals to bring in the family allowance for the first child? As the whole House knows from leaks, this plan has been put back beyond the intended date of April 1976. When will the right hon. Lady have the courage to come to the House and make a statement explaining why she has abandoned such an important part of the social contract and why she is ratting on a clear election commitment of the Labour Party?

The hon. Gentleman has no ground whatsoever for that assumption. I would point out to him that again, unlike our predecessors, the present Government have fulfilled their promises to increase family allowance, within a year of taking office in February 1974. Therefore we have lost no time, and we shall certainly keep our promise about a child benefit scheme.

Following is the information:

On the latest information available, the rates of family allowances payable for first or only children are as follows:

Monthly FAM

Sterling equivalent of Monthly FAM

Sterling equivalent of Weekly FAM

££
Irish Republic£2·302·30(1)0·53(1)(2)
Italy8,060 Lire5·281·22
Holland54·86 Florins9·572·21
Belgium1,026·50 BFr (3)12·392·86
Denmark132·3 Kroner10·022·31
Germany50 DM9·052·09
Luxembourg814 LFr9·822·27
FranceNo general provision (4)
United KingdomNo general provision at present
(1) Exchange rates as at 20th February 1975.
(2) Weekly rate calculated on basis of 52 week year.
(3) Plus an allowance for child aged 6 or over, according to age, of up to 548·25 BFr monthly (£6·62 monthly, £1·53 weekly)
(4) In certain circumstances, and subject to a means test, an increase of up to 242·05 Fr monthly (£23·72 monthly, £5·47 weekly) may be added to the allowance paid to a family with only one wage earner.
Comparisons of rates and coverage of family allowances are misleading unless they take account of the local cost of living (particularly that affecting the maintenance of children) and other factors which vary from country to country, such as the levels of wages and taxation, housing or food subsidies, and the extent of free education, medical care and ante and post-natal welfare and advice services.

Children In Care

5.

asked the Secretary of State for Social Services how many children in care are members of one-parent families; and what proportion of all children in care they represent.

I thank my right hon. Friend for that reply but I am sorry that the information is not available. I find it a matter of concern that such information is not available, and I must ask her whether she agrees. Does she agree with me that the impression among those who work in the social services is that although one-parent families form only one-tenth of the community the proportion of children in care who are members of one-parent families is considerably higher than that? If my right hon. Friend agrees about that, will she accept that many of those children are in care unnecessarily and simply because our society does not provide the services and the money for their families to sustain them in the community? Will she give some hope to one-parent families, whether or not their children are in care, of greater help in the future, apart from the family endowment scheme? Although I welcome that scheme, it will not solve the problems of one-parent families.

In answer to the first part of my hon. Friend's question, information about children in care was collected by our predecessors and published in March 1973 in Command 5815. It was considered more important to place emphasis on identification of the circumstances in which children were placed in care than on the nature of the families from which they came. That is the information which is given in the White Paper and which is crucial for social policy. It is important to emphasise that.

With regard to my hon. Friend's other point, I should be glad to send her a copy of the speech I made on Friday to the Conference on One-Parent Families which sets out in considerable detail not only what steps we have already taken to fulfil the recommendations of the Finer Report but the other considerations we have in mind.

Is the right hon. Lady aware that the Opposition would very much support a full debate on the whole question of one-parent families and the Finer Report? Is she aware that the matter of children in care is only one part of the problem we are facing, that there are over 1 million children whose future is affected and that it would be quite wrong if the House could not give a full day's debate to this very important question?

The hon. Gentleman has the remedy in his own hands. We should be delighted if the Opposition were to devote one of their Supply Days to this subject.

The right hon. Lady has not been fair to the House—and I am sure she is not fair to herself—to suggest that the Government do not have time to debate the whole question of the Finer Report and then to ask my hon. Friend for a Supply Day to be used. Will the right hon. Lady say this afternoon when she will give time to help the one-parent families?

The hon. Gentleman is perfectly well aware that matters of the allocation of time for debate are not for me; they are for the Leader of the House. As far as I am concerned, however, I should welcome an opportunity of telling the House at length the steps we have already taken to fulfil the 230-odd recommendations of the Finer Report. I should also point out that my Department has a massive programme of legislation on social advance and social reform and that we need a great deal of parliamentary time to get it on to the statute book.

Community Hospitals

6.

asked the Secretary of State for Social Services how many community hospitals she has authorised for the year 1975–76.

At present I am afraid that I cannot say which capital schemes will be authorised to start during 1975–76. Consultations have taken place with regional health authorities on tentative proposals for the 1975–76 programme. No final decisions will be taken until their priorities have been carefully considered. This should be very shortly.

Will the Minister say whether a new community hospital in Newbury may be in his thoughts? Will he also say what level of service community hospitals will provide and how their services will compare with those already provided by district hospitals?

No community hospital at Newbury is at present in the regional health authority programme. But the announcement of the Government's acceptance of the community hospital concept was made only last summer, and many regional health authorities will take time before they develop their programmes. The size and scope of the community hospitals will vary considerably from area to area.

Is the Minister able to assure the House that he is continuing to urge upon health authorities the desirability of retaining existing cottage hospitals where they have a future rôle as community hospitals now that there is a recognition of the place of community hospitals?

The recognition that in some rural areas the community hospital had a part to play where patients had to travel over great distances was a strong part of our announcement last summer on community hospitals. I cannot say that there will not be closures of some community hospitals, but I can reinforce the message of the White Paper that there is scope for smaller hospitals in rural areas and, in my view, in urban areas. The whole question of the size of the large district hospital is one which we shall have to call into question increasingly over the next few years.

Keighley

7.

asked the Secretary ot State for Social Services if she will pay an official visit to Keighley.

May I say how sorry I am to receive that answer? If my right hon. Friend were to visit my constituency she would receive representations from many of my pensioner constituents who are very much concerned at the injustices and anomalies regarding the allocation of free television licences. Will she assure the House that she will give urgent consideration to making free or reduced-price television licences more readily available? Finally, will my right hon. Friend prevail on her right hon. Friend the Secretary of State for Defence to stop buying nuclear missiles so that the cost of my proposals can be met from defence savings?

It is obvious that my hon. Friend is anxious to keep me busy not only by visiting Keighley but by running a couple of other Government Departments as well. My hon. Friend is aware that our policy on television licence fees is a matter for my right hon. Friend the Secretary of State for the Home Department. Of course, as my hon. Friend the Minister of State, Home Office made clear last Friday during a discussion on this matter, we are concerned, as is everyone in the House, about the existence of anomalies which give rise to a great deal of irritation. I appreciate that point. The simple way of getting rid of the anomalies by making free television licences available to all pensioners would be extremely costly and would in a way, create its own anomalies. It would mean that families which happened to have a pensioner living with them would benefit, whatever their income, at the expense of a family living on a very low income. I repeat the assurance which my hon. Friend the Minister of State gave on Friday that the Home Department is considering providing cheap licences for black-and-white television for pensioners and getting rid of some of the anomalies.

Does the right non. Lady accept that if she made free television licences available to pensioners living on their own or with a spouse the anomaly to which she has referred would not arise? Is the right hon. Lady aware that there are many people who feel strongly that the problem of loneliness which old people now face could be reduced in this desirable way by spending a relatively small amount of money?

Of course, the Government have examined that possibility. The concentrating of help on specific cases is a very obvious course to take. I can assure the hon. Lady that the matter is not as simple as all that. Even that step would not remove the difficulties. As I have said, the Home Office has made it clear that it is considering the matter again.

On a point of order, Mr. Speaker. Has not the right hon. Lady wandered a little far from Keighley and the point which was raised by the hon. Member for Keighley (Mr. Cryer)? Do you not think, Mr. Speaker, that the hon. Gentleman was treating the right hon. Lady more as a Prime Minister than as a Secretary of State by asking her to visit his constituency?

Order. I would much prefer these points of order to be made at the end of Question Time. The right hon. Lady is responsible for her answer, I am not.

Public Expenditure

8.

asked the Secretary of State for Social Services if she will publish a White Paper setting out in detail the effects of the latest cuts in public expenditure by her Department.

No, Sir. I am not aware of any cuts of the kind the hon. Gentleman seems to have in mind.

Does not the right hon. Lady think that it is about time she took the country into her confidence about the cuts which are being made piecemeal in such projecs as St. Mary's Hospital, Paddington and hospitals in Birmingham and Leeds? Does she not think that it is about time she joined the ranks of her colleagues who are trying to spell out to those who are responsible for much of our inflation that every fresh breach of the social contract means less money for the nation's health and welfare services?

I merely say to the hon. Gentleman that I think it ill becomes any Conservative Member to use the word "cuts" about the future prospects of my Department. That is the suggestion that is coming from supporters of the then Tory Government which instituted the cuts of December 1973 and reduced my public expenditure programme for health and personal social services by £138 million. Conservative Members have no right to try to give the impression that we are facing cuts in my Department. In the current year we have already restored £100 million worth of that reduced expenditure. Some of it has been restored in national health services. It is true that we have said—and we must continue to say—that the growth in the expenditure of my Deparment can only be modest over the years ahead if we are to get on top of our economic difficulties. None the less, it would be misleading to suggest that there was anything but growth.

Why should we have any cuts at all in public expenditure, whether in my right hon. Friend's Department or any other Department, while the Cabinet and the Government can seemingly find approximately £250,000 to satisfy the Queen?

My hon. Friend knows perfectly well that that is not within the scope either of my Department or of the Question before the House. I must tell him that I am thinking in terms of expenditure in my Department of much more than £200,000.

In real terms, has the expenditure for which the right hon. Lady's Department is responsible been maintained or reduced?

The expenditure for my Department, as the White Paper on Public Expenditure makes clear, reveals a situation of steady growth. [Interruption.] Oh yes, it is a position of real growth in real terms. This is an extremely important point. The figures I have given are based on real terms. Already this year the Government have added £600 million in Supplementary Estimates for my Department to cover the increases in pay and prices, and the inflation-proofing of the expenditure on the National Health Service which we have introduced, along with the marked improvement in the pay of the people working for the Service, has done a very great deal to restore the flagging morale of the NHS which I inherited.

Birmingham And Midland Eye Hospital

10.

asked the Secretary of State for Social Services if she will make a statement on the future of the Birmingham and Midland Eye Hospital.

The region's capital programme for 1975–76 is not yet finalised, but it now seems certain that it cannot include replacement of the eye hospital. The regional health authority will consider the future of the hospital during its review of priorities for 1976–77 and subsequent years.

I thank my hon. Friend for that reply. I was awaiting it with interest having listened to the answer which my right hon. Friend gave to the previous Question. Does my hon. Friend accept that that answer will not be considered to be very satisfactory in the region, bearing in mind that the regional health authority has already spent £1½ million on laying out sewers and associated work and is now considering having to put it in an empty office block? Lastly, when can I expect a full answer to the Question which I asked on 4th February concerning this hospital?

I have a reply outstanding to my hon. Friend and I shall give it as soon as the information is available. I regret the delay. On the question of the need for the hospital there is no difference between us. This, like many other hospitals, definitely needs to be built. It is a question of the work already undertaken. The replacement of the eye hospital has been planned as about 11 weeks for ophthalmology and planned for the Queen Elizabeth site costing perhaps £20 million. That cannot be fitted into the programme for 1975–76.

Is the hon. Gentleman aware that his answer will strike a chill throughout the West Midlands, where the decision by his Department to close this hospital, however temporarily, is regarded as callous?

I hope that when the public expenditure Estimates are next discussed in the House the hon. and learned Gentleman will be the first to argue for greater public expenditure. It is about time that Conservative Members stopped talking with two mouths. They are always against increases in public expenditure in general but want them in their own constituencies and want them in particular. They will carry more weight and conviction in the House, in the National Health Service and outside when they support increases in public expenditure across the board.

Charges For Services

11.

asked the Secretary of State for Social Services what is her policy on increasing existing charges or introducing new charges in order to expand the social services to give greater help to those in greatest need.

I do not believe that income from charges should play a larger part in financing these services than it does at present.

Does the Secretary of State recall that the present basic prescription charge was fixed in April 1971 at 20p? Does she realise that in real terms that charge would have to be fixed at 30p today to match the 1971 figure? Does she realise that as we will be short of money for the health service every possible avenue for money for the social services needs to be examined?

I am in no position to contest the hon. Gentleman's figures. He is merely proving that we are standing by our policy to phase prescription charges out of the National Health Service. That is our policy. In the same way, we refused to increase dental charges even when dental rates rose, thus continuing the policy to which we are committed. I simply disagree with the hon. Gentleman on policy.

Will the right hon. Lady explain how she will replace the revenue which at present she gets from private hospital beds?

In exchange for the phasing out of private beds from the National Health Service I shall get more National Health Service beds.

Hospital Waiting Lists (Staffordshire)

12.

asked the Secretary of State for Social Services how many patients are on the waiting list of the North Staffordshire hospitals; what is the average delay in receiving treatment; what are the causes of delay; and whether she will make a statement.

Four thousand, five hundred and fifty-five at 31st December 1974. Waiting times differ between specialities, and during 1974 they varied between about 11 weeks for ophthalmology and 20 weeks for ENT. These figures are broadly comparable with the latest available figures for the West Midlands Region. I know of no particular difficulties affecting the waiting lists in North Staffordshire hospitals.

Do not these figures reveal the totally unnecessary discomfort and anxiety which is caused to a very large number of people in North Staffordshire? Will my hon. Friend ensure that greater resources are allocated to North Staffordshire hospitals, which have long been neglected? In particular, will he make provision for the replacement and extension of geriatric facilities in my constituency?

The replacement of geriatric beds and the expansion of facilities, particularly acute rehabilitation services for geriatrics, stand very high in our assessment of priorities. I readily agree with my hon. Friend in that. Priorities within the region are primarily for the West Midlands Regional Authority itself.

One of the major causes of the long delays in admission to hospital is the large number of empty hospital beds. On any one day there are 75,000 beds empty. Further, there are more than 11,000 beds empty due to shortages of staff. If the hon. Gentleman and his right hon. Friend were to pay a little more attention to staffing problems rather than attacking private practice and pay beds, we might reduce the waiting lists.

The reasons for waiting lists are very complex, as the hon. Gentleman is probably the first in the House to know. Staffing is one of the factors. The most important factor of all was shortage of nursing staff. The pay of nurses was in a most disgraceful situation when we came into office. As a result of a very substantial award, following the Halsbury Report, of over £180 million, I think there are some signs that nursing recruitment is improving and that we will be able to staff more of our wards then we have done hitherto. This will make a contribution to reducing the waiting lists.

Chester (Hospitals)

13.

asked the Secretary of State for Social Services if she will make an official visit to the hospitals in the city of Chester.

Is the Minister of State aware that we are very upset that he has no plans to come to Chester? That aside, will he tell us whether the proposed new district general hospital has been delayed or cancelled and, if the latter, whether he is prepared to make available, so as to bring up to date the existing hospitals, money which is not being spent because of the proposal for the new hospital?

In the current financial year works with a completed cost of over £¼ million have started or are planned to start for Chester hospitals. The works include a geriatric day hospital, an intensive therapy unit, and anaesthetic unit and the upgrading of a pharmacy. On the main question, the regional health authority reluctantly decided that design work on phase 2 of the West Cheshire hospital project should be suspended.

Is the Minister of State aware that if he were to go a little further east and come to Macclesfield he would find the people in that area appalled at the attitude of his Department and of the Merseyside Regional Health Authority in their total ignorance of the need for a new district general hospital in Macclesfield? This has been planned for some 10 or 15 years. I gather from information that has come to me—I hope that the Minister is aware of this—that the project has been shelved indefinitely. Will he comment?

The project in Macclesfield and that in West Cheshire were both deeply affected by the capital expenditure cuts notified to the region in November 1973. No doubt both hon. Gentlemen voted against the cuts of 20 per cent. in capital expenditure imposed by the Tory Government at that time.

Family Allowances (Increase)

14.

asked the Secretary of State for Social Services if she will take steps to raise social security entitlements so that parents receiving supplementary allowances are enabled to benefit from the increase in family allowances which is due in April.

No, Sir. It is the aim of this Government to replace means-tested benefits by benefits as of right wherever possible, and that is one of the purposes we have in mind in increasing family allowance.

Does not my right hon. Friend accept that for those families which are receiving means-tested bene- fits and which are actually on supplementary benefit her words will seem very pious indeed? Of course we would prefer the replacement of means-tested benefits. But the increase in family allowances will not improve the situation of the poorest families unless my right hon. Friend takes the steps suggested in my Question. On behalf of the poorest in our society, including the one-parent families, many of whom are on supplementary benefit, I ask her urgently to reconsider this matter if the increase in family allowances is to be more than a hollow joke for many poor families.

I cannot agree that my hon. Friend's approach is the right one. We shall never get rid of means-tested benefits if every time we increase the benefits as of right we then say that we are going to increase the means-tested benefits on top. The correct way to deal with the problems of the families to which she refers is through proper and regular upratings of supplementary benefits. This is what we did in July. Those benefits will be uprated again this April and again later in the year. I assure my hon. Friend that she is—I am sure with the best motives in the word—leading us up a dangerous blind alley by saying that every time the family allowance rises this must be disregarded for supplementary benefit.

If the right hon. Lady really cares about family poverty, why does she refuse even to produce a Green Paper on family endowment? Is she aware that in the five-year forecasts of Government expenditure which have been referred to already this afternoon there is no provision for an increase in family allowances?

A Green Paper is not necessary. The Government's proposals will be announced very shortly.

Disabled Persons (Petrol Costs)

15.

asked the Secretary of State for Social Services what evidence she has of cases where disabled people are unable to continue in employment as they are unable to afford the petrol to get to and from work.

I have no details of any case in which this has happened, although several people have written expressing concern about the possibility. If the hon. Member is aware of any such case, I hope that he will let me know.

Is the Minister aware of the special difficulty that faces disabled people who go to work in an Invacar in that they cannot engage in car-sharing schemes or in the pooling of journeys which their more able-bodied workmates can do? Does not this place those people at a disadvantage compared with workmates, and will the hon. Gentleman look into this special point?

Yes, I am very aware of the general concern about ways in which disabled people are affected by the recent increase in petrol prices. I shall bear the point very much in mind.

Will my hon. Friend give more serious thought to the suggestion which has been made to him and bear in mind that it is particularly hard for disabled people to meet the increased petrol cost? Will he also bear in mind that any increase in road tax will have an equally bad effect on disabled people who have to use larger cars than normal because they cannot drive smaller vehicles? Therefore, it will be a greater hardship for them to be able to go from A to B, to work or, indeed, to anywhere else.

I know of my hon. Friend's very close personal interest in these problems. I shall bear in mind all he has said. I am sure he will be pleased as I certainly was, that we were at least able to restore, and indeed double, the petrol allowance which was cancelled in the February 1972 announcement.

Will the Minister accept that the standard car for the disabled driver is wholly unsuitable for long-distance journeys to work or outings? Is he aware that one of my constituents has given me figures suggesting that it is more expensive for him and for the taxpayer if he uses that type of car than, say, a standard mini car?

I am familiar with this type of criticism. If the hon. Gentleman likes to contact me about the particular case, I shall be glad to look into it again with him.

National Insurance (Self-Employed Blind Persons)

16.

asked the Secretary of State for Social Services whether she will introduce legislation to give relief from national insurance contributions for self-employed blind persons.

No, Sir. A self-employed person with low earnings is already able to obtain exception from contribution liability but it would be wrong to deprive self-employed blind persons generally of their benefit rights by relieving them of contribution liability,

Is the Minister aware that there is a grey area and that there are people who are in the same situation as one of my constituents about whom I have corresponded with him—a self-employed person making wire brushes who, out of a net income of £900 per annum, has to find £125 to pay his national insurance contributions? Is not that typical of the way in which legislation hits unfairly at the self-employed, particularly those facing hardship such as the constituent I have mentioned?

The hon. Gentleman is right in his general remarks, and we have corresponded on the particular case he mentioned. He should bear in mind that if we were to accept the apparent attraction of his proposal we should be denying to his constituents the right to retirement pension, sickness benefit, widows' benefit, maternity grant and death grant.

Is not my hon. Friend the Member for Arundel (Mr. Marshall) right in saying that this is a further example of the grave hardship caused by the Government's discrimination against the self-employed? Is he not aware of the intense public feeling on this issue? Will he, at this late stage, announce a Government response to this public feeling?

May I say with great respect to the hon. Gentleman that he is showing his ignorance in this case. In the case to which the hon. Member for Arundel (Mr. Marshall) referred, the constituent will from next April pay no increase in contributions.

Mid-Sussex (Hospital)

17.

asked the Secretary of State for Social Services whether she will make a statement on the possibility of a new general hospital being built in the Mid-Sussex area.

I assume that the hon. Member has in mind the needs of the new Cuckfield and Crawley health district. He will be reassured to learn that a joint working party, consisting of representatives of the regional and area health authorities and the health district's management team, is now studying this district's immediate health needs and making long-term development plans.

Is the Minister aware that discussions about the new general hospital have been continuing for 10 years and that no firm plans have been made? Is he further aware that Mid-Sussex lies in a major growth area and that, on the basis of projected population growth, 760 new hospital beds will be needed in the area by 1981? Where are those beds to come from?

I am aware that there is an expansion in the population of the area concerned. I look forward to the hon. Gentleman's support for the increases in public expenditure for the hospital building programme that he seems to envisage.

Community Health Councils

18.

asked the Secretary of State for Social Services if she is satisfied that sufficient publicity is given to the membership and powers of the community health councils.

Community health councils are responsible for their own publicity, and I am satisfied that those which have been in operation for any length of time are generally discharging this responsibility very actively.

Does my hon. Friend agree that, bearing in mind the urgent need for proper democratic control in our National Health Service—an opportunity which was missed in the 1973 legislation—we need to take far more positive steps to publicise the activities of community health councils, which we are likely to have to live with for a number of years, so that people are made aware of the fact that the NHS is their service and is, and should be, answerable to them?

I strongly agree with my hon. Friend. We intend to try to increase the democracy in the National Health Service. We believe that the community health councils have a very important part to play. My right hon. Friend the Secretary of State for Social Services appointed two advisers on the community health councils who have produced a valuable report. We are in process of establishing a national council to be the national voice of the community health councils, and it will be the independent voice of the patient in arguing no doubt for extra resources for the health service.