asked the Secretary of State for Social Services if he is satisfied with industrial relations within the National Health Service; and if he will make a statement.

It would be difficult ever to be fully satisfied with the state of industrial relations within the National Health Service, given its size and diversity. But I and my colleagues are constantly seeking to effect improvements.

Is my right hon. Friend aware that much of the negotiation that goes on within the Health Service with the trade unions involved is concerned with improving the efficiency of the Service and the welfare of patients? Does he not agree that this is in marked contrast to some statements by leading Members of the Opposition? Will he also consider the legal position of male nurses in psychiatric hospitals and wards, and the great strain that is imposed upon them? Will he look at their problems?

It is absolutely true that the nursing unions and the staff side in general are basically concerned with the strength of the Service and the welfare of patients. The question of nurses in mental hospitals is an issue that I have discussed especially with CoHSE, and I am certainly ready to have further discussions with it.

Is the Secretary of State aware of the continuing sense of grievance felt by telephonists in the NHS, particularly about their conditions and pay as compared with those in the Post Office?

This is a matter with which the House and public have concerned themselves before. It is being looked at through the proper channels between staff side and management. Certainly we know of the grievances, but it is proper that the telephonists should pursue these grievances in a proper manner rather than take the sort of industrial action to which they have resorted.

Does my right hon. Friend agree that morale in the Health Service is closely linked with the question of pay beds? Will he make a statement on the introduction of common waiting lists, as recommended by the Health Services Board in a report which he received many, many months ago?

I know that I have disappointed my right hon. Friend the Member for Blackburn (Mrs. Castle) because it has taken some time for consultation. However, I am anxious that when we take a decision as a result of this consultation it will further improve morale within the Health Service. That is why I think it is proper to consult fully those who agreed with our decision and those who disagreed with it.

Will the Secretary of State now answer the question that he did not answer in the debate on 20th April? Does he accept unequivocally that clinical safety must be the responsibility of those qualified to take clinical decisions? Will he support health authorities which transfer or dismiss staff whose conduct has been shown to be prejudicial to the safety of patients?

I shall want to give further consideration to the second question put by the hon. Gentleman because I would want to know the circumstances in which persons had been transferred. If he tables a Question, I shall deal with it. The safety of patients is important. In my discussions with the leaders of the medical profession and with leading trade unions, an interesting idea, put forward and supported by a number of those concerned, was that we should have special committees directly concerned with the safety of patients. Such committees would not be involved in the negotiations but would have the prime duty of saying "Thus far and no further, because the safety of patients is concerned." That is a very helpful proposal.

asked the Secretary of State for Social Services when he last met the chairman of Motability; and if he will make a statement.

I met Lord Goodman on 26th April, when I attended a meeting of the new organisation. Motability has made very good progress toward its objective of enabling disabled people who wish to obtain a vehicle to get maximum value for their money. In particular, during the summer it will launch a car-leasing scheme for recipients of the mobility allowance. I pay warm tribute to the work of Lord Goodman and his colleagues and welcome the degree of co-operation they are receiving from motor manufacturers, the banks and the many other interests with which they are in touch.

In view of the very high cost of purchasing adapted or specialist vehicles for the disabled, does the Minister accept that the Motability leasing scheme will use up every penny of the mobility allowance? Will he therefore lend his full support to the disablement organisations' campaign for exemption from vehicle excise duty?

I am familiar with the many claims for further help. The Opposition parties last night took out of the kitty in a full year some £370 million. That does not make it easier to provide new help for the disabled. The hon. Gentleman has a distinguished role in this area, as secretary of the All-Party Disablement Group. I shall continue to do whatever I can to improve matters in this area.

Notwithstanding the difficulties caused by the Opposition's action last night, will my hon. Friend confirm that the leasing period for a car will be four years? Will he indicate how much money the Government will be putting into the pockets and purses of disabled people during that time?

There is a proposal that the car-leasing scheme should cover a four-year period. By the end of 1979 we expect there to be 125,000 beneficiaries of the mobility allowance. That means that we expect to spend £65 million a year on the mobility allowance by the end of 1979. Over the four-year leasing period, if that is the period, the amount being supplied by the Government to spend with Motability, if that is what disabled people wish, will be £260 million. That figure does not take into account any uprating.

Does the Minister accept that, however successful Motability is, there will remain a residual requirement for those who cannot benefit from a conventional motor car? Will he tell the House what action is being taken further to research a specialised vehicle which will be needed for a small proportion of people long after Motability has satisfied other needs?

I appreciate that point. We are keeping in touch with developments in specialised vehicles and adaptations of production cars for the disabled. We have commissioned the Motor Industry Research Association to study and identify how best the needs of the disabled for personal road transport can be met. I shall be keeping in close touch with all developments in this important area.

asked the Secretary of State for Social Services when he expects to be able to make a full statement on his discussions on research into alternative systems instead of use of animals in toxicity testing and hazard evaluation.

When interdepartmental discussions co-ordinated by my right hon. Friend the Home Secretary, in which my Department is playing a part, are concluded. I am aware of public concern.

Does my hon. Friend recall that as long ago as December last the Prime Minister said that he would be bending all possible efforts in this matter and would be moving as quickly as possible? Is my right hon. Friend satis- fied that the Prime Minister is bending all possible efforts and is moving as quickly as possible? Will he at least say something on the matter?

Yes, but the principle of policy involved extends across at least three other Government Departments and it is essential to co-ordinate our approach. Subject to that, we are working as fast as we can.

Does not the expression that other Government Departments are involved frequently mean that there is interminable delay in arriving at conclusions? Will the Minister give an undertaking that the matter is being looked on by his Department as one of urgency and that he is also trying to instil the same urgency in the other Departments involved?

Yes, I can give that assurance.

asked the Secretary of State for Social Services what representations he has received concerning the Medicines (Prescriptions Only) Order 1977.

Representations have been received from medical, dental, nursing and pharmaceutical organisations, trade associations, other interested bodies and individual companies concerning various aspects of the order.

Why will this order prevent dentists from prescribing fluoride products whereas a general medical practitioner will be able to do so? Will fluoride products have to carry a poison label? If so, will not many parents be prevented from choosing fluoride products as dental supplement for their children in the interests of dental health?

No, the products will not need to carry a poison label. That is a misconception. It is also a misconception that the order is responsible for dentists not being able to supply fluoride products on prescription. This is because of the historical organisation of the National Health Service and the fact that the dental profession, generally speaking, has not been willing to take continuing clinical responsibility for patients once a course of dental treatment is over.

As the implementation of this instrument has been delayed for six months, does the Minister agree that the Government's handling of it has been extremely clumsy and has caused further problems to local chemists' shops, which are now closing in record numbers?

The Government's handling of the order has been remarkably sensitive to general opinion. We have allowed representations to be made in order to ensure that the various professions are in a position to administer the order.

None the less, the Minister must accept that chemists' shops, particularly in rural areas, are still closing at too high a rate. Will he say whether he has yet managed to settle the claim for increased remuneration?

The hon. Members for the Isle of Wight (Mr. Ross) and Walsall, North (Mr. Hodgson) are under a misapprehension. There has been a remarkable and rapid reduction in the rate of closure of chemists' shops. The offer which my right hon. Friend has made to the pharmaceutical profession is designed to protect small pharmacies that were in danger of closing. We are carefully monitoring the outcome of that offer.

asked the Secretary of State for Social Services whether he has any plans to introduce or expand visiting services for physiotherapy and chiropody.

Whether to introduce or extend community physiotherapy services is a matter for individual area health authorities in the light of local circumstances and availability of resources. As regards chiropody, guidance has been issued to health authorities advising them to examine the scope for more economical alternatives to domiciliary treatment which would not adversely affect the standard of service.

Will the Minister say whether there has been any examination of the cost of a domiciliary service and of the benefit that such a service might give, compared with the present residential treatment in hospital? Would not a domiciliary service free beds and be cheaper than the present hospital treatment?

We have recently had a report from the Health Service research unit at Canterbury on the subject of community physiotherapy services. We have circulated it to health authorities, and when we have their reactions we shall consider whether further guidance is necessary.

Is my hon. Friend aware that there is also a considerable shortage of physiotherapy services in hospitals in many parts of the country and that this is partly due to a lack of proper teachers for training courses? Despite the actions of the Opposition in recent days, can my hon. Friend help on this matter?

My hon. Friend has made an important point. My Department has drawn the attention of regional administrators to the importance of increasing output from the NHS physiotherapy schools, and we have suggested action that they might take to bring about this end.

Will the hon. Gentleman bear in mind the steadily increasing numbers of elderly people in our society and the pressing need to do everything possible to keep them fit and out of geriatric hospitals? Will he urge and help local authorities to provide chiropody services in day care centres and clubs for the elderly until we can afford the money and have the personnel to provide home visiting again?

There is a shortage of resources for the NHS, which provides the chiropody services. I take the hon. Lady's point that this is a way in which we could provide better services for elderly people. However, there is a shortage of State-registered chiropodists. We are doing our best to expand output in the training schools and we start new training schools from time to time, but these things take time. In the meantime, we have advised health authorities on ways in which they can effectively improve the existing standard of services within present resource constraints.

asked the Secretary of State for Social Services what are the effects on home visiting for pensioners that have resulted, or will result, from cuts in staffing in the Department of Health and Social Security offices.

The supplementary benefit home visiting service for pensioners has been improved because more routine review visits will result from the reduction of the interval between these visits. New claims from pensioners are still being dealt with on visit.

Will my right hon. Friend bear in mind that, unlike the parties opposite which voted to cut taxes and now seemingly want to increase public expenditure at the same time, I am asking him to ensure that a large amount is spent on visits to old-age pensioners so that they can claim supplementary benefit? Will he ensure that there are no further staff cuts in these offices and note that it would be helpful if some of the cuts could be restored?

I understand my hon. Friend's feeling on this matter. He referred to the Opposition—

And the Liberals.

—and their attitude to public expenditure, but their irresponsibility has not yet finished because tomorrow night they will take it a stage further. I can assure my hon. Friend that pensioners are now being visited once every three years as opposed to once every five years previously, and I certainly take note of the need to see that pensioners and others are properly taken care of by our office.

As delays occur in connection with benefits—

How did the hon. Gentleman vote last night?

Despite the jeering of Labour Members, will the Minister pay attention to the fact that the cuts carried out by the Government three years ago caused a deterioration in services? What surveys have been carried out by his Department into the effect of those cuts and their impact on benefits?

The hon. Gentleman has not helped the Government very much in trying to replace the cuts, and it is right that my hon. Friends should respond as they have to the hon. Gentleman and his hon. Friends. We have carried out a survey and pensioners are being looked after by increased visits. Unemployed people are being called to the offices rather than being visited, and we are keeping the matter very much under review.

Does not the right hon. Gentleman consider that the supplementary question of the hon. Member for Bolsover (Mr. Skinner) proceeded on an entirely erroneous basis? Is it not a fact, as demonstrated in an answer given by the Under-Secretary last month, that the number of staff per 10,000 claimants has doubled in the last 12 years and that within that huge total there must now be room for staff savings without affecting the service to clients?

I remind the right hon. Gentleman that although the number of staff in the Department has increased, benefits and services have also increased under this Government. We must serve the public.

asked the Secretary of State for Social Services whether he will now state whether he proposes to grant a Christmas bonus for pensioners in 1978.

No decision has been taken on this issue.

Does the Secretary of State accept that last year many pensioners were confused by hearing early in the year that there would not be a bonus and then, rather late in the year, having the Government introduce one? Can he undertake this year to give an early indication to pensioners of whether there is to be a bonus?

On the contrary, I think that pensioners were delighted with the news. It was a magnificent achievement that about 8 million people, most of them retirement pensioners, were able to get a sum before Christmas which enabled them to enjoy their Christmas and to enjoy it with others.

Does my right hon. Friend agree that, even if a Christmas bonus is paid, many pensioners are most anxious that it could be swallowed up by a substantial increase in the television licence fee? Will he undertake to have discussions with the Home Secretary to see whether a half rate or free system for television licences can be introduced for all pensioners living alone, as this would be warmly welcomed by all pensioners?

I shall discuss that with my right hon. Friend.

asked the Secretary of State for Social Services if he can give an estimate of the cost to the National Health Service of skateboarding accidents.

The Royal Society for the Prevention of Accidents has recently suggested that the cost of skateboarding accidents to National Health Service hospitals may be as much as £6 million annually. Towards the end of this year I am expecting from the home accident surveillance system fuller information on which to base an estimate.

Does the hon. Gentleman agree that those are very alarming figures in relation to a hard-pressed Service? Since prevention is better than cure, what practical steps does the Minister propose to take to try to reduce the number of accidents?

We wish to encourage all skateboard users to wear protective clothing and, as far as possible, to keep to areas specifically designated for skateboarding, away from roads and pavements. In addition, the Department of Prices and Consumer Protection has arranged for a skateboard safety code to be supplied to those who buy British-manufactured skateboards. It is a comprehensive document, and if the hon. Lady is interested I shall arrange for a copy to be sent to her.

I recognise that my hon. Friend is awaiting a report on the situa- tion, but can he indicate what sort of accidents are being caused and to whom?

I am most concerned by evidence from studies carried out here and in the United States which suggest that skateboard users are particularly vulnerable to head injuries and fractures of the lower limbs. Obviously, such injuries can have serious consequences for young people and they should be forewarned.

asked the Secretary of State for Social Services when he expects to make a statement on vaccine-damaged children, pursuant to the Pearson Report recommendations.

I ask the hon. Member to await my statement at the end of Questions.

I shall do that.

asked the Secretary of State for Social Services what would be the net cost of abolishing (a) dental and (b) optical charges for all those over State retirement age.

Assuming no increase in demand, I estimate that the annual cost of abolishing dental and optical charges for those over State retirement age would be in the region of £4 million and £6 million respectively.

Will my hon. Friend accept that I understand the difficulties arising from what happened last night and that only hon. Members on this side of the House have a right to put Questions of this sort? Can he confirm, however, that it is still the Government's intention to abolish all Health Service charges? Would he not agree that a good start could be made with elderly people and that the sums he has indicated are not prohibitive? Would this not be far better than the present system under which only those on supplementary benefit and those who do not know that they qualify for low-income exemption, at £2·50 above supplementary benefit level, get any advantage? Will he look at this matter seriously with a view to exempting all retired people, who are the one section of the community who have no time to wait?

It remains our intention to phase out all NHS charges. We shall be giving continuing consideration to the possibilities of bringing about the course of action that my hon. Friend desires. However, I am not entirely sure whether it is the right way to start as there are a number of people over retirement age who are better off than many under retirement age. Nevertheless, I shall want to give consideration to that.

What steps will the Minister take to help pensioners who are being turned away by dentists who refuse to carry out treatment on them because it is uneconomical to do so?

We have put the dispute between ourselves and the British Dental Association to the Doctors, and Dentists' Review Body, and we hope that it will be able to make some suggestions that will help us to resolve the matter.

Does my hon. Friend realise that in "The Right Approach" the Conservative Party has said that it will substantially increase all charges in the NHS, although it was significant that in yesterday's debate Opposition Members did not put forward that proposal as a means of reducing public expenditure?

It is quite clear, as my hon. Friend indicates, that the way in which the Opposition hope to recoup the £370 million that they cost the Government last night is by imposing charges on the Health Service. That emerged during our debate a couple of weeks ago.

Will the hon. Gentleman take note that the information given by the hon. Member for Fife, Central (Mr. Hamilton) is entirely incorrect? Will he consider the possibility of achieving savings in the NHS in both specialties by altering the clerical machinery? Is he aware that the form filling that is involved in providing NHS spectacles for the elderly is cumbersome, complicated, bureaucratic and thus extremely expensive?

We are always reviewing the administrative procedures in the Health Service with a view to simplifying them. If the hon. Lady expects to save £370 million by reviewing and re-organising the administrative procedures of the Service, I think that she is looking for savings that are not there. What Opposition Members intend to do if ever they become the Government is on the record in the report of the debate which took place a fortnight ago.

asked the Secretary of State for Social Services what is his estimate of the latest number of children in one-parent families whose parents are dependent on supplementary benefit.

About 610,000 at the end of 1976.

Will my right hon. Friend ensure that the parents that he has mentioned, who are indisputably those in the greatest need, receive the full benefit of the child benefit increases announced by the Chancellor of the Exchequer in his Budget Statement? Does he accept that it would be disgraceful if the fact that child benefit levels are soon to be above supplementary benefit rates were to be used as an excuse to deprive parents of their full entitlement to supplementary benefit?

It is not an excuse. The purpose of raising child benefit to the level that it has been raised by the Government is to take people off supplementary benefit. If not, we would be paying two benefits to the same person for the same issue. We note seriously what my hon. Friend has said, but it would be our desire eventually to raise child benefits to a level higher than the dependancy allowance, or to the same rate.

Will the right hon. Gentleman confirm that many divorcees are not obtaining their rightful maintenance from their ex-husbands, which is putting intolerable strains on the social security system? What does the Secretary of State intend to do to rectify this sad and unfair situation?

I think that the hon. Gentleman and the House will recognise that it is an extremely difficult job collecting the payments. The Department spends a great deal of time doing so and has a great deal of success, but obviously the success is not 100 per cent. In the meantime supplementary benefit will, quite rightly, have taken care of these parents.

In view of the Minister's comment about the complications of supplementary benefit, is he able to tell us when we may expect publication of the review by the Supplementary Benefits Commission, which we hope will go some way to clarifying an increasingly confused benefit situation?

My right hon. Friend and I have the review before us and it is hoped to publish it some time in June.

asked the Secretary of State for Social Services if he will make regulations to allow the initial assessment for mobility allowance to be carried out by the claimant's family doctor.

The independent medical practitioners on whose advice the insurance officer makes the initial decision, are, in fact, normally family doctors who live near the claimant's home. The aim of concentrating the work of initial assessment on some 1,000 selected general practitioners is to build up expertise and to achieve consistency of assessment between cases. It is, of course, open to any claimant to put in supporting evidence from his own doctor if he wishes to do so.

I thank my hon. Friend for that answer. Does he accept that the claimant's own family doctor is no less independent than any other family GP, and is more often aware of the difficulties of the claimant? Would it be in order for the claimant, when he makes application for mobility allowance, to make a request for his family GP to make the assessment? How many people are presently in receipt of the mobility allowance?

I am aware that what my hon. Friend suggests will be supported by many others. At the same time, many family doctors would not welcome being asked to make any obligatory or definitive judgment on their patients' entitlement to mobility allowance as that could well put a strain on doctor-patient relationships. I am glad to have in mind what my hon. Friend has said, and I shall consider any case that is of concern to him. Over 72,500 claims for mobility allowances have now been accepted.

Is the hon. Gentleman aware that any movement and any step that he can take to involve the GP in a greater and larger responsibility for health care and decision making will relieve the pressure on more expensive facilities in hospitals, for example? Will he remind his right hon. and hon. Friends in the Department of that point?

I am well aware of the importance of community care and of the importance of the general practitioner in that context. As I said in my original reply, the family doctor can have an important place in the process for claiming the mobility allowance. I shall have in mind what the hon. Gentleman has said, but I hope that he will appreciate that we have placed a high premium on community care since we have been in power.

Is my hon. Friend aware how much the mobility allowance and the proposed Motability scheme is appreciated by the disabled? It will give many of them the independence that they have not had in the past. Is he also aware that, because of the help that has been given by the Government, more and more of the disabled are contemplating buying a car but are finding it extremely difficult to get driving lessons in an adapted car before they make this extremely important decision? It seems that private enterprise driving schools are not meeting the need. I appeal to the Government to do what they can.

I am grateful to my hon. Friend. He may like to know that we are in the process of increasing fivefold our expenditure on outdoor mobility help for the disabled in driving instruction. My hon. Friend has been in touch with me about a certain case and he has done a great deal to draw attention to the importance of adequate driving instruction for disabled drivers. I know that Motability is now aware of the points that he has made. I shall keep in close touch with any developments.

Is it not true that the British School of Motoring has already offered to Motability some specialised help to ensure that all those who can avail themselves of a car through Motability will have the driving instruction? Is that not worth while?

Motability is in touch with the British School of Motoring. I am familiar with what the British School of Motoring wants to do. It is not for me to make any announcement for Motability, but I know that the hon. Lady, with her colleagues and my colleagues, is keeping in close touch with developments in this area.

asked the Secretary of State for Social Services how many pensioners will be dependent on supplementary benefit in 1980.

asked the Secretary of State for Social Services how many pensioners will be dependent on supplementary benefit in 1980.

We estimate about 2·1 million, including dependants and assuming the present level of take-up.

I thank the hon. Gentleman for the figures. They show an increase over today's figures. As a consequence of that, and because of the disappointing figures that they represent in future, has the hon. Gentleman considered any future or alternative schemes to help to reduce the list, such as a tax credit scheme?

I must correct the hon. Gentleman on his first point. The December 1976 figure represents 22 per cent. of pensioners, and our estimate assumes no significant change by 1980. As for the second part of his supplementary question, the new pension scheme will progressively take more and more pensioners off supplementary benefit. Although we have already stated that we have no objection in principle to tax credits, the further development of a tax credit scheme is not a high priority compared with other developments in benefits in the area of taxation.

Do not the figures that the Minister has given to the House make complete nonsense of the Government's statement about reducing the number of pensioners on means-tested benefits?

Not at all. Our aim is to get pensioners off means-tested benefits. The new pension scheme will do just that. The fact that by 1980 the numbers will still be roughly the same as they are today is no fault of the new pension scheme, which builds up over 20 years. By the end of that period, there will be very few on supplementary benefits.

Does my hon. Friend agree that if by strange mischance the Tories are returned to power, the number of pensioners on supplementary benefits in 1980 will be much greater, bearing in mind that ruthless cuts in public expenditure hurt pensioners more than anyone else?

That is a matter of opinion. I share my hon. Friend's opinion that the Conservative Party, in order to cut public expenditure, must tackle the problem of social security benethere will be very few on supplementary public expenditure, the vast bulk of which goes on pensioners and dependants. I do not know how it will get out of that difficulty. It will have to answer to the electorate during the General Election campaign.

Perhaps the hon. Gentleman will recognise that his rather cavalier dismissal of the tax credit scheme will deprive the Government of what could be the biggest single step to reduce means-testing of pensioners, in that if we had a tax credit no bigger than the tax allowance up to 1 million pensioners could be taken out of the supplementary benefits scheme. If this Government are not prepared to do it, will they make way for a Government who are?

First, it would involve additional public expenditure. Secondly, and just as important, there would be acute practical difficulties. My Department would have to employ about 3,000 extra staff to pay the 8 million pensioners. We make 100 million payments a year. We would also probably need further staff to check on each £1 of income even for odd jobs that pensioners were doing. Leaving aside the problem of finding the resources, I do not think that the practical difficulties will be overcome until the mid-1980s, when both tax records and local office benefits will have been computerised.

asked the Secretary of State for Social Services whether he is satisfied with the level of nursing staff at hospitals.

The number of nurses in hospitals increased nationally by some 23 per cent. between 1971 and 1976, and the proportion of qualified staff has been maintained at approximately 47 per cent. There are, of course, local variations in nurse staffing levels, and I shall not be satisfied until major variations have been ironed out. Even taking into account changes in leave and hours worked, the national increase in hospital nurses represents an encouraging improvement.

Is my right hon. Friend aware that staffing levels are falling so dangerously that one hospital is refusing to admit patients because it is concerned for their safety? Why are hospitals allowed to employ only so many nurses when at the last count there were at least 5,000 unemployed qualified nurses in this country?

It is not true that staffing levels are getting worse. They are getting better. It is also not true that there are 5,000 unemployed nurses. The figure is now below 4,000, and there is an increasing number of vacancies. The additional funds made available for the National Health Service in the Budget announcement, will lead to about 5,000 new nurses being taken on. Throughout the period of this Government we have seen a steady increase in the number of nurses in the National Health Service and in the ratio of nurses to patients.

In view of that answer, will the Secretary of State tell us what his reply was to the secretary of the Royal College of Nursing when she recently said that nursing levels were at a dangerously low level and that staff morale was lower than had ever been known?

The Royal College of Nursing and others who represent nurses always want to see an improvement. I, too, want to see an improvement. This is a question of public expenditure, and I am not going to take lectures from the hon. Gentleman about increased public expenditure.

What will be the effect on the morale of the nursing profession, which has stuck rigidly to the pay guidelines, of the foreshadowed 28 per cent. increase in doctors' incomes, particularly when linked to the new consultants' charter which has been described as a moonlighter's charter?

The second description of the new consultants' contract, or the contract that is now open for ballot by the consultants, is absolutely wrong. No statement has been made about the Doctors' and Dentists' Review Body's report. The House will have to wait for that.