House Of Commons
Monday 12th June 1978
The House met at half-past Two o'clock
Prayers
[Mr. SPEAKER in the Chair]
Oral Answers To Questions
Prices And Consumer Protection
Retail Price Index
1.
asked the Secretary of State for Prices and Consumer Protection what has been the monthly increase in the retail price index for the latest available month.
3.
asked the Secretary of State for Prices and Consumer Protection what was the increase in prices since February 1974 to the latest available date.
15.
asked the Secretary of State for Prices and Consumer Protection when the monthly increase in the retail price index last exceeded 1·5 per cent.
The retail price index rose by 1·5 per cent. in April: this was the largest increase since April 1977 but the smallest April rise for six years. The increase since February 1974 has been 91·3 per cent.
Is the right hon. Gentleman aware that, accepting the last three months' figures, we now show a yearly increase of 11·2 per cent.? Will he accept that what he is doing in making these comments—particularly the comments he made in Birmingham—is exactly what Mr. Alan Fisher has termed "kite-flying before the election"? Will he withdraw some of the comments that he has made and face up to the reality of the continuing increase, particularly in view of the last increase in the mortgage rate?
What I said yesterday and what I am happy to repeat today is that the inflation rate will remain at or about the present figure for the rest of this year and that the inflation rate for 1979 is for the British people to decide when they decide the wage bill for that period. As for the three-monthly annualised figures, there is a Question later on the Order Paper on that subject, to which I look forward, because it is a very good figure.
After the Government's appalling record, which has seen prices all but double in four years, and after numerous fraudulent forecasts of better times ahead, how can the Secretary of State deny what all best-informed commentators are telling him, namely, that the inflation trend will be rising again by the end of the year and that it will probably be in double figures in 1979?
I hope that, as this Question Time goes on, the hon. Gentleman will give an example of an inflation forecast that I have made which has turned out to be incorrect. As for other forecasters, I dealt in my speech yesterday in detail with two forecasters—the London Business School and the National Institute. The forecasts of both those institutions are more gloomy than the Government's view, and both are already wrong—indeed, one was wrong before it was published. It prophesied that the lowest point for 1978 would be 8·4 per cent. and we are already down to 7·9 per cent.
In my right hon. Friend's view, is there some vested interest in the Conservative Party in some sort of damaging change in the rate of inflation? Are not the figures that he has given entirely reasonable, based ort every reasonable piece of statistical information available? Are the "well-known experts" to whom Tory Members refer in fact in Tory Central Office?
No; the reason that these questions are persistently put, against all the evidence, is very clear. It is not so much that the Opposition believe that the inflaton rate will increase as that they actually hope that it will increase. What they want to do is obtain narrow party advantage from national deterioration. The Government do not propose to allow that to happen.
Is the right hon. Gentleman aware that, in view of the reply that he has given, we are not required to play for any narrow party advantage? Will he repeat loud and clear what he said—that inflation since this Government came to office has been 91 per cent.? What sort of celebration is he planning when it reaches 100 per cent.?
First of all, I hope that the hon. Gentleman will at least struggle for some statistical objectivity. The trend of increasing inflation began 18 months before this Government came to power. The inflation rate is now much lower than it was when the Conservative Government left office. I refer again to every informed observer who makes it very clear that inflation in this country began with the Barber printing boom of 1973. Our achievement is that we have brought that under control.
Is there not some statistical evidence that the rate of inflation might even fall before the end of this year and that there are experts who put forward that viewpoint? Will not my right hon. Friend agree that not only we on these Benches but the whole country will be behind him in his efforts to curb inflation and that the only renegades are a few Members on the Conservative Front Bench, who seem still to be following their dubious Gloucester index?
There is a prospect over the next two or three months of some small improvement, but I do not want to go further than I went yesterday. The prospect for this country—the statistical certainty, as I described it then and describe it again today—is of inflation remaining for this year at or about its present figure.
Who do the Secretary of State and the Prime Minister think they are kidding when they repeat their fraudulent inflation forecasts? Do they think that the people of this country have forgotten this Government's lies about the rate of inflation before the last election or that the same people will be fooled by this kind of electoral deception again? Will the Secretary of State tell the truth for once and say that the effect of the fall in the pound since last January, of rising raw material prices, of rising interest rates and of rising national insurance contributions are bound to have an effect on inflation by the end of this year and that we shall be back in double-figure inflation by the second half of next year? Does he care to repeat his incredible prediction that inflation will be even lower next year?
I do not think that the people of this country are very impressed by that sort of vulgar stridency. What I believe they understand is the achievement over the past 18 months in bringing inflation down from over 26 per cent. to under 8 per cent. I believe they also know about next year. I made clear yesterday, and my right hon. Friend the Prime Minister repeated the point many times during the previous week, that the inflation rate next year is something for the people to decide. If we have a reasonable wage round, inflation will remain under control. Perhaps the hon. Lady would like to contribute to the education of the people by telling us whether she and her party want a moderate wage round next year or whether they are not interested in that sort of thing.
Food Prices
2.
asked the Secretary of State for Prices and Consumer Protection what has been the increase in food prices since February 1974.
8.
asked the Secretary of State for Prices and Consumer Protection whether he will give the increase in food prices since March 1974.
The Under-Secretary of State for Prices and Consumer Protection (Mr. Robert Maclennan) : The retail food index has increased by 99·8 per cent. since February 1974 and 97·6 per cent. since March 1974. However, the latest figures show that food prices increased by only 6·3 per cent. between April 1977 and April 1978, the lowest annual rate since June 1970.
Will the hon. Gentleman take this matter more seriously than his right hon. Friend the Secretary of State did a few minutes ago, bearing in mind the problems of housewives and the low-paid? Is he aware that, according to the Department of Employment Gazette, food prices rose by 2·8 per cent. in the first three months of this year? That is a Department of Employment figure. Is the hon. Gentleman also aware that the increase in the national insurance contribution that the Chancellor of the Exchequer is now to impose will affect the food industry badly, because it is labour-intensive?
I welcome the opportunity to set straight the record of food prices. They have shown a very marked improvement over the course of the past year. Since last July, there has been a continual steady fall in the rate of increase. At that time it was 25·2 per cent. In December it was down to 10·6 per cent., and it is now 6·3 per cent. For much of that time, the rate of increase in food prices has been below the all-items retail prices index. Indeed, for the past seven months the figure has been below the rate of increase in prices generally.
Does my hon. Friend agree that, despite the improvement in food prices as compared with certain other prices, almost every consumer domestic food would be cheaper if it were not for the higher lunacies of the Common Market? Is it not gross humbug for the Conservative Party, which brought us unprotected into the Common Market and added to the problem by its stupid amendment on the green pound, should now object to the situation it has created?
We can take some encouragement from this Government's success in holding down, with increasing effect, the level of common price increase in the annual price negotiations in Brussels. In 1975, the common price increase was 9·6 per cent. In 1976, it was 7·7 per cent. This year it has been only 2 per cent.
However, my hon. Friend is right to point to the effect of the greater devaluation of the green pound than this Government thought prudent. If it had not proved possible to phase that increase, contrary to the wishes of the Conservative Party, the housewife's food bill would have been increased by no less than £80 million. By the phasing, my right hon. Friend has been able to reduce that burden substantially, to £25 million.Will the Minister confirm that food prices almost doubled during just over four years of Labour Government, compared with rather less than four years of Conservative Government? For the benefit of his hon. Friends below the Gangway, will he also confirm that British membership of the Common Market has been responsible for only a minute proportion of the increase in food prices during the past four years?
If the Conservative Party had taken any steps at any time to indicate support for this Government's measures to reduce the rate of food price increase, the hon. Gentleman's remarks might be treated more seriously.
In addition to the problem that has arisen because of the harmonisation of prices under the common agricultural policy, will my hon. Friend remind Conservative Members, when they talk about the recent measures of my right hon. Friend the Chancellor of the Exchequer, that those measures were taken because of their amendments to the Finance Bill, whereby they have given handouts to the wealthy?
My hon. Friend is entirely right. If my right hon. Friend the Chancellor had not taken the measures that he did over national insurance charges, to correct the consequences of the irresponsible Opposition treatment of the Budget, that treatment would have had serious effects on public sector borrowing and on the money supply, both of which the Opposition never lose an opportunity to remind us are important factors.
What does the Minister think would be the effect on food prices of distributing the various mountains of foodstuffs accumulated under Common Market regulations?
My right hon. Friend has taken steps to release some beef from intervention to institutions, steps which will have a modest effect. But the level of the so-called mountains varies substantially from time to time, and it is not possible to give an exact answer to the hon. Gentleman's question.
Inflation
6.
asked the Secretary of State for Prices and Consumer Protection what was the rate of inflation over the last 12 months; and how this compares with the rate of inflation in West Germany.
The retail price index rose by 7·9 per cent. in the 12 months to April 1978. The rate of inflation in West Germany in the 12 months to April 1978 was 2·9 per cent., a difference of 5 per cent.
Will the Secretary of State explain why we have done so much worse than the West Germans? Will he admit that, since February 1974, prices in this country have risen by over 90 per cent. compared with about 20 per cent. in West Germany? On that basis, the value of the pound in this country has dropped since February 1974 to 52·3 per cent. If we had had in this country West German rates of inflation, the pound would have been worth 83 per cent. of the earlier figure. Can the right hon. Gentleman explain why the Labour Government have cut the purchasing power of the working man's income by about 30p in the pound?
I do not know whether the hon. Gentleman has got his figures wrong or whether he has just got them out of perspective. As I told him in my initial answer, the difference between the German inflation rate and the British is 5 per cent. In February 1974, a month the hon. Gentleman chose and one in the last year of the Conservative Government, the differenece between the German inflation rate and the British was even wider. We have narrowed the gap between Germany and Britain during the four years of Labour Government.
Would not my right hon. Friend agree—he might not, because he is a pro-Marketeer—that the situation has developed very badly for us because of our entry into the Common Market, as compared with Germany, which was already in it and which has gained at our expense?
That is not my interpretation of events, not because I am a pro-Marketeer but because I think that the events are slightly different from those that my hon. Friend described. I share the view of my hon. Friend the Under-Secretary that, if we had not been forced to accept the common agricultural policy in its present form, price increases would not have been as high as they have been over the past four years. I think that no one would argue about that. But that is not the major cause. The major cause is to be found in a number of other more damaging matters, such as the 400 per cent. increase in oil prices.
Would not the right hon. Gentleman accept that in West Germany all political parties and industries subscribe to an incomes policy, and that this must be a major reason for the difference in inflation?
I believe that. I believe that an incomes policy, which I put in its widest sense—I mean not an imposed incomes policy, and certainly not a statutory incomes policy, but a policy which plans the growth in wages—is an essential ingredient of a successful economy. It is one of the things we have achieved over the past three years, and one that I hope we can achieve in the future.
Will my right hon. Friend tell hon. Members, such as the hon. Member for Altrincham and Sale (Mr. Montgomery), whose economic illiteracy is exceeded only by his dishonest use of statistics, that for a real comparison between the two economies he should take into account West Germany's very low defence expenditure obligations, the fact that it already had a high level of food prices before we even entered the Common Market, and that it has a level of investment renewal that we should do well to emulate? Is it not high time we made changes that would bring us into line, not in the social market economy that the hon. Gentleman wants, but in terms of the reality of our status in the world, so that we can protect the consumer?
Part of my hon. Friend's supplementary question is essentially not for me but for others. My hon. Friend has highlighted the central theme of all the Questions we have had from the Opposition today, namely, an incredibly selective use of statistics. This is, I fear, a feature of prices Questions. We are about to get it later on, when false comparisons will be drawn with the three-monthly average.
Industrial Costs
7.
asked the Secretary of State for Prices and Consumer Protection what was the change in industry's input prices over the last 12 months.
In the past 12 months the wholesale price index for the inputs to manufacturing industry has fallen from 348·1 in May 1977 to 341·8 in May 1978. This is a fall of 1·8 per cent.
Does the Minister agree that this is an example of selective statistics—
The hon. Gentleman asked for them.
since in the past three months the index has actually risen by 5·3 per cent.? Is he aware that that will be a 20 per cent. increase on an annual basis? If there is a 20 per cent. increase, will the Minister confirm that the retail price index rate of increase will be no higher at the end of this year than it is now?
The hon. Gentleman must decide what figures he wants and, when he has decided, table the appropriate Question. I have given him precisely the figures for which he asked. They demonstrate that there has been a fall of 1·8 per cent. in the wholesale price index for last year. We should take considerable encouragement from that and, furthermore, recognise that it is evidence, if evidence were needed, that my right hon. Friend is wholly correct in stating that the rate of inflation in the remaining months of this year will be at or about the present figure.
In view of the relationship between the value of sterling and input prices, is it not strange that Tory Members should pretend to protect sterling and yet, when it is necessary for the Government to take action to repair the damage the Tories caused by their vote on the Budget, they shout "crisis", thereby damaging sterling? Is this not hypocritical and unpatriotic?
I absolutely agree with my hon. Friend. I think that the patriotism of the Tory Party is beginning to be called into question generally.
Bureaux De Change
10.
asked the Secretary of State for Prices and Consumer Protection what representations he has received from consumers about the trading practices of bureaux de change.
None, Sir.
Is the Minister aware that the British Tourist Authority is most concerned that some bureaux de change are abusing foreign tourists by charging unreasonable rates of commission and giving unreasonable rates of exchange? Will the Minister take account of the fact that it is not surprising that he has not received any complaints since it is the foreign tourists who are being abused? Will he accept some responsibility for protecting the good name of this country as a trading nation?
What I do notice is that the hon. Gentleman is complaining about prices and profits but has always voted against any means of dealing with excessive prices or profits. I know that the hon. Gentleman has done some very good work on this subject. If he would be kind enough to send me the details, I will forward them to the Price Commission.
Prices
11.
asked the Secretary of State for Prices and Consumer Protection what was the increase in prices over the past three months expressed at an annual rate.
11·2 per cent.
Is the right hon. Gentleman aware that, far from getting figures wrong and comparing convenient figures, the Chancellor's 8·4 per cent., quoted for the convenience of the Government, was on the same basis? Can the Secretary of State tell me how he reconciles this figure with his confident assertion over the weekend? Does he not understand why many of us feel a scepticism which is shared by the general secretary of NUPE?
I will try to explain to the hon. Gentleman. The three months about which he asked me include April, which is always a month of uncharacteristically high price increases. For example, in the three months including April 1974, which take in six weeks of Conservative Government followed by six weeks of immediate Conservative inheritance, there was an increase of 24·6 per cent., twice as large as the figure I have just given. Hence my assertion earlier today that 11·2 per cent. for the three months including April is a very good figure which confirms my prognosis that prices in this country will remain for the rest of the year at or about their present level.
Will my right hon. Friend confirm that the great likelihood is that the figure for the three months up to October 1978 will compare very favourably with the much-quoted 8·4 per cent. given by the Chancellor?
It is important not to pick out any specific three-month period. The important thing is the overall trend. I understand why my hon. Friend picks those three months. It is important to ensure that inflation remains at or about its present level from now through October into 1979 so that we can build on this year's achievements next year. That is this Government's strategy. The Government's infation policy is not geared to any one month or date. It is geared to getting the whole inflation cycle broken and beaten down to the level of our industrial competitors.
When the Secretary of State defended his prognosis—as he has just called it—yesterday, speaking on Radio 4, one of the elements in this prognosis was that:
Can the right hon. Gentleman explain which exchange rate, tied to which factor? Was it to the dollar? Was it to the basket of currencies? How will he tie it and predetermine it for the rest of the year?"The exchange rate has been predetermined for the rest of this year."
Even with the benefit of reading, the hon. Gentleman slightly misquoted me. What I said, and what I confirm now, was that the basic ingredients of the inflation pattern for the rest of this year have already been predetermined, partly because there are lags in these matters, which the hon. Gentleman will come to understand. As to the measurement of the exchange rate, conventionally we now measure it against the weighted basket of currencies. Now that the hon. Gentleman has joined us in the House perhaps he will urge his Front Bench to tell us what they believe about the exchange rate and to say whether they share the view of some of their friends in industry that it is too high or whether they share my view, which is that the exchange rate ought to be protected to help the consumer.
Retail Price Index
12.
asked the Secretary of State for Prices and Consumer Protection if he will give an estimate of the effect of the depreciation of the £ sterling on a trade weighted basis, since the Budget, on the retail price index.
Roughly speaking, each 1 per cent. fall in the exchange rate adds about ¼ per cent. to the retail price index, within about 12 months. The trade-weighted depreciation since the eve of the Budget has been 1·4 per cent.
Was it not the Budget which caused the subsequent fall in sterling? Did the Government fail to understand that the public sector borrowing requirement forecast for this year would be totally unacceptable? At the time of the Budget, was this outcome anticipated, and has it been taken into account in the forecasts which the Secretary of State made yesterday?
I am astonished by the effrontery of the hon. Gentleman, who tells us that the public sector borrowing requirement in the Budget was too high but nevertheless supports a party which voted to make it £500 million higher.
Legislation
13.
asked the Secretary of State for Prices and Consumer Protection if he is satisfied that current legislation sponsored by his Department is operating in the interests of the consumer.
Yes, Sir.
Is the Minister aware that he is one of the two, or possibly three, remaining members of the "Hattersley for King" club if he is really satisfied about current legislation? Is he perhaps suggesting that Mr. Alan Fisher, who used to be a sycophantic Socialist until this weekend, has either become a supporter of the Conservative Party or is as misguided as apparently the Government think the rest of the British public are about the success of the Government's counter-inflation policy? When will Government stop trying to legislate themselves out of our four years of inflation and realise that it is only by reducing income tax, getting people back to work and giving them an incentive to work that they are likely to achieve their stated objectives?
I do not see what any of that has got to do with the Question tabled by the hon. Gentleman. With respect to Mr. Alan Fisher. I must say that the figures given by my right hon. Friend are reliable. The figures for this year are predetermined, and those for next year depend on the sort of wage agreement that we get later this year.
Proprietary Drugs
14.
asked the Secretary of State for Prices and Consumer Protection what study he has made of the Price Commission Report on the profit margins of proprietary drug manufacturers; and what additional steps he is taking to limit these profits.
Consultations with interested parties about this report are in progress. My right hon. Friend will make a statement when these are concluded.
Does not my hon. Friend accept that much of the advertising in this area is quite unnecessary and unacceptable to the public? Does he agree that people generally, when we have this sort of report about prices in the drug industry, would expect many of these prices to come down?
I have noted what the Price Commission had to say on this matter, as has my right hon. Friend. We shall bear in mind my hon. Friend's remarks in the consideration that we are now giving to the report.
Does not my hon. Friend agree that many of the costs which drug manufacturers adduce in favour of their profits are quite unnecessary and wasteful? Has not the time come to recognise that their main customer is the community and that this industry should be brought into public ownership by the community?
I am sure that my right hon. Friend the Secretary of State the for Social Services will note my hon. Friend's suggestion.
While the Minister looks into the increasing profits of drug manufacturers, will he also examine the decline in profits of rural chemists, who are closing at a very fast rate, and perhaps do something about that?
I am aware of the problem, which, as the hon. Gentleman knows, is due to a number of factors, some of which lie outside my province.
Is it not essential that proprietary drug manufacturers should be allowed to retain sufficient of their profits to be able to carry out future research and development, the cost of which can be very high?
I think that the hon. Gentleman will recognise that my answers today have not been very forthcoming on this subject. I am afraid that I cannot be more forthcoming about the report until we have had time to consider it and what all the interested parties who have a right to make representations to us have to say.
Will my hon. Friend consult the Department of Health and Social Security on this question of drug profits, since there have been innumerable examples of drug companies putting medicines on the market which have later proved totally unsafe, showing that they had not done their research? What is the purpose of retaining profits if the sole purpose is simply to get more profits without proper research into safety for the consumer?
My hon. Friend makes a number of strong and forceful points. We have been in discussion already with the Department of Health and Social Security on the question of the profitability of the industry.
The hon. Gentleman has just admitted that he has not been very forthcoming. Will he now give an answer to the question put by the hon. Member for Renfrewshire, West (Mr. Buchan) about the proposed nationalisation of the drug companies? Is this Government policy? Will it be the Labour Party's policy at the General Election?
I hope so.
I had hoped that the House would recognise that it would not be in the interests of those with whom I am in consultation to have announced substantive responses to the Price Commission's report at this stage. Those responses will be forthcoming, as, no doubt, will be responses to the suggestions which have been made by my hon. Friends, which go somewhat beyond the recommendations of the Price Commission.
Inflation
16.
asked the Secretary of State for Prices and Consumer Protection what was the average annual rate of inflation between 1945 to 1951, 1951 to 1964, 1964 to 1970, 1970 to 1974 and from 1974 to the latest available date, respectively.
I would refer the hon. Gentleman to the answer I gave to the hon. Member for Chertsey and Walton (Mr. Pattie) on 6th June.
I am grateful to the right hon. Gentleman for that reply. I am sure that he will appreciate that the Question to which he referred was put down after I had put down this Question for oral reply today. Would not he agree that the figure quoted of 91·3 per cent. as the cumulative increase in prices since the Government took office is an appalling indictment of their stewardship? Would not he also agree that an analysis of the figures he quoted showed that during the period of office of Conservative Governments the increase in prices had been just over 5 per cent. while during the period of office of Labour Governments it has been just over 9 per cent.? Is not that one of the figures that the general public should take into account when deciding how much credence they should give the statement that the right hon. Gentleman made yesterday?
I think that the British public have far more sense than the hon. Gentleman gives them credit for. The figures demonstrate two things—first, that the world, and Western Europe in particular, has had a period of increasing inflation since 1945, and the Labour Government have been in power for the last four years of that period; secondly, the hon. Gentleman picks his dates in an arbitrary and what some people would regard as a trivial fashion. The dates he chooses are General Election dates, but the trends change between General Elections. As I have told the House many times—and will no doubt have to repeat again many times—the increase in inflation in this country, which we have at last brought under control, began in the late winter of 1972 under the Government of the right hon. Member for Sid-cup (Mr. Heath) with Lord Barber at the Treasury.
Will not the right hon. Gentleman concede for once that the facts are that under successive Conservative Governments the rates of inflation, based on an average annual rate, are almost half of those under successive Labour Governments in similar periods of time?
Even that supplementary question is not quite statistically right. But even accepting that it has some approximation to statistical accuracy, which is an achievement in itself for the hon. Lady, let me again make the point, which is the only point worth making, that there have been a number of factors which I wish that one day the hon. Lady would pay special respect to. For example, there was the 400 per cent. increase in oil prices in the winter of 1973–74. This is the sort of thing that determines inflation in this and other countries. The important point about inflation in this country is that it is coming down; we have stabilised the rate. That is in part the achievement of the British people as well as of Her Majesty's Government. I wish that just for once the Conservative Party would celebrate that achievement as something that is very well worth while.
is my right hon. Friend aware that I do not know which I am most worried about—whether Conservative Members actually believe what they are saying, with all the stupidity and ignorance of history that that would involve, or whether they are doing it simply as a cynical stunt to try to convey to people outside that there is some coincidence between the rate of inflation and General Election dates? Would not that make people outside as stupid—which is inconceivable—as hon. Members opposite?
Recent history demonstrates the point my hon. Friend makes. The Conservative Party was saying that inflation would begin to rise again in the early summer when it thought that there might be a spring election and wanted to suggest that things would only remain moving in the right direction until that election was over. Now the Conservative Party is making the same error and the same false prophecies again. My only pleasure in all this is that it will be proved right in one thing only—that is, that its constant hope that there will be national deterioration which will bring with it political success for the Conservatives will be proved absolutely false.
Railways (Consumer Representations)
20.
asked the Secretary of State for Prices and Consumer Protection if he is satisfied with the arrangements for consumer representation on the subject of rail fares.
18.
asked the Secretary of State for Prices and Consumer Protection if he is satisfied with the arrangements for consumer representations on railway matters.
Paragraph 35 of the White Paper on nationalised industries (Cmnd. 7131), published on 5th April, describes the Government's intention to extend the powers of the Central Transport Consultative Committee and in particular to give it a new power to consider the British Railways Board's general tariff structure.
While welcoming the intention of the Government to give extra powers to the transport users' consultative committees to consider fare increases, may I ask the hon. Gentleman whether he can explain why, in the circumstances, the Government, on the recent Transport Bill, resisted amendments that would have achieved that result?
The Government will introduce legislation to bring about the intended effect as soon as it is possible to do so.
Will my hon. Friend congratulate British Rail on its initiative last weekend in giving the elderly the opportunity to travel free on the railways? Is not this a good example of public enterprise which could perhaps be taken up by other enterprises?
I have noted a number of examples of sensible promotional work by British Rail of this kind, and indeed its more recent statement that it is looking at the possibility of cheaper fares for families, too.
On a point of order, Mr. Speaker. Does free rail travel come under the subject of prices and consumer protection?
It is no good asking me.
Wales
House Building Costs
Mr. Kinnock—Question No. 24.
Question No. 24, Sir. This is unbelievable.
If getting to Question No. 24 is unbelievable to my hon. Friend, I assure him that it is unbelievable to me as well.
24.
asked the Secretary of State for Wales if he will introduce legislation to seek to prevent house building companies from making price increases which exceed demonstrable cost increases between the time of an initial agreement with a purchaser to sell and the completion of sale to that purchaser.
It would be extremely difficult to devise effective and enforceable legislation in such cases. Excessive price increases are best prevented by restoring stability in the housing market—which is the objective of the recent agreement with the building societies on lending levels.
Is my hon. Friend aware that this may be yet another case of one of those famous misprints? I thought that I had put this Question down to my right hon. Friend the Secretary of State for Prices and Consumer Protection.
Is my hon. Friend aware that there are now several instances of firms building new houses and then, in between the time of the original agreement to sell and the eventual sale, imposing substantial increases in price, amounting to several thousand pounds? Whereas in ordinary domestic transactions it is difficult to stop gazumping, it must be possible to introduce an interim contract which would hold firms to the original price plus any demonstrable cost increases. This would be a significant advance in protection for house buyers and families.Perhaps I should explain that my hon. Friend's Question was transferred to the Welsh Office by virtue of my right hon. Friend's responsibilities for housing in Wales. Gazumping is a problem which has concerned many of us for a very long time, but we nave to be careful in these matters that we do not introduce, or attempt to introduce, a remedy for gazumping which would be far worse than the disease.
My hon. Friend is probably aware that, following detailed investigations of these matters in 1974 and in 1975, the Law Commission concluded that effective legislation against gazumping could work against the interests of the purchaser in many cases.Does the Minister appreciate that the way to control prices is to increase competition? Will he have a word with the Secretary of State for the Environment to ensure that land is made available for builders, so that they can build more and so that there can be more competition? The sort of case to which the hon. Member for Bedwellty (Mr. Kinnock) referred, whether true or not, would not then happen.
I believe that my hon. Friend's question was particularly concerned with the aspects which have arisen in Wales. The Community Land Act 1975 is working extremely effectively in Wales, and land is available for building in Wales.
On a point of order, Mr. Speaker. Is it in order for the hon. Member for Folkestone and Hythe (Mr. Costain), in referring to the case I raised, to use the words "whether true or not"? I would certainly not dream of introducing or mentioning a case if it were not true.
I have no doubt that the hon. Member for Folkestone and Hythe (Mr. Costain) did not intend to make any imputation concerning the honour of the hon. Member for Bedwellty (Mr. Kinnock).
Further to that point of order, Mr. Speaker. I certainly had no such intention. As a matter of fact, the hon. Gentleman did not mention the name of the case. I gathered that it was a supposition and may or may not have happened.
Will my hon. Friend—and no doubt the hon. Member for Bedwellty (Mr. Kinnock)—agree with me that it is most unsatisfactory for Questions on general housing policy to be transferred to the Welsh Office purely because they are asked by Welsh Members?
I must admit that I am not responsible for the transferring of the Question. I am merely responsible for the answer.
Agriculture, Fisheries And Food
Margarines And Vegetable Oil Products (Labelling)
26.
asked the Minister of Agriculture, Fisheries and Food if he will take steps to ensure that soft margarines high in polyunsaturated fats are labelled as such and that vegetable oil products containing saturated fats are differentiated from them.
My right hon. Friend the Minister is awaiting a report from the Food Standards Committee on these questions. Its report will be available to all interested parties and its views on the recommendations will be considered before we decide what action is necessary.
I thank my right hon. Friend for that reply. In the meantime, however, is it not important that it should be drawn to the attention of those who purchase these products that it is incorrect to make the assumption that soft margarines in plastic tubs are always high in polyunsaturates and that many soft margarines sold in plastic tubs are just as damaging from the point of view of cholesterol levels as other margarines sold in other packages? Will he assure the House that steps will be taken to make sure that manufacturers do not try to make margarines which are high among the dangerous products look the same as margarines which are not?
I appreciate my hon. Friend's concern on this matter. He may know that, under the Labelling of Food Regulations 1970, a list of ingredients has to be given for most foods containing fats and oils. The fat or oil ingredient may be described simply as fat or oil, and the manufacturers may give information voluntarily about the fatty acid composition of their products. Any such information or claims will be subject to the general provisions of the Food and Drugs Act 1955. I am sure that the view expressed by my hon. Friend and others will be taken into account in due course.
Is my right hon. Friend aware that it is vital to the health of heart cases that saturated fats should not be included in their diet? Is it not of vital health importance that the public should be given clear guidance, so that people under medical instruction may choose their diet carefully?
I appreciate my right hon. Friend's concern. I think that she and the public generally will know that foods which are usually high in saturated fatty acids are butter and other dairy products, cooking fat and red meat. The foods containing a higher proportion of polyunsaturated fatty acids are white meat, fish, some cooking oils and some soft margarines.
I hope that this information, given at the Dispatch Box, will be of general interest. My right hon. Friend and the House may recall that the Government's White Paper "Prevention and Health", which was published last December, made recommendations which were very much in line with the comments made, and these factors will be taken into account.Is there not perhaps a possibility that, if we were to listen to all the reports on diet, the result would be that people would eat nothing at all?
The comments of hon. Members and of people outside the House, including those in the industry, will be considered. These are important matters and we hope to issue a report shortly.
Will the Minister please explain what is meant by the term "polyunsaturated"? Does he agree that it is a meaningless word and can mean nothing at all?
The right hon. Gentleman will be aware that polyunsaturated and saturated fats should be more correctly referred to as polyunsaturated fatty acids and saturated fatty acids, since the terms refer to the fatty acid component of oils and fats, which are all compounds of glycerol and three different types of fatty acids. I could say much more. If the right hon. Gentleman wishes, I will willingly write to him on the matter.
On a point of order, Mr. Speaker. Are you aware that I am beginning to be sorry that I started all this?
It was very interesting as we went along.
Small Firms
28.
asked the Chancellor of the Duchy of Lancaster if he is satisfied with the progress he has made in his policy of assisting small firms.
Yes, Sir, but I expect to make further progress in the months ahead.
Does the right hon. Gentleman believe that the further tax on employment, the prices and credit squeeze and the rise in interest rates, all aimed at transferring resources from the private sector to help to finance the State's overspending, will make a major contribution to helping the small firms sector in this country? What is he doing about it?
First, I doubt whether there are many impartial authorities who would accept the hon. Member's summary of the consequences of the Chancellor of the Exchequer's recent actions. My main reply to the hon. Member, however, is that the welfare of small businesses depends intimately on the general success of the economy. The Chancellor of the Exchequer's measures were wisely designed to achieve a strengthening of the economy, and particularly its monetary aspects. For these reasons, I would expect the economy generally to be all the more confident as a result of those measures and that small businesses will get their share of that benefit.
Is my right hon. Friend aware that many small businesses, especially in fish processing, believe that they should be able to take advantage of the temporary employment subsidy? Has he had representations on this? If not, will he consider discussing with my right hon. Friend the Minister of Agriculture, Fisheries and Food how the level of temporary employment subsidy can be reduced to include these small firms?
The fish processing industry has been singularly reticent in its correspondence with me. I must confess that I have had no such representations. In the light of my hon. Friend's comment, I shall certainly take this matter up with my right hon. Friend the Minister of Agriculture, Fisheries and Food.
What progress has the Chancellor of the Duchy of Lancaster been able to make to help small businesses to obtain insurance cover for their products, particularly for those who are trying to open up markets in the United States? Is he aware how difficult this is?
If the hon. Gentleman will specify more particularly what insurance cover he is talking about, I shall be very happy to look into it. We have done our best to extend the facilities for insuring certain risks with regard to exports, but we are talking of a very wide range of subjects. I can assure the hon. Gentleman that if he gives me particulars—
I have done so.
The hon. Gentleman has done so. I cannot recall immediately the reply that I have given to the hon. Gentleman or whether it has yet been through the official processes so that I can look at it myself. I can promise the hon. Gentleman that I shall take up any such points that he has made, and with even greater zeal any points that he makes in the future.
Does my right hon. Friend appreciate that the additional resources made available in the Budget to the Development Commission are much appreciated because many of us believe that the Development Commission has a very important role to play in providing small industrial premises in rural areas, thus supplementing the advance factory programme of the Department of Industry? Will he, therefore, do everything possible to encourage the Development Commission to continue its very good work in this area?
I am grateful to my hon. Friend for his encouraging comments. I completely share the view that he has expressed. I shall certainly do my best to encourage further achievement by the Commission.
Is the Chancellor of the Duchy of Lancaster aware that slaughterhouses and abattoirs for which renovation grants are sought to comply with EEC regulations are eligible only if the grants are for more than £25,000? Whether or not he is aware of that, will he do his utmost to help my constituency slaughterhouse in Chatteris which needs £10,000, because it is ineligible under the current criteria for grant-aid?
I am encyclopaedically interested in the problems of small firms. I must confess that I am not encyclopaedically erudite in the area which the hon. Gentleman mentioned. I shall certainly look into this to see whether I can give any useful help to these gentlemen.
29.
asked the Chancellor of the Duchy of Lancaster what representations he has had since the Budget from representatives of small businesses on the effects of the Budget on small businesses.
In general, representatives of small businesses have warmly welcomed the measures in my right hon. Friend's Budget. But most feel that we have not reached the limit of what can be done to help small firms through the tax system.
Is the Chancellor of the Duchy of Lancaster aware that I must congratulate his private office on its efficiency, because a copy of the reply which he has just given reached me on the Letter Board before he or I had arrived in the Chamber?
How can he give me an answer of this kind in view of the recent Budget? The right hon. Gentleman talked about not having reached the limit of the concessions that can be made to small businesses. The Chancellor of the Exchequer has just imposed new burdens upon small businesses. If he has had to bring in this kind of Budget, how can he have any scope for giving more advantages to small businesses beyond what has already been done? This is urgently required because small businesses require further help, but how can the Chancellor do it in view of the situation which now obtains?The hon. Gentleman will not expect me to comment upon the timing of replies. Unless he had a prophetic prescience not given to me, I took his Question to be referring to my right hon. Friend's Budget and not to the recent financial measures that were taken. That Budget was replete with very important concessions for small businesses. It was very warmly welcomed by most responsible people in that area. The recent financial measures were in no way specially burdensome on small businesses.—[HON. MEMBERS: "Oh."] I said "specially". In other words, they fell upon the big and the small with total impartiality, unlike the Chancellor's Budget where there was special, partial and favourable treatment for small businesses. Therefore, I think that the hon. Gentleman is mistaken in supposing that in some way these recent measures would be specially harmful to small businesses. On the contrary.
The hon. Gentleman asked where the money would come from for further measures. I cannot prejudice the Chancellor of the Exchequer's decision next year—What about next month?
but the hon. Gentleman will appreciate that the recent measures, which were mainly directed to monetary achievement, would result in a considerable accretion of revenue from indirect sources, namely, the national insurance contribution, in the next financial year. The hon. Gentleman may rest assured that the Chancellor has by no means come to the end of the consideration of reasonable potential tax concessions to small businesses.
I welcome the measures to help small businesses announced by the Chancellor of the Exchequer in his April Budget, but can my right hon. Friend say what progress has been made about the consideration of some better loan guarantee facilities for small businesses and what conversations he has had or is having—particularly in the inner city and new town areas—about the provision of small premises for those who want to start small businesses?
With regard to the latter part of my hon. Friend's question, he will appreciate that I am not departmentally concerned with it. But I can assure him that I have been in close touch with developments in the inner cities with a view to ensuring that that problem receives adequate emphasis, namely, the provision of premises to smaller firms which are liable to be squeezed out in much modern development. I am glad to be able to say that I and my right hon. Friend the Chancellor of the Exchequer have given considerable encouragement to developers to provide these premises. I am confident that the period ahead will see much better treatment for small firms with regard to premises than has been their experience over the last decade.
If we can have shorter answers, I may be able to call another two Questions.
30.
asked the Chancellor of the Duchy of Lancaster what recent consultations he has held concerning the level of personal taxation as it affects the prospects of small businesses.
I continue to receive representations on this matter from a variety of sources and I continue to bear them in mind.
Does not the Chancellor of the Duchy of Lancaster think it odd that, in view of his present position, he felt unable to support attempts to reduce the burden of personal taxation when the matter was before the House?
No. This is a question of timing—the proper time, the proper place and the proper amount.
Ministerial Overseas Visits
31.
asked the Chancellor of the Duchy of Lancaster what have been the costs to public funds, and the cash value of benefits, derived from his visits abroad during the past 12 months.
I have made one official visit abroad in the past 12 months, at a cost to public funds of £250. The cash value of the benefits derived from this visit is inestimable.
We are not surprised that the right hon. Gentleman prefers not to put a cash value upon the benefits which have accrued to the taxpayer. Will he say whether on these trips abroad, or, indeed, at home, he still stands by the remarks he made in the television interview with Mr. Brian Walden in January, namely, that the higher rates of taxation in the United Kingdom should be reduced as a matter of urgency and high priority in the economic interests of the United Kingdom?
I have no difficulty whatever in confirming the wisdom of those remarks and the accuracy with which the hon. Gentleman has quoted them.
Is the right hon. Gentleman aware that as he is generally regarded in this country and, I am sure, wherever he travels as a civilised, witty and intelligent human being—in contradistinction to most of his Government colleagues—it might be a good thing if he travelled a bit more and others of his right hon. Friends travelled a bit less?
Although that comment is obviously courteously intended, it could be taken in more than one way. Any welcome given to my absences, or the suggestion that they should be further increased, has to be considered with great care.
Money Supply
32.
asked the Chancellor of the Duchy of Lancaster how many representations he has received from the Duchy of Lancaster about the rate of growth of the money supply.
None, Sir.
Is the Chancellor of the Duchy aware that, had I lived in the Duchy of Lancaster, he would have received one representation? Will he say whether he regards the figure for the increase in the money supply for the last financial year of 16¼ per cent. and the increase for the first two months of this year at an annualised rate of 24 per cent. as being a state of affairs which he regards as satisfactory?
As for the last financial year, since I do not attach totem precision to these figures, I would say that the outcome was reasonably satisfactory.
As for the last two months, I think that it is a mistake to turn monthly, weekly or daily figures into an annual rate. It is wiser to take these figures over a reasonable period of several months and then adjudge whether we are on the right course. If the hon. Member will be a little patient and seek to judge the annual rate of increase of the money supply in, say, three or four months' time, he will not have to alarm himself to the same extent as appears to be the case now.Bill Presented
Parliamentary Pensions
Mr. Michael Foot, supported by Mr. Joel Barnett, Mr. John Smith and Mr. Charles R. Morris, presented a Bill to make further provision with respect to the contributory pensions schemes for Members of the House of Commons and for the holders of certain Ministerial and other offices: And the same was read the First time; and ordered to be read a Second time tomorrow and to be printed [Bill 143].
Orders Of The Day
Supply
[19TH ALLOTTED DAY]— considered.
Preventive Medicine
3.32 p.m.
I beg to move,
This inquiry of the Social Services Employment Sub-Committee took 14 months. There were 23 sessions of oral evidence from 33 interested groups of witnesses and visits were made to medical premises and ICI. There are two volumes of evidence—That this House takes note of the First Report from the Expenditure Committee in the last Session of Parliament (House of Commons Paper No. 169) on Preventive Medicine and of the relevant Government observations (Command Paper No. 7047).
Good stuff.
As my hon. Friend says, it is good stuff, and I hope very much that those who are specially interested in the subject and in health services generally will take the trouble to look at some of the evidence from the witnesses and at the documents.
One of the features of the Expenditure Committee is that very busy and very important experts are prepared to come to the House and give evidence and to assist the Sub-Committees in every way that they can. Very often they supply written evidence which takes them considerable thought and effort. The appendices and the volumes of evidence are not to be ignored. When I was a member of the Newcastle Regional Hospital Board, I must confess that I would have welcomed very much the kind of report that the Sub-Committee has produced. I can remember being inundated with reports on special services and special aspects of curative medicine, but I do not recall ever having any very constructive information on preventive medicine. The report before the House today would have given me rather more to do on the hospital board than I found in the atmosphere prevailing at the time. So I congratulate the Committee on having produced a practical document which will be of considerable use to lay members of the various hospital authorities and of course to the lay public as well, to say nothing of general practitioners and a good many specialists. Looking at the high and increasing costs of the National Health Service, the Committee noted that the vast majority of that expenditure appeared on the surface to be for curative services and that a very small sum proportionately was spent specifically on preventive services. In a way, this picture is not entirely fair, because the line between curative and preventive medicine is not all that easy to draw, and the White Paper refers to this in a number of places. In any event, the general practitioner practises both. But by and large, the Committee was right to say that the preventive side had been neglected in various ways and that some effective prevention could in the end free resources of medical skill and facilities to tackle diseases which could not be prevented at present. This was the main reason why the Committee began its inquiry. The inquiry was partly the result of growing public interest in preventive medicine, and this interest was shared and fostered by the Department of Health and Social Security. But the inquiry has provoked further discussion, on the whole at a very high level. Ministers say in their White Paper that they are indebted to the Committee for adding to the public discussion of these matters. The Ministers concerned have throughout been most co-operative with the Committee. It is fair to say that the tone of that co-operation was set by my right hon. Friend the present Foreign Secretary, who gave evidence on 28th April 1976 in his capacity as a Health Minister. His evidence was very frank and fair, and he was very well prepared to go along with many of the major recommendations of the Committee and with the attitude the Committee was taking. I think that this is emphasised by the form of the Government's White Paper. They have gone further than merely giving a formal reply to the Committee and have covered a wider range of matters. One example of this concerns preventive medicine for the elderly, with which the Expenditure Committee did not have time to deal. In my judgment, it is the best reply from Ministers for a very long time. From time to time we in the Expenditure Committee have criticisms to make—and I have made them here—of slowness and of rather superficial treatment of our reports. It is true that this report is not exactly a Concorde. It has taken its time. But, having arrived, it is thorough and constructive and it reflects very well the careful constructiveness of my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) and her colleagues on the Sub-Committee and, as I say, for a long time the Government's response has matched the considerations of the Committee. Indeed, many of the points made by the Government in the White Paper invite a continuing dialogue from the Committee. I hope very much that this will occur. Some right hon. and hon. Members will know that in the last two years the Expenditure Committee has tended to move in the direction of a more continuous survey of public expenditure. Some of the criticisms which have been made of lack of control of public expenditure are a bit superficial. In the Expenditure Committee, there is now an annual review which all the the sub-committees do of their areas of expenditure, and there is much more a continuing review of those matters which have been raised, normally with the Government though not invariably, and which need further comment and further pressure for development. This White Paper offers many opportunities, and I am sure my right hon. Friend the Minister of State, whom I congratulate on being made a Privy Councillor, will be in the van in co-operating with the Committee in furthering this very helpful dialogue. Perhaps I may turn to the very last pages of the Government's observations which set out the way that they have handled the Committee's recommendations. At the end of the day, what action has resulted in really the test of the effectiveness of the Committee's work. Of 65 recommendations—58 main ones, plus some double-barrelled ones—the Government have accepted 24 without reservation and 17 with some reserva- tions. By and large those reservations are very helpful and constructive. They are not the sort of reservations which damn the original proposition but those which carry the main recommendation forward. Therefore, two-thirds of the Committee's recommendations have been substantially accepted. Of the remainder, 16 are still under consideration. These are the ones that the Sub-Committee will have to get its teeth into in the future, but again, very few of the Government's comments on these recommendations are negative. Even of the eight recommendations which are rejected there are some in which the rejection is more or less sympathetically in line with what the Committee had been striving for. For example, if hon. Members look at Recommendations Nos. 26, 27 and 28 on smoking, they will find that the Minister's comments on these are designed to further the objective which was in the mind of the Committee. Hon. Members should read paragraph 71, on page 22, of the Government's report on sponsorship of sport by the tobacco manufacturers. Here the Government are in the process of negotiating with the sponsors in order to eliminate some of the worst effects of what is implied by sponsorship. That might not go quite as far as we had hoped, but at least it is a move in the right direction. As a second example, let us take coupons, which are referred to in paragraph 72. The Minister comments that coupons have almost disappeared, andThat is a very convenient phrase, but I give the Minister the benefit of the doubt. I can imagine hon. Members having something to say about that, but I must point out that there have been Government reports on Expenditure Committee reports in which the Government have not even been watching developments. The same applies to fluoridation. The Committee asked for more research. Ministers, rather surprisingly, were very positive about this. Normally, research is a wonderful let out for Government and for inaction generally. But here the Government says that fluoridation research is not necessary because they know the answer. Good for them. I think that I am going to be stabbed in the back over that, and perhaps in the front as well, but that is no uncommon experience for an ex-Defence Minister—"the Government is watching this development closely."
Will the hon. Member not agree that this is a perfect example of the utter complacency of this Government? Having had a recommendation that there should be further research, the Government sweep it to one side and say that there is no need for it.
I would have thought that the hon. Member would appreciate the smack of firm government.
I have a feeling that the actual recommendation of the Committee—and here I speak personally—was motivated by the need for a certain amount of consensus. Of course this is a weakness of the Expenditure Committee. We seldom have any great party controversy. Throughout this investigation the conflicts were not great. There were some, as hon. Members will see if they look at the proceedings of the full Expenditure Committee and the voting on some issues. Generally speaking, consensus is the way in which we can get reports out and get movement in certain fields. I praise this Committee and this report for a large area of consensus which is in the public good. Expressing another personal view, I am not sure about Recommendation No. 40 on fluoride research. However, I think that the Government handled it with a smack of firmness, and they are to be commended for it. A similar situation arises on Recommendation No. 57. Here the Committee asks the health authorities to give their percentage of expenditure on preventive medicine. Again, the hand of firm Government has been shown with the Minister saying that this is not practicable. Of course, that is a standard reply from Ministers and I shall be interested to hear my colleagues' views on this. Of the eight rejected recommendations, five were rejected in a constructive way which does not in any way derogate from what the Committee had in mind. Members of the Committee may argue one way or the other about this, but I am sure that it will not upset them very much. In several fields where the Committee has pressed for more resources—I pick out two, more dental hygienists and more health centres—it is perfectly right that it should concern itself with these matters. A few years ago I campaigned hard for more dental hygienists. The matter has dropped out of my sights lately, and I was rather disappointed to find how few hygienists there are. Therefore, the Committee was right to say that we want more. Obviously, if there were enough there would be a great improvement in the dental health of the population, particularly children. At the end of the day the Government must decide the priorities and provide the cash. This again is partly a weakness of controlling public expenditure, or attempting to, through Committees which have no responsibility. In the end it comes back to Ministers who have to take that responsibility. I have always campaigned for health centres. When I was on the Durham County Council we made excellent progress with health centres—although it was a long time ago. But once again, I have not applied my mind to that matter much lately and I was delighted to see the answer that the Minister gave to the Committee's request for more health centres, because it is pretty encouraging. Paragraph 198 says:That is a substantial move forward and it has certainly taken us a long way from the days when we had to struggle to convince the public, the House and local authorities that health centres were a good thing. In these days of complaint about the National Health Service, there is considerable building of health centres. This is the kind of comment from the Government which shows nothing but good sense. There is the typical, comparatively minor matter of the Committee wanting taxation placed on harmful cigarettes. This arises in paragraph 75. The Government say that they are very sympathetic towards this proposal but that they are prevented from doing anything by the EEC. No doubt that will provoke some rather interesting replies from unexpected sources. It demonstrates the difficulties that the Government face in carrying out these recommendations, and how much easier it is for us, without responsibility, to make recommendations. The Committee was absolutely right to concentrate on readily identifiable aspects of prevention where early practical action was possible. The report is not an academic exercise on prevention. It is entirely practical and will produce a great many changes for the public good. It is particularly important and interesting to note the concentration on what ordinary people can do to prevent themselves from getting ill. I do not know whether the parliamentary gymnasium arises out of this, but if hon. Members consider preventive medicine on themselves, that is a marked step forward. The points made in the report are made not solely with an eye to saving money or freeing resources but to improve the quality of life. There is much talk of improving the quality of life, but I believe that there is no area of activity in preventive medicine which will not benefit from the recommendations of the Committee and the stimulus to discussion provided. Health education is clearly a very important part of prevention, and the Committee's recommendation providing for increased financial support for the Health Education Council is sound and has been matched by a tangible effort of Government approval in the allocation of £1 million in the current year and in the next two years. I am also pleased that the Government have accepted the Committee's views about radio and television publicity. The media, directly and indirectly, can have a large impact in this respect. They are taking more interest in these matters, which can do nothing but good for the public in general. Great responsibility rests on parents and teachers and on those who are responsible for bringing up young people. The advice in the Committee's report is directed at parents and teachers as much as it is directed at anybody. In the same way, general practitioners have an extremely important part to play, and the Government entirely endorse the Committee's view about greater improvement in preventive medicine and the training and education of nurses, health visitors and doctors in this field. In conclusion, I wish to emphasise two points. The education of children, preventive medicine as it applies to children and the general care of their health should be given top priority. Not only will this provide an investment for the future on economic grounds, but it will be an area in which the quality of life can be improved. A great deal of the Committee's comments amount to common sense and to a plea for self-control. It is easy to enunciate that concept, but it is much more difficult to see that it is carried into action. I very much hope that a wider public than Parliament and those associated with it will take an interest in this subject and will be in which ways they can get the best out of these recommendations. This report illustrates what is within the capacity of the Expenditure Committee, most of which is entirely laudable. The Sub-Committee has fixed on a sector of public expenditure which it can put into focus. That expenditure is of considerable concern to the public. The Sub-Committee subjected the matter to a thorough and searching review and took an all-party view. Such differences as existed were not based on party considerations, and the discussions in Committee will help to stimulate, debate, which can only be helpful to the Government and do nothing but good to the public. I wish to congratulate my hon. Friend the Member for Wolverhampton, North-East on the way she drives her Committee and on the manner in which she leads its deliberations. She is a formidable Chairman and hon. Members respond to her lead."At the end of 1976 there were 120 health centres under construction, most of which were likely to come into use in 1977 or 1978. A further 93 health centres were due to be started in 1977–78. Many others are being planned to come into the capital programme within the next few years."
Very formidable.
I am glad to see that the hon. Gentleman, who is a member of the Committee, responds to that comment. My hon. Friend and her colleagues are most diligent—and I make that as a point of praise, not of criticism. The staff of the Committee is very small, and I can think of no better cost-effective exercise than the way in which this Committee operates. I congratulate my hon. Friend, the Committee members and its staff who joined in making the report effective. I hope that, as the debate develops, we shall have the same enthusiasm among those who have not been on the Committee for the excellent work which it has carried out.
3.55 p.m.
I wish to thank my hon. Friend the Member for Bishop Auckland (Mr. Boyden) for his kind words of support and I am grateful for his accolade to the Committee. I am pleased that he also commented on the high productivity rate of the Committee, particularly as we work with a very small staff. I believe that there is a good case for an improvement in its numbers.
Preventive medicine is not new. It is about 150 years since the first measures of preventive medicine were introduced, and those occurred during the upheaval of the Industrial Revolution. People came into the towns from the countryside and were living in appalling conditions, involving overcrowding in poor dwellings. There was widespread pollution of water supplies, no proper sewage disposal, problems of air pollution, and the use of women and children in sweated workshops and factories. All these matters provided a backcloth for change. It was in 1848 that the first Public Health Act was passed, and that was the forerunner of many other mandatory Acts. Diseases such as smallpox, pneumonia, diphtheria and tuberculosis caused heavy loss of life among adults and children. Because of the existence of preventive medicine and the legislation that was introduced, many of those diseases have now disappeared. In those early days many women died in childbirth or as a result of horrific methods of illegal abortion. This led to a high death toll among women and girls. Gin was the solace of the poor and was given as a pacifier to babies and young children. The average life expectancy in those days was 40 years. Therefore, it can readily be seen that much progress has been made. Public Health Acts were passed regulating work in factories, and that legislation had a profound effect on the nation's health. All these Acts affected the nation's health, environment and life expectancy. It can be argued that the greatest benefactors of our people were not doctors but civil engineers who were responsible for installing sewerage schemes, pure water supplies and so on. I hope that the doctors will not be offended by that comparison. In these days, in the very much better conditions in which we all live, we are nevertheless cencerned, as my hon. Friend emphasised, about certain areas of disease where environmental factors, personal habits, susceptibility to accidents and other factors indicate a higher incidence of disease, a rising death rate from certain avoidable diseases in some sections of the community, and hazards arising from the individual's own life style appear to be deliberately ignored or not understood at all. Better education is required to cope with preventable disease and we require a greater understanding of causes and effects. Such diseases not only cause premature death and unnecessary suffering to individuals and their families, but also place an unnecessary burden on those concerned in terms of cost and pressure on medical and nursing services within the National Health Service. This situation causes great anxiety. It must therefore be possible to relieve the National Health Service of some of this burden of self-induced disease and thus release resources urgently needed in other areas of the NHS by shifting resources from curative to preventive medicine. This was the background to our study, and it provided a vast collection of expert papers and oral evidence from a great number of eminent witnessses We were encouraged and helped in our inquiry by the medical and supporting professions in many varied areas. We received many opinions and reactions as a result of our invitation to witnesses to give evidence to our Committee. Since the publication of our report, we have received many welcoming comments, and I wish to take this opportunity of expressing our thanks to our witnesses, to those who showed us their work in medical schools, dental schools, health centres and clinics and to others who unsparingly gave us their advice and time. It was a rewarding experience and I hope that it forged strong links between Parliament and those working in the NHS at every level. I must also thank those who submitted written evidence. Our special thanks are due to our Clerk, Miss Milner-Barry, who had the considerable and exhausting task of organising the whole inquiry, assembling the witnesses in order from one week to the next, and collecting, indexing and presenting the mass of evidence in the three volumes that are before the House. My thanks are also due to hon. Members on both sides of the Committee who make it a pleasure to be a driving Chairman, as my hon. Friend the Member for Bishop Auckland described me. They gave great support to the work of the Committee. There were ways and means of hon. Members expressing their opposition to the report but the report was unanimous, even on the fluoride issue. I was entirely on the side of saying that enough research had been done. We know enough about the effect of fluoride. Experimental fluoridation schemes have been carried out. I should like to see the Minister taking a firm line about the addition of fluoride to water supplies. However, there were some hon. Members who were not so convinced. Unfortunately, one member of the Committee changed his view after hearing the evidence. It was, therefore, a compromise to say that more research should be carried out. I have been perfectly honest about that. We had to be selective in our choice of areas of investigation. The whole range of preventive medicine is so vast and goes into so many medical specialties that clearly we had to choose. We chose areas where we believed that there was considerable concern among both the profession and the public, where we felt that progress had to be made as rapidly as possible in educating the groups most at risk, and where progress could be made fairly quickly. Our recommendations have now been responded to by my right hon. Friend and his advisers. I hope that more consideration has been given to the recommendations where my right hon. Friend indicated that ongoing consideration was continuing. I hope that he might have had second thoughts about some of our recommendations that he felt unable to accept, or about those to which he felt unable to give further consideration. I must stress that underlying the whole of the report and the recommendations is the need for more effective education in all matters affecting the nation's health and the individual's health. There is a special need to improve the health of women and children. We suggested that that need should be given priority, especially to promote good health among children. We were concerned to learn that at the time of the inquiry the income of the Health Education Council from the Department was only about £1 million a year. It is in competition with some of the big spenders that are advertising ways and means of undermining health, and that was clearly an inadequate sum. We were glad to hear of the allocation of a further £1 million to the Council beyond that to which my right hon. Friend is already committed. I think that the House will wish to hear of the further help that the Department intends to give to the Council. In pursuing our proposals for more education we recommend the reintroduction of the Radio Doctor programme, preferably at the high peak listening spot before the eight o'clock news in the morning. My right hon. Friend accepted that recommendation. I hope that he will tell us what progress he has made in consultation with the BBC. We recommend the strengthening of the health education content of teacher training embracing the range of preventive medicine in the report as a first instalment. We cannot emphasise too much how important we believe it is that teachers should be properly and adequately trained to deal with young children at school and young adolescents who do not receive the guidance and help that they should get from their parents in matters pertaining to adult relationships, such as sexual relationships. It is essential that teachers should be trained. Teachers who are especially interested in undertaking that valuable work in school should have special training courses to fit them for it. We recommend that preventive medicine should play a more important part in the training of medical students. It is amazing that it does not do so already when so many within the medical profession understand that it is an important part of medicine. I am sure that medical students learn much that is not completely relevant to most of them when they go out into the great wide world to practise and to start treating patients, which they do not do when they are training. Therefore, we recommend that the content of medical training should be reconsidered in that regard. We recommend that community medicine as a career should be more attractive and should enjoy better status to attract more people into it. I understand that community physicians are now concerned about their salary increases vis-à-vis those given to clinicians. My right hon. Friend should also consider that matter. One of the areas that causes us most concern is smoking. I think that it is generally accepted throughout the country that smoking is a major area where firm action is needed. It is accepted by the medical profession that the smoking of cigarettes, in particular, causes lung cancer, coronary heart disease, and chronic bronchitis. The medical profession does not distinguish between low and high tar cigarettes. It considers all cigarettes to be dangerous. In 1976 the tobacco firms were spending no less than £15 million on cigarette advertising. That is apart from their increasing expenditure on sport sponsorship. Since our report has been available we understand that the British American Tobacco Company is intending to spend a considerable amount on sponsoring sport, thus propagating the entirely erroneous view that husky young sportsmen and tough young sportswomen may be equated somehow with cigarette smoking. That is unacceptable. The fact that my right hon. Friend the Minister with responsibility for sport has given approval to new expenditure in that area is surely a contradiction of what my right hon. Friend the Secretary of State said only a month or so ago, when he stated that sponsorship of sport by the British American Tobacco Company and other cigarette firms was grotesque. Given the efforts of the Department to reduce cigarette smoking, it seems especially appropriate that my right hon. Friend should take action to reduce rather than increase the toll of premature death and disease caused by cigarette smoking. I hope that my right hon. Friend the Minister of State will comment on that. It is most annoying that such an announcement should be made at the time when the report is before the House for discussion and when the tobacco firms are spending a great deal of money on straight advertising. When the Health Education Council had its campaign against smoking about two years ago it was able to spend only £400,000 to counter the fantastic expenditure of over £15 million by the tobacco firms. It is worrying that more women are suffering from lung cancer. As more women in socio-economic groups 4 and 5 are smoking more, men and women in the higher groups are smoking less. There has been a worrying increase among men and women in groups 4 and 5. It is vital to give young people proper information about the consequences of smoking so that they never start to smoke. That is why the training of teachers is so important. There is evidence that children are starting to smoke while at primary school, not even waiting until adolescence. Clearly that has to be taken on board by the Department of Education and Science. That places great responsibility on teachers to guide their pupils on such matters and to give them a good example when they are in school. What they do at home is their business, but teachers must decide not to smoke in school if they are to give a good example to pupils. That means not smoking in the staff room either, because when a youngster knocks on the door to speak to a teacher and is met with clouds of stale smoke billowing out, it does not reinforce the teacher's example or teaching. That is a counter-productive exercise. I hope that the teaching profession will take it on board.Did the hon. Lady's Committee receive any evidence about the rise in smoking among nurses in hospitals? Does she think that is perhaps a matter for almost greater concern, because those who ought to know better are not necessarily setting the kind of example that we want to see?
I absolutely agree with the right hon. Gentleman. Nurses ought to follow the example of the medical profession. Many doctors have now given up smoking altogether. Nurses should follow suit. Smoking caused 25,000 unnecessary premature deaths in 1974–75. Yet it is in this area that I find the Department's and my right hon. Friend's response the least satisfactory.
We had the opportunity to talk to Dr. Kjell Bjartveit who was responsible for the preparation of the Norwegian legislation which now exercises strict control over cigarette advertising, the availability of cigarettes for young people and so on. His report was highly encouraging. He was able to report a steady reduction in cigarette smoking. I had occasion to discuss this matter again at a medical seminar. I was glad to learn that the decline in smoking in Norway had been maintained. Yet our recommendation to follow Norway's example and to ban advertising except at the point of sale—that is, at the tobacconist's shop, not in the Press, on radio and television, in magizines and so on—was not accepted. Nor was our recommendation that cigarette machines should be available only in places where children do not have easy access to them. I found it even more surprising when my right hon. Friend refused to consider the need for a much stronger health warning on cigarette packets specifically saying that cigarette smoking caused lung cancer, coronary heart disease and bronchitis. That would be stronger than the warning on the packet now. Perhaps the Minister of State will tell us why these strong recommendations were not accepted. However, my right hon. Friend supported our recommendation that there should be more non-smoking areas in public places, including buses, trains, cinemas and so on. I hope that British Rail, London Transport and other bus companies will take this on board and eliminate smoking areas altogether. The smell of stale smoke and having to breathe in other people's smoke if there are not places available in non-smoking compartments is sickening to non-smokers. Smoke clings to hair and clothes, and the debris of cigarette ends and spent matches thrown on the floor is unattractive and dirty. I have tried, unsuccessfully so far, to persuade my right hon. Friend the Prime Minister, who is a non-smoker, to raise the whole question of cigarette advertising and the specific matter of the Royal Warrant, which is given to certain cigarette manufacturers, with Her Majesty on one of his Tuesday visits. The consequences of cigarette smoking are now widely recognised, and it would be a great encouragement to all who are concerned about the serious diseases which arise from the habit if the Royal Warrant were withdrawn from those firms. I hope now that it will be possible for that to be done.Does the hon. Lady agree that in certain cases the Royal Warrant is exceedingly useful—for example, the picture of George V on a cigarette packet with the motto
"By appointment to His late Majesty King George V".
I understand that he died from lung cancer. In fact, four of our kings have died from smoking-related diseases. That makes it even more extraordinary that the Royal Warrant should be given.
I thought that was a health warning.
People do not see it as such. They are perhaps not as well informed as we are about the causes of royal deaths recently.
Before my hon. Friend leaves the question of cigarette smoking, may I ask her to comment on the lack of success of the recent campaign to get people to smoke what was known as new smoking material?
I was going to come to that matter. The fact that so much money was spent on research into this smoking material and on its manufacture, packaging, promotion and so on indicates the steps which some tobacco firms will take to try to continue to make money out of this activity. All those millions of pounds could have been better used in some area of preventive medicine. It is sad that all that money, effort and resources were wasted in that way.
On that point, I hope that the hon. Lady—
I have not given way.
Will the hon. Lady give way?
I am sure that my right hon. Friend, for whom I have great regard, will catch Mr. Speaker's eye a little later in the debate. Perhaps the hon. Gentleman would care to make this point then. I have given way several times. I say that in all friendship.
I should like to know my right hon. Friend's view on our recommendation for a significant increase in duty on cigarettes, which was being considered when the White Paper was published, bearing in mind that cigarette smoking has increased in certain sections of the population. I know that a small step was taken in the last Budget, but I do not regard that as a prohibitive increase. We want to see a considerable increase in tobacco duty so that people really will think two or three times before buying another packet of cigarettes. The attitude of doctors to alcohol is different from their attitude to smoking. The doctors in their evidence told us that reasonable quantities of alcohol could be beneficial. It is the abuse and misuse of alcohol which is dangerous and the incidence of drinking among the young which is so worrying. Violence in the family, foetal damage, road accidents, cirrhosis of the liver, absenteeism from work and other problems arise from the misuse and abuse of alcohol. We raise over £2,000 million in duty and tax on alcohol. We should like to see some of that money devoted to the education of the young about the dangers of alcohol abuse. The price of alcohol must have some effect on consumers, just as the price of cigarettes does. If it appears relatively cheap, consumption will go up. That applies particularly to the young who are able to go into supermarkets and buy alcoholic drinks, apparently with impunity in some cases. Diet also plays an important part in the promotion of good health and the avoidance of certain diseases. If only we could persuade parents to give children less sugar, sweets and chocolate, that would certainly help children, particularly the state of their teeth. It would also help adults and children in the slimming process, which causes such a lot of people so much concern. Some people say that they cannot give up smoking because they are afraid that they will put on weight. If they would look at their diets as well as giving up smoking, they would find it easier to avoid putting on weight. People who are overweight put additional strain on the heart and joints, so it is to their advantage to try to lose weight. If children could be offered things other than sweets and chocolate, their teeth would improve. The nation's teeth are nothing to brag about. We have very poor teeth. Too many children lose too many teeth much earlier than they should. We spend £150 million a year on dental treatment. Yet our children's teeth are in a poor state. This is partly because they eat too many sweets and partly because they have never been told how to brush their teeth properly. We recommend that more dental hygienists should be trained and employed, and this is an important part of the job they would do. It is also an important job that teachers could do, especially teachers in nursery schools where children have to learn to brush their teeth as soon as they have teeth to brush. A high consumption of saturated fats can cause coronary heart disease. Housewives should be told much more about the food they buy, especially convenience foods. Then it is up to them to avoid what they understand to be dangerous. In order to improve teeth, we recommend that dentists working within the NHS should be able to use sealants and fluorides. The White Paper accepts this with some reservations. I wonder whether my right hon. Friend could tell us what those reservations are. Perhaps he can say why the proposals were not accepted wholeheartedly and what he intends to do about it. We have strong dental evidence to support the use of sealants and fluorides as being of great help, especially for young children. Of special importance to women is the provision of safe, efficient fertility control and an adequate number of day-care centres for the termination of pregnancies within the NHS. We have evidence to show that a day-care abortion costs £35 whereas an in-patient abortion costs about £112. My right hon. Friend has taken this matter on board and has agreed that some expansion of day-care facilities should be provided. Unwanted pregnancies, apart from the misery that they cause to the girls and women concerned, are a great financial burden on the NHS and local authorities. In 1972, Mr. W. D. Laing estimated the cost of an illegitimate child, by the time it reached the age of 16, at £4,400 to the taxpayer and ratepayer in providing care and facilities. That figure must have more than doubled by now. One can see the cost of not having an efficient and effective family planning service and proper education. Family planning advice is available now on the NHS for men and women. It is possible to get information locally about doctors and hospitals. We recommend that the same information should be available for women seeking abortions to save shopping around when their general practitioners refuse to help. Time is crucial if early, safe abortion is our aim. I hope that my right hon. Friend will be able to take this matter on board and will agree that it will be of good value to the NHS if it can be done. Another of our proposals was that one of the tiers of administration in the NHS should be removed. I am interested to see that in a research paper produced for the Royal Commission which studied the National Health Service entitled "The Working of the National Health Service", there is a thorough examination of the cost and the effect of the present administrative system of the NHS. The report calls it "top-heavy and over-elaborate" and says that it leads to extra work and delayed decision making. The conclusion of the research team, which was led by Professor Maurice Kogan of Brunel University, was that there were:He went on to say:"too many levels of administration and too much duplication of functions at the different levels."
That bears out the evidence that we took about the present administration system of the NHS. This is a major cause of the frustration and anxiety among nurses and doctors working within the NHS. This should be considered as quickly as possible so that all the frustration and delay can be removed. It is not only staff who suffer. Patients have to wait for long periods before they see a doctor, before they get a consultation, before there is any follow-up and before they are referred to a hospital for whatever treatment or operations they need. My right hon. Friend has in our report a good deal of ammunition for many of the things that the Department is considering and would like to do. I hope that he will recognise our concern about the incidence of disease caused by the lifestyle of people. By education and proper instruction of parents and children, much of this can be reduced so that resources, which are never sufficient in an expanding NHS, can be transferred to the areas of medicine in which there are still acute shortages and long lists of patients awaiting certain specialist attention in hospital. I hope that my right hon. Friend will be able to answer the points that I have raised and that he feels that the report supports him in the work that he and his Department are doing."The multiplicity of levels, the over-elaboration of consultative machinery, the inability to get decision-making completed nearer the point of delivery of services, and what some describe as unacceptably wasteful use of manpower resources were recurrent themes in most of the areas where we worked."
4.26 p.m.
I was not a member of the select Committee, so I begin by congratulating the Committee on a stimulating and interesting report. I congratulate the Government on being able to reply quickly to what the Committee said.
I agree with the hon. Lady the Member for Wolverhampton, North-East (Mrs. Short) on what she said about education. If we are not careful and push this bandwagon too far too fast and do not carry public opinion with us, we shall be in danger of setting up a countervailing public reaction against what she and I are seeking to do. I agree also with what the hon. Lady said about the need to transfer resources to make sure that we get the maximum good effect from the money that we are able to spend on the health services. The figures in the report that show the amount spent on prevention, as against that spent on cure, demonstrated the point better than any figures or remarks that I might make. The definition of "health" in the preamble of the charter of the World Health Organisation reads:If one accepts that as a desirable objective, one's approach to preventive medicine is considerably changed. If we support this reversing of traditional objectives, perhaps the Government's response to the Committee's report has been a little flabby in certain places. For in reversing the traditional approach, we no longer exclusively consider sick people. We consider the population as a whole. We get away from the problem that we have now in that the NHS has become more of a national hospital service or a national medical service. If we could find ways of re-emphasising the health aspect at the expense of the curative side, perhaps we should be able to make greater strides toward the fulfilment of the World Health Organisation's definition of health. The aim must be to keep people out of the hands of the doctors—I mean that in no disparaging sense—because this would increase individual responsibility and cut costs. Every person who goes to hospital must be regarded as a failure of our health services rather than a success. It is no good Secretaries of State for Health and Social Services from whatever party proudly saying that more people were admitted to hospital this year, as if that were evidence of good stewardship. That is the wrong way to look at it. We should prevent people from going to hospital by not allowing them to become sick in the first place. This may seem Utopian, but there is a considerable need for urgency. Two groups in our population are particularly at risk to illness and particularly absorb resources from the NHS—the children and the elderly. Though there will not be a dramatic change in the number of children over the next few years, there will be a considerable increase in the number of elderly people. I was therefore slightly disappointed to see that the elderly rated only four paragraphs in the Government's response. While it is true that the number of males over 65 and females over 60 will rise only from 9·3 million to 9·7 million over the next 15 years—an increase of 400,000 or about 5 per cent.—the number of elderly and very elderly people will increase much more dramatically than that. The number of elderly, who are defined by the Department as being aged between 75 and 84, will increase from 2·2 million to 2·8 million. That is an increase of nearly 30 per cent. The number of very elderly, who are defined as those over the age of 85, will increase from 500,000 to 750,000—an increase of nearly 50 per cent. I would hypothesise, though I have no figures to back it up, that the older a person becomes, the more he will be dependent on medical resources of one sort or another and the more value we shall get if we are able to find ways of preventing such elderly people from becoming ill in the first place. This is only part of my overall contention that unless people are encouraged to take more care of themselves and to take more responsibility, above all, for minor illnesses and ailments, the NHS will continue under intolerable strain. How do we do this? The hon. Lady the Member for Wolverhampton, North-East spoke about the need for education. I agree with that and I also emphasise the need for fiscal incentives. The hon. Lady mentioned some of these, but there are others to which I should like to refer later. We also need to create the right social climate and end the "smart-to-smoke" idea which can be carried, by analogy, into other areas of preventive medicine. This three-pronged approach—education, fiscal incentives and the creation of the right social climate—is a process which must go on through the lives of every citizen. It starts with every child being a wanted child. Much has been done in family planning, but there are still gaps in the service that need to be filled. There are still clinics where opening times are poor, the location is unattractive and where the doctors are of an age and generation which inhibits young girls from approaching them to discuss these delicate social questions. More needs to be done in that area. I do not want to stray down this next avenue for more than about two sentences, but we are concerned in the West Midlands about inequalities in relation to abortions on the NHS. Figures have been produced time and again to show that because of the activities of a handful of gynaecologists in the region, it is extremely difficult for women in the West Midlands to obtain an abortion on the NHS. The national average is 50 per cent. of abortions carried out under the NHS, but in the West Midlands it is 20 per cent. and in my constituency, the figure is 10 per cent. That is not very satisfactory and the Government could take action here. We need to have a great deal more advice provided on parenthood. For example, I have heard in my constituency of mothers wanting to look after their children by feeding them fruit juice at a relatively early age. Of course, the juice contains sugar, which gets stuck in the child's gums, rests against the teeth for a long time and, even though the mother has acted with the best of intentions, the result is severe dental decay for the child. It is in that simple example, repeated many times in other areas, where an ounce of prevention and education is worth several tons of cure. In schools, the words "health education" have too often been nothing more than a euphemism for sex education. We need to expand this to cover diet and exercise—I was glad that the Committee referred to the need for exercise—and education about the future responsibilities of parenthood. For example, why is it not possible to have crèches or nurseries attached to some comprehensive schools so that in the last few years of their school life, pupils can see what parenthood involves by working with children? This would be a valuable way of ensuring that all sections of the community and all socio-economic groups have an opportunity to learn what parenthood and having children involve. Turning from childhood to adult life, I should like to refer particularly to the question of diet. The Committee's recommendation on fats was accepted by the Government only with reservations—and that is a great disappointment. The Committee said:"Health is a state of complete physical, mental and social wellbeing and not only the absence of disease or infirmity."
The Royal College of Physicians' Report in 1976 and the McGovern Report in the United States seem clearly to have linked coronary heart disease with a high fat intake. The Registrar-General's figures show that out of about 600,000 deaths in this country in 1975, 300,000 were a result of coronary heart disease. The Government's own White Paper said that 3,500 beds a day were used by people under the age of 65 suffering from coronary heart disease. In that context, it is unsatisfactory that the Government have been able to accept the Committee's clear suggestion only with reservations. We can also do a great deal more to improve the amount of information on food content. In a pamphlet entitled "Exemptions from Ingredient Listing and Generic Terms" the Ministry of Agriculture says:"We recommend that information about fats should be placed before the public in order to show up clearly the risks from a high intake of saturated fats and to encourage people to moderate their fat intake or switch to polyunsaturated fats."
I know that this does not fall within the Minister's departmental brief, but I should like to know what the Government are doing to implement the recommendation of that study group. The Government have accepted the need for research into dietary needs, but what is going on in this area? I have read the annual report of the Medical Research Council for last year and it contains little about preventive medicine and virtually nothing about research into diet and dietary needs of different sections of the population. The hon. Lady the Member for Wolverhampton, North-East comprehensively covered the question of smoking. I add only that our successors in this House in 25 or 30 years' time will be amazed that we have allowed public advertising of a product which clearly has a linkage with major causes of death, namely bronchial disease, coronary heart disease and emphysema generally. We shall look illogical and stupid to succeeding generations for having allowed this advertising to continue when we are clearly in possession of facts that indicate, without a shadow of doubt, that there is a link between smoking and chronic ill-health. I wonder whether there would not be some benefit and value in considering the possibility of a reduction in national health insurance contributions if a person has annual screening against some of the more common diseases. This sort of fiscal incentive could encourage people to take advantage of such a screening process. I turn finally to research into what I understand is called iatrogenic illnesses, that is, those that are side effects of being treated for other illnesses. We have, increasingly powerful drugs that set up countervailing reactions. A constituent of mine who was being treated for nerves—she lives in a multi-storey block of flats, a condition with which many hon. Members will be familiar—found that a side effect of the drug she was taking was that it gave her chronic vertigo, a condition which is not conducive to living on the twentieth floor of a block of flats. We need to discover much more information about such illnesses and more research should be done into the effects of the treatment of one illness on the creation of another. This is particularly important as we are using increasingly powerful drugs which are changing the basic metabolism of the body. The chronic problem of the elderly is loneliness. There have been many articles on this. Much loneliness shows itself in psychosomatic illness or nervous diseases, which are now believed to account for a third of the average doctor's caseload. Again, I was slightly disappointed in the Government's response. There was not much emphasis on the importance of building up the voluntary organisations which are so familiar with their localities and responsive to local needs and which can respond much more imaginatively to specific local interest groups than the rather more plodding although more thorough Government organisations. There is an increased need for home helps, health visitors and district nurses. If we are to have an effective preventive policy, it will be achieved only if we can get at people in the community, which will mean having non- or only partially medically trained people. This places heavy responsibility on the medical profession to respond constructively to this development. I understand that the medical profession are jealous of their position. After all, they take the ultimate responsibility for the treatment of patients and have done extensive training and their professional livelihoods depend on it being kept at a high level. Their professional standards are of worldwide approbation. But if prevention is to work and become effective, doctors will have to allow a broader range of people to become involved in the treatment of the public. They will have to allow less skilled people to have a primary role in preventive medicine. Has the Minister any thoughts about discussions with the medical profession to allow such auxiliaries an important role in developing comprehensive preventive care? I have described the Government's response as a little flabby. There are two pieces of evidence for this. Paragraph 15 of the White Paper says:"We have for some time believed that it is no longer a defsensible argument to propose to a consumer, who may be a busy housewife, that to discover the ingredients of, for example, bread or ice cream she should visit the public library or buy the appropriate food standards regulation from HM Stationery Office."
I accept that it permeates, but on the other hand administrative reorganisation is hardly what we are looking for. We are looking for evidence that we shall be able to move forward and achieve concrete results affecting the health of the community. The hon. Member for Bishop Auckland (Mr. Boyden) quoted from paragraph 247 of the White Paper as evidence of the smack of firm government. I hope that I do not misquote him. However, that paragraph says in part:"Preventive medicine permeates to a greater or lesser extent the work of virtually all Divisions within the DHSS and this has been reflected in an administrative reorganisation".
That is hardly the smack of firm government—"This recommendation is, however, one which presents substantial problems and one which the Government is unable to accept."
The point is that the Government were not accepting the Committee's recommendation that there should be more research. There was enough known about it—that was the important point.
I take the point on fluoride, but this is a reference to diversion of resources from curative to preventive medicine.
Perhaps I got the figures wrong. I was talking about fluoridation.
Perhaps I have misquoted the hon. Gentleman in carrying forward his reference to the smack of firm government to the contents of paragraph 247.
Hon. Members are perhaps over-used to tramping over familiar ground and this is a new field in which there is room for imagination, new projects, original thought, pioneering and flair. Flair is what is missing from the Government's response. Worthy it certainly is, but a little dull. I hope that the Minister will be able to bring some leaven to the subject when he replies.
4.44 p.m.
In common with other hon. Members, found the Select Committee's report interesting and at times fascinating and I am sure the chairmanship was exemplary. If one must criticise, the only obvious criticism is that its terms of reference were too wide; it was virtually impossible to touch on all the subjects. Despite all those who accuse us as a nation of being medically cossetted, it should be remembered that a lower percentage of our gross national product is spent on health than is the case in France and many European countries—and it is certainly less than is spent by almost any country on the other side of the Iron Curtain.
The point which comes out from the report is that medicine has infinite financial demands, especially if one considers some of the innovations, whereas finance in general, especially our finance, is finite. Obviously, there has to be a limit and we have other necessities than health—for instance, food, housing, education and transport, all of which are close and relevant to health. Over the years, medical science and technical innovation have seen the end of some disease. Thanks to hygiene and improved housing, vaccination and industrial safety schemes, we have helped to eliminate once common ailments. But alongside that process, new medical problems have arisen, some of which are actually brought about by our new hygiene, by our new leisure-conscious and mechanised life, by the extra stress of sophisticated work and by early retirement. In a ballad written in the 1920s, W. H. Auden made a point which was then believed to be only poetry but which later became virtually accepted by the medical profession. Writing of an old lady named Miss Gee, who had cancer, he wrote that the doctor came home to his wife and mused:It is now found that when people give up work or are frustrated in their ambition, those are the circumstances in which cancer proliferates. Greater wealth has led to more eating and drinking. Clearly, that has had its own problems. And the healthier lives we lead, even despite the new ailments, mean a greater number of older people; therefore greater geriatric expenditure. So the workload will grow and our resources for health expenditure are likely to remain more or less static. I suppose that it is possible, although this can be no part of this debate, that one advocates the abolition of something else in order to find more money for health. The Diplomatic Corps or the Army could go. I have no great faith in those arguments either. With static resources, we have to decide how we should get value within the NHS. This debate is useful because it gives the House a chance to examine our processes. One of the difficulties about the new medical practices is that once it is decided that something is desirable in medicine—whether it be a new practice, a screening method or a diagnostic procedure—we decide to try to make it available to everyone because it is "a good thing". The present-day doctor's dilemma is not so much what to do as what not to do. The efficiency of our NHS and probably of any health service depends on four things: the number and the quality of the people who do the work; the adequacy or otherwise of the premises in which they do it; the availability and the effectiveness of the tools with which they work; and the administration whereby those three are welded together. I believe that in all four fields there are serious shortcomings. First, as a matter of urgency, we have to try to eliminate waste and duplication. My noble Friend Lord Winstanley gave a lecture not long ago at the Manchester Statistical Society, a print of which is available at a price of £1·50. He said:"Childless women get it and men when they retire; It's as if there had to be some outlet for their foiled creative fire."
He went on to the nursing services, talking about the health visitor who"Take for example the School Medical Service. (I am not making any criticism of school doctors who I am sure do their very best in difficult circumstances.) I have done sessions of School Medical Service work just for interest. I find that I am examining healthy child after healthy child after healthy child. Finally, when I come across one with a defect and the light of knowledge shines in my eyes as I say triumphantly to his mother, 'Oh, he needs his tonsils removing,' she says 'Yes, he's been on the waiting list at Crumpsall Hospital for four years'. Or I say, 'He's got flat feet'—'Yes, he goes regularly to such and such a place for exercises.' This is skilled medical manpower working in isolation that could be helping the general practitioner or the hospital services, but, because it is working in isolation, it is very often merely duplicating their work. The School Clinic does useful work, but is so often used by patients merely as a sort of buckshee second opinion. They bring the child along to me and say 'What do you think it is?' and I say 'Well I think it's so and so', and on the way out they say 'We'll go and see the school doctor and see what he says', and they go and see him and he says something different, as often as not, which helps neither the child nor the parents nor me nor the school doctor. Please do not take this as an attack on the School Medical Service; I just mention it by way of illustration."
She does not do it. He also said:"will go and see a patient and talk about meals on wheels or invalidity allowances or whatever it might happen to be. If you say' And while you are there, will you give him an injection?'—oh no, that is the District Nurse, the working nurse."
Those medics in the House will appreciate that, for instance, a student would fail his medical examination if the psuedopatient whom he was examining said that he had a change in his bowel movement and the examinee omitted to answer that the patient needed a barium meal. Yet what chaos there would be in the medical service if every patient who had a change in his bowel movement went to the doctor and demanded a barium meal. Health education must be partly education of the healthy as well as education of the sick and of the doctors. Patients should learn danger signals and, above all, non-danger signals. Far too often a patient rings up the doctor and says "I have what I think is a 48-hour cold", and it is utterly pointless if the doctor replies "I have no time for you today. I shall come and see you the day after tomorrow." The doctor's criteria today are "Does it matter?" and then "Can I do anything about it?". The doctor's complaint is no longer "Why did you not come sooner?" but very frequently that the patient has come too early, that patients come with a non-symptom which they identify as something somebody else had before he or she got something different. That is immensely time wasting. I would like to give a warning on statistics—which can be and usually are enormously misleading. Anyone who attended Question Time today and heard the Secretary of State for Prices and Consumer Protection answer Questions will have noticed just how misleading statistics can be. I read recently in a paper on the evils of consuming animal fats that in the United States in a 12-year period during which the consumption of liquid milk doubled, the average American woman's thigh increased in circumference by seven inches."Another example is industrial medicine where skilled, highly trained doctors are doing pre-employment medical examinations day after day, not at all sure what it is they are looking for or whether they will ever find anything, but often tying up highly technical and expensive resources in a field of activity the usefulness of which is questionable to say the least. Now do not suppose that I am dismissing industrial medicine; I am merely saying that some of the work done by the industrial medical services seems to me to be wasted work and that they could in fact spend much of the time better."
I do not believe it.
This is a perfectly accurate statistic, but it is difficult to believe that the increase is connected solely with the increase in the sale of liquid milk.
It is all that jogging.
It is rather like the statistics on hanging. Those who are in favour of reintroducing the death penalty will tell us that since it was abolished crimes that were hanging crimes have increased by 450 per cent., without saying that muggings have gone up by 2,800 per cent, and that non-hanging crimes in general have gone up by 3,000 per cent., or whatever.
What is indisputable in the matter of preventive medicine is that there are things that we now do that we should not do. That is what the debate has been about. Smoking is perhaps the most signal example. I believe that our mistake is very much in the attitude that we adopt as a nation towards nonsmokers. We seem to believe that it is natural to smoke and that one is a freak if one does not smoke. If one walks down a railway carriage one sees seven compartments with nothing written on the door and five with "No Smoking" on the door. For good measure, there is also one marked "Lavatory".The hon. Gentleman means "Toilet".
It shows that the hon. Gentleman has not been on a train for a long time.
Is it now called "Toilet"?
Yes.
I thought that it was called "Toilet", but that is such an ugly word that I expected them to have changed it by now.
My point is that by the same token, if it were that unnatural, the extra compartment should have nothing on it and all the others should say "This is not a toilet" or even "This is not a lavatory". It would be much more sensible if a railway compartment that had nothing written on it meant that one did not smoke there. For good measure, there could be certain compartments with "Smoking" written on them and perhaps someone to see that people damned well smoked in them. The attitude is what I object to. Smokers are notoriously thoughtless. They never realise how desperately unpleasant it is for non-smokers to go into the polluted atmosphere, especially in cars and lifts. I suppose that it is good for me, because I am overweight, that I cannot use the lifts in the House because there is not one that has a "No Smoking" sign on it. Those who find smoking obnoxious or difficult to take are in a bad way if they are in a lift and are unlucky enough to have someone come in puffing a pipe or a cigar.The hon. Gentleman should change to "Hamlet".
I shall give way to the hon. Gentleman's lunatic remarks if he wishes.
Attention must clearly be given to smoking, drinking, diet and exercise. On the subject of exercise, it is very important to remember that if people could become breathless twice a day—no matter how—there would be much less cardio-vascular disease. If one prepared one's heart for shock by working it to its full extent, there would be fewer heart attacks, because the heart would be ready. However, it is also important to remember that none of these matters works in isolation. Although it is another statistic, and therefore open to doubt, I believe it to be a fact that carrying an extra 10 lb in weight is equivalent to smoking 20 cigarettes a day, which means that none of us has a right to look down on the possibly suicidal mode of life of others, unless we abide by rules relating to smoking, drinking, diet and exercise. Let me quote again from Lord Winstanley:"It is time that we in the health services all look at what we are doing and asked ourselves whether what we are doing really is necessary and whether it is bringing any real help to anybody. It is time that we thought about standardising some of our procedures and requirements in the interests of economy of both time and resources. It is time too that we gave some thought to the business of cutting corners and taking risks on a calculated lather than a random basis. Finally it is time to persuade the public and ourselves to begin to put health back into perspective. We have got to do those things, all of them. The medical profession has to and I think the general public has to as well. The present road leads to chaos. Ever-increasing demands on resources which are fixed and an ever-increasing inability to cope, result in an ever-increasing requirement to cut corners, often in a very dangerous way.
Finally, I want to mention one matter which I did not see in the report and which has not so far been touched upon in the debate, except fleetingly by the hon. Member for Walsall, North (Mr. Hodgson). I refer to the infant, the very young child. It has to be remembered that what is done in the first two years of a baby's life determines much in its adult existence. The multiplication of the fat cells determines whether the baby will grow up to be in the image of my hon. Friend the Member for Rochdale (Mr. Smith) or in that of the hon. Member for Ealing, Acton (Sir G. Young). Perhaps that is a good point at which to sit down.I will just give one final example of how we should start thinking about priorities again Look at the enormous waiting list for so-called "non-urgent" operations. Let me add that the degree of urgency in any particular operation rather depends on who is going to have it. If it happens to be your own operation, you tend to think perhaps it is not so non-urgent after all. Look at the social and economic consequences at the moment. Let me take a patient of mine, a worker in a heavy job, who has an irreducible inguinal hernia. He is the family breadwinner, with four children, and he has a wholly non-urgent complaint in the sense that it is not suddenly going to kill him. But he is unable to work and he may have to wait two years before it is operated on. During those two years the State may very well have to maintain him, his wife and his four children because he is unable to work, because he needs a non-urgent operation. I am not saying that economics should always take precedence over medical urgency, but I really do say that it is time we started thinking about these things and looking at the priorities that we give to certain things."
5.3 p.m.
I believe that it is important, as a member of the Committee, to thank my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) for the efforts that she made as Chairman of our Committee and for the results which she achieved with a Committee made up of what I would described as parliamentary individuals with many conflicting political philosophies. As hon. Members can imagine, we had our political moments. It says much for my hon. Friend's chairmanship that they were overcome.
There was one area, concerning fluoridation of water, which cut across party barriers and upon which there was no choice but to agree to disagree. There was no consensus about that. There was merely total disagreement. The thread that ran through the inquiry was that, although Britain's Health Service is under attack—is it not always, not least by those who run it and do not necessarily believe in it?—it is still Labour's greatest achievement and compares immeasurably favourably with any system of medicine in the world, particularly in the United States of America where ambulance men still fight for the privilege of picking up lucrative insurance cases. Latterly consultants in this country have been pursuing private interests at the expense of public service. I have been a total critic of this practice, both in the House and in my constituency in Northampton, where a new private hospital is being built and where National Health Service facilities have been used for private, queue-jumping patients. It is common knowledge in my constituency, and in the constituencies of many of my hon. Friends, that a person can buy an operation privately rather than have to wait for the same operation on the National Health Service, which might not take place until next year or the year after. I hope that in considering this report my right hon. Friend will study the other, more serious, abuses of the NHS because they are still an unthinkable cancer on a great and honourable service which has achieved honourable success. Despite all of its faults, and despite some of the consultants in Britain, we in the Labour Party still have reason to believe that Nye Bevan's introduction of the National Health Service amounted to a revolutionary and basically irreversible decision, which ensures that those in need receive medical attention and that those who are well pay for that attention. Such is the blend of Socialism and dignity, and long may it continue to survive. What I still do not believe is widely realised in Britain, because we constantly hear so much about cuts, is that this Labour Government have given more and more resources to regional health boards and from them to area health authorities while they have received less and less patient care for the money. This is something which must be remedied. Too many health authorities have built administrative offices to too high a standard, overlooking the point that their first motivation ought to be the improvement of patient care. Priorities have been wrong. I hope that my right hon. Friend will have something to say about that. There is no doubt that private practice in Britain has been a barrier to the NHS. It is up to those working in the Service to see that the barriers are done away with. NUPE and COHSE share this view and are showing the way ahead. Medicine has become highly scientific and centralised, with the general practitioners being the fundamental key to preventive medicine. More resources must be directed to them so that they in turn can give a more thorough service to those who really matter—the patients—particularly when it comes to the prevention of disease. This is the area where money should he spent. The Committee's report shows this up very clearly. A great many of the Committee's recommendations tell ordinary people what to do to avoid illness and premature death. The Committee totally believes that people must take more direct responsibility for their own health. It makes sense for public money to be spent in educating them to do this, in helping them to achieve that responsibility towards themselves. We have made many recommendations about health education, cancer screening for women, self-help medicine—which is being practised in women's groups—abortion, dentistry, alcohol and tobacco. We have said that cigarette coupons should be abolished, and that cigarette machines should be available only on premises to which children do not have access. One thing we have forgotten to comment upon is cigarette smoking in schools. We should have included a recommendation on this subject. We know of the dangers and the appalling health risks and the cost to the community arising from heart disease, bronchitis and lung cancer. In short, we know that cigarettes are killers. It is extraordinary that so many of our young people in the fifth and sixth forms are allowed to smoke. I am a non-smoker, but I have three children who smoke, which I very much regret. They were never allowed to smoke at my table or in my sitting room, and it does not seem to me unreasonable that teachers should be able to resist allowing children to smoke in the lower sixth or sixth form common rooms. But the answer I have received is that there is nothing or very little that teachers can do about it. What an extraordinary example these schools are setting. In the light of the evidence we took, a really strong Government would ban smoking altogether, and I hope that the Minister will tell us that the Government are prepared to introduce legislation at least to ban the advertising of tobacco and tobacco products except at point of sale, which is what the Committee recommended. That would be a significant advance towards preventive medicine if the Government had the will to do it. But unfortunately, if their response is anything to go by, they have no such will because, with respect to them—and here comes the nasty bit—I have never seen such a wet and weak-kneed response to a very strong Select Committee proposal as we have had from the Government on this subject. They simply say that they believe they should keep an open mind on the question of a total ban on cigarette advertising.And an empty head, by the sound of it.
And, as my hon. Friend says, an empty head, by the sound of it.
What are the Government to do also about the question of the high-tar cigarettes being sold in the Third world? Is my right hon. Friend not prepared to ban them? Is the motto of the cigarette companies not rather reminiscent of the words of Goldsmith:I hope that my right hon. Friend will give very serious attention to what we are doing to our brothers and sisters in the Third world, and particularly also to the activities of the British American Tobacco Company, which is making a very strong attempt to get into the British market. We read in The Guardian today that State Express, despite the fact that cigarette sales are falling in Britain, is producing an advertising campaign implying that sales campaigns for cigarettes are something to do with world ideological battles. The Government have a direct responsibility to do something about cigarette advertising rather than continue to sit on the fence and pretend that nothing very much harmful is happening. BAT is extending into what it calls the "free world". It is one of the main sellers of high-tar cigarettes to the Third world, and is trying to persuade Africans, South Americans and Asians to advertise, too. Perhaps there is not a great deal that the British Government could do about that, but they could put their own house in order and do something about the situation in this country, and, if they had the will, do something serious about carrying through, in the light of the evidence and of the Select Committee report, a complete ban on cigarette advertising. We were told in the Committee that it was the policy of the Department of Health and Social Security to encourage the development of water fluoridation schemes, and that the Department had made available £500,000 for assisting with the annual capital cost. Although we were told also that at present there were no plans to legislate for compulsory fluoridation, the Secretary of State told us that he felt that the time might come. As an opponent of the fluoridation of water, I must put on record that, after listening to the Committee's evidence of the Department's plans for preventive medicine, it seemed to me that its main plan, indeed the only plan that it had available for preventive medicine, was to put fluoride in our water. When it was asked who had taken this decision, since Parliament had not, it did not appear to know. So I must protest very strongly about these plans. It has even been put to me that contracts are about to be signed, or were to be signed, by the Government with Rio Tinto-Zinc for the supply of fluoride. If there is any truth in that report, perhaps we can hear about it from the Minister."And honour sinks where commerce long prevails"?
Could my hon. Friend tell us why she is opposed to fluoridation? Given her commitment to the importance of preventive medicine, that the matter has been debated over many years, and the examples that where fluoride is in being it has shown itself to be safe and effective, why is my hon. Friend opposed to this useful, worthwhile and urgent measure?
We are not having a fluoridation debate, but my hon. Friend must have read all the arguments about fluoridation of water by its opponents. We have been a very active and intelligent pressure group, and I shall not delay the House at this stage by reading out reams of reasons why I am opposed to fluoridation.
Give us one.
I am not going to play this public schoolboy game. My hon. Friend knows very well what the opponents of fluoridation say, and we are just as entitled to have a say about the fluoridation of water as anyone in the Department of Health and Social Security who has not been elected to have a say. Certainly the fluoridation of water is properly the concern of Parliament. Why should not Members of Parliament be the ones to take the decision as to where the money available for preventive medicine should go, and if there is a body of opinion in the House which is opposed to fluoridation why should there not be a debate on it so that we can hear both sides of the argument and then make a decision? A lot more research is needed before such a decision is taken, and I was shocked by the Department's evidence to the Committee, by its attitude that the decision had more or less been taken, and by the reply from the Department to the Committee's report.
My hon. Friend keeps threatening us about the anti-fluoride lobby. Will she tell us what more research is required? Fluoridation has been used for more than 30 years in many well-developed parts of the world, where it is to be expected that all kinds of precautions are taken and investigations made. In spite of that, there is no evidence of any value to indicate that fluoride in small amounts does anything but good. It causes no harm at all.
That is the point of view of my hon. Friend but it is not the point of view of the anti-fluoride lobby, which has an entirely opposite view. It believes that the research does not show what my hon. Friend claims that it shows. People want pure water. They do not want additives. Why cannot those who wish to have fluoride additives take tablets for the purpose, and permit other people to have unadulterated water?
My hon. Friend knows the answer—
My hon. Friend says that I know the answer. The difficulty is that he is getting up and down and saying either that I know or I do not know, or that he knows and I do not know.
Will my hon. Friend permit me—
I will not give way. Why should I continue to give way to my hon. Friend when he is playing games about fluoridation? I am making the perfectly proper democratic point that I am totally opposed to it. I do not like the Government's attitude to it, and I did not like the evidence given to our Committee about it by the DHSS. As an opposer of the fluoridation of water, I suspect that this policy will be foisted upon the British people and foisted upon Parliament without adequate discussion and debate.
I take the opposite view to my hon. Friend about fluoride. May I draw her attention to Recommendation No. 40 of the report, in which the Committee recommended that there should be more research into the long-term effects of certain levels of fluoride addition to water supplies? Concern was expressed in the Committee about the almost total absence, in any of the countries which have used fluoridation for a number of years, of adequate long-term research into the effects of fluoridation. That was the point that we were making.
I thank my hon. Friend for that information. I suppose, in a way, that that was part of the agreement to disagree. It did not seem to be an unreasonable thing to do, with the Committee split very evenly up the middle.
Another aspect of the Government's reply which I find very unsatisfactory to women concerns screening for breast cancer. We recommend in our report that radiographers should be trained in and used for the interpretation of mammography, and that a national breast cancer screening service, for women most at risk, should be introduced This recommendation did not receive very much support from the Government, despite the figures showing that 13,000 women died in the United Kingdom in 1975 from breast cancer. The Committee visited the British United Provident Assocation and saw—it comes hard to me to confess to this—its first-class facilities for breast cancer investigation.And the Royal Marsden Hospital.
We also went to the Royal Marsden Hospital as my hon. Friend said. I was very impressed by the facilities set up by BUPA, and by the costings that it was able to make, as well as the efficiency with which people were dealt and the comfort that they received. We were given some very worthwhile figures of the cost of this sort of investigation. Here is an example where the National Health Service can learn a great deal about preventive medicine from private enterprise. It was a very interesting and informative visit, and I should very much like my right hon. Friend the Secretary of State to consider whether the kind of business costings done by a private medical group such as BUPA cannot be introduced into the National Health Service. Apart from this aspect of accountability, there is an agreeable environment in which women are able to undergo this kind of investigation. It could well be copied by the National Health Service.
The Government, in their reply to the Committee, should at least have admitted that facilities are not available for women. In fact, the Well Women Clinic at the Royal Marsden Hospital, which started life as the Well Women Clinic—the psychology of the name was very important—has now deteriorated, in that it applies to women who are thought to be at risk from cancer. There is not a great deal of preventive medicine in that kind of screening. The inquiry was wide-ranging. The Committee dealt with important issues concerning smoking, diet and health screening, and considered all the things which are absolutely vital if the NHS is to be a preventive medicine service rather than a disease service. I hope that the report will be of immense value to the House and of immense value also to area health authorities and regional health authorities. I hope that those hon. Members who have contacts with members of area health authorities and community health councils will ensure that those people have an opportunity of reading the report. It was a great pleasure to work on the Committee. I hope that the Government will be less wishy-washy than they have been in some of their attitudes to the report. I hope that they will have the will—they certainly have the ability—to act on some of the more difficult and controversial recommendations.5.28 p.m.
May I begin by saying how much I welcome the debate? It is long overdue. The House knows that I have an interest in the matter, in that for some years I have been chairman of the National Council on Alcoholism. In that capacity I should like to pay my tribute to the hon. Member for Wolverhampton, North-East (Mrs. Short) and to those members of the Expenditure Committee who gave the problem of alcohol abuse so much consideration. I find the Committee's recommendations generally acceptable, although I shall have one or two reservations to make.
There is no doubt that alcohol abuse—here I entirely agree with the hon. Lady—is immensely costly in human, social, and economic terms. It is a major factor in the tragic story of battered wives, of child cruelty, of death and injury on the roads, and of accidents at work. I acknowledge straight away that the Government have been generally helpful to those of us working in this area. Their publications "Prevention and Health: Everybody's Business", "Better Services for the Mentally Ill", "Priorities for Health and Personal Social Services in England", have constantly reminded us of the need for primary and secondary prevention, for a multi-disciplinary approach to the problem, and for the development of services involving local authorities, social services and local voluntary organisations. In the last few years there have been some encouraging developments. But progress generally is still very slow, and in some parts of the country it is an uphill battle to get adequate services established on the ground. The National Council on Alcoholism and its affiliated regional councils are voluntary bodies but we now receive about £250,000 a year in public money from the DHSS, local authorities and area health authorities. This is perhaps an appropriate point for me to say that we are also very grateful to the officials of the Department of Health and Social Security for the advice and help which they so willingly give. I must declare my belief that the best way of tackling the problem of alcohol abuse is by this type of partnership between the statutory authorities and voluntary bodies. Again I want to emphasise—it is necessary to go on saying it—that there are still areas in this country where partnership of this kind is poor. Yet there is no doubt about the gravity of the problem of alcohol abuse everywhere. I was disturbed that members of the Expenditure Committee held out very little hope for adults who are already alcohol dependent. That is, I fear, a view which is commonly held. The Committee says in paragraph 142 that:It is a great pity that the Committee did not call for oral evidence from the National Council on Alcoholism. We would not have encouraged such a pessimistic view. I am, therefore, very pleased indeed that the Government came down on the Council's side when they expressed their own view that"It may be that those who have already surrendered their freedom to choose whether, and how much, to drink, and are driven to alcoholic abuse are beyond any reasonable action by a well-intentioned legislature."
That message must go out. The sufferers are not beyond reach. Indeed, the Advisory Committee on Alcoholism, which is a committee of specialists, in this field, maintains that a main ingredient of a prevention strategy is that people who may be developing a drinking problem should be encouraged to recognise the problem and to seek help. There are two areas where a break into the circle of excessive drinking at an early stage is possible and would have beneficial results. The first is at work, in the context of the Health and Safety at Work etc. Act. It is surprising that very little attention has been paid to alcohol-related accidents at the work place. The important Robens Report never mentioned alcohol as a factor in industrial health and safety. But the fact is that people with drinking problems do not cease to have those problems on a Sunday night. They take them to work on Monday morning. The relationship between drinking and road accidents is well established and is recognised by the general public. But the fact that problem drinkers have three times more accidents at work than the generality of workers is totally ignored. In research commissioned by the French Government it was found that alcohol was the main factor in 7·4 per cent. of all accidents. Where accidents involved a work stoppage the percentage increased to 15 per cent. Last year I was chairman of a working party which brought together a number of specialists. We went into this matter and found that people with drinking problems at work had five times the absence due to sickness as the generality of workers. The report of my working party recommended that industry should have a code of practice for people with drinking problems. It is absolutely essential that employers should encourage early recognition of problem drinkers so that their employees will seek treatment and rehabilitation during which their jobs will be safeguarded. The time has come not to treat this as a crime but as a condition which cries out for help. In the United States more than 300 companies have adopted policies to help their employees with drinking problems. I submit that cost-conscious American companies would certainly not have formulated and implemented such policies unless they were cost-effective. The interesting thing is—and this is the answer to the Expenditure Committee's pessimistic view—that the recovery rates for alcohol dependents are in the region of 70 per cent. to 80 per cent.—well above the recovery rates for this country. I am confident that money spent to initiate health education and counselling programmes for problem drinkers will reap substantial benefits. American experience in this regard has been very encouraging and we in the National Council believe that such positive programmes in this country would lower costs, reduce absenteeism, improve production, increase safety, assure better decision making at every level, retain the services of skilled and valued employees, and reduce the heavy toll on the hard-pressed NHS. I note that the Government's reply to the Expenditure Committee's report accepts the view that research is needed to identify those drinkers most at risk and that a number of relevant research projects are being considered by the health departments, the Medical Research Council and the Health and Safety Executive. I hope, therefore, that the recommendation of my working party that"Adults who have already surrendered to alcoholic dependence or alcohol abuse are not beyond reach".
is being taken seriously. I am in no doubt that when the true costs of alcohol abuse are ascertained they will shock the nation. Only when industry has been shown the true costs will it find the means of tackling this seriously neglected problem. The second area in which we could break into the circle of excessive drinking is with regard to drinking and driving. Here, I am sorry to say, I find that the Government have been dragging their feet for far too long. This is an area where, on the Government's own estimates, road accidents caused by alcohol costs the NHS £6 million a year and the material cost to the community is about £80 million a year. The figures leap upwards when one looks at the total human and economic costs of road accidents. There are grounds for believing that a high proportion of drinking drivers are alcohol dependent or problem drinkers and that at present the consequences of conviction are not sufficient to break their habit or motivate them to seek treatment. The Expenditure Committee report rightly shows very great concern about abuse by young people but appears to shy away from, or ignore totally, abuse by the middle-aged. The figures support my contention. It is, of course, a dreadful thing that the major cause of death for young male adults is a road accident with a raised blood alcohol level at the time of the fatality. Yet we should not be surprised. A survey published only last week in the consumer magazine Which? shows that the drink-driving laws of this country are now being extensively abused. This is not solely by young people. Why should young people always be dragged out as an example of what is going wrong with this society? The middle-aged and older drivers are equally affected. I do not have the time to go into the details of the figures now, but I could prove it if I had to. More than two-thirds of middle-aged drivers have a blood alcohol level of over 150 milligrammes at the time of their offence. Educational messages about the dangers of drink and driving will have very little impact on a driver who has developed a dependence on alcohol. In my view aiding and motivating the alcohol-dependent driver to seek treatment would make as valuable a contribution to reducing accidents as any educational campaign on drink and driving. It is a scandal that this House has not had an opportunity to debate the findings of the Blennerhassett Report. It recommended that those motorists convicted with a blood alcohol level of above 200 milligrams and recidivists should not have their licences reinstated after statutory disqualification until they could prove to the magistrates that their drinking no longer presented a problem. Implementation of these proposals would mean the screening of 16,000 convicted drivers a year. But the costs should be offset against improved safety on the road and less misery in the home. Can anyone dispute that such screening would be a lifeline in society for countless numbers of problem drinkers and their families? We must always remember that it is the family who pay for the last round. It is the family who pay in embarrassment, fear, disruption and sometimes violence from alcohol abuse. Money is required for both primary and secondary prevention services. We cannot do anything very effectively without it. Many of my regional councils are run on a shoestring. Their staffs do not know at the end of each month whether there will be sufficient to pay their salaries. Although we are very grateful to the Department of Health and Social Security, there is still too often a failure by local authorities and area health authorities to accept their responsibility for financing the voluntary component of a service which in many areas is the only community-based service offered, despite the recommendations in the White Paper on "Better Services for the Mentally Ill". Hon. Members will remember the phrase in that document:"the Health and Safety Executive should commission research to assess in terms of financial costs the loss in production earning due to accidents, absenteeism, sickness and substandard work performance as a result of alcohol impairment"
I beg the Minister to indicate that he will use his best endeavours to persuade these authorities to face their responsibilities. I support warmly the recommendation of the Expenditure Committee that a larger proportion of the £2,000 million raised annually in duty and taxation on alcoholic drink should be spent on prevention. But I would extend it to those who are alcohol dependent and to their families, who also require counselling and social work support. In another place the noble Lord, Lord Kimberley, has raised the matter repeatedly of the Licensing Compensation Fund, which was established in 1904 to compensate landlords whose licences were not renewed in an attempt to cut the number of drink outlets and to help alleviate the widespread alcohol abuse of the time. Surely it is appropriate that the money held in that fund should be used to help alleviate the problem today. I congratulate the Health Education Council on its initiative in organising a mass media campaign on alcohol abuse in the North-East of England. The National Council and our regional council in Newcastle have collaborated closely with the Health Education Council and been the focal point of the campaign. This has been a very good example of the way in which national and local agencies, both statutory and voluntary, can operate. The Advisory Committee on Alcohol, in its most interesting report, published recently, recommended using health education to alert people to the dangers of alcohol abuse and to encourage those with drinking problems to come forward for help. I am pleased to see that the Government accept that view. However, I think that they will have to be a bit more realistic in the amount of money that they grant the Health Education Council if future campaigns are to make sufficient impact, because the £175,000 which the Council was able to spend on alcohol campaigns from its increased budget of £1 million is paltry compared with at least £30 million spent on advertising alcohol by the drink industry. Let us, at least, get that matter into perspective. The Expenditure Committee had suggestions put to it for raising additional revenue but rejected them. The Government find difficulty in accepting the Committee's revenue proposals. Let me speak plainly. If we mean to conquer the problems with which alcohol abuse confronts us and if society means to control alcohol rather than having alcohol control it, the Government must recognise that more public money will be required to equip those in the front line to win this vital battle. If we mean business, we must stop playing games. I welcome also the Government's decision not to introduce any wild and reckless gamble with any further liberalisation of the licensing laws. Their answer to the report states:"voluntary services have a part to play for many years to come. Area health authorities, separately or jointly, need to accept a degree of responsibility for their financial viability, and for the support their staff may sometimes need."
That is a very sensible approach. Before any tampering is done, we need to be certain that changes will not increase consumption and alcohol-related disabilities. It is far too early to make claims about the changes in Scottish drinking patterns, since amendments to the licensing laws take at least five years before any judgment can be made. However, I know that the early euphoria and claims by those in favour of liberalisation need to be treated with the utmost caution. The recent record of the Chief Constable of Strathclyde said:"At the present time the Government has no plans for legislation to change the minimum drinking age or to make major amendments to the licensing laws."
Last week I asked the Secretary of State for Scotland how many road accidents where alcohol was considered to be a factor took place in Scotland between the hours of 8 p.m. and 2 a.m. in each of the years 1974 to 1977. I got the written reply on Tuesday 6th June. It showed that offences declined from 1974 to 1975 by 5·2 per cent. and by 6·1 per cent. from 1975 to 1976 but that they increased by 4·6 per cent. in 1977 from 1976. After the first six months of the operation of the licensing changes, claims were made about the success of the venture which now seem clearly to be, in the face of these figures, a little imprudent. The second six months showed a deterioration. Indeed, comparison of the last six months of 1977 with 1976 shows an increase in the number of drivers involved in accidents with a positive breath test of more than 14·1 per cent. during the period 8 p.m. to 8 a.m. Those figures show me, at any rate, that any tampering with the licensing laws at present, when we see the evidence of alcohol abuse all around us, would be a great mistake. Therefore, I support strongly the stand which the Government have taken. Finally, I congratulate the Health Department on its initiative to publish a separate consultative document on the mis-use of alcohol. I hope that the document will have the effect of informing public opinion more clearly about what is happening and what needs to be done and that it will encourage a more concerted, complementary approach by Government Departments and local authorities to the prevention of alcohol abuse. Dr. Griffith Edwards, a very distinguished witness was asked by the Expenditure Committee what he would do to reduce the cost of alcoholism and save money. He replied that there was a great need for statutory organisations and Government Departments to get together, adding:"The changes in licensing laws which came into operation towards the end of 1976 have now had a full year to prove themselves. I regret to say the decline in drunkenness noticed in early 1977 was not maintained and by the end of the year the level of drink-related offences had returned to their former level."
That is simple advice, but it is quite crucial in this context. Perhaps from this debate we shall recognise that alcohol control policies are a public health issue and act accordingly. The problem of alcohol abuse is so great and the implications are so far-reaching for our society that the time may well have come for us to set up a specialist Select Committee of the House to look into the matter in depth and to carry on where the Expenditure Committee, which has done such a splendid job, left off. I recommend that course to the House."Alcohol problems touch labour problems, the Department of the Environment, problems with roads, then Home Office, the DHSS … but I say if you want more value for money first of all get better integration so that the left hand knows what the right hand is doing."
5.50 p.m.
I speak as one who believes that the National Health Service is the greatest accomplishment of the State in our generation. I have derived great personal benefit from it. I am one of millions who has had an enormous amount of benefit from the ministrations of doctors and nurses in the NHS.
Of course, there have been weaknesses and disappointments in the service, but these are inevitable. Some of the greatest disappointments spring from the aspect of medicine that we are debating today. It is probably unavoidable that the emphasis within the Health Service is on the consequences of the breakdown of health rather than on the maintenance of good health. It is no criticism of practitioners to say that the NHS has been disease-oriented rather than health-oriented. Members of the medical professional are educated in, the main, to deal with disease and ill health, and we are conditioned to expect that of the profession. I have heard that in China members of the medical profession are paid so long as those for whom they are responsible have good health. When the patient becomes ill, the doctors are no longer paid. I do not know whether that is true.This has been claimed for a long time. What I would like to know is, who makes the diagnosis whether a patient is ill?
I shall touch on this in commenting on the situation. The situation that I should like to see is one which may be thought to be Utopian—one in which people would visit their doctors once every year or two for a check-up, or for good advice on the best way of looking after their health.