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Social Services

Volume 951: debated on Tuesday 13 June 1978

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Dental Services


asked the Secretary of State for Social Services what progress he has made towards ensuring that dentists provide treatment under the National Health Service for all patients.

A settlement reached with representatives of the British Dental Association on 17th May ended the dispute over expenses. The way is now open to a return to normal working with dentists offering the full range of treatment under the National Health Service.

Is my right hon. Friend aware that much of that agreement is still unacceptable for a large area within the profession? Does he recognise that there are now whole areas of the country where dentists no longer accept National Health Service patients and intend to keep it that way? Is he also aware that many of his hon. Friends, including myself, accuse him and the Chancellor of the Exchequer of deliberately starving the National Health Service dental service of funds so that private patients will continue to contribute a far larger share of the cost of upkeep of the National Health Service? Therefore, will he now institute immediate steps to make good this deficit?

On the first part of the question, the British Dental Association has reached agreement with me as Secretary of State. I very much hope that all dentists will co-operate. I am very hopeful that, as a result of this decision and the new agreement which provides additional resources for the dentists, the troubles will be ended. However, even during this period there has been a steady increase, month by month, in the number of treatments which have been provided under the National Health Service by dentists. As for the suggestion that the service has been starved, that is not so. There is a steady increase in the number of dentists as well as in resources made available for the service generally.

Would it not be easier to provide dental treatment for all patients who need it if water were fluoridated, since this would drastically reduce the incidence of dental decay?

I am in favour of fluoridation and I and my ministerial colleagues are doing our best to find ways to encourage it all over the country. Bit by bit, this is happening, and the majority of area health authorities have taken a decision in favour of fluoridation.

Does the agreement which my right hon. Friend has made get rid of the gross injustice to patients that it is not obligatory on the dentist to let them know whether he is treating them privately or on the NHS? Since he has concluded this agreement, will he now implement the working party report which I submitted to his Department two years ago, which would save much of the £223 million that we are now spending on dental services?

Some of the proposals made by my hon. Friend have been implemented and I am ready to look at some of the others. On the first part of the question, it has been very wrong and irritating for patients when dentists have not explained the situation exactly. We have drawn this to the attention of dentists. They are asked, as are other practitioners, to make the situation clear to patients so that they may know whether they are having treatment under the NHS or are expected to enter into a private agreement.

Will the Secretary of State now explain why, for the first time in this country, so many dentists who work in the NHS are going bankrupt?

I have no statistics of dentists going bankrupt. The hon. Gentleman will know that one of the difficulties which led to the rift between myself and the British Dental Association was the refusal of the Association to cooperate in the work of the dental rates study group and in the production of an up-to-date scale of NHS fees. This was partly because there was an objection to the system whereby they were expected to repay expenses which had been paid to them over and above what was required. That dispute has now ended. Dentists will be receiving an increase of 12 per cent. on authorised fees. That is partly an advance for expenses, and it is being made available during the course of this year. This will greatly improve the position of dentists.

Birth Rates


asked the Secretary of State for Social Services what estimate he has made of the proportion which births to mothers born in the New Commonwealth and Pakistan bore to total births during the last 10 years in Birmingham, Bradford, Huddersfield, Leicester, Wolverhampton and the boroughs comprised in the Inner London education area.

Information on births by birthplace of mother, which first became available in 1969, is published annually by the Registrar-General. As the answer involves a number of figures, I will, with permission, circulate a table in the Official Report.

Do not these proportions, already covering nearly 10 years, give a very good indication, at any rate as a minimum, of the eventual proportion of the total population in these areas which will be of New Commonwealth ethnic origin?

What they show is something very different from what I think the right hon. Gentleman has been suggesting. He picked his own years and his own areas. The figures show an average figure for New Commonwealth and Pakistan births of 22 per cent., which is far less than the figure of 33 per cent. to which the right hon. Gentleman has frequently referred. He should not assume that fertility rates in these ethnic communities will continue at a high level, nor that there will not be a movement of minority groups from one city to another, as is already happening. I point out to him that in many of the areas which he specified the proportion of births to New Commonwealth and Pakistan mothers went down during the period concerned. That includes the constituency that the right hon. Gentleman originally represented.

Will my right hon. Friend accept from me that the obsession which the right hon. Member for Down, South (Mr. Powell) has about the births of coloured people is not shared by human beings in general throughout the entire universe, and that women will go on having babies as long as there are men with them? Is it not about time that we thought about improving the lot of all human beings instead of being obsessed with this particular aspect, as the right hon. Gentleman is?


Area of usual residence of mother









Inner London Education Authority: Total2222222222222324
Kensinston and Chelsea1413121012121212
Tower Hamlets1717182125272731
City of Westminster and City of London1616151515161518
Total of above areas2121202121222323

* As constituted at 1st April 1974.

† April 1969 to March 1970.

Hospital Waiting Lists


asked the Secretary of State for Social Services what is the average waiting period for a National Health Service patient requiring orthopaedic treatment.


asked the Secretary of State for Social Services what is the average waiting period for a National Health Service patient requiring general surgery.

I regret that the information is not available. Obtaining such statistics would involve considerable extra manpower. With each specialty, patients with very different conditions and of differing degrees of urgency would be averaged together. The results would not be sufficiently meaningful to justify the cost.

been an obsession of the right hon. Gentleman now for 10 or 12 years. I think that this obsession has done great damage to race relations in this country and to community relations. I believe that my hon. Friend is right and that the majority of people do not look at the colour of other people; they take them as citizens.

Following is the table:

I am much concerned with this problem, and my Department and the health authorities are energetically seeking to bring about an improvement.

Does the Secretary of State agree that the problem is not so much a shortage of surgeons as a shortage of facilities—beds, nurses, theatre time and physiotherapy—and that it is this which is causing these long waiting lists? Will he consider the possibility of using the facilities which are available in the private sector, for a fee, in order to overcome this present difficulty?

That is no answer. The reasons for the problem vary in different parts of the country. Sometimes there are staffing problems. There is also the fact that there is a constant increase in the demand by patients for treatment. There are more accidents. There is also a wider range of surgical techniques. There are more elderly people requiring additional support. There are more cases of cancer, and so on.

If I had produced the statistic that the hon. Gentleman wanted, it would have shown a tremendous variation. There are consultants in some parts of the country with quite short lists. Others, elsewhere, have very long lists. It is essential that the necessary information should be readily available to general practitioners, and that consultants should co-operate together. We should try to improve the management of waiting lists. It is not just a question of money and resources, important though that is.

Had the Secretary of State produced the statistics, there is no doubt that they would have shown a very unsatisfactory and deteriorating situation in many specialties. Bearing in mind that figures often conceal individuals in pain and misery for a very long period of time, what possible ground has the Secretary of State for telling the Royal College of Nursing that pessimism about the future could not be justified?

What I said to the Royal College of Nursing was that we have to get the problems of the National Health Service into perspective. I spelt out, as I have done several times to the House, some of the major pressures which bear upon the National Health Service. I made it perfectly clear that neither this Government, nor any other, would be able to provide adequate facilities to meet all the needs, because the demands are never ending. I said that we need to get into proportion the problems faced by those who work in the National Health Service, and at the same time note its great successes.

We have roughly the same sort of percentage of patients-10 per cent.—on waiting lists, and the number of inpatients treated in the National Health Service is steadily increasing year by year.

Will my right hon. Friend accept that the delay in obtaining orthopaedic appointments is one of the biggest single causes of unnecessary suffering, among young people particularly? Why has my right hon. Friend's Department placed a bar on the appointment of further registrars in orthopaedics?

Where there is a shortage of consultants in particular specialties, we have to do some sort of rationing to ensure that they are available in all parts of the country, and therefore to approve a post, if it would automatically then mean that another area would be deprived, would be unfair to that area.

Is the Secretary of State aware that nearly 1,000 people are awaiting orthopaedic surgery at the Newcastle hospitals, and that they include many who could be back in productive work if they could get hip operations?

Will the Secretary of State indicate whether he thinks that the opening of the Freeman Road hospital will make a difference, or can he think of further measures which could be taken?

I am sure that it will make a difference. That is why, when the Chancellor of the Exchequer announced that additional funds were to be made available, we gave a high priority to ensuring that new hospitals would be fully commissioned as soon as possible, and we put additional money into the acute services for equipment and urgent maintenance, in addition to the special £2 million which was entirely linked with easing some of the problems of waiting lists.

Is it not true, contrary to what the hon. Member for Canterbury (Mr. Crouch) said, that National Health Service facilities are sometimes used for the treatment of private patients because of the higher standards, for example, of asepsis in the National Health Service theatres?

Returning to the right hon. Gentleman's speech at Harrogate, since he has now been forced to concede that he ought never to have made that speech at all—and has gone so far as to say that in future he ought not to make any speeches at all to the nurses—will he confirm that he is not proposing altogether to cut out meetings of that sort? Such meetings give him the opportunity of a glance at reality, and at what it is like to work at the coalface in the National Health Service today, in contrast to his own blatant complacency, which aroused such fury on the occasion of that speech.

The right hon. Gentleman has totally misrepresented what I said. I said that the arrangement which had been reached, long weeks in advance of the conference, whereby those concerned wished me to send a script of what I was to say, does not lead to the best sort of exchange and the best sort of debate. I have made it clear that I am very anxious to see them and to have a talk around the table about some of their problems, but that I would much rather have a conference without any prepared speeches, at which we could deal directly with the issues which most worry the nurses.

The right hon. Gentleman knows that I spend a great deal of my time in travelling round the country, visiting hospitals, meeting doctors and nurses, and facing their problems.

Wyatt V Hillingdon London Borough Council


asked the Secretary of State for Social Services what action he intends to take in the light of the ruling of the Court of Appeal on 9th May in the case Wyatt v. Hillingdon London Borough Council; and if he will make a statement.

Mrs. Wyatt has now been invited by my Department to specify her complaints against the London Borough of Hillingdon. When these have been received, and we have comments from the local authority, I will consider what further action it may be necessary to take.

Is my hon. Friend aware that the court of appeal decision will cause great anxiety to hon. Members on both sides of the House and to the disabled, including disabled children and their parents? Is he further aware that the geographical gamble with regard to the care of the disabled will widen? Will he please spell out the default powers of the Government for bringing action against defaulting local authorities.

I appreciate my hon. Friend's concern. He will know that I am anxious to do all that I possibly can to improve services for disabled people. Briefly, our default powers provide that a local authority may be declared in default by my right hon. Friend who may then direct the authority to remedy the default. If the authority fails to comply with that direction, my right hon. Friend may transfer the relevant functions of the authority to himself and recover expenses from the authority. I know that he will not hesitate to use his default powers should that be necessary.

Does not the Minister accept that he, previous Secretaries of State and the parliamentary Ombudsman have all indicated, and made statements to the effect, that the 1970 Act was legally enforceable? Does not this court ruling now mean that he will have to bring forward new legislation to enable the courts to deal with, and enforce, the law?

The ruling of the court of appeal, as I understand it, does not mean that the Act is not legally enforceable. The question is "enforceable by whom?" Most disabled people want an effective remedy for their problems. How that is obtained is a secondary matter. I can assure the hon. Gentleman that I shall do everything I possibly can to resolve present difficulties at the earliest possible date.

Mobility Allowance


asked the Secretary of State for Social Services what estimate he has made of the cost of extending entitlement to mobility allowance to those whose immobility is as a result of medical factors other than physical disability.

If we were to extend the scope of mobility allowance to cover people who can walk but who have other mobility problems, we could not limit the extension to particular disabilities or diagnostic groups. While I cannot give any precise estimate, the cost of such an extension would be very considerable indeed.

Does the Minister accept that many thousands of people suffer from a severe lack of mobility caused by mental illness or mental handicap rather than physical inability to walk? Does he not accept that under the regulations there is an unfair and arbitrary distinction and that it would be much more appropriate if a mobility allowance were available to anyone who could show that his lack of mobility was due to medical factors?

I am aware of this problem. I shall consider the claims of the people referred to by the hon. Gentleman together with all other claims. I must emphasise that we should not be placed in a position of being unable to put right anything which has gone wrong. I would ask Opposition parties not constantly to be campaigning for a reduction in public expenditure while simultaneously asking us to increase all the parts of that expenditure.

Does not my hon. Friend agree that mobility allowance should be payable in all cases where mental condition has resulted in a physical inability to walk? When will he introduce his new regulations, which he promised at the time I raised my constituency case of Mr. Trent Brown, in order to establish this principle quite clearly?

We shall shortly be making regulations to put it beyond doubt that a person unable, or virtually unable, to walk for at least 12 months because of physical disablement is eligible for mobility allowance regardless of the nature of his incapacity. I am most grateful to my right hon. Friend for the important part which she has played in this matter.

Does not the term "mobility allowance" continue to be a misnomer when, in fact, there are so many people with physical disadvantages who are not entitled to benefit because of the very tightly drawn terms on which the allowance is presently available'?

It is not a misnomer. The allowance is intended to help people who cannot walk or who virtually cannot walk. It is in the process of helping 100,000 new beneficiaries. We are in the process of increasing five-fold our expenditure on outdoor mobility for the disabled. There are many more claims, and we shall do whatever we can to make further progress.

Will my hon. Friend state how many now benefit from the mobility allowance? What is the total cost of this scheme? Does he realise that the scheme which has been introduced by this Government is deeply appreciated by those disabled people who benefit from it?

At the latest date for which figures are available—5th June 1978–71,142 people were in receipt of mobility allowance. I expect that by the end of 1979 our total expenditure on this new benefit will be £65 million a year. I am most grateful to my hon. Friend for the comment that he made about the importance of this new benefit.

Mental Health Act (White Paper)


asked the Secretary of State for Social Services when he expects the White Paper on the Mental Health Act to be published.


asked the Secretary of State for Social Services when he expects the White Paper on the Mental Health Act to be published.


asked the Secretary of State for Social Services when he expects the White Paper on the Mental Health Act to be published.


asked the Secretary of State for Social Services when he expects the White Paper on the Mental Health Act to be published.

Preparation of the White Paper is at an advanced stage. While I cannot today give a precise date for publication, I hope that it will be published before the Summer recess.

I am grateful to my right hon. Friend for that answer. Does this mean that it is still the Government's policy to raise mental health patients from their status of Cinderella to a higher priority? Will he soon introduce a policy on medium security units?

The status of mental health cases has already been determined without any amendments to the Mental Health Act. Within our present priorities we have been channelling an increasing proportion of available resources towards helping the mentally ill and the mentally handicapped. This is part of Government policy. In the answer to a number of other questions we can see the result of this at local authority level. This is being done without any need to amend the Act.

Will the Secretary of State explain why the White Paper has taken so long to produce? Surely he is aware of the deep concern which has been felt for some years about the lack of adequate provision for the mentally ill, particularly mentally handicapped children? Will the White Paper, when it is produced, indicate when we shall have positive proposals for dealing with the disgraceful situation under which magistrates are recommending for treatment mentally ill young people brought before them, yet there are no facilities for such treatment to be given?

The main problems that are dealt with in the White Paper are concerned with the law. The White Paper is not so much concerned with the actual provision of services, which continues anyway, although I am not saying the White Paper will not also deal with that. The main reason why this has taken a long time is that this is very complicated legislation. The consultative document was sent out in August 1976. There have been 300 representations, most of them from organisations, although some from individuals. They deal with very complicated matters. That is why it has taken a good deal of time to bring the White Paper to fruition.

Will my right hon. Friend indicate whether the White Paper, which has been a long time coming, will give some regard—despite its complexity—to problems such as the personalised clothing systems in psychiatric hospitals and whether it will take into account the fact that on the latest data about one family in three in this country will require some help for their mental problems in the course of their lives?

The White Paper deals with the rights of patients. That includes questions of property, correspondence and so on. The White Paper does not deal with the resources to be made available for mental health, be it mental handicap or mental illness, because it deals with the 1959 Act. Resources raise a quite different issue.

It is nine months since the Secretary of State outlined his thinking on this subject to the Mental Health Foundation at Oxford. While I entirely accept that these are very complex matters, will he also accept that there needs to be a very full, public and open discussion in the newspapers and elsewhere of what are extremely difficult matters? Will he now bring forward this White Paper so that this discussion can take place publicly at the earliest opportunity?

I absolutely agree. There is no doubt that we need to have a very wide debate in this House and among the organisations concerned. That is why, if we are to have a responsible debate, we must have a responsible White Paper which deals very carefully with the difficult issues involved. That was why I decided that we should proceed first on the basis of a consultative document, which has led to very wide consultation, and then with a set of proposals from the Government, again with adequate time, so that they can be explored.

Is my right hon. Friend concerned about the arbitrary procedures of the Mental Health Act 1959 under which people can be committed? Will his White Paper make any recommendations for amending these procedures?

Can the right hon. Gentleman say whether the White Paper will deal with the position in which people who are perhaps marginally of unsound mind, and who might a few years ago have been kept in detention but who have now been released, as a result of a more enlightened attitude, to live in communities, which may be small or large, to live as far as possible a normal life, can sometimes, as the Minister knows, cause great havoc to those who live in what otherwise is a peaceable community?

It certainly does not deal with those who are no longer the subject of legislation, namely, people who may have had a mental illness and who have now settled back in the community. I am sure it would be quite wrong for legislation to deal with that. However, it deals with the definition of mental disorder, which undoubtedly needs to be brought up to date following the 1959 Act.

Doctors' Ancillary Staff (National Insurance)


asked the Secretary of State for Social Services how many representations he has received about the advancement from 31st to 6th March 1978 of the deadline for application to the new scheme for direct reimbursement of employers' national insurance contributions for doctors ancillary staff; how many such staff have been in consequence refused access to the scheme; and if he will make a statement.

The arrangements for general practitioners to be directly reimbursed the employer's national insurance contributions that they pay for their ancillary staff came into effect as intended on 1st April last. It was the date for occupational pensions schemes that was brought forward. I have received only a few letters about the change from individual doctors, though representations on behalf of the general practitioners as a whole have been made by the profession's representatives. Following consultations with the profession, detailed guidance on the acceptability of claims should shortly reach family practitioner committees.

Is my right hon. Friend aware that I have doctors in my constituency who were told about this pension scheme on the very day that they were also told that the closure date had been brought forward? Cannot he see that that looks like sharp practice to ancillary staff in the National Health Service? Can he tell the House whether the Department calculated the additional amount that would be needed to include everyone who applied by the original closing date of 31st March?

I reject allegations of sharp practice, since all that was done was done by joint agreement between the Department and the profession after discussions on the principle. No calculations have been made about any increased costs which would arise if all the claims were met.

Elizabeth Garrett Anderson Hospital


asked the Secretary of State for Social Services if he will make a further statement about the Elizabeth Garrett Anderson Hospital.


asked the Secretary of State for Social Services whether he will make a further statement on the closure of the Elizabeth Garrett Anderson Hospital.

Having considered all the available evidence I announced on 16th May that the Elizabeth Garrett Anderson Hospital, on Euston Road, should close and I asked staff urgently to consider proposals to move to alternative accommodation at the Whittington Hospital. The staff at the EGA have now confirmed that they are prepared to consider any offer of alternative accommodation, but without commitment. I have therefore invited the health authorities, representatives of the staff of the EGA and other interested parties to come together under the chairmanship of a senior official of my Department to consider detailed proposals for alternative accommodation In these circumstances I have agreed to postpone the closure of the Euston Road hospital.

Will the right hon. Gentleman explain why he keeps dithering over the future of this hospital? Does he not realise the immense amount of damage it does when he cannot make up his mind what should happen? Will he now give a clear promise that the hospital will be kept open?

There is no question of dithering. My right hon. Friend the Member for Blackburn (Mrs. Castle) entered into a commitment rather more than two years ago in which she said that the hospital on the Euston Road site would close and that it was her view that we should seek an alternative where that facility could be provided within a district general hospital. There has been a great deal of consultation about this. It was my conclusion, after discussion with the staff of the EGA, that since they were now prepared to consider an alternative I should not be tough and insist that the closure had to be on a specific day. Certainly if I had stuck to that when negotiations about an alternative were being considered, I would have been accused in this House of being obdurate.

May I say, first, how much my right hon. Friend's decision in favour of postponement has been welcomed by the staff and patients of the Elizabeth Garrett Anderson Hospital? However, can my right hon. Friend say what sort of time scale he has in mind? How long will all these consultations take? Pending the consultations, cannot he agree to do the urgent repairs which are necessary—for instance, to get the lifts working again, because these broken lifts are putting half the hospital out of commission?

I have made it clear that I hope that the discussions about an alternative will not take long. I have also made it clear that the hospital on the Euston Road site will close. In view of that, it would be quite unjustified to authorise substantial expenditure, or for the area health authority to do so, for the replacement or substitution of the lifts. But certainly essential repair work to enable the hospital to continue during such period as remains to it is the responsibility of the area health authority.

Retirement Age


asked the Secretary of State for Social Services what representations he has received from the Equal Opportunities Commission and the National Association of Pension Funds on the subject of the retiring age for men and women; and if he will make a statement.

My right hon. Friend and I have received copies of the National Association of Pension Funds' publication "Towards Equality in Retirement Ages" and of the Equal Opportunities Commission's consultative document "Equalising the Pension Age".

We shall shortly be publishing a discussion document on the elderly which takes account of the views expressed in these publications. We look forward with interest to the response to our document.

Are not all shades of opinion, including that of the TUC, now reflecting the need to move towards flexible retirement, with the ultimate objective of a common retirement date for both men and women? In these circumstances, is the Minister satisfied that the document to which he refers is all that is needed? Should he not now be under- taking a detailed financial assessment of the true cost of moving towards a common retirement date? Most of the statistics produced by the Government so far appear to some of us to have been somewhat bogus.

The figures that we have produced are not bogus. A great deal of information has been given of the cost of moving towards equalisation. Flexibility will be a central issue in the document. We deal with this in great detail, as well as equalisation. But we feel that there is a need for a national debate on this issue.

Does my right hon. Friend agree that it is very difficult to reconcile the principle behind the current legislation on equal opportunities and sex equality with the startling difference in the retirement ages for men and women? Does he agree, further, that this applies also to widows and widowers who when in employment often have equal wages and equal responsibilities, bearing in mind that the widower does not receive a pension? Will my right hon. Friend take these factors into consideration?

Yes, and they will be discussed in the document. I accept that the present differential is illogical, but, as I have explained already, equalisation creates many problems and difficulties, and these will have to be discussed fully.

Does the right hon. Gentleman agree that what really matters is not a blanket reduction in age but flexibility, so that each individual can retire at the age which suits him or her best and which suits his or her job? Does he recognise that we shall make little progress with flexibility until he persuades his Treasury colleagues to reduce the penal rates of tax on personal savings?

I accept fully the first part of what the hon. Gentleman says, but I cannot accept the second part.

Emergency Services (Bromsgrove And Redditch)


asked the Secretary of State for Social Services in the light of the continuing refusal of general practitioners in Redditch to Operate a 24-hour casualty service and in view of the lack of facilities at Bromsgrove General Hospital, if he will make a statement on the future of accident and emergency services in that area.

The area health authority will be reviewing these casualty services in the light of the survey it is making of existing facilities and the use made of them. A major accident and emergency unit will be included in the plans for the new district general hospital at Red-ditch.

This survey has now been going on for more than a year. Cannot the Minister give some indication when a casualty service will be resumed in this very important manufacturing area? How does he view other areas where general practitioners are responsible for the provision of these services?

On that last point, if the hon. Member will table a Question about it and give me notice, I shall answer it. As for the first part of his supplementary question, the survey will be laid before the area health authority on 16th June.

Kidney Machines


asked the Secretary of State for Social Services whether he will make a further statement about the withdrawal of the attendance allowance from patients using kidney machines.


asked the Secretary of State for Social Services whether he will make a further statement about the withdrawal of the attendance allowance from patients using kidney machines.

An application for leave to appeal has now been made to the National Insurance Commissioner and I am awaiting the outcome.

Does the Minister agree that the loss of attendance allowance leads to a generally less effective use of dialysis units? Would it not be better to cut across the nonsensical situation whereby everything is stored pending the results of the appeal to the National Insurance Commissioner, and go for both shorter dialysis periods and the attendance allowance?

I cannot add to my original reply, except to say that whatever the National Insurance Commissioner's decision may be, we shall need to consider the implications most carefully. I readily undertake to do this. It would be quite wrong for me to reach any conclusion now, in anticipation of the Commissioner's decision. It is not an easy matter, since dialysis patients are only one of the groups to whom the conditions for attendance allowance must be applied.

Does the Minister admit that it is unacceptable if dialysis patients lose the attendance allowance without any improvement in their condition? What is he doing to try to speed up the decision of the National Insurance Commissioner?

I am sure that the National Insurance Commissioner is well aware of the interest in the case which has now been referred to him, and that there will be no undue delay in reaching a decision. However, as I have said, I cannot at this time anticipate the decision, and it would be quite wrong of me to start speculating about what should be done in future on any decision or on whether further action might be necessary.

I understand that the oral hearing before the Commissioner, involving my constituent, is to take place in a few weeks' time. Will the Minister give an undertaking that the representations made by the Department at that hearing will be of benevolent neutrality?

I am aware of my hon. Friend's considerable interest in this matter, as it is his constituent who has appealed. However, I cannot speak today on the matter of evidence. As to speeding up proceedings, I must emphasise the independence of the adjudicating authorities, including the National Insurance Commissioner.

Since we understand that this decision is unlikely to be announced until the autumn, could the Minister not persuade the Government to accept the Bill brought forward by my hon. Friend the Member for Ealing, Acton (Sir G. Young), which would deal with this expeditiously and make the payment of the attendance allowance to these people?

It would be wrong to attempt to change the law before we are told by the National Insurance Commissioner what the law, in his view, means. I have no knowledge that there is likely to be a delay until November. My right hon. Friend has said that he expects the case to be heard in a few weeks' time.

Emergency Services (North-West London)


asked the Secretary of State for Social Services if he is satisfied with the scope and provision of emergency medical services and casualty departments in North West London.

The number of general practitioners in North-West London is generally adequate. Many of them rely for out-of-hours emergency cover on deputising services, which are now subject to the code of practice issued by my Department in April. Responsibility for the provision of accident and emergency departments rests with the health authorities concerned, subject to broad guidelines issued by my Department, and I have no reason to believe that the service for this in North-West London is inadequate. If the hon. Member has a particular case in mind I will investigate it if he will write to me.

I thank the Minister for his reply. I shall send him details of some cases. In view of the continuing staff shortage on the casualty side in the whole area, is the Minister satisfied that there will be no further partial or complete closures of casualty departments for the rest of this year?

Partial or complete closures of casualty services take place from time to time throughout the Health Service. When a hospital's beds become full, casualties are directed to another hospital. This is part of the normal process, subject to arrangements made between hospitals for the transfer of cases. Therefore, I cannot give the undertaking that the hon. Member seeks.

Is my right hon. Friend aware that there are severe problems throughout London in this respect? Did he see the recent television programme about King's College Hospital and the problems there? If so, what does he intend to do about the problems in his and my area?

There are, of course, occasional shortages of theatre staff, particularly theatre nurses. I did see the television programme and I am due to visit King's College Hospital in the not-too-distant future, so I shall look at the problem.

Will my right hon. Friend look again at the North-West London area's casualty departments—especially those in Willesden? Is he aware that there has been a rationalisation, which has gone much too far? Will he check what has been done in that area?

I take note of my hon. Friend's remarks on that matter. I know that he has a very deep concern for hospital services in his area, and I shall certainly check what has been done.

Pensions (Over-80S)


asked the Secretady of State for Social Services by how much the 25p addition to the retirement pension payable to pensioners aged 80 years and over would have to be increased to restore it to its real value when introduced.

To restore the value which the national insurance age addition had when it was introduced in 1971, on the basis of the movement of the general index of retail prices, it would be necestary to increase it from 25p to 60p.

Was this not a very valuable and widely welcomed supplement when it was introduced? Why have the Government effectively devalued it in this way?

This is one of many benefits that must be considered in the light of public expenditure costs. This Government have done a great deal for pensioners in this country. We do not need to apologise about it.

Prime Minister (Engagements)


asked the Prime Minister if he will list his official engagements for 13th June.

Earlier today I greeted President Ceausescu of Romania on his arrival for a State visit to this country. In addition to my duties in this House, I shall be holding meetings with Ministerial colleagues and others. This evening I shall be the guest of Her Majesty The Queen at the State dinner in honour of President Ceausescu.

No doubt the Prime Minister has had time today to consider the effects of his policies of higher spending, more borrowing and higher interest rates. When this is coupled with stagnant production and a questionable wages policy, how can it be a fact, as pronounced recently by one of his Ministers—this is a vitally important point—that single-figure wage inflation will continue for the indefinite future? Surely this is no more and no less than election window dressing.

I realise the anxiety with which the hon. Member's thoughts are concentrated on possible forthcoming events. I beg him to contain his impatience. In terms of inflation, it is important that he should not, by slipshod words, convey an impression that is incorrect. I do not suppose that he intended to do so. Nobody has said that inflation will continue indefinitely into the future at single-figure rates. What my right hon. Friend the Secretary of State for Prices and Consumer Protection said was that it would continue at single-figure rates for the remainder of this year. What happens next year will depend to a large extent on the level of wage settlements, which begin again in the autumn. What is much more important than examining the statistical entrails every day is that the Government should have the will—as they have—to carry through their policy to keep down inflation.

With due deference to the debate that will take place tomorrow, will my right hon. Friend take time today to remind the general public of the substantial benefits which the Government's existing economic and financial policies have brought to the workers and the under-privileged sections of our society?

I do not wish to anticipate tomorow's debate. It is true that the family budget was distorted by the Opposition and that the measures that we propose to take will remedy the situation. Nothing can alter the fact that pensions will increase, that child benefit will improve, and that there will be a tax rebate in July. All these are valuable benefits, but we must not be complacent, because there is a great deal to do. I constantly remind the country of this. I did so again at the Nottingham miners' gala last Saturday.

As one of the Prime Minister's duties today is to answer Questions in the House, will he tell us why, in his package of economic measures, he deliberately chose to put a tax on exports and on all home production, thereby making us more vulnerable to imports?

There were many means by which we could have put right the recklessness of the Opposition in adding £500 million to the Budget by reducing taxation. We considered them, and no doubt the House will debate them tomorrow. Having looked at them carefully, it seemed to me that because the whole House agrees that inflation is the vital issue, it would not have been appropriate to take action through value-added tax, which might have been sensible in other directions but would have had the effect of pushing up inflation. Therefore, we chose the national insurance surcharge. I dare say that if we had chosen VAT there would have been complaints from the Opposition that we had not chosen something else.

If the Prime Minister has no confidence in the decisions of the House of Commons about cutting income tax, he knows exactly what he can do about it, because it lies in his power to make arrangements to elect a new one. In the meantime, does he not recall that his Chancellor of the Exchequer, during his Budget speech, dismissed the claim of the Liberals when they wanted to increase the national insurance contribution by saying that it would be wrong to threaten jobs at a time of unemployment, wrong to put up industrial costs when we had a problem of competitiveness, and wrong to introduce a tax which would be passed on in prices at a time of higher inflation? Why has he changed his mind?

With respect to the right hon. Lady, I must inform her that it is not I who changed my mind. It is the Opposition who have added £500 million to the Budget. As I have said on earlier occasions at this Dispatch Box, I would much have preferred it if those reductions in tax had not taken place. We would then not have had to bring forward a proposal for national insurance surcharge. Both matters should have been left on one side. I very much regret that the House of Commons took this decision, but, as it did so, we intend, as we said at the time, to put the matter right. We intend to follow a sound financial policy on all these matters.

Does my right hon. Friend agree that what happens about inflation next year will depend largely on whether we have a Government who are prepared to co-operate with the unions or a Government who are determined to have confrontation with them?

I think the last four years have adequately shown that the policy of the previous Government on confrontation and conflict was not successful. We have been much more successful in the policy of conciliation that we have followed. As for next year's incomes increases, I propose to wait, listen and hear what the trade union conferences which are now taking place have to say. They will come to an end in July. After that the Government will have to put forward their own proposals.


asked the Prime Minister if he will list his public engagements for 13th June.

I refer my hon. Friend to the reply which I gave earlier today to the hon. Member for Leominster (Mr. Temple-Morris).

I welcome my right hon. Friend's earlier reply to my supplementary question, but will he emphasise to the trade union movement the benefits which the Labour Government have conferred on their members, and stress that they should not be kidded by the Opposition, who appear to be trying to woo the trade unions with false promises?

I shall certainly point that out to the trade unions, but I believe it would be better if there were an all-party view about the importance and significance of the trade union:: and of the great role that they play. It would serve the Opposition far better if they were to emphasise that aspect, instead of constantly attacking the trade unions.

As the Prime Minister referred to this evening's banquet, will he reflect how he can best commemorate the extinction of freedom and democratic Socialism that took place in Czechoslovakia 10 years ago?

President Ceausescu on that occasion spoke out clearly against what took place in Czechoslovakia, and I am very glad indeed that he did so.


asked the Prime Minister if he will list his official engagements for 13th June.

I refer my hon. Friend to the reply which I gave earlier today to the hon. Member for Leominster (Mr. Temple-Morris).

In the course of a busy day, will my right hon. Friend find time to reflect further on the subject of inflation, particularly the rate of increase in food prices, which is now the lowest since 1970? Will he make it clear to the country that if the Opposition have their way in devaluing the green pound, the healthy situation that now obtains on food prices would be totally destroyed?

I am glad to say that there is no doubt that food prices have risen far less rapidly in the past 12 months. The figure I have is 6·7 per cent., which is very good indeed. The devaluation of the green pound has the effect of putting up prices, but I repeat that it is the Government's policy and intention, so far as we can carry the country with us on issues in which the country is involved, to try to keep inflation down. We are succeeding at the moment, and we hope to continue to do so, because I think that the people of this country understand the issue.

Is it not the case that by increasing the national insurance contribution the Government will put up food prices, whereas if they increased value added tax that would not happen?

An increase in value added tax would have put up immediately the retail price index substantially. [HON. MEMBERS: "What about food?"] Hon. Gentlemen are baying as though they are in the zoo, waiting to be fed. The food index, as the hon. Member for Worthing (Mr. Higgins) knows, even if his Conservative colleagues do not, is part of the overall index and not separate from it, and forms only one element of it. The simple truth is that the Opposition cannot escape from the responsibility that they have forced the Government to introduce a measure that is unwelcome to the Government—namely, the national insurance surcharge. The only alternative would have been to increase value added tax, and that would have increased the retail price index even more. The Opposition can take their choice of which part of the responsibility they wish to assume.

I know that my right hon. Friend has tried to alter this silly system, but will he, in future, when met with a Question such as the one before him, or Question No. 1, answer it in the style of an American President? Leaving out matters of security, will he give the details of his engagements during one day? That might persuade hon. Members that they should not ask Questions to which they do not want answers.

As always, I shall take my hon. Friend's views into careful consideration.

If it is necessary to recoup the £500 million to the Treasury because of the amendments moved on the Finance Bill, will the Prime Minister explain to the country why it is essential to put a tax on employment of £1,500 million?

The tax is to recover the amount that has been lost this year—namely, £500 million. That is what it will do. As I am sure the hon. Gentleman knows, the tax itself does not come into effect until November. There will be another Budget next April, when the matter may be reconsidered.



asked the Prime Minister when he next intends to visit Ankara.

If my right hon. Friend sees Mr Ecevit in the near future, will he tell him that although we welcome the new co-operation agreement between Europe and Turkey and sympathise with Turkey's economic difficulties, the present Government take human rights very seriously, particularly the machinery of the European Convention on Human Rights?

What action will British Ministers take in Strasbourg when this matter is next considered? Is my right hon. Friend aware that if the complaints against Turkey about violations of human rights in Cyprus were got out of the way it would help Britain's reputation for a belief in human rights, in terms not just of complaints against Russia but of human rights throughout the world, and would assist a final settlement in Cyprus?

I know that my hon. Friend takes a deep interest in these matters. The question of human rights, which my hon. Friend raised in the debate on foreign affairs last week, is a matter for the Council of Europe to reach a conclusion upon. I gather it has failed to do so on the last two occasions on which it has considered the subject. I hope that it will reach a just conclusion on the next occasion when it considers the matter. British Ministers will endeavour to ensure that that is done. If so, that conclusion should be published. I agree with my hon. Friend that this matter should not be left hanging around.

If the Prime Minister has an opportunity to discuss these matters with the Turkish Government, will he explain to them that if they have either civil or military aircraft with Rolls-Royce engines requiring repair, the possibility of having those engines repaired will depend not on whether they pay the bill but on the view taken by the T and GWU—not the Foreign Office—of human rights?

No, Sir. I do not think that it will be necessary to explain that to the Turkish Government.

In view of world concern about human rights, and particularly in respect of the discussions taking place between the two great Powers—the United States and Russia—on the dangerous situation that still exists in Africa and the serious situation affecting the policy of detente, what is my right hon. Friend's view about the holding of a summit conference in the not-too-distant future?

As my hon. Friend knows, a conference of seven of the major industrial Powers is to take place, but I do not believe that we shall be discussing the question of Africa or detente. That conference will be concerned with the economic prospects of the Western world.

Does the right hon. Gentleman think that the richer NATO countries should extend more economic aid to Turkey and to Greece, particularly having regard to their key position in NATO and the fact that the Soviet Union is extending more and more economic aid to Turkey?

That matter could be looked into. When the Turkish Prime Minister, Mr. Ecevit, saw me, he asked whether we could assist in supplying arms because of the difficulties that Turkey is having with the United States Congress. I undertook to look into the matter, but so far no propositions have come forward that would be satisfactory.