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Commons Chamber

Volume 33: debated on Monday 6 December 1982

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House Of Commons

Monday 6 December 1982

The House met at half-past Two o'clock


[MR. SPEAKER in the Chair]

Oral Answers To Questions


Cork Committee On Insolvency


asked the Minister for Trade when he expects to announce his conclusions on the recommendations of the Cork committee on insolvency.

I understand the wish of my hon. Friend that the Government should make an announcement on the recommendations of the Cork committee. I shall do so as soon possible. I am still waiting for replies from several major bodies which have been consulted.

Notwithstanding what my hon. Friend may feel about the commercial sector bearing too heavy a burden of the rates, is it not grossly unfair that local councils should have the same preferential powers as the Inland Revenue and be able to bankrupt a company for the non-payment of rates and thus prejudice the position of unsecured creditors? Will my hon. Friend therefore pay particular attention to Sir Kenneth Cork's recommendation on that aspect?

Yes. The report contains complicated recommedations. I am trying to pull out one or two parts on which we can act to stop the various abuses. For example, I am seeing whether we can strengthen the powers to deal with directors who take advantage of their position.

Does not the Freddie Laker fiasco prove the importance of legislating quickly? That matter involved the loss of £250 million of other people's money and 17,000 Skytrain ticket holders were left in the lurch, despite what Tiny Rowlands said in public. Now Sir Freddie Laker, with Tiny Rowland's help, is able to set up in business again. Does that not make the present insolvency laws a welsher's charter?

It took the Cork committee a long time to report on this complicated matter. We must be careful, before introducing new legislation, to ensure that it benefits the people it is meant to benefit.

Order. I hope that hon. Members will find a word other than "welsher". It is a loathsome expression.

Manufactured Goods


asked the Minister for Trade what was the value of exports of manufactured goods from the United Kingdom in the past six months.

In the past six months, exports of manufactured goods amounted to £18·4 billion.

Does my hon. and learned Friend agree that the figure would have been higher if exchange rates had been more stable? What action do the Government intend to take to reduce the fluctuations in exchange rates in the EC and the wider world?

My hon. Friend makes assumptions, and I do not know whether I am qualified to follow him into that uncertain area. My hon. Friend and the House will recognise that, at the end of the day, the stability of exchange rates is determined by market forces and that the Government's role can only be marginal.

Does the Minister accept that the figures that he has quoted represent a deterioration in the annual balance of payments on manufactured goods since 1979 of about £2 billion? Does he view that with complacency or alarm? Will he take the opportunity to say where he stands in the controversy between the Prime Minister, the Chancellor of the Exchequer and the Secretary of State for Industry as to whether exchange rates are to be added to the list of matters for which the Government abdicate all responsibility?

This is the first occasion on which the right hon. and learned Gentleman has appeared at the Dispatch Box in his new role. I congratulate him on his new responsibilities. I am sure that he will make a distinguished contribution to our debates.

When the right hon. and learned Gentleman becomes more closely acquainted with these matters he will find that this year, taken with the past two years, will show a record surplus in our current account. Therefore, he is taking an unduly gloomy view of Britain's trading position.

Does my hon. and learned Friend agree that the terms of trade on which we attempt to export our goods to Spain are grossly inequitable? When will the talks about renegotiation and doing meaningful things in the Community end and when will some serious action be reported to the House?

I know of my hon. Friend's deep concern about these matters. I know he feels that they have a particular effect on the area of which he is a distinguished representative.

It is undoubtedly true that there is a gross disproportion between the tariffs imposed by Spain on imports from the entire European Community—not only the United Kingdom—and those imposed on Spanish imports entering European Community countries. This is a matter of deep concern to the Government and to the European Commission. At my request the issue was placed on the agenda of the most recent Foreign Affairs Council meeting. I hope that we shall soon have an urgent report from the European Commission on the full implementation of the 1970 agreement, to which the United Kingdom was a party, and on how tariff disproportions can be redressed.

Heathrow Fifth Terminal


asked the Minister for Trade whether his Department will give evidence when the public inquiry into the Heathrow fifth terminal moves to West London.

My Department has already provided evidence on the Government's airports policy during the Stansted phase of these inquiries, and have indicated that officials will give further evidence during the Heathrow phase if this is requested by the inspector or the parties.

Will the Department of Trade make it abundantly clear to the inquiry inspector that, although for technical reasons an inquiry into a fifth terminal had to be held and that a quasi-judicial position must be maintained during that inquiry, successive Ministers at the Department of Trade—including my right hon. Friend the Leader of the House, who is in his place, and my right hon. Friends the Members for St. Ives (Mr. Nott) and for Chingford (Mr. Tebbit), who are now the Secretaries of State for Defence and Employment—have repeatedly stated that it is Government policy that a fifth terminal at Heathrow should not be built and that there has been no change in Government policy?

Yes. I am sure that any officials who are called to give evidence will make clear the Government's policy.

Will my hon. Friend have uppermost in his mind the terms of the policy that he has just confirmed—a determination to diminish aircraft noise over west London? Will he do everything that he can to ensure that that policy is implemented and that we do not have a policy that will have the opposite effect?

I know that my hon. Friend has fought extremely hard for his constituents, and I am glad of this opportunity to tell him that the Government will do everything that they can to preserve a proper balance in those matters.

Textiles And Man-Made Fibres (Imports)


asked the Minister for Trade what is the estimated financial value of imported textiles and of man-made fibres in particular for the years 1980, 1981 and for 1982 so far; and if he will make a statement.

With permission, I will circulate the figures in the Official Report.

In the first nine months of this year imports of textiles were valued at £1,501 million cif, of which manmade fibres—staple fibre and continuous filament yarn—accounted for £254 million, or 17 per cent. of the total.

Is not the message from the Copenhagen conference of Ministers that unjust and unfair import penetration must be countered strongly and urgently? Does the hon. and learned Gentleman agree that the textile industry is still Britain's largest employer? What will the Government do to help this industry?

We are within measurable distance of completing the last bilateral multi-fibre arrangement. The only two countries waiting to sign are South Korea and Argentina. If and when the arrangement is completed—I have high hopes that it will be before the end of the year—we shall have a tougher MFA than the previous one. I hope that that will give some satisfaction to the hon. Gentleman and to the rest of the House. I am aware of the hon. Gentleman's concern.

Will the Minister confirm that there has been a deficit in textiles and clothing over the past few years and that it makes sense to negotiate some planned trading arrangement through the MFA, and also with the Common Market, to ensure that our textile and clothing industries—which, as my hon. Friend the Member for Flint, East (Mr. Jones) said, constitute the largest private enterprise employers in Britain—have a secure home base so that jobs in the industry are not diminished further? As the Minister knows, there has been a massive reduction of jobs in the textile and clothing industries over the past three years.

I repeat that the clothing and textile industries can look forward to certainty and a sound measure of protection under the new multi-fibre arrangement. Clothing exports, which have been doing remarkably well, amounted to £750 million in 1979, £808 million in 1980 and £691 million so far this year.

Does the Minister recognise that since 1979 210,000 jobs have been lost in the textile and clothing industries, which, with 580,000 workers remaining, are extremely important industries? Will the multi-fibre arrangement negotiations be concluded before next week's meeting of the Council of Ministers? If so, will the hon. and learned Gentleman make a statement to the House? If not, will he make a statement before the House rises for the Christmas Recess? It would be a tragedy for the workers and the employers if the House were to rise for the Christmas Recess without the fullest possible discussion having taken place.

I am conscious of the number of jobs that have been lost over the past few years in the textile and clothing industries generally. I have raised the issue constantly at the Council of Ministers in Brussels. It is one of the reasons that has led the United Kingdom to take a prominent part in debates on clothing and textiles and to press for a strong MFA. I hope that the House will be reassured about the likely outcome of the MFA. It is for my right hon. Friend the Leader of the House and the usual channels to decide whether a statement should be made by me or by my right hon. Friend the Secretary of State for Foreign and Commonwealth Affairs. I have no doubt that note has been taken of the hon. Gentleman's remarks.

Following are the figures.

£ million cif



(a) Textile imports of which:—


(b) Man-made staple fibre and continuous filament yarn



United Kingdom Overseas Trade Statistics,

  • (a) SITC/R2 Division 65, Groups 266 and 267, Item 847.11 and Subgroup 268.7 (part);
  • (b) SITC/R2 groups 266 and 267, Sub-group 651.4 (excluding Item 651.48) and Items 651.71, 72, 73 and 78.
  • Steel Exports


    asked the Minister for Trade if he will make a statement on the relative steel exports of the United Kingdom, France and West Germany.

    Steel exports for the United Kingdom for 1981 are estimated to have been 3·9 million tonnes, those for France 11·4 million tonnes and those for West Germany 19·1 million tonnes.

    Does the Minister agree that the figures are deplorable? Is it true that we have been losing ground over the past three weeks in the import and export of steel and that more imports have entered Britain than have entered West Germany, France and other member States? When will the Government do something to stop the destruction of the steel industry? Will it be left to suffer like the textile industry and other industries? I hope that the Minister will bear in mind that thousands of workers have been declared redundant in the steel industry and that the total will increase substantially until the Government take action.

    I know of the anxiety of the hon. Gentleman and of others about events in the steel industry, which have been evidenced in many recent debates, including one last week. I remind the House that the penetration of the United Kingdom's steel market is less than that of the Federal Republic of Germany or of France. The penetration of the United Kingdom market is 25 per cent. compared with 35 per cent. in the Federal Republic of Germany and 43 per cent. in France.

    What estimate has the hon. and learned Gentleman made of the effect of various devaluations of the pound on steel exports? Will he consult the Secretary of State for Industry on what steps should be taken, pending devaluation, to save what remains of the steel industry from continued and unabated imports?

    The right hon. and learned Gentleman is not right to say that there are unabated imports. We have secured a much tougher regime against third country imports into the European Community. I cannot give the precise figures that result from varying exchange rates. Perhaps the right hon. and learned Gentleman will take comfort from the recent drop in the value of the pound.

    Does my hon. and learned Friend appreciate that the unnecessary steel strike last year has caused more imports to come into Britain? Is he aware that a number of firms in my constituency and in his are continuing to import steel, following their decision to import during the strike, when they had to get supplies from elsewhere?

    My hon. Friend makes a valid point, which I am sure has been noted by the steel unions and the British Steel Corporation. I hope that the restructuring operation will enable the steel industry to regain these lost markets before too long.

    Does the Minister realise that the steel strike was not the industry's main problem? Is he aware that the industry's problems are the result of Government policies? Does he accept that account should be taken of the number of steel workers who are now redundant and not likely to get other jobs?

    If the Labour Administration had faced the problem of restructuring the steel industry, we should not have had such grave problems from 1974 onwards, and the shock would not have been as great as it has been.

    Tariff Barriers


    asked the Minister for Trade what evidence he has that new tariff barriers to trade between the Western world trading nations and Japan may be erected, to the detriment of the United Kingdom.

    I thank my hon. and learned Friend for that encouragement. Bearing in mind that Japan has got away with a great deal in the past two or three decades in terms of free and fair trade, does my hon. and learned Friend agree that it would be wrong and tragic for the Western nations to retaliate by erecting new barriers? Should we not persuade Japan of the necessity and indispensability of opening its markets to us and to other exporters in the Western world?

    My hon. Friend makes a fair point. One of the Government's and the European Community's preoccupations is to persuade Japan to dismantle some of its trade barriers. Japan has been reducing its tariff barriers under the Tokyo round, and accelerated reductions will start in January. That may have been the result of the visit of my right hon. Friend the Leader of the House.

    Is it not a fact that we continue to bark at but never bite Japan? Following the Prime Minister's robust words in Copenhagen, will the Minister assure us that the Community will now put together a package on open trade which it will invite Japan to discuss, and that if that fails we shall take unilateral action?

    Many discussions have taken place with Japan, and modest measures of liberalisation have been forthcoming as a result. I assure the hon. Gentleman and the House that the Community is taking action against Japan under article XXIII of the GATT.

    I thank the hon. and learned Gentleman for his courteous reference to me earlier.

    In the first three quarters of this year this country had a trade deficit with Japan of £1,488 million. Does the Minister regard himself as having had anything to do with that? For example, has he noticed that at the Smithfield show the low-cost all-purpose tractor, for which so many small farmers are looking, is now on offer by the Japanese? Will he invite British manufacturers of agricultural machinery to discuss with him how the new challenge can be met, or is that not part of his job?

    I do not accept responsibility for every aspect of our trade. The right hon. and learned Gentleman must realise that Ministers have, not a marginal, but a limited impact on events of that kind. I am certain that tractor manufacturers will take note of what the right hon. and learned Gentleman has said. I suspect that it would be impertinent of me to tell them how to conduct their businesses.

    In view of what the right hon. and learned Member for Warley, West (Mr. Archer) said about the imbalance of trade, will my hon. and learned Friend confirm that in the past 12 months Japan has exported to us goods to the value of £2,000 million more than we have exported to it? As most of the imports that we take from Japan are not vital, should we not insist on fair trade between the two nations?

    There is. It is on the basis that voluntary restraint arrangements have been negotiated.

    Does the Minister agree that the covert barriers to trade between this country and Japan are the cause of greatest worry? Does he appreciate that the standards for cars exported to Japan are considerably higher than those required by the strictest state in the United States of America?

    We are constantly drawing the Japanese Government's attention to the barriers that we perceive to our imports. The Japanese have produced only modest packages of liberalisation measures over the past two or three years.

    Firms (Receivership)


    asked the Minister for Trade what has been the change in the number of firms placed in receivership between the periods January to September 1981 and January to September 1982.

    The appointment of 1,288 receivers was recorded during the first nine months of 1981. The comparable number in 1982 was 2,225.

    Why is the number of firms going into receivership this year nearly double that of last year? Will the Minister confirm that so far this year about seven firms a day have gone into receivership? Does he agree that the only businesses that appear to be booming in Great Britain today are those dealing with insolvency?

    I do not accept everything that the hon. Gentleman says. This is a complicated matter. Since the beginning of 1979, 266,000 new companies have been registered, including 68,000 this year.

    Is not one of the reasons for so many companies going into receivership or liquidation the delay in the notification of information about companies to Companies House? Will the Minister do what he refused to do last Thursday and tell the House whether the Government are complying with the first and fourth directives of the European Community on the harmonisation of company law?

    I do not accept what the hon. Gentleman has said. During the debate I said that I would look at the point that he made, but I did not think it was relevant.

    The figures quoted by the Minister show an increase of 166 per cent. in liquidations. As the Government conducted their election campaign on the basis of giving a better deal to small companies, do they still hold the view that Governments are largely responsible for the climate in which small companies operate? Is the hon. Gentleman not troubled by the ever-escalating score of heartbreaks and lost jobs, or is it another matter on which the Government have given up trying?

    The right hon. and learned Gentleman knows that we are taking steps to improve the economy. The dramatic fall in inflation and the fall in interest rates will be of help to everybody. There are many new companies starting every day.

    Free Ports


    asked the Minister for Trade if he will list the organisations he has consulted with a view to promoting free ports.

    We have had useful discussions with hon. Members, local government authorities, airport managements and industrial organisations. Further consideration of this question will now take place under the chairmanship of my hon. Friend the Member for Knutsford (Mr. Bruce-Gardyne). Both these and other interested parties will have an opportunity to present their views.

    I thank my hon. Friend for that helpful response. As free ports could create prosperity and jobs, will my hon. Friend and the working party consider setting up at least one free port at Aldergrove, Prestwick or Southend-on-Sea before the next general election?

    We shall be going ahead with this inquiry as fast as seems reasonable. Within the scope of the inquiry we shall consider many places, including, no doubt, those mentioned by my hon. Friend.

    Does the Minister agree that Great Britain has been slow to realise the potential of free ports? They are already successful in Ireland and Germany, and Belgium is now looking at the possibility. In view of the evidence given by the hon. Member for Knutsford (Mr. Bruce-Gardyne) to the Select Committee on Scottish Affairs, does the Minister agree that to put him in charge of any examination of the matter is to give it the kiss of death?

    Not at all. I am sure that my hon. Friend the Member for Knutsford (Mr. Bruce-Gardyne) will be as willing to listen to wisdom as any other member of the Government. I have no doubt that we shall benefit from the comments of the Select Committee on Scottish Affairs when it reports soon.

    Does my hon. Friend realise the huge advantages that Harwich would have as a free port? Unemployment there has in the past year and a half.

    I am sure that Harwich will be one of the many places whose interests will be advanced by hon. Members on both sides of the House. We shall be delighted to consider each one.

    British Airports Authority


    asked the Minister for Trade what discussions he has had with the chairman of the British Airports Authority concerning that authority's future financial structure.

    I meet the chairman of the British Airports Authority regularly to discuss all aspects of its activities and I expect to see him again early next week.

    Does my hon. Friend agree that the BAA has nothing to fear—indeed, quite the reverse—from an injection of private capital and privatisation? Will he tell the chairman how much he agrees with me and many of my hon. Friends that that should come about sooner rather than later?

    The Government always have an open and sympathetic mind to privatisation. But the BAA is the subject of litigation by international airlines, at the heart of which is its ability to fix its charges. We are, therefore, restrained from going ahead as we cannot yet set out a prospectus when so much depends on its ability to fix the charges.

    May I ask my hon. Friend not to close his mind to the full-blooded privatisation of the BAA, and in particular the three London airports, nor the semi-privatisation and perhaps municipalisation of the regional airports under its control in Scotland?

    Japanese Imports


    asked the Minister for Trade whether he will introduce port of entry requirements for Japanese imports similar to those used by France and other members of the European Community.

    No, Sir. Such measures would almost certainly not be compatible with our international obligations or our current domestic legislation. The French requirements are already the subject of complaint in the GATT and are currently subject to challenge by the Commission.

    Have not the Japanese been getting away with blue murder in international trade for many years? Is it not time for the Government to do what the French Government have done, not to secure unfair terms of entry for our goods, but merely to give notice to the Japanese Government that we expect the entry of our goods to Japan to be treated in the same way as Japanese goods coming here?

    That message has been loudly and forthrightly given, as will emerge from a later answer. However, I do not believe that it would advance the case of the United Kingdom or the Community to adopt measures subject to challenge in international and national courts.

    Have not the French, as becomes them, found the most elegant method of, at one and the same time, pursuing strictly French national interests and, in theory, supporting an open trading policy? Are there not lessons for us all in that example?

    I would not challenge my hon. Friend's choice of adjective, but I am not sure that the French have substantially advanced their case by the methods that they are allegedly adopting. It is not elegant to be challenged in the European Court or before a GATT tribunal. Other methods can be just as effective to support the United Kingdom's interests.

    Does the Minister accept that, although the French method may not be elegant, it is effective, as they are applying 25 sets of regulations to stop Japanese penetration into their market and the Commission will not investigate all 25? Have they not been extremely successful in ensuring that Frenchmen are not unemployed because of excessive Japanese competition? Is not the Government's response of taking no step that might offend European rules and regulations extremely disadvantageous to our people?

    I should not like to comment in depth on the economic policies of a friendly power, but I point out that the French rate of inflation is considerably above ours and accelerating, as are its unemployment figures.

    Will my hon. and learned Friend reconsider his answer to the hon. Member for Huddersfield, East (Mr. Sheerman) and recall that the West Midlands has a number of eminently suitable sites for port of entry control and a large labour force with the skill, and only too willing, to analyse the nature of manufactured imports? May I particularly commend Aldridge-Brownhills as having all the necessary features?

    Should we ever be tempted to adopt the methods recently canvassed—I hope that we shall not—I shall bear my hon. Friend's suggestions in mind.



    asked the Minister for Trade if he will publish the evidence he receives in the course of his review of tourism in Great Britain; and if he will make a statement.


    asked the Minister for Trade if he will make a statement on the progress of his review of tourism as it relates to the responsibilities of central Government.

    I have received a wide range of views from organisations and individuals in the course of my review. I expect to complete the taking of evidence by Christmas. I have encouraged everyone who wished to give me their views to be frank in their comments. It would be wrong to publish detailed evidence given to me on this basis of confidence, but I would expect to state the main themes that emerged from my consultations when I am in a position to make known the conclusions of the review in the new year. Some of the issues that have been raised with me affect the responsibilities of other Departments, and I am pursuing them with my right hon. and hon Friends.

    In case some members of the British Tourist Authority board have not been as frank with my hon. Friend as they might have been, may I point out that with its present structure it spends an inordinate length of time on unprofitable arguments among representatives of England, Scotland and Wales rather than doing the job for which it is well suited? If the review shows that legislation is needed to improve matters, will that be undertaken in this Session of Parliament?

    I am well aware that others hold the same view as my hon. Friend. His point has been well taken into account in the review. We shall consider when legislation should be introduced when we see whether it is required.

    In this important review, will the Minister bear in mind the recommendation of the Stoddart committee to the effect that the Scottish Tourist Board should be free to promote Scotland overseas without going through the United Kingdom agency?

    I shall bear that in mind. I am seeing Mr. Devereux in the near future and doubtless he will put the same view to me.

    In his review, will my hon. Friend take into account the fact that the Yorkshire and Humberside tourist board has achieved a self-made operating income as a proportion of its total income that is higher than that of any other tourist board? Will he ensure that such effort is properly rewarded, by maintaining the level of grant from Government funds?

    The Yorkshire and Humberside tourist board has every right to be proud of its achievements. We shall bear what my hon. Friend says closely in mind in any conclusions that we reach.

    Will the Minister bear in mind the fact that regional airports are a key factor in promoting package tours.

    I certainly shall. I hope that Manchester feels pleased with the Department's recent decisions.

    Is the Minister aware that in the last year of the Labour Government the surplus on tourism was almost £700 million, while for the current year there will be a deficit of about £300 million? What is his explanation for the massive loss of £1,000 million? Does it not show that Britain on the dole is not the most attractive place to visit?

    It shows no such thing. The hon. Gentleman's figures are inaccurate. The figure for last year was £286 million. This year we hope to do even better, the main reason being the value of sterling. The hon. Gentleman will be pleased to hear that as a result of the strengthening of the dollar this year we expect a 7 per cent. increase in tourists from America.

    British Airways


    asked the Minister for Trade in what circumstances his consent is required for the disposal of assets by British Airways.

    British Airways do not require the consent of my right hon. and noble Friend for the disposal of assets, but the Government would expect to be consulted beforehand in important cases.

    When my hon. Friend is consulted by British Airways on, say, the proposed sale of TriStars to the Ministry of Defence as tanker transports, will he give the proposal favourable support, as it would merely be a book-keeping transaction and not a question of buying a new product from overseas—as is the case with its competitor—and it might be a more equitable way of reducing British Airways' debt than by writing off loans?

    It is for the Secretary of State for Defence to say whether his Department prefers TriStars or DC10s, but I have no doubt he has heard my hon. Friend's view.

    As the Britoil flotation was a fiasco, as British Airways' results for the first half of the year are very poor indeed, in spite of the accounts being massaged, and as every other European country is proud to have a flag-carrying airline, will the Minister abandon his private peccadillo aimed at selling off British Airways, send Sir John King back to where he came from and let the professionals run British Airways properly?

    The short answer to all of those interesting and absurd questions is "No, Sir". I am sorry that the hon. Gentleman cannot join me and, I should have thought, all other reasonable people in giving a tremendous welcome to the fact that British Airways have turned in a net profit of some £80 million for the first six months of this year. That is an almost miraculous turn around—

    Does my hon. Friend agree that, notwithstanding the good management that BA now enjoy, unless the accumulated deficit is written off, there is no chance of BA becoming truly viable and able to float on the stock market? When does my hon. Friend intend to write off that accumulated deficit?

    I am acutely aware of the heavy burden of £1 million of debt that past mismanagement and misdemeanours have loaded on BA. It is an important matter, upon which we have not yet come to any substantive conclusion.

    Will the Minister end the uncertainty and confirm that he will not sell BA off before the general election? Does he agree that a time of slump, uncertainty and over-capacity is the worst possible time to consider selling off a large airline and that the move could result only in a cut-price sale of a valuable national asset? Have the Government learnt nothing from the Amersham International and Britoil sales? Cannot the Government begin to understand the Stock Exchange, even if they cannot run the economy?

    The answer to the hon. Gentleman's first three questions is "No, Sir", "No, Sir", "No, Sir". With regard to the lessons to be learnt from Amersham and Britoil, the hon. Gentleman may be absolutely confident that we have learnt all the wise lessons that it is possible to have learnt.



    asked the Minister for Trade, following the recent general agreement on tariffs and trade meeting, if Her Majesty's Government will take steps to persuade the Japanese to open up their markets to British goods and services to the same extent as United Kingdom markets are open to Japan.

    The declaration of the GATT ministerial meeting explicitly recognised that imbalances are particularly detrimental to the stability of the international trading system. We and our EC partners will continue vigorously to press the Japanese to open further their markets to our exports.

    I thank my hon. and learned Friend for his reply. Does he agree that on past experience it is unlikely that the Japanese will voluntarily concede what Britain is asking for? Therefore, does he agree that his previous answers and refusal to accept the tactics of the French will be received with disappointment by hon. Members on both sides of the House? Will he consider, rather than going to Aldridge-Brownhills, having safety checks on all Japanese cars at either Inverness or Caithness?

    I am not sure that those tactics would be of advantage to the British consumer. Nor am I sure that they would be compatible with United Kingdom domestic legislation. I assure my hon. Friend and the House that we shall continue to press the case against the Japanese until their markets are open to our products.

    What good reason is there, either theoretical or practical, to seek bilateral balance of trade between the United Kingdom and Japan? Do the Government intend to aim at bilateral balance with all our other trading partners?

    No. We believe in the multilateral system, but, as my hon. Friends have pointed out, there is a considerable imbalance in our trading relations with Japan. That does not depend on a fair exchange of goods, but, to a considerable extent, on the fact that the Japanese market is less open than ours. That is why I express concern and will continue, with my right hon. and hon. Friends, to press the Japanese for fairer access to their markets.

    Is the Minister aware of the increasing irritation of many large, respectable and reputable firms in Britain, especially in the electrical appliance industry, which are having their goods turned down by the Japanese on the ground that their machines do not meet the health and safety requirements set by the Japanese Government? Is he further aware that the Japanese Government seem to change their regulations depending on the country of origin and the type of product that is on offer? Will he therefore ask his advisers to look into this matter?

    This is obviously a matter for concern. If the right hon. Gentleman will give me details, I shall ensure that every case is investigated. I understand that the ombudsman that was set up by the Japanese Government to deal with alleged cases of unfair practices in these matters has received only two complaints from British companies. If the right hon. Gentleman would like to direct his friends in that direction, to make better use of the ombudsman, it is possible that jointly we shall achieve something worth while.

    Does my hon. and learned Friend agree that the imbalance has grown up over many years and that, whatever he may say about the actions of the Japanese ombudsman, British industry believes that the intransigence of the Japanese Government has been largely responsible for the adverse balance? Does he also agree that something positive must be done in the near future if employment opportunities at home are to be preserved?

    I understand my hon. Friend's anxiety. The Government and other Governments of the EC share it. That is why we have pressed, and will continue to press, the Japanese Government strongly. I must emphasis, however, that not all of the tariffs barriers are due to Japanese governmental intervention, if it can be so described. Many of the barriers are cultural. I must emphasise that the "imports ombudsman" has been going for only one year. It is a little early to judge whether he has succeeded.

    Insurance Markets (Regulation)


    asked the Minister for Trade if he will seek to appoint a roving inspector to assist in the proper regulation of the insurance markets including Lloyd's.

    Is it not clear that, even if the recent Lloyd's Act had been operative in the past year, the latest stream of scandals would almost certainly still have been neither detected nor weeded out? Does that not suggest, first, that there must now be statutory disclosure of all documents as fully as is required under the SEC rules, since that alone brought the Howden scandal to light, and, secondly, that power to investigate prima facie evidence of malpractice quickly should now be invested in an inspector accountable to the Secretary of State, not to the Lloyd's council?

    The hon. Gentleman will realise, with regard to rapid inspections, that we inspected the Minet allegations extremely rapidly. The investigation was started in two days and within a few days after that inspectors were appointed. We now have an Act that comes into full operation in January. Meanwhile, my right hon. and noble Friend has made our general anxieties about the subject quite clear. At a meeting at which I was present last week, the chairman of Lloyd's assured us that he would keep in close and regular contact with us.

    Does my hon. Friend agree that the contribution of Lloyd's to Britain's invisible exports is too important for its image to be tarnished as it has been in the past few months and years? Will he make the seriousness with which hon. Members view the present activities in Lloyd's crystal clear to Sir Peter Green and other members of the council?

    I am well aware of that. We have made it absolutely clear. We should not forget that Lloyd's is the largest insurance market in the world. Every other insurance market does business with it because of its high standards of professionalism.

    Does the Minister agree that, as increasing opportunities exist for insurance frauds at international level, the public can be protected only by full international co-operation in detecting and prosecuting those who are responsible? Will the Minister therefore discuss with Sir Peter Green the allegation that Mr. Bill Allan made at the recent Dallas conference to the effect that he experienced a complete lack of co-operation from Lloyd's when investigating the Kenillworth scandal? Will he ask Sir Peter to assist those of us who want to retain international financial institutions in London by issuing a denial, an explanation or a promise of improvement?

    We received a warning just before the weekend about the Kenillworth scandal. I have carefully examined the reports that have been appearing in the press. The matter must worry us. I shall bear the right hon. and learned Gentleman's points in mind.

    Does my hon. Friend agree also that it is essential to restore confidence in Lloyd's by putting an end to the present shambolic atmosphere of leaks, rows and scandals? Does he agree also that probably the best and quickest way to do that is to follow the apparent advice of the governor of the Bank of England and to appoint an independent chief executive of Lloyd's who would do the job of regulation which the present chairman and committee are so manifestly failing to do?

    I agree with the general tenor of my hon. Friend's remarks. We should now wait until the Act if fully implemented, which, after all, is a matter of only about four weeks from now.

    Is this not an example of the Government's double standards? They are refusing to have any sort of regulatory device over Lloyd's, largely because about 100 Conservative Members are members of Lloyd's. Scandal after scandal breaks out in Lloyd's, yet very little is done. Government supporters went into the Lobby in support of the Lloyd's Act, which gives the council of Lloyd's massive immunities and at the same time attacked trade unions and, by means of legislation, tried to treat them in a highly discriminatory and savage manner.

    If I followed the hon. Gentleman correctly, I must say that I do not agree with a word of what he said. The 1982 Act was based on the belief of both the Government and the Opposition, as well as Lloyd's, that in principle the most appropriate form of regulation for a market as flexible as this Is self-regulation.

    Is it so important that it cannot wait 10 minutes, so that I can take it at the end of Question Time?

    In response to the remarks of the hon. Members for Keighley (Mr. Cryer), I wish to point out that no Member of Parliament who belongs to Lloyd's voted on the Lloyd's Act.

    Overseas Development

    Development Education


    asked the Secretary of State for Foreign and Commonwealth Affairs what representations he has received in the past 12 months about the level of Government funding of development education in the United Kingdom.

    Two organisations, one previously in receipt of a Government grant and the other still in receipt, have made representations. In addition, about 50 letters from members of the public about this issue can be readily identified from our records.

    Is the Minister aware that the British Government currently give three-tenths of a penny per-head of population to this activity, compared with more than twice that amount given by Italy and Belgium and six times that amount given by West Germany? Is he not terrified that, if British public opinion is made aware of the abysmal poverty in Africa and Asia, it will be more critical of the Government's stinginess in the overseas aid programme?

    Not in the least, but I do not want to divert aid funds that should be devoted to the developing world to educating the British.

    In the light of that remark may I ask whether it is the Minister's intention to end development education in 1984? Will that not do tremendous damage to aid prospects from this country in so far as voluntary societies will be less informed and less able to encourage their memberships to play an active part in assisting the poorest countries overseas, which is what they are doing at present?

    No. Development education can well be taught in school, which is the place to learn, as well as in the voluntary agencies, the Churches and so on. The Foreign Affairs Sub-Committee, of which the hon. Gentleman was then a member, was critical of our grant to the Centre for World Development. I have now changed this to a conventional accountable grant at the original maximum value of £150,000 this year and £100,000 next year. I still expect this organisation to be independent of offical funds by April 1984.

    Is this not a subject which even people of mediocre intelligence could study without the assistance of public money?

    I do not entirely agree with my hon. Friend, because the Centre for World Development is a place to which all intelligent, semi-intelligent and subnormal people can apply for advice on the education that it proposes to give.

    Is the right hon. Gentleman not the slightest bit concerned about the figures quoted by my hon. Friend the Member for Sheffield, Heeley (Mr. Hooley)? Does he not realise that development education is a vital aspect of education in this country, in the sense that people need education in unstable world economic conditions and the reaction that we ought to be making to them? Does he not also recall that the Heads of Government of the Commonwealth and the Archbishop of Canterbury, as well as the Select Committee, have criticised him heavily for withdrawing support for this aspect of policy?

    One gets criticised a lot by a variety of people for giving too much, too little and so on. Nevertheless, I still believe that it is up to our education system to educate.

    South America (Aid)


    asked the Secretary of State for Foreign and Commonwealth Affairs what proportion of United Kingdom overseas aid goes to South American countries.

    In 1981, 1·2 per cent. of the gross bilateral aid allocated to individual countries went to countries in South America. In addition, a proportion of our contributions to multilateral agencies such as the World Bank, the Inter-American Development Bank and the European Community, went to South American countries. Figures for these multilateral contributions are not yet available for 1981, but in 1980 we estimate they amounted to nearly 5 per cent.

    What is the estimated figure available in the Minister's Department for the cash that would have gone to Third world countries but did not because it was used for civil and military purposes in the Falklands?

    The best way for the hon. Gentleman to learn the answer to that question is to await the statement on aid for the Falklands that will shortly be made in the House.

    Bearing in mind our long and historic association with Guyana, will my right hon. Friend assure the House that every possible consideration is given to requests from that country for development and loan aid?

    Why is the proportion so extraordinarily low? Is the hon. Gentleman aware that there is great poverty in Latin America? Would it not be a good thing to give additional assistance to the needy countries in Latin America in order to improve our relationships with them, which have inevitably suffered as the result of the Falklands war?

    Our policy is to direct most of our aid to the poorest countries, and in general South American countries do not fall within that category. South America has a developmental need, and many of its citizens still live in poverty. It is also important to Britain, both politically and commercially, and we have great historical ties with that continent.

    On a point of order, Mr. Speaker. In view of the unsatisfactory nature of the Minister's reply I beg to give notice that, I shall seek leave to raise the matter on the Adjournment as soon as possible.

    Victoria Dam, Sri Lanka


    asked the Secretary of State for Foreign and Commonwealth Affairs if he will make a statement on progress on the United Kingdom funded Victoria dam in Sri Lanka.

    I am glad to report that work on the Victoria dam is going ahead well. The dam is now more than half way to completion; the drilling of the power tunnel, which is three-and-a-half miles long, was finished last month; and the construction of the power station is well advanced.

    I welcome that progress. Does my right hon. Friend agree that the Victoria dam project is a good example of how British aid can most effectively be employed, not only in its funding allocation, which is perceived by the people to have beneficial results, but because, as on this occasion, it is married to the expertise and skill of the construction industry? Will my right hon. Friend promote more such bilateral agreements?

    I cannot promise to promote more such bilateral agreements. This depends on demands from the various countries. I agree with my hon. Friend that this is a valuable project for the Sri Lankans, because the dam will provide 210 mW of electrical power, which will be a substantial contribution to Sri Lanka's power requirements. In addition, the irrigation benefits will be spread over 112,000 acres and will ultimately provide settlements for 50,000 farming families. Therefore, this project is of great benefit to the poorest people in the developing world.

    Asian Sub-Continent (Aid)


    asked the Secretary of State for Foreign and Commonwealth Affairs if he will make a statement on the level and quality of aid to the Asian subcontinent.

    In the last financial year we provided £188 million bilateral aid for countries in the area. We expect to provide about the same amount in the current financial year. All the aid is given without interest or repayment. In addition, those countries benefit from British contributions to various international funds such as the World Bank, the European Community and the Asian Development Bank.

    In view of the expertise that has been built up in Britain in the establishment of new towns, would my right hon. Friend consider using some of the aid to the Asian sub-continent for the creation of further new towns to house the outflow of migrants from Britain that is likely to occur during the next 10 years?

    It is for the developing countries to request aid for the creation of new towns. We always consider those requests.

    Steel Industry

    3.30 pm

    I beg to ask leave to move the Adjournment of the House, under Standing Order No. 9, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,

    "the British Steel Corporation's proposed redundancies in Newport, Gwent."

    Despite the fact that we had a full-scale steel debate in the House last Wednesday, the Minister of State, Department of Industry did not mention the redundancies and the Secretary of State for Industry did not put in an appearance. In the few days since the debate, at the Orb works in Newport, which is part of the Associated Products Group, 214 redundancies were announced, at Llanwern, 350 redundancies were announced and at Whiteheads works, 197 redundancies have been announced. That is a total of more than 750 jobs lost in Newport.

    It could safely be said that the crisis in the steel industry is due to lack of demand, and especially to the decline in our manufacturing industry. However, the flow of imports into Britain also gives cause for concern. The Government should now say "Enough is enough" to those imports, or there will be no steel industry in Britain.

    Even more significant is the behaviour of some Ministers. Why were the redundancies not reported to the House during the debate last week, if only as a matter of courtesy? The omission displays negligence, or even a lack of courage. It certainly displays a lack of frankness with the House and it places in my mind a question mark over the integrity of those Ministers.

    One could also ask about the Secretary of State for Wales. Why is he not standing up for the industry in our area—

    Order. The hon. Gentleman must concentrate his argument on justifying why we should have an emergency debate.

    The Secretary of State for Scotland is standing up for the steel industry there. Perhaps the Secretary of State for Wales is afraid that if he were to tender his resignation it would be accepted.

    The steel industry is vital to the economy of South Wales. The House is entitled to a full statement that will rectify and clarify the omissions of last Wednesday. I ask you to accept this motion for an immediate debate.

    The hon. Member for Newport (Mr. Hughes) gave me notice before 12 o'clock midday that he would seek leave to move the Adjournment of the House for the purpose of discussing a specific and important matter that he thinks should have urgent consideration, namely,

    "the fact that more than 750 new steel redundancies in Newport were announced on Thursday 2 December and the failure of the Secretary of State for Industry to notify the House of that development in the steel debate the previous evening."

    The hon. Gentleman has brought to our attention a serious matter—redundancies in the steel industry. The House knows that, under Standing Order No. 9, I am directed to take into account the several factors set out in the order but to give no reason for my decision.

    I listened carefully to what the hon. Gentleman said, but I must rule that his submission does not fall within the provisions of the Standing Order and, therefore, I cannot submit his application to the House.

    On a point of order, Mr. Speaker. I accept your ruling, but I wonder whether you could give the House some guidance. Last week about 6,000 jobs were lost in the steel industry. As my hon. Friend the Member for Newport (Mr. Hughes) said, many of those jobs were lost after Wednesday's debate. The Government are supposed to be reviewing the matter, but while that review is taking place thousands of jobs are being lost and no account has been given to the House of Commons since last Wednesday. Would you give us some guidance on that?

    Further to that point of order, Mr. Speaker. My hon. Friend the Member for Newport (Mr. Hughes) applied for a debate under Standing Order No. 9 on the somewhat narrow ground, although I appreciate his anxiety, of the new redundancy figures announced for Newport. However, more redundancy figures have been announced for Port Talbot. Would it have made a difference to your ruling if my hon. Friend had made his application, or if he or I were to make one tomorrow, for a debate on the steel redundancies in South Wales that were not disclosed in last Wednesday's debate?

    Further to that point of order, Mr. Speaker. I do not disagree with your ruling on my hon. Friend's application. My hon. Friend referred to the position following the debate in the House on Wednesday. However, this morning—my hon. Friend may not have heard this—his constituency sustained further blows because of redundancies at Whiteheads, which are additional to his figures. Will you consider a future application on this matter, Mr. Speaker?

    The House is aware that I have listened carefully to the points of order and that I am well-versed with the situation. However, I must be guided by the factors that guide me in all the applications that come before me, and I cannot change my ruling.

    Baby Seal Products

    3.38 pm

    I beg to ask leave to move the Adjournment of the House, under Standing Order No. 9, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,

    "the failure of the European Community to impose a ban on Community imports of baby seal products and the British Government's decision to oppose a Community-wide ban."

    I had hopes that it would be unnecessary to raise the matter under Standing Order No. 9, because I expected, naturally, that the appropriate Minister—who is in his place now—would wish to make a statement today. You will recall, Mr. Speaker, that during business questions on Thursday I raised the matter with the leader of the House, who replied:
    "The right hon. Gentleman raises a point which has excited deep feeling not just within the House but generally. I shall see that the point is brought to the attention of the appropriate Minister".—[Official Report, 2 December 1982; Vol. 33, c. 409.]
    I can assume only that it was brought to the attention of the appropriate Minister and that he decided not to make a statement, although he was available to do so.

    The matter is urgent, important and of great public concern. I am pleased that the British Fur Trade Association Incorporated agreed to the Government's request to recommend to its members a one-year voluntary ban on imports of baby seal pelts starting from March this year, when the culling season starts. However, that is an unsatisfactory way in which to deal with the problem.

    The matter is specific, because, on the recommendation of the Nature Conservancy Council, the Commission proposed a regulation that would have been binding on all member States. For reasons that the Government have not explained—I had hoped that they would do so today—they opposed that recommendation and sought to persuade other countries to do the same. Yet the Government then expressed disappointment at the inconclusive outcome of the meeting.

    The matter is urgent, because I understand that there is to be further discussion by the Commission on 17 December. The House is entitled to express its view in a more positive and committed manner than through the early-day motion, which has attracted more than 300 signatures, from both sides of the House.

    The public importance of this matter is known to every hon. Member from the very heavy post that we have all received on the subject. Cruelty to inoffensive animals is always abhorrent to people in Britain and the annual baby seal cull in the Canadian north is especially barbaric and arouses strong feelings among the people of this country. Millions have expressed that view, and the House itself should have the right to express its opinion.

    The right hon. Gentleman gave me notice before 12 o'clock midday that he would seek leave to move the Adjournment of the House, under Standing Order No. 9, for the purpose of discussing a specific and important matter that he believes should have urgent consideration, namely,

    "the failure of the European Community to impose a ban on Community imports of baby seal products and the British Government's decision to oppose a Community-wide ban."

    As the right hon. Gentleman and the House will know, it is not for me to decide whether the House shall discuss this important matter. That is not a decision that the House leaves to me. The decision is for others to make. I have to decide only whether there should be an emergency debate today or tomorrow on a matter which I know is of considerable concern.

    I listened carefully to what the right hon. Gentleman said, but I must rule that his submission does not fall within the provisions of the Standing Order and, therefore, I cannot submit his applicant to the House.

    On a point of order, Mr. Speaker. So that the House is not under any misapprehension, I hope that you will confirm that I gave notice this morning that I would seek to raise the matter under Standing Order No. 9 only if the Minister failed to make a statement on the subject. That is why I said at the beginning that I had hoped I would not need to raise the issue. I had assumed that the Minister would make a statement—

    Order. The right hon. Gentleman has made his application. I must confess that, at that moment, I was more concerned that everyone should understand that I was not stopping the House from discussing this matter.

    Statutory Instruments, &C

    By leave of the House, I shall put together the questions on the three motions relating to the draft statutory instruments.

    That the draft Commonwealth Foundation (Immunities and Privileges) Order 1982 be referred to a Standing Committee on Statutory Instruments, &c.
    That the draft Parliamentary Constituencies (Northern Ireland) Order 1982 be referred to a Standing Committee on Statutory Instruments, &c.
    That the draft Criminal Injuries (Compensation) Amendment (Northern Ireland) Order 1982 be referred to a Standing Committee on Statutory Instruments, &c.—[Mr. Lang.]

    Opposition Day


    Inequalities In Health

    3.43 pm

    I beg to move,

    That this House notes that there is little sign of health inequalities in Great Britain diminishing, according to the Report of the Working Group on Inequalities in Health; endorses their conclusion that the causes of health inequalities are so deep-rooted that only a major and wide-ranging programme of public expenditure is capable of altering the pattern; and condemns both the refusal of the Government to undertake such a programme of public expenditure and their general failure to act on the recommendations of the Report.

    In 1977 the then Secretary of State for Social Services, my right hon. Friend the Member for Norwich, North (Mr. Enna1s), set up a working group to consider inequalities in health. To enable the working group to go deeply into this vital subject he gave it the following terms of reference:

  • "(i) To assemble available information about the differences in health status among the social classes and about factors which might contribute to these, including relevant data from other industrial countries;
  • (ii) To analyse this material in order to identify possible casaul relationships … and
  • (iii) to suggest what further research should be initiated."
  • The idea of such an inquiry arose because it had become obvious to many people, including those working in the Health Service, that there was strong evidence of inequalities, not only between one sector and another but between one region and another. I congratulate my right hon. Friend on having understood that such inequalities could not be identified by using the normal statistics but required far more careful examination.

    The working group, which comprised extremely distinguished members under the chairmanship of Sir Douglas Black, decided that it should first examine what was meant by "health". It decided to take as its guideline the concept of health adopted by the World Health Organisation at its inception after the Second World War—that health was not just freedom from pain and discomfort but a positive sense of well-being. That seemed a sensible decision, as it became obvious that only by considering a number of factors could one begin to understand what had happened in this country despite 30 years of the National Health Service.

    The definition of health as a
    "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"
    summed up exactly what we sought to investigate. The working group realised that its task was complex and that there was no single, simple answer. It decided to base its work on that complex definition, because it believed that it was important to have a mixture of social and medical models.

    For far too long, health care in this country has been merely sickness care without necessarily including prevention or the extension of conditions that would enable people to live with the fullest possible benefit of all of their faculties. Existing information from a number of sources was therefore collated. The working group decided to use the definition of class by occupation that is used by the Registrar-General, as it provided a simple and easily understandable way to present the important facts.

    The large number of in-depth studies involved took a considerable time, so the working group was still sitting when the Conservative Government took office, although it was clear that the work would soon be completed. The Conservative Government found the inquiry at best an embarrassment and at worst a matter to be got rid of as hastily as was decently possible. The reason for that is obvious. Far from being committed to destroying inequalities in society, the Conservatives believe in the maintenance of privilege. The Government soon became uncomfortably aware of the unequivocal nature of many of the findings in the report. It is one thing for the Conservative Party to identify the family as the core of its policy; it is quite another to do anything radical to deal with the real problems and difficulties facing family groups in this country. Child poverty and illness must be prevented.

    Not surprisingly, the Secretary of State and his predecessor found it embarrassing to have the inequalities in health spelt out in such stark detail and they were scarcely enthusiastic in welcoming the report. Indeed, they made sure that very few copies were printed initially and that it was difficult for people wishing to obtain copies to discover where they were available. That ploy, however, did not work, because the TUC was so impressed by the quality of the report and so incensed by the social differences that it revealed that it reprinted the report under the title, "The Unequal Health of the Nation". Furthermore, Penguin Books Ltd. chose to produce a paperback, because it realised that the information concerned every family in the land.

    The Government's response was not to hold a series of press conferences, as they have for many of their more superficial projects, but to suggest that the report put forward answers which were too expensive, too imprecise and, in the words of the previous Secretary of State, the right hon. Member for Wanstead and Woodford (Mr. Jenkin), that some of the matters in the report were the pipe-dreams of Professor Townsend. When such a useful and high-powered report is produced, it is extremely unhelpful if Ministers find it difficult to accept that it is a remarkable social document and cease to support it.

    The report is important to us, because it identifies the real causes of inequalities and the effects of those difficulties on the lives of the people of Britain. First, it identified the inequalities between people—the marked differences between the health care that is available for different classes. In Britain today, at birth and in the first month of life, twice as many babies of unskilled manual workers die as do those of professional parents. In the next 11 months of life, four times as many girls die and five times as many boys. The children of social class I can expect to live, on average, five years longer than the child born into a household where the head is an unskilled manual worker. Those differences are retained all the way through the child's school life and through his early teens. Only in his early twenties does he manage to catch up with the more privileged members of social classes I and II, and then the differences begin to appear again.

    Secondly, the report identified the differences between the provision and the use of health services. It drew attention to the fact that there were inequalities between different areas of the country and, using mortality statistics, made it clear that where one lived and the income that one enjoyed had a direct effect on one's standard of life. That is called the inverse care law—good medical care tends to be least available to those in the greatest need and most available in areas where the need is smallest. The Government have done little to reverse that trend.

    The regional variations in mortality show, for example, that those who live in the South-East have a much lower mortality rate than those in the North-West, while those in the Northern region have a still higher rate.

    The Government tacitly acknowledged that when they appointed Professor Acheson to examine closely what was happening in primary care, because the report also identifed the fact that many of those most in need of good health care go more often to their general practitioner, but for one reason or another do not seem to get the benefit that they should from those visits. Professor Acheson reported that there were many difficulties with general practitioner services in inner cities. There were too many elderly GPs, too many inadequate single-handed practices, too many people with restricted lists and too few practices housed in adequate premises. The Government, who commissioned his report, have so far done little to improve the general practitioner service.

    Thirdly, the working group acknowledged that those were complex factors and that it was not just a matter of health care but, inevitably, bad housing, poverty and lack of preventive medicine, and also that the provision of social services had a direct effect on the health of the community. The group produced careful and considered analyses and many detailed policy recommendations. It said that it was anxious to give children a better start in life and that that was the point at which we could have the most effect on the health of our people. The working group said that it wished to encourage good health among the larger proportion of the population by preventive medicine and by educational action. With regard to the disabled, it said that we should consider not only the provision of services but the quality of life of the people who are suffering from some form of disability.

    The report was, however, merely echoing some other aspects of research that have been commented upon in the House. In June 1980 the Select Committee on Social Services produced a report on perinatal mortality. Although it concluded that there were four main factors, in all but the immediate causes social and economic factors played a major part. Those included poor education and poor housing, although it also stressed the contributory causes such as chemical, environmental and occupational hazards. The Committee said that while the perinatal mortality rate had been falling rapidly in Britain, it was still 50 per cent. above the best world rate, achieved in Scandinavia.

    The Under-Secretary of State, in a written answer on 8 June 1982—two years almost to the day after the publication of the report—listed the Government's responses. He claimed that perinatal mortality was falling more rapidly than ever before, but what he did not say was that the Committee had identified a major difference within that figure between social groups. For example, in 1979 social group I had a death rate of 10·2 per thousand, whereas the same figure for group V was 18·2 per thousand. For illegitimate births the rate rose to 19·3 per thousand.

    The Select Committee described those rates as totally unacceptable and made a number of detailed recommendations. The Government's response was to point out that they were considering various policies and in the meantime were supporting the mother and baby campaign of the Health Education Council. If it were not so sad, that would be so little as to be laughable. In the financial year 1980–81 the Government spent £75,000 on supporting the mother and baby campaign, but in 1981–82 they cut the budget by £50,000, to £325,000. So much for their desire to do something about perinatal deaths.

    The working group report said that resources within the NHS and the personal social services should be shifted more sharply than ever before towards community care, particularly antenatal, postnatal and child health services. It also specified the need for home helps and nursing services for disabled people. It is therefore interesting to examine the Government's policies on personal social services since they came to office.

    The restrictions on local government spending have meant that two-thirds of local authorities have cut their personal social services budget for 1981–82. When the Government expenditure steering group for personal social services was asked to comment on expenditure plans for 1982–83 up to 1985–86, it estimated that there would be cuts of 6·8 per cent. in 1982–83, rising to 12·3 per cent. in 1985–86. Indeed, the group claimed that it would be impossible to achieve the current targets, because of the damage to services that would result.

    Even if the target were reached in later years, there would be compulsory redundancies among social service officers. The group said that as the cuts would inevitably be made at random, they would fall most heavily on those very domiciliary services that have the greatest effect on patient care in the community—meals on wheels, home helps and the fostering services. The group also said that some local authorities had already resorted to charges, even though the Select Committee on Social Services had made it clear that those charges undoubtedly deter some clients.

    However, the cuts do not end there, because, as local authorities are wary of committing themselves to the revenue implications of new buildings, there is an estimated 28 per cent. shortfall on capital spending. In other words, the personal social services—the arm with which the Government have said they are most concerned and which could be used as the spearhead of a campaign to reverse the trends identified in the Black report—are suffering very badly from the Government's economic plans.

    It is true, perhaps, that the Government have been looking at other areas of social spending, but what have they been doing in housing? Not only the Social Services Committee, but the Black report, in very definite terms, says that inadequate housing and inadequate social conditions contribute very strongly to poor health.

    The Government's policies towards local authorities have ensured that housing has suffered the most in successive rounds of public expenditure cuts. The Association of Metropolitan Authorities was so concerned that it carried out its own survey and discovered that there were 1 million dwellings lacking one or more of the basic sanitary amenities, 1·5 million dwellings in need of renovation, 800,000 houses statutorily unfit, 1·2 million council houses suffering from damp, and over 300,000 difficult to let. Last year the number of building starts in the public sector was the lowest for at least 60 years—down to about 37,000. Completions in 1981 were 85,000 down on 1978, and there has been only a bare improvement in 1982. In addition, we see from the newspapers today that there is yet another Think Tank report which seems to be suggesting that only the most poverty-stricken will find it possible to obtain any form of public housing in the future, while others are being pushed increasingly towards taking on the burden of a mortgage, whether or not that is in their general interest.

    Council house rents will soon have increased by 135 per cent. since the Tories came to power. Meanwhile, the sale of good housing stock under the right-to-buy provisions has gone ahead, so that between October 1980 and March 1982 nearly 120,000 houses were sold, without a comparable replacement in the housing stock.

    In my constituency we see increasing numbers of people who, having taken out mortgages on their council houses, are now, because of the loss of employment and the other difficulties that they are suffering, unable to continue to support their own homes. They are in the intolerable position that, being unable to pay for their mortgage, they have to go back to the council authorities and ask if they can come to some arrangement to have the houses taken back. The opportunity to acquire a decent home and ensure that the children are brought up in healthy conditions is becoming much more difficult for those who are most in need.

    The working group says that we must give top priority to measures that will enhance family living standards. It says that one way to do that is to improve the family benefit level and to give a direct improvement in child benefit. The importance of that becomes clear when we not the answer that was given by the Under-Secretary of State to the effect that there are about 1 million children—the figure is not as accurate as it should be—living in families where the head of the family is unemployed and in receipt of unemployment or supplementary benefit. Yet one sees no obvious move on the part of the Government to improve benefits at any level. Indeed, far from doing that, since they came to office they have made it more difficult for those who have children to obtain a decent standard of living.

    The Black report says that top priority must be given to measures that will enhance family living and that the abolition of child poverty should be adopted as a national goal for the 1980s. Yet, since the Government came to power, those on any kind of benefit have been told that in future they will face clawbacks and readjustments and, if need be, a cut in their standard of living. Many other Conservative policies have affected adversely some of the most important needs, such as the level of heat in a home, and are affecting most the poorest in our society.

    It does not seem that the Government are prepared to follow any of the recommendations on matters which they could so easily control—the rate of benefit, the provision of public housing, the provision of health services, and so on.

    There is clear evidence that the Government not only object to the provision of cash but have a firm conviction that those who are receiving aid from the State should in some manner or other be made to feel aware of their inferior status.

    The Black report made it clear that there were several things that could be done apart from improving benefits and providing public housing. It suggested that there should be an action programme for special areas. It mentioned 10 suitable areas and took as a guideline those with very high death rates. It said that in each of those areas experimental programmes could be introduced to see whether the care of mothers and pre-school children, the care of the disabled in their own homes, and preventive care projects could be improved.

    The report said that the results should be closely monitored and that the innovation should be the subject of rigorous experimental assessment. Such a flexible programme should be initiated as quickly as possible and would provide a great deal of useful evidence which could be used in other parts of the country. Inevitably, it would need to be funded by the Government, but the response should be carefully evaluated.

    The report suggested that special funding on the lines of joint funding for health and local authorities would improve the planning and the provision of services for the disabled and for the elderly. The response of the Secretary of State was to announce an extra £80 million this year, of which £60 million is already committed in terms of pay, so that there will be very little left over either for the projects in mental illness that the Secretary of State has identified or, for an improvement in children's services.

    We do not need to be asked what is needed. We know that there is a great divide between those in the higher social classes and those in social classes IV and V—those who suffer from poverty and from the lack of decent housing and education. We know that the Government have no intention of helping them. Indeed, the Government have promoted a positive drive in the opposite direction. They have increased the difficulties of the section of the community that is most in need.

    The Government do not particularly want any kind of publicity for the Black report, precisely because it reveals how those in social classes IV and V suffer throughout Britain. We need a massive injection of public expenditure if we are only to begin to reverse the trends. That expenditure must relate not only to the health services but to the provision of new schools, new hospitals and new personal social services.

    If there is to be a genuine programme to support community health care, we must not cut down on the number of nurses. We must not endure a situation in which 1,400 doctors are still unemployed. We must seek to put the money where it can be used to the best advantage.

    I have been listening with care to the hon. Lady. Did she say that the Government were reducing the number of nurses? Does she not realise that there has been a substantial increase in the number of nurses?

    I was speaking specifically about the provision of primary services and services in the community. What is happening—and will happen increasingly in the inner city areas with the cuts next year—is that community nurses are finding it increasingly difficult to get employment. If the Secretary of State has not understood the effect of the cuts in local authority services and in the National Health Service as a result of his own policies, I assure him that at primary care level there will be a continuous running down of the services that are most needed. He will find that an increase in the number of nurses in the hospital service will mean no provision over large areas where social services in the community are breaking down in the most dramatic fashion.

    Does my hon. Friend recall that the number of unemployed nurses rose in November to 8,800, an increase of nearly 1,000 since June?

    I am grateful to my hon. Friend. That is the case. It is obvious that there will be growing problems of unemployment among nurses when the various regional health authorities find that they are unable to maintain the present standards of services. The Secretary of State constantly tells hon. Members how much money he is spending on the National Health Service. The right hon. Gentleman does not explain how four regional health authorities and the Merseyside region will next year experience difficulty, or how areas such as Oxford, which he has tended to attack for producing plans which he has described as over-dramatised and unreal, will maintain their present level of services when the effect of his economic policies becomes clear in coming years.

    The Government are anxious to achieve cuts in services by stealth. Whenever there is publicity over individual hospitals, such as Tadworth Court, or individual services, such as screening, the Secretary of State finds an interim sum of money to keep those services going. That is not the answer. The right hon. Gentleman knows that what he is doing is far more radical. He is aware that hospitals in areas where the need is desperate will close because they will not receive the same kind of publicity or the same support. Those hospitals will be a major loss to the communities that they serve. One suspects that the Government actually accept a policy of inequalities in health because it is part of their concept that the State should provide only a second-class service and not have universal provision paid out of taxation and free at the point of use.

    I agree with a great deal that the right hon. Lady has said. However, her speech, like the motion, refers to extensive, massive and wide-ranging increases in public expenditure. During the debate on the Loyal Address the Leader of the Opposition also referred to expenditure. Is the hon. Lady able to put a figure on this massive expenditure, so that hon. Members know what she means?

    If the hon. Gentleman will contain himself with his usual patience, I shall explain what the next Labour Government propose. It is obvious that unless there is a change of Government both the personal social services and the National Health Service will face a desert of finance in the coming years. It is our intention to commit 4 per cent. to the increase in personal social services. By improving primary care it will be possible to achieve a direct effect on child poverty and child health. We intend to increase the child benefit as soon as possible, along with the maternity grant. We believe that both those benefits will have a direct effect upon the health of the child.

    If the hon. Member for Newcastle upon Tyne, East (Mr. Thomas) is worried about finance, I suggest that he examines his own Social Democratic Party's plans, which seem to have been largely lifted from the Labour Party, to get rid of the married man's tax allowance. The hon. Gentleman will discover that there is considerable scope for shifting resources from one group of taxation to another to benefit the children, who are our main concern. Our plans for expanding public expenditure allow for the fact that the health services should spearhead the changes that we want to see in the social pattern.

    If we are to build new houses and new schools, to improve our hospitals and to provide a much higher standard of primary care, it will be necessary to start soon on the changes that Black demands as a matter of urgency. Unless we achieve that kind of change, it is obvious that the 1980s will be the year in which social services provided in the community, within the hospital service and by local authorities cease to be the means of improving conditions for the majority of people. They will become the poverty struck, the abandoned and the sad deposit of the hopes of those who are most in need.

    There have been no plans from the Government for an improvement in preventive medicine. Even where action could have been taken—for instance, legislation over tobacco advertisements or sponsorship—it has been funked by the Government. They have accepted whatever the companies have demanded in terms of voluntary arrangements. They have done nothing to change the law. The Government must know that if the companies were to agree to a better warning on the effects of smoking on pregnant women, this would have a direct effect on the health of the children who most concern us. They have done nothing positive. Indeed, they seem to have ran away from the difficulty as fast as possible.

    The Opposition would undertake, as a matter of urgency, a programme to provide at least 10 action areas throughout the country. The areas would be those most in need and those where we could experiment with the provision of far better child services and far better primary care. It is obvious that we must take action to make better general practioner services available across the country. We must not accept that the health services exist only to prevent sickness at the lowest level. Instead, we should encourage the kind of health that gives hope to our people.

    The Black report is a well-thought-out, positive and constructive document. It represents a long-term policy, but it identifies some matters that can be dealt with immediately. The failure of the Government is that since receiving the report they have sought either to ignore it or to pigeon hole it so that it receives no publicity. The Government know better than most that if the real inequalities that exist between one section of the population and another were known the electorate would no longer support their health policies. A direct attack would take place upon a group of people who seem to believe that privilege can be bought and that the market place is the only means of deciding the future of the provision of health services.

    The Government intend, by stealth, to run down the lifeline services that could make all the difference to the health of the nation. One of Labour's first tasks on coming to office will be to see that the Black report is implemented urgently. Only by doing that will we begin at long last to bring some justice and some decency to those most in need, the sick and the old.

    4.18 pm

    I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:

    "notes the content of the Report of the working group on inequalities in health; congratulates the Government on the sustained increase in resources committed to the National Health Service; approves the progress which has been made in allocating resources more fairly between the Health Regions, and the emphasis which as been given to making the best use of the resources available; welcomes the announcement of special initiatives to secure improvements in health services to groups with particular needs; but rejects any programme of massive and damaging increases in public spending, in the knowledge that the maintenance of the Government's economic policy is essential to produce the steady increase in real resources that are required to ensure continued improvements in health care.".

    My first criticism of the speech of the hon. Member for Crewe (Mrs. Dunwoody) is that she appears to believe that, by summarising chunks of the Black report, she has triumphantly overcome all the problems in it.

    It is worth remembering not only that the Black committee was set up by the Labour Government, but that its report set out what were thought to be the defects of a sustem over which the Labour Government had presided for six years.

    The Black committee has set out a comprehensive list of the problems facing Britain. I do not seek to disguise that. However, surely no one suggests that problems such as health care in inner cities and, indeed, the unequal distribution of resources are anything but long-standing. They existed long before the Black report listed them on paper.

    If the hon. Member for Crewe believes that all that is needed is a massive injection of public expenditure, she might explain why the Labour Government tried to control that and explicitly stated that runaway public expenditure would lead to runaway inflation, which would be against the interests of the sick, the elderly and the poor. That point was made by the hon. Member for Newcastle upon Tyne, East (Mr. Thomas).

    The hon. Member for Crewe might also reflect upon the fact that Sir Douglas Black's working group on inequalities in health was established in April 1977 when total spending on the Health Service was £6·8 billion. That constituted about 4·8 per cent. of the gross domestic product. This financial year, total expenditure on the Health Service is £14½ billion. That is a rise, related to the retail prices index, of about 20 per cent. Health spending now constitutes 5½ per cent. of gross domestic product.

    Next year, spending on the Health Service will be £15½ billion. All told, spending on health, social security and the personal social services will be £52 billion—about 43 per cent. of total public spending. The position is that spending on health, social security and the personal social services is taking up not a diminishing but an increasing share of public spending.

    Will the Secretary of State tell the Housé how much of the sum spent on the NHS is net of charges and how much of the sum related to social security is represented by unemployment benefit?

    About half of the social security budget is made up of retirement pensions. However, as unemployment has increased, unemployment benefit has increased. I should have thought that the hon. Lady would wish to applaud the Government for having sought to make provision for social security and personal social services.

    The hon. Lady's figures for personal social services were wrong, as were those for health. However, my major objection to the hon. Lady's speech is that it was too shallow by half. We need to go deeper in our analysis if we are to make progress in tackling many of the problems set out in the Black report.

    No one in the House would deny that an objective of our policy should be to give children a better start in life; to encourage good health by health education and preventive measures; to improve the quality of life of disabled people; to secure a quicker movement from institutional to community care; and to seek to tackle the inequalities in health between different parts of Britain.

    It is, of course, right that we should debate the health needs of the nation. It is equally right that we should debate all the policies which are necessary to tackle those needs. The hon. Lady is utterly wrong, because I in no way want to minimise the areas of need in Britain today. I certainly claim that the Government have taken important steps to tackle those needs. However, no one should be in doubt about the needs of many people in Britain or the demands that there will be over the next decade.

    The Secretary of State will know that I have a great interest in the Black report, having established the group which produced it and being a member of the Select Committee. Apart from the right hon. Gentleman's unfair reference to the speech of my hon. Friend the Member for Crewe (Mrs. Dunwoody) as shallow, I hope that he will not suggest that the study is shallow, because it is one of great depth. Will the right hon. Gentleman say precisely how many of the 37 recommendations in the Black report will be carried out by the Government?

    I shall touch upon many of the recommendations, but the House would be here for a considerable time if I were to go through each one. I am not suggesting that the study carried out by Sir Douglas Black and his working party is shallow. That is not what I said. I said that the so-called solutions suggested by the hon. Member for Crewe were shallow.

    I hope that the Secretary of State accepts that to some extent I agree with him about the money that has been spent by the Government. In the circumstances, is it not extraordinary that lack of priorities—the main thrust of the Black report—and lack of imagination have meant that most of the inequalities during that period have increased rather than diminished?

    Some have, but many have not. I shall deal with those matters later.

    I want to tell the House, and the public generally, that we should be in no doubt about the demands and needs of the Health Service and its connected services, not only today but over the next decade.

    The very elderly are increasing in numbers. By 1991 there will be 3½ million people over the age of 75, including three-quarters of a million over the age of 85. At the other extreme of the age scale, divorce rates have increased, creating one of the major reasons for nearly 1½ million children living in one-parent families. Among the mentally handicapped—neglected for so many years—there are children and adults now in hospital who would be better served in the community.

    That will present an enormous challenge to the NHS and the social services. However, we should recognise—this point was absent from the speech of the hon. Member for Crewe—that parents, relations and neighbours can often give the kind of support that could never be provided by an outside body. Voluntary organisations often provide invaluable assistance, and a wise Government should recognise and encourage that source of help.

    I shall not give way for the moment.

    Central Government and local government cannot do everything by themselves. The aim should be to ensure that the total resources of the community for social care are mobilised.

    I shall not give way for the moment.

    What progress has been made over the past few years in meeting some of the Black report's major objectives? One of its major objectives was that children should have a better start in life. For example, it wanted to see better services for children under five. That is an area in which both the statutory and voluntary sectors have important roles. Already, over 80 per cent. of 3-year-olds and 4-year-olds receive education in nursery or infant classes or attend play groups. However, there are still important groups to help. Accordingly, some of the additional Health Service money that is available to be spent on central initiatives next year will be used for work with pre-school children. I intend to make £2 million available for that purpose in 1983–84.

    The emphasis will be on helping voluntary bodies which work with the under-fives and which support families with very young children. We already support national bodies working with the under-fives, and grants amount to almost £½ million this year. I now want to finance particular projects that would not otherwise get off the ground, such as schemes to help childminders to provide a more effective service by providing them with support, training and equipment. There are also home visiting schemes in which volunteers befriend and assist mothers who find life with small children difficult. These are often very effective and deserve to be encouraged.

    I also want to assist community self-help schemes which seek to provide day care for under-fives and support for mothers. We are still looking at the possibilities, so we may be able to add to the list. However, I stress that I am anxious that such schemes should benefit disadvantaged families: one-parent families, those on low incomes where both parents need to work, and those parents with very young children who need help in order to cope. I also want to see what can be done for young children from ethnic minorities, because we need to encourage schemes which are of particular value to them.

    I share the Secretary of State's desire to maximise voluntary support, but will he discuss an anomaly with the Treasury? Organisations sometimes provide care, especially in the form of residential homes for the disabled, comparable with that provided by the social services department of a local authority. The anomaly is that local authorities are exempt from VAT whereas charities are not. Will the right hon. Gentleman give some incentive in that direction?

    As the hon. Gentleman knows, my right hon. and learned Friend the Chancellor of the Exchequer is considering that matter. It has been put to him several times. However, nothing further can be said until at least the Budget.

    The Black report drew attention to another important area concerning care in childbirth. Again, the Government have taken a number of steps to improve services. First, we have set up the maternity services advisory committee. The committee recently published its first report, on antenatal care. Our objective must be to ensure that the services meet the mother's needs as an individual—and often in a more personal way—and that unnecessary waiting and other inconveniences are overcome through better practice. All women are entitled to a service in which their problems are treated sympathetically and in private. The report offered valuable and practical advice on how to achieve those objectives. Through the process of regional reviews, it will be possible to check that progress is being made in putting those recommendations into practice.

    I welcome the fact that the committee is now undertaking a comprehensive review of the whole range of care from the time that the mother believes that she has started labour until delivery. We are expecting that second report in the summer of 1983. I intend that it should be made the basis of further improvements.

    Secondly, I am extremely grateful to the Social Services Select Committee. I see, at any rate, one of its senior members in the Chamber.

    I am grateful to the Select Committee for its comprehensive report on perinatal and neonatal mortality, to which the Government published their response almost two years ago. We asked health authorities to take note of the Select Committee's recommendations and to work for further progress in improving maternity and neonatal services. Three-quarters of its many recommendations concerning detailed improvements to the NHS were remitted to health authorities for consideration in the light of local priorities and needs. The Select Committee has said that it intends to take evidence from four regional health authorities next spring. I am confident that, when it does, it will be able to confirm that considerable improvements are being made.

    Finally, the House will welcome the fact that perinatal mortality—that is, stillbirths and deaths in the first week of life—has been significantly reduced in the past few years. The latest perinatal mortality figure for England, at 11·7 deaths per thousand, compares favourably with the latest available figures for other European countries. For example, the figure for France is 13·8, for Belgium 14 and for Italy 17·4. For two years running now, perinatal mortality has fallen at the fastest rate since statistics were first kept more than 50 years ago—a drop of about 9 per cent. in 1980, followed by an even bigger fall of 12 per cent. in 1981. I very much hope that that progress will be continued.

    The Secretary of State has not answered my point. Although there is a drop in the death rate, there is a considerable difference, within that figure, between social classes I and V. How does the right hon. Gentleman account for that?

    That is right, and that is what the Black report points out. However, I shall come to that issue. In her selective use of statistics, the hon. Lady should recognise that the general trend—despite what she has said—has been significantly better in the past two years than it was during the past half-century.

    Several of the Black report's recommendations covered the important subject of community care. The report called for a shift towards community care, improvements in general practice, and the development of joint funding. The development of community care is a cornerstone of our policy, and we have made substantial progress. Our approach to it flows directly from a belief in the importance of the individual and the family. People should go to hospital only if their health care needs cannot be met in any other way. Indeed, most people would want that. That approach was stressed in the White Paper on the elderly, entitled "Growing Older", which emphasised the vital role that community services play in enabling the elderly to stay in their own homes. The purpose is to prevent or defer the need for long-term care in a residential home or hospital. Similarly, the review published in 1980 about services in England for the mentally handicapped starts with the fact that most mentally handicapped people live with their families or independently. We have sought to take that philosophy further by increasing expenditure and devising new ways of switching resources to meet the needs of the individual.

    The allocations for joint finance have increased year by year to nearly £85 million in 1982–83. In real terms, that is an increase of more than 35 per cent. in the past four years. However, in several respects the existing rules for joint finance have not provided the necessary flexibility that we all want. They are not doing enough quickly enough. That is the problem. There are still people in long-stay hospitals who would not need to be there if more community care were available.

    That is why we published our consultative document, "Care in the Community", and why we now intend to make changes in the administrative rules so that, for example, health authorities can transfer resources with patients for as long as necessary.

    The Bill that we have introduced in the other place will also enable health authorities to contribute to housing and education services. We shall also make a further £6 million available next year for joint finance to support that initiative. During the next five years, we shall reserve £15 million of joint finance money to support selective pilot projects to show how ideas for care in the community can be made a reality. That is real progress towards a better and more independent life for some of the most disadvantaged in our society. I hope that the whole House will welcome those initiatives.

    We shall also make special finance—more than £3 million—available for the development of primary care in inner cities. The initiative is the result of our consideration of the Acheson report on primary health care in inner London and of the Harding report. Both reports were published last year and were commended to health authorities as a basis for action. Broadly, we accept the diagnoses made by Acheson and Harding on primary care in inner cities. The main problems are the disproportionate number of single-handed and elderly general practitioners, the low standard of some of the premises, the shortage of community nurses—I agree with what the hon. Member for Crewe said about that—and the problems of access experienced by some patients. Our initiatives will be directed towards tackling those problems. I hope to be able to announce our detailed proposals to the House shortly.

    The Black committee also laid great stress on the development of health education and prevention. Again, we have substantially increased the grant to the Health Education Council from £3½ million in 1978–79 to almost £9 million in the current year. Health education and prevention are crucial in a number of areas.

    I shall take one obvious example. The number of reported cases of whooping cough this year has risen to epidemic proportions. The latest figures show that there have been 13 deaths—10 were babies under one year old and two were infants under two years of age. The cause of the resurgence of the disease was the falling off over the years in the number of children who were vaccinated. That is why the Government have made strong efforts over past months to encourage parents to consult their doctors about vaccination. It is too soon to give the House the final figures on the response to the campaign, but there is evidence that parents are seeing the need to protect their own and other people's children and that there is an increased uptake of vaccinations. In one area, for example, take-up following the launch of the campaign increased by 13·8 per cent. for triple vaccination, and single vaccinations rose from 60 to 880. The results of a small national opinion poll in September and October suggested that over 60 per cent. of women with children under five are having those children vaccinated against whooping cough. That means that the take-up has almost doubled since the low point in the mid-1970s. That is an encouraging figure. I hope that it reflects a permanent trend.

    At the same time, there is a whole range of other problems where health education is crucial—for example, alcohol misuse and tobacco, about which my hon. and learned Friend the Minister for Health will say more. The report was right to draw attention to the dangers to health caused by smoking. Smoking is the greatest single preventable cause of disease and early death in this country. What is more, unfortunately, the message about the dangers of smoking has not got through to certain groups, or it has got through less than we would like.

    Following the example of the Labour Government, by agreement with the tobacco industry, we have introduced limits on the amount that can be spent on cigarette advertising on posters and in cinemas. We have given the Health Education Council additional money—over £2 million this year—specifically for anti-smoking campaigns. We have improved the presentation of the Government's health warning on cigarette packets and advertisements.

    I heard what the hon. Member for Crewe said about Labour Party policy, should the Labour Party ever come to power. By following the voluntary path, we have continued in the tradition and policy that the Labour Government laid down.

    I want to make certain that the Secretary of State understands what he is saying. The Labour Government entered into an agreement for three years. When the agreement started, most adults were smokers. We ran a vigorous three-year campaign, and by the end of the voluntary agreement most adults were non-smokers. The intention at the end of the three-year agreement was to take action to stop advertising, except at the point of sale. The right hon. Gentleman must understand that he has gone against that intention.

    I shall look into that matter. Doubtless the right hon. Gentleman will tell me where the Labour Government's policy was made clear on that point when they entered into the voluntary agreement.

    Another problem that should cause concern to the House and the public is the misuse of drugs. A report was produced last week by the Advisory Council on the Misuse of Drugs. It said that the misuse of drugs is a substantial problem. No one knows the exact size of that problem, but our best estimate is that probably about 40,000 people are now dependent on drugs of different kinds. Other countries undoubtedly have larger problems, but that is no reason to underestimate our problem. The experience of other countries shows how rapidly the problem can grow unless action is taken. We have made £2 million immediately available to health and voluntary organisations. We also intend to emphasise the dangers of drug taking, particularly to young people. I do not believe that we or the public should underestimate the danger of the problem that we now face.

    I am delighted that my right hon. Friend has raised this matter. Will he take steps to ensure that all those who are addicted to drugs come under specifically chosen doctors? One trouble is that many doctors are playing an unfortunate part in permitting drug addiction to continue. Therefore, it is of great importance that all drug addicts are properly vetted. Will my right hon. Friend ensure that there are suitable long-stay homes or places for drug addicts so that their addiction can be eradicated? Will he liaise with the Home Office to ensure that any additional powers that are necessary are taken at an early date?

    I give my hon. and learned Friend an assurance, particularly on his final point. We are liaising closely with the Home Office. In the near future, there will be a meeting to which we shall invite representatives of the medical profession. I agree with my hon. and learned Friend that unquestionably there is a problem of irresponsible prescribing by a few doctors. We should not overstate it, but there is undoubtedly such a problem.

    However, the major problem is not over-prescribing but the criminal import of heroin, the illegal manufacture of amphetamines and the illegal trade that has grown up. Whereas in the late 1960s Britain was seen very much as a staging post to the United States, now too many of the illegally imported drugs stay here for users and for the illegal market. I assure my hon. and learned Friend that we shall do everything that we can to tackle an important social as well as criminal problem.

    The allocation of resources is at the heart of the debate. In allocating resources to regional health authorities, the Department has, since 1977, followed principles set out in the report of the resource allocation working party. Since then considerable progress has been made towards a more equitable distribution of resources among the regions. For example, in 1977–78 the most deprived region—the NorthWest—was 11 per cent. below target. In 1982–83, the most deprived regions were only 6 per cent. below target.

    The Black report broadly supports the present method of resource allocation to regional health authorities. It agrees that the standardised mortality ratio used in the national RAWP formula provides the best available indicator of health care need when used in conjunction with information about the size and structure of the population. We accept that inequalities exist within the regions and that action will have to be taken to even them out.

    To what timetable are the Government working to achieve a fair allocation? Will it be five years, 10 years or 15 years before it is achieved?

    The timetable will depend on the spending plans that we are able to afford in the coming years. We want the inequalities between regions and inside the regions to be evened out as quickly as possible. A great deal has been done, but under this Government, as under the last, the policies and the progress of policies, such as resource reallocation, depend upon available resources.

    Before sloganising on the problem we should seek to understand what has happened throughout the Health Service's history. The Beveridge report of November 1942 contained a rough estimate of cost showing a flatline projection between 1945 and 1965 on the basis that the development of the Service would lead to a reduction in the number of cases requiring that service.

    The achievement of the National Health Service—it is a real and important achievement—is that it has developed a service which undoubtedly has made a major contribution to the health of the nation. It has also gone a long way—although as the Black report shows, not the whole way—to achieving the goal set by Churchill's coalition Government in 1944 which stated:
    "The Government want to ensure that in the future every man, woman and child can rely on getting the best medical and other facilities available; that their getting them shall not depend on whether they can pay for them or on any other factor irrelevant to real need."

    At the same time as the Service has developed, the costs of and the demands for it have rocketed. That is not in itself a criticism of the National Health Service. It is important that that is understood. Costs have increased in every country in Western Europe. Although I am sure that we can achieve more in efficiency here, the record of the National Health Service in containing costs stands comparison with virtually any other Western European nation.

    Costs have increased for a variety of reasons Medical advances have meant that many conditions which previously could not be treated successfully can now be treated. The fact that people live longer has meant a consequent increase in demand on both the health and personal social services. At any one time, 45 per cent. of beds in National Health Service hospitals are occupied by elderly people over the age of 65. Those two factors—medical advance and demographic change—taken together mean that there is an increase in demand of about 1·2 per cent. a year even to remain static.

    The problem of increasing, if not infinite, demand is one side of the coin. The other side of the coin involves finite resources. Health spending has to be limited in some way. We can certainly argue about what should be, but there is no question about what has been. Under successive Governments in the past 10 years that has been recognised. In many ways, that is the most disappointing feature, if not of the Black report, of the discussion that has surrounded it. The report provides a statement of the problem. It provides an estimate of the type of resources that the committee believe would be required to put all its policy suggestions into operation. That cost is now about £5 billion a year. But the report says next to nothing about where resources of that size are to come from. In surveying the figures of the 1970s—that is what the Black report has done—it has imported some of the assumptions of the 1960s, one of which is that resources will automatically be available.

    There is no suggestion in either the Black report or in the speech by the hon. Member for Crewe of how the resources will be created. The only suggestions are about redistribution. The report suggests that the married man's tax allowance could be redistributed more effectively in the form of cash payments for children. That would save about £3½ billion, but it would also mean a big increase in tax bills. About 12 million married couples would be worse off because their tax thresholds would be lower. The question how that money is redistributed is at the heart of the discussion on the taxation of husband and wife, which followed the Government's Green Paper.

    The Government are still considering the many different views on the subject, but under any system there would be millions of losers. No system would pay for the proposals in the Black report, let alone the proposals put forward by the Labour Party. On that point, Mr. Peter Townsend, one of the authors of the Black report, is most informative. In his introduction to the Pelican summary of the report he attempts to provide an answer. He says:
    "The money for health is only not there if it is being spent on something else like defence or roads."
    I assume that by that mainly he means defence. I do not believe that even the Labour Party is currently suggesting that we should make further capital cuts that affect the construction industry. On the crucial issue of means, that brings us back to the familiar position. The Labour Party is making promises for increased spending without any idea of how the promises are to be implemented, apart from cutting into the defence budget. The Labour Party promises to do that before every election. It has had little effect, for the very good reason that the economies that can be achieved out of the defence programme do not come remotely near to paying for Labour Party ambitions.

    If any further warning is required, I suggest that the Opposition should examine the experience in France, set out in the newly published book of the Nuffield Provincial Hospitals Trust in which Professor Lacronique, who at the time of writing was the deputy director of health and hospitals in the Ministry of Health, wrote that the newly elected Socialist Government had increased public spending by the distribution of money to low-income families and the creation of 150,000 new Civil Service jobs, thus expanding the public sector. He said that the expected outcome of the new policy was a general growth in consumption which would allow the private sector to invest and create jobs.

    However, after one year of various incentives aimed at convincing private investors that the future was promising, the French Government realised in May 1982 that inflation was becoming a major problem and decided to take drastic measures to fight it. In June 1982, it was therefore decided to devalue the franc, and the three-month freeze on wages and prices was decreed.

    In addition, the French Government have altered the basis of uprating charges to save money and they have introduced a board and lodging charge for hospitals inside the health service.

    Overlying all the specific problems mentioned in the Black report is the central issue of the view taken by the different political parties not only of the needs of the Health Service but of how those needs are to be met. The Government believe that the first essential is to base policy upon an economic strategy, which has resulted in lower inflation, which in itself must aid industrial recovery and which, in its turn, will provide the resources for health care. We reject policies that merely put us back on the road to higher inflation, which will affect the resources that can go to the NHS and the lives of most of those with whom the Black report is concerned.

    The second essential is continued support of the NHS by the Government and by those who work in the service. Over the past three and a half years the Government have shown that commitment and that commitment remains. We should remember that the Health Service is not there as a rallying cry for politicians or for trade union leaders. Its fundamental aim is to develop, to the best extent that resources allow, services to prevent ill-health and to cure or care for the sick and the handicapped. It is the individual patient who must come first in any health policy that is worthy of the name.

    Thirdly, we need to make the best use of available resources. In comparison with other countries in Western Europe, the record of the Health Service is a good one. That does not mean that further improvements cannot be made, and I know of no one in the Health Service who takes that view. The search for efficiency is not a threat to the Health Service. It is a way of ensuring that the maximum amount of resources is devoted directly to patient care. That is why we have taken a number of initiatives over the past 12 months, including the annual review by Ministers of the performance of regional health authorities against agreed management objectives. We are formulating and testing performance indicators and we have introduced a programme of scrutinies, with Sir Derek Rayner's help, into the efficiency of the Health Service's performance.

    Fourthly—I end with the point with which I began—we need to develop a partnership with all agencies in health care, including voluntary organisations and the private sector. It seems that there is beginning to develop an unbridgeable divide between the Government and the Labour Party. We do not agree with the attitude revealed in Labour's "Programme for 1982" towards voluntary organisations.

    That document reveals that the Labour Party wants to give priority to the care of mentally handicapped children but states:

    "We wholly reject the Tory assumption that voluntary organisations can or ought to take major responsibility for the care of mentally handicapped children leaving hospital."
    We applaud the efforts of voluntary organisations and we want to see a closer partnership in care for those who are in need.

    No, I shall not give way.

    The view of the hon. Member for Crewe, who leads for the Opposition, is that private medicine has no place in Britain today. That is the motion that she proposed with enormous gusto and undoubted sincerity at the Cambridge Union only two weeks ago. We are told that there are about 34,000 beds in private hospitals and nursing homes and almost 3,000 private beds in NHS hospitals. That compares with the provision in the NHS of about 380,000 beds in over 2,100 hospitals. In other words, the private sector is small compared with the National Health Service. Yet the bulk of private beds are in small nursing homes and not in private hospitals. They are used to look after well over 20,000 elderly people. Is it seriously being argued that we should turn our back on the provision of care, which by any standards is much needed, merely because it is provided by the private sector?

    It is about time that the hon. Member for Crewe recognised that the private sector is a mixture of voluntary, charitable and commercial enterprises, ranging from small nursing homes to modern hospitals capable of undertaking major surgery. Health authorities have had contracts to use some of these facilities for many years. About 3,000 beds in the private sector are used by Health Service patients. It is absurd to characterise such patients as some form of elderly elite. It is equally absurd for Britain to turn its back on the provision that the private sector offers.

    No, I shall not give way.

    The Black report identifies a number of important needs in our society. I do not seek to minimise those needs but I suggest that the real question is how we care and not whether we care. This is an area for serious policy and not for sloganising. The needs that the Health Service faces are likely to increase over the coming years. They can be met only by a combination of policies and by the development of the Health Service. That is essential and it must be underlined.

    At the same time, we believe that it is not only the Health Service that will meet the needs of society. A joint effort is required and a partnership, and the Government are committed to that approach. I ask the House to reject the motion.

    5.7 pm

    The House is fortunate at last to have an opportunity to discuss the Black report. It is a fairly turbid document. It does not make, by any means, the most pleasant of reading. It bears heavily the stamp of the sociologist's jargon but it is an extremely important report. We should be grateful to those who have sought to make it rather more intelligible and more widely known. The TUC, in its attempt to make the public more aware of the conclusions set out in the report, is doing an important job. The report shows clearly that good health and good treatment depend alarmingly on a person's background, his job and on where he happens to live.

    I regard the Government's attitude to the report as disgraceful. It is summed up all too well in the statement that appears on the first page of the document from the previous Secretary of State. He added together all the proposals in the report, produced a large sum and used that as an excuse for dismissing the entire contents of the report. He showed no willingness to implement any part of the report. It may be that the Secretary of State is trying to pull back a little from the posture taken by his predecessor but that posture has coloured the thinking of the Department ever since the report was produced.

    The same computation—that massive public expenditure would be required to implement all the proposals in the report—has influenced the Labour Party's thinking. It has tabled a motion which is a commitment to exactly that sort of programme. I believe it to be over-optimistic in terms of what any British Government in the next two or three years will be able to mount. I do not regard the scale of the total need as any excuse for not committing Governments to doing as much as they can in the direction of the Black report.

    The Government seem to have dismissed the thinking that lies behind the entire report and the direction which it seeks to impose on our health services. What is more, they are pursuing policies that will make the inequalities even worse. There is a series of Government policies that has clearly been entirely uninfluenced by the demonstration in the report that inequalities based on social class and occupation are extremely severe.

    The emphasis that the Government are placing on private medicine involves the underlying attitude that the Health Service is the safety-net service. Anyone who assumes that private medicine has a major contribution to make to the nation's health is misunderstanding the dependence of the vast majority of people on all of the most important services that the Health Service provides. The emphasis on the private sector that has come to the fore in the Government's thinking on health, as in education, is an indication of a safety-net approach to the service, which is clearly affecting the morale and the enthusiasm of many Health Service workers.

    It is not the Government's attitude that the NHS is a safety-net service. What view does the Liberal Party take? Does it support the right for there to be a private sector?

    The Liberal Party has never challenged the right of the people to spend their own money on what they choose. However, we have challenged from time to time forms of private provision that impinge unfairly on the provision for those who are dependent upon the State system. Some of the ways in which private medicine has operated have encouraged queue-jumping by allowing people effectively to buy consultants' time when that time could have been used better to reduce waiting lists in the State sector. We should never seek, however, to deprive people of the opportunity to make provision for themselves independent of the public service.

    At the same time, one cannot escape the Government's rhetoric which again and again promotes the private as against State provision in every sphere. It is my view and that of my party that the State must be the most important provider of most of the health services for most of the people. That is not reflected by the way in which the Government refer to such matters.

    I have specific complaints about Goverment policies. Their attitude to child benefit has been criticised even by some of their right hon. and hon. Friends. This failure to tackle the poverty trap promotes and increases inequalities in health and welfare. The destrucion of the school meals service and the removal of nutritional standards for school meals is another example. Those examples have helped to contribute to a widening of inequalities. The Black report was written before steps were taken about the school meal service. The report lays heavy emphasis on the value of the school meals service in maintaining basic nutritional standards. It is a tragedy that a school meals service, based on nutritional standards which were built up so well over many years, has been destroyed in such a cavalier way so quickly.

    Furthermore, the Government have shown a feeble attitude towards prevention measures, particularly in relation to the problems created by smoking and alcohol. They have failed to tackle the issue of a ban on the advertising of cigarettes. Similarly, I cannot understand the Government's attitude to alcohol and the measures that need to be taken to deal with the enourmous range of problems that it creates. The Government's Central Policy Review Staff has published a major and significant report on the dangers and costs of alcohol in the community. The Government refuse persistently to publish that report. However, it has been published in Sweden. Why do the Government treat it as some vicious form of pornography, which can be bought only in Sweden and must not be allowed to appear on the home market?

    That fairly searching document costed many of the problems created by alcohol and gave pointers to policies that the Government should pursue to reduce the impact of alcohol. Alcohol has the most enormous consequences for ill-health and is one of the areas in which preventive measures could be readily and quickly undertaken. I appeal to Ministers to challenge the Prime Minister's refusal to publish the report. In a parliamentary answer a few days ago she once again refused to publish it.

    The hon. Gentleman is fair, normally. I am sure that he will concede that the report was written three years ago and has been extensively leaked. For some reason, it is being leaked again. In the intervening period, the Government published a substantial policy document called "Drinking Sensibly". I hope that he will accept that that shows the high priority that we have given to the problem. It suggests a policy equal to that of the Think Tank report.

    The hon. and learned Gentleman has the advantage of me because he has both documents. I suspect that there is an enormous gulf between the innocent little pamphlet "Drinking Sensibly" and the more far-reaching document produced by the Central Policy Review Staff. If the Minister thinks that it is out of date he can add to it, and not keep it concealed in a cupboard and available only on the Swedish black market.

    I criticise also the Government's failure to maintain the full momentum of the resource allocation working party—the RAWP formula—to even out regional inequalities. That is illustrated vividly by an article which appeared in "The Health Services" magazine on 1 October. This showed that every Thames region is over-allocated to a staggering amount totalling over £200 million, while other regions remain substantially under-funded. The Northern region, which has the worst mortality rate, has been climbing the league in terms of its under-funding and is no longer the worst, although it has still only 95 per cent. of its allocation and will not be fully funded until well into the 1990s.

    The article showed the staggering differences in cost per case between hospitals in different parts of the country. Roehampton requires expenditure of £783 per case, whereas the Ashington hospital, which serves my constituency, allows £460 per case. Those are two non-teaching examples. There is a £200 difference in the average costs between teaching hospitals in the Thames areas and those in the rest of the country. The article points out that a difference of £200 per case amounts to £70 million a year
    "and could only be justified in terms of teaching needs if it could be shown that patients are dying like flies from the ministrations of those graduating in the provinces."
    As I assume that the Minister does not take that view, he must be puzzled by the remaining enormous differences in the levels of funding for London and elsewhere.

    The hon. Gentleman has spoken of the disproportion of allocation to the four Thames regions—I am a member of one—and the regions of the North. The cutback that the Government have attempted can be achieved only at a certain rate. Massive cutbacks cannot be made in areas that are still growing in population. That is the position in the Thames regions. Whereas London is becoming depopulated, the areas outside London are increasing in population. The hardships are there, and the cutbacks, that I believe should be made to benefit the Northern regions, can be made only at an acceptable rate.

    We are worried when we see insufficient progress made, and when we see that the Government's attitude to dealing with hard cases is different in different parts of the country. It puzzles hon. Members from more distant parts of the country to see cases in the London area which attract publicity such as Tadworth, producing new money and new commitments relatively quickly, while those in the rest of the country do not seem to have that effect.

    I shall compare the Tadworth example with that of the provision of neonatal care in Newcastle. The Newcastle region is estimated to need about 12 cots for babies weighing under 2½ lb at birth. There are only six. Part of that provision is due to outside funding and the generosity, for example, of the novelist Catherine Cookson, whose novels describe vividly many of the conditions that gave rise to lower health standards in the North.

    The consultants claim that they are being obliged to turn away babies who would live if they had the intensive care facility. The consultant in charge of the facility at Newcastle general hospital has said that since April he has had no alternative but to refuse admission to five critically ill new-born babies, four of whom died, from outlying hospitals. It is the consultant's view that many more babies could be saved, and others saved from lifetime handicap, if there were a larger provision for neonatal intensive care. The region has the smallest provision proportionately of any region in England. That deficiency continues and the RAWP process seems unable to make the recoupment necessary to correct it.

    The more distant regions of the country face other problems. Rural areas have the severe problem of access to medical services because of the costs of travel for patients and those who visit them. Berwick is 65 miles away from the main hospital centres, and there must be many other communities with a similar problem. Travel to hospital from Berwick for a patient who does not need an ambulance can cost between £5 and £10 for each visit. A parent accompanying a child can face similar problems.

    The existing Health Service provision for travel is extremely cumbersome. It tends to work on the passport system—if one is receiving social security or family income supplement help may be provided, but otherwise there is none. I welcome what the development commission, encouraged by the Department of Health and Social Security, is doing to experiment in Cumberland with financial help to get patients and visitors to hospital. I hope that that scheme can be developed rapidly to help all rural areas.

    No one should pretend that limitless funding is available to the NHS. It is misleading for the Labour Party to suggest that we can embark on a massive new programme at this juncture; but we are entitled to ask the Government to do a number of things. They should consider the priorities, about which they say little. Do we at present need to put our money into complex high-technology treatments? Should we be concentrating on elaborate provisions for infertility and expensive test tube baby experiments? Are we getting rid of the big mental institutions fast enough and replacing them with community care? Is sufficient being done about the over-prescription of drugs and the prescribing of expensive brand-name drugs?

    The Government should also accelerate the redistribution to benefit underprivileged areas and make progress on the main strategic commitments in the report. The report says that children should have a better start in life; this involves improving child benefit and doing more about the care of young children. The quality of life should be improved for the disabled in the community, which involves a more constructive attitude to local government spending on such things as home helps. In the Government's terms that is bad spending because it is revenue spending on staff, but it is one of the most valuable forms of community service to enable the disabled and the elderly to live in the community. We should not encourage local authorities to regard it as undesirable expenditure.

    Prevention is the third element in the report's strategy. Most of the major triumphs in eradicating disease in the past century have been through preventive methods. Many more diseases have been cured by good plumbing than by a vast range of drugs. I am critical of the Government's attitude to prevention and their lack of vigour in dealing with smoking and alcohol abuse.

    Not a great deal will be done by a political party which sees State medicine as a safety net. Liberals such as Lloyd George and Beveridge built up the NHS; the post-war Attlee Government played a notable part in its development. An earlier generation of Conservatives came to accept it as an essential part of the nation's fabric. But we now have a new breed of Conservatives, who take a different view. They are wrong. I believe that the public consider them to be wrong and they want a free Health Service. The NHS should be so directed that good health no longer depends on class, wealth or occupation.

    5.22 pm

    I followed with interest what the hon. Member for Berwick-upon-Tweed (Mr. Beith) said. Both he and the hon. Member for Canterbury (Mr. Crouch) mentioned the effect of the RAWP changes.

    The Secretary of State said that a 1·2 per cent. increase in provision was needed to keep pace with last year. For the North-West Thames region the increase has been only 0·7 per cent. Patient services are having to be cut. Sacking a few administrators cannot solve a problem of that scale.

    I pay tribute to the Secretary of State for his fluency and footwork, but I wish that he had a little more heart. He baffles me. On the Health Service, over-the past six months time and again he has made out that we are living in the best of all possible worlds, that the Government are doing more than any other have done and everyone is getting a better deal, and that we have more doctors and nurses and they are getting a better deal. But from our knowledge of our constituencies we know that that is far from true.

    The Black report puts its finger on the fact that the poor and the needy are still at the bottom of the heap. In the inner city area that I represent, my district health authority this week must decide for the financial year 1983–84 how many wards to close at the Central Middlesex hospital; whether to close wards and the casualty department at the Wembley hospital, or to close the whole hospital and lose 127 beds; whether to close the Pound Lane chest clinic; whether to close the Neasden hospital, which deals mainly with geriatric patients and the Leamington Park geriatric hospital; and it will be forced to cut back massively on care for the mentally disabled. It needs to find £1,090,000 from last year's estimates. The administration faces an impossible situation, yet the Secretary of State tells us that everything in the National Health Service is marvellous. I hope that his constituency, Sutton Coldfield, is in a better position than mine in Brent, South and Willesden.

    The right hon. Gentleman says that it is not what we do, but how we do it. It is also a question of how much we spend. If we are spending 5·5 per cent. on health care, 94·5 per cent. is left. The United States spends 9·4 per cent. of GNP on health care. I believe that a Labour Government could budget for an expenditure of 7·5 per cent., which would mean another £4 billion. If we take both private and public expenditure we find that people spend more on smoking, drinking and gambling than the Government spend on health and education. Black has made us look at priorities.

    I agree with much of what the Secretary of State said, but the hon. Member for Berwick-upon-Tweed is right to say that priorities are important. The Beveridge report of 40 years ago made comprehensive health care the basis on which the social programme should rest. Forty years later, this Black report is the most significant of all the many reports on the NHS. It goes straight to first principles. We should not be ashamed of having the highest possible ideals. I still claim that the NHS is second to none in any part of the world. It has a record of marvellous achievement. But we must accept that we have fallen short of the highest ideals, as Black points out. The way forward for the next 40 years is marked by its 37 recommendations. Let us not wait another 40 years before implementing them.

    The Government tried to sweep the report under the carpet, and we are debating it in Opposition time.