asked the Minister of Pensions and National Insurance if he will give statistics regarding the number of applications and appeals for death grants which have been refused on the death of invalids from childhood unable to satisfy the contribution conditions for death grant, and who were beyond an age where entitlement could be claimed on their parents' insurance.

I am afraid that this information is not available because separate records are not kept of these cases. Under the 1964 Act, which came into operation last month, these persons will qualify for death grant on the insurance of the parents up to the age of 19 instead of 18.

Whatever the figures may be, in the view of some hon. Members there are 100 per cent. too many. Does not the hon. Lady agree that the present arrangement whereunder the parents of children 19 calendar years of age but only five years of age physically are denied the death grant is a matter which ought to receive the attention of the Government, and is not the need reinforced because these parents are unable to take on any private insurance and the young person reaching the age of 18 is not capable of being insured? In the circumstances, having regard to the great hardship which many parents have suffered because of the appalling burden of keeping such children for a number of years already, will not the Government do something in the matter?

My right hon. Friend is not unsympathetic towards these cases, and we recognise that they command a great deal of sympathy. However, there is the difficulty that death grant is a benefit of the National Insurance Scheme and, consequently, is paid against a record of contributions. As the hon. Gentleman has said, most of these young people have not yet paid any contributions at all and have probably been on a National Assistance grant.

Since these young men and women are able, after reaching the age of 16, to get National Assistance in their own right, would it not be possible for the Minister to consider the possibility of a death grant being made payable through the National Assistance Board, if it is the age of the child and the contribution record which makes it impossible to pay under the present system?

I think that it would be much more fruitful to pursue a line through National Assistance rather than through National Insurance in view of the inherent nature of the scheme. My right hon. Friend already has this in mind.

asked the Minister of Pensions and National Insurance what provisions exist for an appeal against his decision in the case of claims for service disability pensions awarded under special sanction; and whether he will introduce amending legislation to improve the present position regarding appeals related to such claims.

Awards under special sanction can be made in certain circumstances where no award can be made under the ordinary Pensions Instruments. As these awards are in my discretion, subject to the agreement of the Treasury, there is no foundation for any formal right of appeal. But anyone who claims a pension can discuss his case informally with his local war pensions committee, whose recommendations are carefully considered.

I thank my right hon. Friend for that reply, but will he concede that even members of the medical profession are sometimes human and, therefore, fallible? With that in mind, does not he agree that there might be a case for a more formalised procedure to make it possible to look a second time at the primary decision even in special sanction cases?

I assure my hon. Friend that I am perfectly prepared to look very sympathetically at any of these claims. It would be very difficult to establish a formal right of appeal, because there happens to be no right under the Royal Warrant itself. It is essential that we should preserve a discretionary approach, particularly because some of the evidence in support of these claims is now 40 or 50 years old. I believe that, if there is a discretionary approach, this is in the long run in the best interest of pensioners.

asked the Minister of Pensions and National Insurance whether he will reintroduce tobacco coupons for retirement pensioners in order to offset the hardship that will arise from the additional cost of cigarettes and pipe tobacco following the Budget.

No, Sir.

Is the Minister aware that most of us would prefer to see a substantial rise in pensions rather than anything like the reissuing of tobacco coupons? Has he nothing to say about the effect of the Budget on the pension of those who have to eke out their pension to the last penny and for whom a rise of 5d. an ounce in the price of tobacco and 1d. a pint in the price of beer can be a very great hardship?

The hon. Member said that he would prefer to see an increase in pensions. He will have noticed that there are three Questions on that topic later this afternoon.

asked the Minister of Pensions and National Insurance whether, in view of the additional burdens imposed by the recent Budget, he will increase old-age pensions.

asked the Minister of Pensions and National Insurance whether, in view of the recent change in the financial circumstances of old age pensioners, he will now increase old age pensions.

asked the Minister of Pensions and National Insurance if, in view of the increase in the cost of living which has been further raised by the tax increases in the Budget on tobacco and alcohol, he will consider increasing retirement pensions.

No, Sir.

Why is it always the Government's policy towards old-age pensioners to give with one hand and take away with the other? Does not he realise that the recent additional burdens imposed by the Budget have greater effect on old-age pensioners who like to drink and smoke than on any other section of the community? Does he at least accept that?

To go back a little, between 1946 and 1951—[HON. MEMBERS: "Oh."]—I know that the hon. Gentleman does not like to be reminded of it—the value of the pension steadily declined. The last increase in 1963 was 17 per cent., to take account of an increase in the retail prices index of 8 per cent. Since then, the index has risen by 1½ per cent., and the Budget will add less than 1 per cent. Thus the pension has still a far greater value than before the last increase. I believe that the single rate is worth more than £1 more than when we took office.

Is the right hon. Gentleman aware that old-age pensioners do not eat, smoke or drink percentages? Will he, therefore, give a very much better reply about this before the next General Election?

Retirement pensioners are interested in the real value of their pension, which is higher than it has ever been.

Is the right hon. Gentleman aware that, even before the Budget increases on tobacco, the majority of old-age pensioners and other pensioners were spending up to the limit and then were going short? Is he not aware that these increases will impose an additional burden on them? Will not he reconsider his decision and take these additional burdens into account?

As I have pointed out, the increase last year has more than taken account of the increase in the retail prices index.

asked the Minister of Pensions and National Insurance at what level the wage stop is imposed by the National Assistance Board for general labourers in Scotland, North-East England, the Midlands, London and the South-East, respectively.

The level of the wage stop is based, as the National Assistance Regulations require, on what the individual might expect to earn if he went back to work. There is accordingly no standard wage stop figure for all general labourers in these regions.

Is the hon. Lady aware that I have had a number of cases from the National Assistance Board in the Burgh of Clydebank where the wage stop has been applied on the recommendation of the Ministry of Labour at the basic wage which men would receive if they worked, but as all labourers working in any of the industries in that area receive a bonus, should not the wage stop be the basic wage plus the average bonus paid?

The wage stop is the amount which the man might expect to earn if he went back to work in the occupation for which he is registered. We reckon that this normally includes a figure for overtime. I am not sure about the bonus point, but, if the hon. Member has any individual cases, I will gladly look into them.

I have brought cases to the notice of the hon. Lady in which this very situation has been revealed. I am not talking about overtime. The wage stop applied was £8 10s., whereas had that man been working in any of the factories in the district he would have received another 20 per cent. production bonus out of the factory's bonus system. That £8 10s. should be about £9 15s.

I am now seized of the hon. Member's point. I do not recollect any individual cases which he has brought to me personally. However, if he would put them to me I will gladly look into them.

asked the Minister of Pensions and National Insurance which criterion, previous average weekly earnings or basic weekly minimum wage, is taken into account before the wage stop is applied to applicants for National Assistance.

The Board bases the wage-stop figure on the net earnings a man could expect if he returned to work in the occupation for which he is registered at the employment exchange.

Would the hon. Lady recognise that we are dealing here with the poorest section of the community where this wage stop is applied? On what criteria does she base her Answer? Is there a proper liaison with the Ministry of Labour to find out what earnings should be earned by a particular person to whom the wage stop is applied? How is that she says that a person has this wage stop applied, who has been earning overtime for, say, the previous month, before he became redundant? Is that to be the criterion on which it is applied? Or is it applied on some hypothetical situation which may never arise?

It is based on a forward prognosis of what he would get. I recognise that within the general principle we apply there may be scope for argument as to how much the amount would be. We consult very closely with the Ministry of Labour. This is done by the Board's area offices and the local employment exchanges. We do our best to arrive at a figure which is equitable for all concerned.

Would the hon. Lady not agree that if, as she says, there is scope for argument about it there is surely at least scope for examination of the problem to see if the proper principles are being applied? There could be injustice brought into this, the most hard-hit part of our community.

I think that the general principle is almost universally acknowledged, so far as I am aware. It is that a person should not get more by way of assistance than he would get if he were to start work in an occupation for which he is registered.

That is not the point we are dealing with.

Having applied that principle, one has to try to find out how much the amount in any particular case would be. If there are particular cases, perhaps the hon. Member would send them to my right hon. Friend or to me or to the Chairman of the Board.

asked the Minister of Pensions and National Insurance whether he will amend the regulations which disqualify a person from receiving sickness benefit whilst abroad so that persons who are chronic invalids and in receipt of sickness benefit shall not be deprived of such benefit if they take a limited holiday abroad on the advice of their doctor.

The regulations already allow such people to go on receiving their benefit if they are abroad temporarily in order to be treated for their disability.

I thank my right hon. Friend for that Answer. Would not he agree that it seems rather hard that a person who is chronically sick and in receipt of sickness benefit, who saves up and takes a very limited holiday abroad on the advice of his doctor for the general interest of his health and not for specific treatment, when he has the honesty to declare this fact to the local Ministry of Pensions office should be stopped from receiving his sickness benefit? Will my right hon. Friend look at this matter again?

I will continue to look at this matter. It is a difficult problem, as my hon. Friend knows, because clearly the incapacity from illness which can be checked and controlled if a person remains in this country is more difficult to check and control if he is abroad. However, I will look at what my hon. Friend said.

The hon. Member for Hertford (Lord Balniel) was talking about a limited period. Can the Minister indicate how many times the individual is examined? Would not many of the cases instanced by the hon. Member he within the period when normal examinations take place and on which there would be no check?

When people are in this country, we obviously have the facilities to check incapacity for work.

How often?

It is done in a great many cases. If the hon. Member will put a Question down, I will give him the exact figure. But there are problems here, and I will certainly continue to look into them.

asked the Minister of Pensions and National Insurance if he will publish the figures available from his Department's inquiry into the incidence of incapacity for work, especially in so far as they relate to the incidence of chronic bronchitis and emphysema among mineworkers, by comparison with citizens in other occupations.

Yes, Sir. We expect to publish a detailed report on the inquiry in the autumn. It will include figures for a group of diseases comprising all forms of bronchitis, bronchitis with emphysema and emphysema without mention of bronchitis. The details normally given on medical certificates for sickness benefit claims are not sufficiently precise to allow the different types of disease within this group to be separately compared for the purpose of the inquiry.

Will this show clearly a comparison between the experience of those working in coal mining and those working in other occupations, and will it therefore give us direct evidence on what is the commonsense experience of so many people in the mining areas who feel that chronic bronchitis and emphysema are industrially caused diseases of coal mining?

It will certainly take into account the experience of people employed in mining and each of the occupation groups listed in the General Register Offices Classification of Occupations, 1960, of which there are 220. Each of these groups will be accounted for, and will also be analysed in areas. I think that that will cover the hon. Member's point.

Does the hon. and gallant Gentleman realise that the incidence of pneumoconiosis and emphysema is so great as to create a false impression of a man's disability? A man with a disability of 20 per cent. pneumoconiosis and 30 per cent. emphysema is almost incapable of working below ground. It is not the 30 per cent. emphysema but the impact of the pneumoconiosis on the emphysema which creates the tremendous disability. Will the hon. and gallant Gentleman look into this problem in its entirety?

I most certainly agree with the hon. Gentleman that some diseases have a far more incapacitating effect in certain occupations than in others. I think that that is widely recognised. But, as the hon. Member knows, we are bound by two rules under the Industrial Injuries Act: whether a disease is common to the generality of people or not, and whether it can be attributed with reasonable certainty to the occupation.

Is not this a point on which the Industrial Diseases Schedule should be amended within a very short time? If a man is disabled by pneumoconiosis directly attributable to work in the mines and emphysema which is either attributable to it or aggravated by it—if the two go together making him a very sick man—is it fair to compensate him only for the pneumoconiosis?

That is not the case. I think that the hon. Member misunderstands what is done in cases of this nature. Where there is a prescribed disease causing disablement, that is properly assessed. But where also there is a connected disease which is not prescribed but which has a further disabling effect, that is also taken into account in the assessment of disablement.

asked the Minister of Pensions and National Insurance what was the source of his information that more wives of miners suffer from bronchitis than miners; and if he will give the relative figures.

I am sorry that my Answer to the hon. Member for West Lothian (Mr. Dalyell) last Monday was rather imprecise. I had in mind the Registrar General's last Decennial Supplement on Occupational Mortality, which shows that the mortality from bronchitis among coalmine workers under the age of 65 was 35 peg cent. higher than in the general male population of the same age, but for the wives the comparable figure was 75 per cent.

Does not that show then that, as my hon. Friend the Member for Stoke-on-Trent, Central (Sir B. Stross) said earlier, there ought to be much more examination by the Minister of the connection between pneumoconiosis and general chest disability?

I think I told the hon. Lady last week that I was very ready indeed to consider any evidence which she or her hon. Friend, or any other source, liked to produce for me about the connection between bronchitis and any particular employment.

asked the Minister of Pensions and National Insurance in how many instances from 1st January, 1961, to the latest available date the Pneumoconiosis Medical Board, in assessing percentage of disability, attributed part of the disability to hypertension, thus reducing the benefit the man might otherwise have been awarded.

I regret that this information is not available.

Does the Minister realise that a great many of these men who are examined for pneumoconiosis have a certain percentage of disability assessed but are not given industrial injury benefit because part of the disability is due to hypertension? Will he have this examined to see if there is any connection at all, as some medical people believe, between hypertension resulting from pneumoconiosis? Would he also find out something which, one gathers from his reply to the last Question, he did not know? There are many hundreds of men who are told by hospitals that they have pneumoconiosis, and by the Board that they have not. The Minister ought not to wait for one single example to be supplied by any hon. Member.

I will take the hon. Lady's last point first. I told her in a previous Answer to an earlier Question that errors occur, and we acknowledge that. However, the errors are small. Some claimants not diagnosed by the Board as having pneumoconiosis are found on subsequent death to have the disease, but the number is small. Similarly, errors occur the other way round. Obviously, there will always be errors in such matters. Medical questions, however, such as the assessment of disablement, are entirely matters for the independent statutory authorities.

Again I should like to ask the Minister—I think all in the House know that it is for the statutory authorities to decide—whether he will set up an inquiry to find out if there is any connection between pneumoconiosis and resulting hypertension?

We will certainly consider that question, but again, as the hon. Lady knows, when the assessment is made for a prescribed disease account is always taken of other diseases which are not prescribed but which may have a contributory effect.

asked the Minister of Pensions and National Insurance how many persons in the latest year for which figures are available came forward for examination by pneumoconiosis panels; how many were rejected on X-ray examination and without any clinical examination; how many appealed; and in how many cases the appeal was successful.

During 1963, 13,861 claimants received preliminary X-ray examination. Of these, 10,493 were unsuccessful. For the same year, there were 906 appeals dealt with by clinical examinations, of which 35 were successful.

Do not these figures suggest that very great reliance is placed by the pneumoconiosis panels on their first X-ray examination, when there is not necessarily any clinical examination? In view of the fact that replies given by the Minister and the Parliamentary Secretaries in the past have shown that this is not entirely reliable, could not we have a review of the techniques and rely less on X-ray examination, and may we not ask for clinical examination in each and every case?

I cannot agree with the first part of the hon. Member's supplementary question. It is a fact that many miners and others use this machinery to satisfy themselves that they are free from the disease, and the high standard of reading of X-rays is borne out by the very small proportion of successes among those who appeal.

Will the Joint Parliamentary Secretary explain how it is that of 10,000 rejected cases, fewer than 1,000 are ultimately examined clinically? Is not this evidence of the fact that the machinery is not working properly?

The ready explanation is that of the 10,500 unsuccessful claimants, only 906 considered it worth while to appeal. The large majority of them were only having an X-ray to satisfy themselves that they had a clean bill of health.

As the Minister seems to be placing such reliance upon the efficacy of X-ray examination, can the hon. and gallant Gentleman explain how it is that a man is X-rayed in one of the big teaching hospitals, a specialist in lung diseases diagnoses the X-ray plate and says that the man has pneumoconiosis and then the pneumoconiosis medical board says that he does not? Surely, there is a great difference at times in the diagnosis even of X-ray plates by supposed specialists.

The hon. Lady will, I am sure, realise that it is unwise to establish a general rule from particular cases. If, however, she has a case in mind, I shall be glad to look into it.

Surely, the Minister must answer——

Order. We must make more progress. Only seven Questions have been answered so far.

asked the Minister of Pensions and National Insurance what would be the increased cost to the fund if all pensioners who worked after the age of 65 years were to have their extra weekly pension rate based on 1s. for each 12 stamps on the contribution card.

Increments are awarded on this basis to men who have deferred retirement beyond the age of 65 since August, 1959. If the current rates were to be applied in respect of contributions paid after minimum pension age before this date, the extra cost would be about £7 million a year immediately. This assumes that contributions paid by women after 60 would be treated similarly.

Does not the hon. Lady believe that it is time that men who continued working up to the age of 70 and women who continued working up to the age of 65 and who retired on 2nd August, 1959, or later should be brought up to date with other pensioners who retired later? Does not the hon. Lady consider that the Insurance Fund should be fair to all pensioners and should pay them all equally?

The increments are related to the amount of pension which is forgone and they are increased from time to time. They are not intended to compensate completely for the amount of pension which a person would have received had he retired earlier.

Does not the hon. Lady realise that these people have forgone quite large sums by working after the age of 60 or 65, in the case of men and women, respectively? Does the hon. Lady not think, therefore, that to pay them at the rate of 1s. per twelve contributions on their card would be more equitable bearing in mind the amount of money which they have lost by working from 60 to 65 and from 65 to 70 for women and men, respectively?

They would then not in any way be increments which were related to the amount of pension that is forgone. Increments have risen from time to time but so have pensions. We have never accepted that any increase in increments should entail retrospective increases to people who have retired earlier.

asked the Minister of Pensions and National Insurance what standard rate of basic pension was assumed, or is implied, in the estimates of public expenditure in 1967–68 published in Command Paper No. 2235.

The estimates in Command Paper 2235 carry no implication about the rates of particular benefits in 1967–68. They are a financial projection, at 1963 prices, of the Government's policies. The assumptions which relate to benefits and assistance are given in paragraph 21 of the White Paper. The increase in expenditure of £360 million would represent a substantial improvement in real terms.

Is the Minister not being just a little bit coy about this? Is he aware that the paragraph to which he refers suggests that pensioners must stick to the guiding light whatever happens to other incomes generally? Does not the Minister feel that the actual rate of pension implied in that paragraph, whether he likes it or not, should be announced, so that a public debate can take place about whether this is a fair method of handling pensions?

No, Sir. I do not think that it would be desirable because, as the hon. Member will agree, a number of assumptions are contained in the White Paper, and one of the important assumptions is that of constant prices. All I can say at the moment is that if the expenditure of £360 million were added to the existing expenditure, even despite the increasing number of pensioners who would then qualify, the general increase in benefits would be considerable.

asked the Minister of Pensions and National Insurance whether he will introduce legislation to ensure that a woman pensioner separated from her husband derives at least the same benefit from her husband's National Insurance contributions as a divorced woman.

No, Sir. A wife separated from her husband is treated for retirement pension purposes in the same way as any other married woman and is at a general advantage compared with a divorced woman.

Is the Minister aware that this is a difficult problem and that he is quite right in saying that generally the separated woman does at least as well, but that there are cases in which she does substantially worse? Will he not consider the particular cases which have been directed to the attention of his hon. Friends the Joint Parliamentary Secretaries and see whether amending legislation should not be put in hand to bring these difficult cases within the scope of the law?

As the hon. Member knows, the difficulty time and time again in National Insurance is that we are dealing naturally with large groups of people, and it is difficult always to take account of particular cases within those groups. I believe that it is the case, as I think the hon. Member admits, that in general separated women have an advantage over divorced women; but there may be hard cases. I know that the hon. Member has been in correspondence with my hon. Friend and I am certainly prepared to look at any individual cases which he likes to send me.

Will the Minister at least state the principle that where there are loopholes and where separated women are getting a smaller pension, he will consider legislation to amend this anomaly?

No, I cannot go as far as that. Although separated women may, in certain cases, be getting a smaller amount than divorced women, they are eligible for other benefits, such as the widow's pension, for which the divorced woman is not eligible.

asked the Minister of Pensions and National Insurance what guidance he has given to the National Assistance Board to take into account in their assessment of the needs of recipients of assistance the recent increases in the prices of milk, meat, tobacco, spirits, and beer.

This is a matter for the Board.

The relationship between the Ministry and the National Assistance Board is precisely what we do not know. Will the Minister nevertheless agree that at least most of the items mentioned in the Question are regarded as much more essential by old people than by most other sections of the community? In view of the fact that the Budget placed heavier burdens proportionately on these people than on any other section of the community, will not the right hon. Gentleman have informal consultations with the National Assistance Board to bring this point to its attention?

Naturally, I am always in touch with the National Assistance Board about these matters. There are three Questions on the alleged rise in the cost of living caused by the Budget which will be reached a little later, and perhaps the hon. Member will raise the point then.

I do not know why the Minister should talk about the alleged rise in the cost of living. This is a fact which can be measured by the old-age pensioners themselves, as I have learnt in my constituency. Will not the Minister bring this fact to the attention of the Board?

The hon. Member is going rather beyond his Question, which asked what guidance I had given. I have suggested that I have not given guidance and that this is a matter for the Board.

asked the Minister of Pensions and National Insurance if he has yet reached a decision on wage-related unemployment benefit; and if he will make a statement.

I have nothing to add to the reply I gave on 24th February to a similar question from the hon. Member for Fife, West (Mr. W. Hamilton).

Will the Minister bear in mind that this is now established practice in most of the advanced industrial countries? Will he also bear in mind that the Labour Party for a long time have advocated this? Will he further bear in mind that National Insurance contribution on a worker's earnings now is markedly higher proportionately to the benefit he gets?

I think the hon. Member has demonstrated that there are some very important questions to examine, and that is why this is taking some time.

asked the Minister of Pensions and National Insurance what pension a man will receive who has contributed at the maximum rate since the inception of the graduated pension scheme and retires in 1975.

On the unlikely assumption that no changes in pension rates or contribution liability have been made by 1st June, 1975, a man of 65 then retiring would receive a total pension of £4 5s. 6d. (single) and £6 7s. (married) and a man of 70 £5 11s. (single) and £8 3s. (married).

Surely this is a farcical amount? Surely the Minister could agree that this is not a pension scheme—that it is really a tax measure to avoid new taxes and the Government carrying out their responsibility?

I cannot agree that the amounts are farcical amounts. I think that if one takes account of the increasing benefit paid to an increasing number of beneficiaries one must expect to have both increasing contributions and taxes.

asked the Minister of Pensions and National Insurance what would be the estimated cost of allowing men in receipt of a National Insurance pension to earn an extra 20s. weekly before applying the earnings rule.

About £½ million a year.

Does the hon. Lady not agree that this is not too great a cost for lessening the anxieties which accrue to, and adding to the enjoyment of, old-age pensioners? Is her right hon. Friend contemplating a review of the situation?

Where would the tax come from?

I notice that the hon. Member for Paisley (Mr. J. Robertson) is much more favourable towards women than men. The extra cost would be £2 million a year if it were applied to them as well. The amount was quite recently—last month—put up to 100s., the fourth rise in the last five years, and is now a higher percentage of average earnings than ever before.

Would the hon. Lady tell us by how much the amount is reduced to arrive at that? How much is knocked off?

I cannot deduce the meaning behind that supplementary question.

The earnings rule says how much a man may earn. The amount is not paid on that basis. It is reduced. It is reduced to a given figure which the Board operates. Can the hon. Lady tell us by how much, as a rule, the figure which is first laid down is reduced?

The Question does not arise from National Assistance but from National Insurance pensions. The Question refers to National Insurance pensions and the cost of an extra 20s. weekly before applying the earnings rule.

rose—

The same rule applies in both cases—

We are not doing ourselves credit today. Only 18 Questions have been answered by 3.9 p.m.

asked the Minister of Pensions and National Insurance whether he will review the level of family allowances in view of the fact that more large families are now living on an inadequate diet than 10 years ago.

I would refer the hon. Member to the reply I gave my hon. Friend the Member for Tynemouth (Dame Irene Ward) on 20th April.

Has the right hon. Gentleman's attention been drawn to the report of Dr. Lambert on this matter? What does the right hon. Gentleman propose arising from the evidence that, over the last ten years, the nutri- tional standard of families with three or four children has gone down? Since the real value of family allowances has declined in that period, is there not an urgent need for adjustment?

As I pointed out last week, the deficiencies in the large families which the hon. Gentleman has, quite rightly, noted are not confined to the lowest income groups but are common to all income groups. This suggests that it is not only a matter of income. It is only fair to remind the hon. Gentleman that family allowances are only one element in the improvement in nutrition. More important elements, perhaps, are welfare foods and school meals.

asked the Minister of Pensions and National Insurance why it is not possible to state a sum representing the part of expenditure on National Assistance which is attributable to rent and rates.

Rent is only one of several factors, including resources, in the assessment of assistance grants. In many cases the sum granted is less than the sum allowed for rent in the process of assessment.

Is the hon. Lady aware that that answer means nothing? Does she recollect that last week the Minister announced that in about one and a half million cases the full rent was being allowed by the National Assistance Board? If we assume a ridiculously small rent of £1 a week, does not that mean that the Board at the present time is paying out at least £1½ million a week in the form of subsidies to landlords? Is this not what it boils down to? Does the hon. Lady also accept that, since 1957, the outgoing from the Board in respect of rent has vastly increased?

The hon. Gentleman does not think much of the answer, but if he knew more about the subject it would mean more than it does now to him. If he had read the reports of the National Assistance Board for the last two years, he would not have needed to ask a question on the point of principle. If he refers to those reports, he will find the assessment of needs and resources very clearly set out.

asked the Minister of Health if he will make brucellosis a notifiable disease; and if he will make a statement.

No, Sir. I am advised that notification would be of little practical value because of the length of time that may elapse before the disease is recognised.

Is my hon. Friend aware that this is very unsatisfactory and that England, Scotland and Wales are about the only countries in Europe where brucellosis is not now a notifiable disease? As there have been serious outbreaks of the disease, will not he ask the Minister to look into the matter again?

Our experience in this country is that delay in recognising the disease makes notification of very little help in tracing the source of infection. As my hon. Friend probably knows, the disease is not normally transmitted from man to man but is the result of contact with infected animals or by drinking infected milk. The best way to deal with it is by routine examination of untreated milk. However, in view of what my hon. Friend has said, I will ask my right hon. Friend to look at our arrangements again.

asked the Minister of Health what investigations his Department have made into the possible effects of the various non-nutritive substances introduced into the diets of animals upon the consumer.

None, Sir, but my right hon. Friend and my right hon. Friend the Minister of Agriculture, Fisheries and Food are advised on these matters by expert committees.

I thank my hon. Friend for the facility of his Reply but will he bear in mind that his Department could helpfully advise the Minister of Agriculture that many of the substances in use, such as pesticides, for instance, have, after a lapse of time, had unforeseen side-effects which had they been anticipated would have saved much distress?

This may be the case, but non-nutritive substances such as my hon. Friend has in mind are liable to be considered under the Veterinary Products Safety Precautions Scheme. This is a matter which is under constant scrutiny.

Has the hon. Gentleman noted the fact that the Minister of Agriculture tends to be on the defensive on this matter when he is questioned in the way in which the hon. Lady the Member for Petersfield (Miss Quennell) has questioned the hon. Gentleman? But the Minister of Agriculture is concerned with cattle and agricultural substances while the Minister of Health has a duty to look after human beings. Will the hon. Gentleman, therefore, accept the implication in the hon. Lady's Question and see that his right hon. Friend makes an investigation into what is happening to us?

I hold no brief for my right hon. Friend the Minister of Agriculture—[HON. MEMBERS: "Oh."]—in this context. My right hon. Friend the Minister of Health receives advice from the appropriate body and I assure the hon. Gentleman that he looks at it very closely.

asked the Minister of Health what action he is taking to promote the greater use of the existing maternity services by expectant mothers.

Advice on the importance of making full use of these services has been widely circulated and is regularly emphasised in health education material put out by the Ministry.

Surely this does not make a very great impact. Does not my right hon. Friend realise that in our figures for infant mortality we lag behind the progress being made in some other countries? For example, if we had the same proportionate figures as Sweden 4,000 lives would have been saved last year. Will not my right hon. Friend, therefore, give extra emphasis to what is being done so that existing services can be more widely known and more fully used?

As I expect my hon. Friend knows, doctors in hospitals, G.P.s, midwives and health visitors all play their part in encouraging expectant mothers to take advantage of the services which are freely available to them. Of course, they can only encourage; they cannot compel. For example, there is the leaflet entitled "Maternity Care", a copy of which is sent to each expectant mother with the book of tokens for welfare milk. If there is anything more we can do, I will be happy to do it.

asked the Minister of Health if he will now exempt patients being treated for coronary thrombosis and diabetes from payment of the 2s. per item prescription charge.

No, sir. There are already adequate arrangements for refunding prescription charges in cases of financial hardship.

Apart from the continuing unfairness: that those who are most sick have most to pay; will not the right hon. Gentleman do something about the health hazard to patients with coronary thrombosis? Is he aware that the usual treatment of 100 tablets of trinitron costs 1s. 4½d. and that many patients go straight to the chemist, thus saving 7½d. in cash and getting quicker prescriptions, which means that angina patients are not seeing their doctors regularly? This is a danger to the patient. Will the right hon. Gentleman regard it from that point of view and not only from the financial angle?

To exempt any group of patients, however one defined that group, from payment of prescription charges without reference to their means would be unfair to the patients in comparable and sometimes less favourable financial circumstances. I am informed that a patient requiring long-term treatment for coronary thrombosis would probably not require more than two drugs simultaneously and that a month's supply could often be prescribed.

As more tablets are needed, will not the right hon. Gentleman issue advice to general practitioners to give greater quantities, so that at least patients will be encouraged to go to their doctors and not just to their chemists?

That I am very happy to do.

asked the Minister of Health what limitations on the expansion of training for physiotherapists still exist as a result of the shortage of teachers of physiotherapy.

The number of training places cannot yet be increased.

Is this due to a shortage of teachers of physiotherapy, to a lack of financial resources or to a shortage of buildings? Surely there is a great lack of facilities because of a shortage of staff. Why cannot facilities be increased?

As the hon. Gentleman guesses, this is due entirely to a shortage of teachers which has persisted since the beginning of the National Health Service. We are now discussing with the Chartered Society of Physiotherapy the introduction of a more attractive course of a duration of less than two years in an attempt to bridge the gap.

asked the Minister of Health what conclusions he has reached following his consideration of the March 1964 report of the city of Birmingham analytical laboratories on the subject of the Birmingham drug-testing scheme.

I have nothing to add to the reply which my right hon. Friend gave to the hon. Lady on 13th April.

Would the hon. Gentleman at least confirm that proposals for an independent central drug authority for the licensing of drug firms and to undertake the sampling of drugs at all points in the chain of distribution have been circulated to all the interests concerned following the appalling revelations from Birmingham? Would the hon. Gentleman say by what date he expects to receive comments and when he proposes to introduce legislation?

I am not sure that I can answer the last part of the question. I will take note of it and communicate with the hon. Lady. The report from Birmingham is disturbing. It has already been decided to review the statutory arrangements for the control of the quality of drugs, but conclusions have not yet been reached on that. This is only one aspect of the legislation connected with medicine which, as the House knows, is being reviewed. The problem is very complex and needs careful and detailed study if it is to be tackled effectively.

asked the Minister of Health (1) whether he will make a statement on the contracts which he is placing with three British firms to import drugs from Poland and Italy for the hospital service;

The contracts are made under the powers conferred by Section 46 of the Patents Act, 1949, which has been invoked on three occasions, in respect of drugs to the total value of approximately £750,000. The contracts provide for the supply to hospitals for a period of one year from 1st May, 1964, of the same five drugs as are obtained under existing contracts. Royalties will be paid to the patent holders after negotiation.

Would the right hon. Gentleman confirm that the cost of tetracycline, a very widely used drug, when supplied in its proprietary form, is £45 per 1,000 whereas the cost for imported B.P. standard is between £4 and £6 10s.? Before the voluntary price agreement is renegotiated will the right hon. Gentleman emphasise to the proprietary drug manufacturers the great disparity among the prices they are charging? Is it not the case that to invoke the Patents Act is to use a very crude means of bringing the drug companies to heel? Would it not be very much fairer if, this matter having been brought to the attention of the drug companies, either they themselves should agree to a voluntary reduction of the exorbitant prices which they are now exacting from the community, or that the Minister should consider taking over the marketing of drugs himself?

I think that our arrangements are broadly satisfactory. I would not like to say anything this afternoon which would prejudice the renegotiation of the voluntary price scheme which is taking place with the industry.

May I first ask the Minister what is the source of his information that the Opposition policy is gradually to nationalise the pharmaceutical industry? [HON. MEMBERS: "Is it not?"] I am asking the Minister to state his source of information.

It is difficult to be sure without notice, but I believe that my predecessor took advice, and I think that the advice that he received was in the negative.

"We propose that the Health Service meets its needs increasingly from public enterprise, either through new publicly owned undertakings, or by the acquisition of existing ones."

asked the Minister of Health how many deaths took place in hospitals as a result of recent troubles in the electricity supply industry.

I know of none.

Is the right hon. Gentleman aware that the whole country will welcome that statement—with the possible exception of the proprietors of the Sunday Express? Can he say what progress has been made to ensure that all hospitals have an auxiliary alternative supply of electricity generation since the last scare in this context?

The hon Gentleman would have done better to have expressed his gratitude to all those working in the hospital service who went to great trouble to cope with what in his Question he calls the "recent troubles". In the past year an additional £1 million has been spent on special standby electrical equipment. Nearly 100 generators from central stocks were distributed to hospitals and arrangements were made for some 400 mobile generators to be made available by the Armed Forces.

Is the right hon. Gentleman aware that, in view of the Government's attitude to nurses' salaries, the expression of gratitude lies better in our mouths than it does in theirs?

asked the Minister of Health what teaching hospitals make it a condition of admittance and treatment that the patient should if required be subjected to teaching procedures; how many patients have been refused admittance on account of refusing to give such permission; and which hospitals ask the patient to give a signed statement accepting this condition.

asked the Minister of Health how many teaching hospitals make treatment conditional upon the patient being used for teaching purposes.

The answer to each part of the Question is none; five hospitals have on a few occasions recommended attendance at another hospital but none refuse treatment that is urgent or not readily obtainable elsewhere.

May we take it that in no circumstances has any patient ever been sent out of hospital for refusing to allow an examination and, secondly, that any suggestion that there is any widespread condition involved or made is unfounded?

I have answered the Questions quite specifically and I did so after making considerable inquiries I was told that the number of patients unwilling to take part in teaching is negligible and that some hospitals knew of none and others of only two or three in recent years. Perhaps I might mention that when I entered a teaching hospital for a medical examination, I was surrounded by students who were told by the consultant that they had better pull up their socks if the hospital was to stand any chance of getting the funds it needed.

Would it not be illegal to refuse any patient entrance to a National Health Service hospital, provided always that facilities for treatment were available?

My Answer to the two Questions was "None". Frankly, I do not think that I could be more specific than that.

In the course of his inquiries, did the right hon. Gentleman make sure that in all cases teaching hospitals asked the permission of patients before using them as teaching material?

No, I did not. However, many hospitals, I am told, now explain their teaching activities in leaflets which are handed to patients on admission. I believe that half the undergraduate and one-third of the postgraduate hospitals do this.

Does not the right hon. Gentleman agree that in all cases the permission of the patient should be sought? If he does agree, will he take steps to see that that is done?

I will be happy to see if we should extend the sort of arrangements to which I have referred.

asked the Minister of Health how many of the additional maternity beds to be provided as a result of projects started this year will be in the Greater London Area.

167.

Does the right hon. Gentleman realise that this is an annual Question from me and that the reply is nearly always the same and that in the meantime the situation, at any rate in North Middlesex, is so serious that mothers are now being sent out of hospital 24 hours after the baby is born? Does he not realise that this battery system of producing babies is most inhuman and is unfair both to the staffs and the mothers concerned? When will he provide enough beds to make it possible for mothers to have a reasonable stay in hospital in proper conditions?

No specific increase in the birth-rate in the Metropolitan regions in the next few years is expected, although, of course, the effect of migration cannot be fully assessed. Nevertheless, some 5,000 extra confinements could be provided for by the starts to which I have just referred. The hon. Lady will know that the Cranbrook Report on maternity services advised that 70 per cent. of confinements should take place in hospital. Throughout the Greater London Area we are doing very much better than that. Another figure which will interest the hon. Lady is that 90 per cent. of the mothers of first children are delivered of their children in hospitals n the Greater London area compared with about 85 per cent. elsewhere.

Can the right hon. Gentleman say how many of those 5,000 additional confinements are 24-hour confinements?

This number is on the basis of the average stay throughout the country.